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Rana MS, Billah SM, Moinuddin M, Bakkar Siddique MA, Khan MMH. Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017-2018. Heliyon 2023; 9:e15875. [PMID: 37206020 PMCID: PMC10189511 DOI: 10.1016/j.heliyon.2023.e15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Background Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. Objective To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. Participants Reproductive-aged women (15-49 years) of Bangladesh. Methods and materials We used the latest five rounds (2004, 2007, 2011, 2014, 2017-2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. Results A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017-2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. Conclusion Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities.
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Affiliation(s)
- Md Sohel Rana
- Department of Statistics, Comilla University, Kotbari, 3506, Cumilla, Bangladesh
- Corresponding author.
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
- School of Public Health, The University of Sydney, Australia
| | | | - Md Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
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Nahar MT, Anik SMFI, Islam MA, Islam SMS. Individual and community-level factors associated with skilled birth attendants during delivery in Bangladesh: A multilevel analysis of demographic and health surveys. PLoS One 2022; 17:e0267660. [PMID: 35767568 PMCID: PMC9242462 DOI: 10.1371/journal.pone.0267660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Skilled birth attendants (SBAs) play a crucial role in reducing infant and maternal mortality. Although the ratio of skilled assistance at birth has increased in Bangladesh, factors associated with SBA use are unknown. The main goal of our study was to reveal the individual- and community-level factors associated with SBA use during childbirth in Bangladesh. We also showed the prevalence and trend of SBA use and related independent variables in Bangladesh over the past decade. Methods This study utilized the Bangladesh Health and Demographic Survey (BDHS) 2017–2018, a cross-sectional study. We used binary logistic regression to examine the extent of variation in SBA use attributable to the individual- and community-level variables. Results Overall, 53.35% of women received assistance from SBAs during childbirth. The average annual rate of increase (AARI) in the number of SBA-assisted births over the past 10 years was 8.88%. Respondents who gave birth at or above 19 years had 1.40 times (AOR = 1.40; 95% CI: 1.21–1.62) greater odds of having skilled delivery assistance than respondents aged 18 years old or less. Women and their husband’s education levels were significantly associated with using skilled assistance during delivery, with odds of 1.60 (AOR = 1.60; 95% CI: 1.45–2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21–1.66), respectively compared to those with education up to primary level. Women from rich families and those receiving better antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed significance towards having professional assistance while giving birth. Women from urban communities and those who utilized more than four ANC visits and had completed secondary or higher education showed a greater tendency to use an SBA during childbirth than their counterparts. Conclusion The use of SBAs during delivery was significantly associated with some individual- and community-level factors. To reduce maternal and child mortality, there is a need to focus on rural and uneducated people who are less likely to access these facilities. Special programs could increase awareness and help the poor community obtain the minimum facility in maternal care.
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Affiliation(s)
- Mst. Tanmin Nahar
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
| | - S. M. Farhad Ibn Anik
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
| | - Md. Akhtarul Islam
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
- * E-mail:
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Kasede AN, Tylleskär T, Mukunya D, Tumuhamye J, Ndeezi G, Arach AAO, Waako P, Tumwine JK. Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:763. [PMID: 34758766 PMCID: PMC8579617 DOI: 10.1186/s12884-021-04222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker). Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home. Conclusion Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04222-5.
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Affiliation(s)
- Agnes Napyo Kasede
- Busitema University Faculty of Health Sciences, Department of Public Health, P.O. Box 236, Tororo, Uganda. .,College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda. .,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - David Mukunya
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - Josephine Tumuhamye
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway
| | - Grace Ndeezi
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Anna Agnes Ojok Arach
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda.,Department of Nursing and Midwifery, Lira University, P. O. Box 1035, Lira, Uganda
| | - Paul Waako
- Busitema University Faculty of Health Sciences, Department of Public Health, P.O. Box 236, Tororo, Uganda
| | - James K Tumwine
- College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, P.O. Box 7072, Kampala, Uganda
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Abraham SA, Clow SE. Staying, leaving and returning: Trends of prevention of mother-to-child transmission retention among newly diagnosed HIV-positive pregnant and postpartum women. Int J STD AIDS 2021; 33:81-87. [PMID: 34632873 DOI: 10.1177/09564624211046995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uptake of services and retention throughout the Prevention of Mother-to-Child Transmission continuum are necessary to achieve the goal of reducing Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV). Adopting a retrospective cohort design, we tracked the uptake of services in a district hospital in Ghana from antenatal booking through to six weeks postnatal when early infant diagnosis was conducted. Of the 1252 pregnant women booked antenatally, 94.1% (n = 1178) received pre-test counselling, 96.3% (1134) opted for HIV testing and 3.8% (n = 43) women tested positive for HIV throughout the continuum. The retention rate at six weeks postpartum was 67.4%. Missed opportunities occurred throughout the programme and the highest disengagement, 58.9% (23/39) occurred antenatally. Instances of re-engagement were also recorded. Establishing measures to promote retention throughout the programme is critical to ensuring HIV-infected mothers maintain their health and their exposed newborns are HIV-free. This phase of the study provided a comprehensive view of retention in the absence of any baseline.
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Affiliation(s)
- Susanna A Abraham
- Adult Health Department, School of Nursing and Midwifery, College of Health and Allied Sciences, 63726University of Cape Coast, Cape Coast, Ghana.,Division of Nursing and Midwifery, Faculty of Health Sciences, 63726University of Cape Town, Cape Town, South Africa
| | - Sheila E Clow
- Adult Health Department, School of Nursing and Midwifery, College of Health and Allied Sciences, 63726University of Cape Coast, Cape Coast, Ghana
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Understanding Women's Choices: How Women's Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study. Matern Child Health J 2021; 25:1787-1797. [PMID: 34529225 DOI: 10.1007/s10995-021-03214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This policy led to a substantial increase in women's delivery options. This increase in coverage might have led to a reduction in quality of care. This study explores women's perceptions of quality of delivery services in the context of the free policy and how the perceptions lead to the choice of a place for delivery. METHODS Our study site was Naivasha sub-County in Kenya, a rural context, whose geography encompasses pastoralists, rural agrarian, and high population density informal settlements near flower farms. Women from this area are from the lowest wealth quintile in Kenya. We conducted a qualitative study to explore the women's perceptions of quality of care based on their experiences during maternity care. The participants were women of reproductive age (18-49 years) attending antenatal care clinics at six health facilities in the sub-county. Six focus group discussions with 55 respondents were used. For inclusion, the women needed to have delivered a baby within the six months preceding the study. Interviews were recorded with consent, translated and transcribed. The interviews were analyzed using a thematic content approach. RESULTS Four broad themes that determined the choice of health facility for delivery were identified: women's perceptions of clinical quality of care; the cost of delivery; distance to the health facility and management of primary health facilities. An unexpected theme was the presence of home deliveries amongst pastoralist women. These findings suggest that in this setting both process and structural dimensions of quality of care and financial and physical accessibility influence women's choices for place of delivery. CONCLUSION This study expands our understanding of how women make choices regarding place of delivery. Understanding women's perceptions can provide useful insights to policy makers and facility managers on providing high quality patient centered maternity care necessary to sustain the increased utilization of maternity services at health facilities under the free maternity policy and further reductions in maternal mortality.
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Ezenwaka U, Manzano A, Onyedinma C, Ogbozor P, Agbawodikeizu U, Etiaba E, Ensor T, Onwujekwe O, Ebenso B, Uzochukwu B, Mirzoev T. Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study. Front Public Health 2021; 9:670534. [PMID: 34307277 PMCID: PMC8297950 DOI: 10.3389/fpubh.2021.670534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme. Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set. Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government. Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.
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Affiliation(s)
- Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria.,Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Nsukka, Nigeria
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, United Kingdom
| | - Chioma Onyedinma
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria
| | - Pamela Ogbozor
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria
| | - Uju Agbawodikeizu
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria.,Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Nsukka, Nigeria
| | - Tim Ensor
- Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria.,Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu, Nsukka, Nigeria
| | - Bassey Ebenso
- Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu, Nsukka, Nigeria
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hampanda K, Helova A, Odwar T, Odeny T, Onono M, Bukusi E, Turan J, Abuogi L. Male partner involvement and successful completion of the prevention of mother-to-child transmission continuum of care in Kenya. Int J Gynaecol Obstet 2020; 152:409-415. [PMID: 33108671 DOI: 10.1002/ijgo.13442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 07/07/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the relationship between male partner involvement (MPI) in prevention of mother-to-child transmission (PMTCT) activities and successful completion of the PMTCT continuum of care, which remains sub-optimal in settings with high prevalence of HIV. METHODS A cross-sectional survey was administered in June-August 2017 to a sample of 200 postpartum Kenyan women with HIV enrolled in a parent trial. Composite PMTCT and MPI variables were created. Descriptive, simple and multivariable regression, and mediation analyses were performed. RESULTS Of the women, 54% reported successful completion of PMTCT. Depression and internalized HIV stigma were independently associated with lower likelihood of successful completion of PMTCT (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI] 0.94-0.99; aRR 0.92; 95% CI 0.88-0.98, respectively). Each MPI activity was associated with 10% greater likelihood of successful completion of PMTCT (P < 0.05). The relationship between MPI and the successful completion of PMTCT was partially mediated through women's reduced internalized HIV stigma (β -0.03; 95%CI -0.06 to -0.00). CONCLUSION Greater MPI in PMTCT activities has direct and indirect effects on women's successful completion of all necessary steps across the PMTCT continuum. Reduced internalized HIV stigma is likely a key mechanism in the relationship.
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Affiliation(s)
- Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA
| | - Anna Helova
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.,Department of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa Abuogi
- Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Oluoch-Aridi J, Adam MB, Wafula F, Kokwaro G. Understanding what women want: eliciting preference for delivery health facility in a rural subcounty in Kenya, a discrete choice experiment. BMJ Open 2020; 10:e038865. [PMID: 33268407 PMCID: PMC7713193 DOI: 10.1136/bmjopen-2020-038865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery. DESIGN A discrete choice experiment (DCE) was conducted to elicit rural women's preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes. SETTING Six health facilities in a rural subcounty. PARTICIPANTS Women aged 18-49 years who had delivered within 6 weeks. PRIMARY OUTCOME The DCE required women to select from hypothetical health facility A or B or opt-out alternative. RESULTS A total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare worker (β=1.184, p<0.001), second availability of medical equipment and drug supplies (β=1.073, p<0.001) and third quality of clinical services (β=0.826, p<0.001). Distance, availability of referral services and costs were ranked fourth, fifth and sixth, respectively (β=0.457, p<0.001; β=0.266, p<0.001; and β=0.000018, p<0.001). The opt-out alternative ranked last suggesting a disutility for home delivery (β=-0.849, p<0.001). CONCLUSION The most highly valued attribute was a process indicator of quality of care followed by technical indicators. Policymakers need to consider women's preferences to inform strategies that are person centred and lead to improvements in quality of care during delivery.
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Affiliation(s)
- Jackline Oluoch-Aridi
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
- Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute of International Studies, University of Notre Dame, Nairobi, Kenya
| | - Mary B Adam
- Pediatrics and Community Health, Kijabe Hospital, Kijabe, Kiambu, Kenya
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
| | - Gilbert Kokwaro
- Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya
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Distance to HIV and Antenatal Care: A Geospatial Analysis in Siaya County, Kenya. J Assoc Nurses AIDS Care 2020; 30:548-555. [PMID: 30694879 DOI: 10.1097/jnc.0000000000000050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
As maternal child health (MCH) programs expand in the setting of HIV, health systems are challenged to reach those most vulnerable and at the greatest need. Cross-sectional surveys of MCH clinics and recent mothers in the Siaya Health Demographic Surveillance System were conducted to assess correlates of accessing antenatal care and facility delivery. Of 376 recent mothers, 93.4% accessed antenatal care and 41.2% accessed facility delivery. Per-kilometer distance between maternal residence and the nearest facility offering delivery services was associated with 7% decreased probability of uptake of facility delivery. Compared with a reference of less than 1 km between home and clinic, a distance of more than 3 km to the nearest facility was associated with 25% decreased probability of uptake of facility delivery. Distance to care was a factor in accessing facility delivery services. Decentralization or transportation considerations may be useful to optimize MCH and HIV service impact in high-prevalence regions.
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Ongaki D, Obonyo M, Nyanga N, Ransom J. Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016. J Int Assoc Provid AIDS Care 2020; 18:2325958219838830. [PMID: 30931683 PMCID: PMC6748522 DOI: 10.1177/2325958219838830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother's unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake of PMTCT.
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Affiliation(s)
- Dominic Ongaki
- 1 Lodwar County Referral Hospital, Lodwar, Turkana County, Kenya.,2 Turkana County Health Department, Lodwar, Turkana County, Kenya
| | - Mark Obonyo
- 3 Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Nancy Nyanga
- 1 Lodwar County Referral Hospital, Lodwar, Turkana County, Kenya
| | - James Ransom
- 3 Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya.,4 Piret Partners Consulting, Research & Evaluation, Washington, DC, USA
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Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh. PLoS One 2019; 14:e0211113. [PMID: 30759099 PMCID: PMC6373895 DOI: 10.1371/journal.pone.0211113] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.
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Bonawitz R, McGlasson KL, Kaiser JL, Ngoma T, Lori J, Boyd C, Biemba G, Hamer DH, Scott NA. Maternity Waiting Home Use by HIV-positive Pregnant Women in Zambia: Opportunity for Improved Prevention of Maternal to Child Transmission of HIV. Int J MCH AIDS 2019; 8:1-10. [PMID: 30899603 PMCID: PMC6423550 DOI: 10.21106/ijma.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Maternity waiting homes (MWHs), defined as residential lodging near health facilities, are an intervention to improve access to maternal care recommended by the World Health Organization. Little is known about utilization of MWHs by HIV-positive women. This paper describes: 1) maternal awareness and utilization of MWHs in rural Zambia among HIV-positive women, and 2) health outcomes for HIV-positive women and their infants with regards to utilization of MWHs. METHODS Data were collected from recently delivered women (delivered after 35 weeks in the previous 12 months) living >9.5 km from 40 health facilities in rural Zambia. For our analysis, primary outcomes were compared between self-identified HIV-positive and HIV-negative women in the sample. Primary outcomes include: 1) awareness of MWHs and 2) utilization of MWHs. We summarized simple descriptive statistics, stratified by maternal self-reported HIV status. We conducted bivariate analyses using chi-square tests, t-tests and Wilcoxon rank sum test. RESULTS Among 2,381 women, 50 (2.4%) self-identified as HIV-positive. HIV-positive women were older and had more pregnancies and children than HIV-negative women (p<0.001). There was no difference in awareness of MWHs, but HIV-positive women were more likely to use a MWH than HIV-negative women. There was no difference in receipt of infant antiretroviral prophylaxis between women who did or did not stay at a MWH. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Though HIV prevalence in this sample was lower than expected, MWHs may represent a useful strategy to improve prevention of mother to child transmission of HIV in high prevalence, low-resource settings.
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Affiliation(s)
- Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA.,Department of Pediatrics, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, USA
| | - Kathleen Lucy McGlasson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
| | - Thandiwe Ngoma
- Right to Care, 11059, Off Brentwood Road Mikwala House, Longacres, Lusaka, ZAMBIA
| | - Jody Lori
- Center for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Carol Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Godfrey Biemba
- National Health Research Authority, University Teaching Hospital Pediatric Centre of Excellence, P.O. Box 30075, Lusaka, ZAMBIA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, 1 Boston Medical Center Place, Boston, MA, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
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Mochache V, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Correlates of facility-based delivery among women of reproductive age from the Digo community residing in Kwale, Kenya. BMC Res Notes 2018; 11:715. [PMID: 30305159 PMCID: PMC6180567 DOI: 10.1186/s13104-018-3818-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Objective This study sought to describe factors associated with facility-based delivery among women of reproductive age in Kwale County, Kenya. Results Between March and December 2015, 745 women from 15 villages were interviewed through a cross-sectional household survey. Respondents were selected using stratified, systematic sampling and completed a sexual and reproductive health questionnaire. Of 632 (85%) women who had a previous birth, 619 (98%) reported antenatal care attendance. Of these, 491 (79%) subsequently had a facility-based delivery. Factors associated with increased likelihood of facility delivery included respondent’s education (odds ratio, OR = 2.0, 95% confidence interval, CI 1.2–3.2, P = 0.004), ideal antenatal care attendance (OR = 2.3, 95% CI 1.4–3.7, P = 0.001) and pregnancy intention (OR = 1.5, 95% CI 1.0–2.2, P = 0.040). Being in a polygamous relationship (OR = 0.6, 95% CI 0.3–0.9, P = 0.024) and having a husband ≥ 40 years (OR = 0.5, 95% CI 0.3–0.9, P = 0.013) were associated with reduced likelihood of facility delivery. Respondent’s education (aOR = 1.9, 95% CI 1.1–3.3, P = 0.030) as well as ideal ANC attendance (aOR = 2.0, 95% CI 1.0–3.8, P = 0.040) remained significantly associated with facility delivery in multivariate analyses. Electronic supplementary material The online version of this article (10.1186/s13104-018-3818-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium.
| | - Amyn Lakhani
- Community Health Department, Aga Khan University, Mombasa, Kenya
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Community Health Department, Aga Khan University, Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,University of Nairobi, Nairobi, Kenya
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14
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Hofer CB, Magalhães MDAFM, Frota ACC, de Oliveira RH, Abreu TF, Manhães B, Bond J, Périssé ARS. HIV Vertical transmission in Rio de Janeiro, Brazil - does the distance matter? AIDS Care 2018; 31:314-317. [PMID: 30189750 DOI: 10.1080/09540121.2018.1515466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mother-to-child transmission (MTCT) is the main route of transmission for HIV among under 5 children in Brazil. National data indicate that missed opportunities for HIV prevention of MTCT are still common in antenatal care (ANC). We studied variables related to target process indicators in a cohort of HIV exposed children. We used data from 1996 to 2013 related to HIV exposed uninfected and HIV-infected children attended in an HIV reference hospital in Rio de Janeiro, Brazil. Data were collected from baseline questionnaires applied to all children followed-up in the hospital. Gestational and perinatal history were extracted from the mother's ANC card. Infants were categorized according to dates of first HIV care at the unit (1996-2000, 2001-2006 and 2007-2013). Distances between recorded addresses and the nearest maternity/hospital were measured by Euclidean distance, the shortest car route calculated in Google Maps and the route of the available bus line. Of the 599 children who fulfilled the inclusion criteria, 178 (29.7%) were HIV-infected. Approximately 70% of infants exposed to the virus from 1996-2000 were infected, dropping to 15.2% from 2001-2006 and rebounding to 30.1% from 2007-2013. Birth cohort was associated with ANC, and mothers from 2007-2013 had a lower chance of attending ANC (OR = 0.16; 95%CI 0.08-0.30). In addition, when the distance home-birthplace was higher than 9.5 km, there was a lower chance that the mother had attended ANC (OR = 0.35; 95%CI 0.18-0.68). Birth cohort was associated to HIV and ANC, and our data showed that a reduction of ANC might be related to rebound in HIV cases. There seems to have an association between larger distances from home to the birthplace and absence of ANC, which suggests that ANC was being performed in the tertiary units instead of in the primary care facilities as recommended.
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Affiliation(s)
- Cristina Barroso Hofer
- a Departamento de Medicina Preventiva, Escola de Medicina , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Mônica de Avelar F M Magalhães
- b Instituto de Comunicação e Informação Científica e Tecnologia em Saúde , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil
| | - Ana Cristina Cisne Frota
- c Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Ricardo Hugo de Oliveira
- c Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Thalita F Abreu
- c Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Bruna Manhães
- c Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - João Bond
- c Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - André R S Périssé
- d Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca , Fundação Oswaldo Cruz , Rio de Janeiro , Brazil
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15
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Huda TM, Hayes A, Dibley MJ. Examining horizontal inequity and social determinants of inequality in facility delivery services in three South Asian countries. J Glob Health 2018; 8:010416. [PMID: 29977529 PMCID: PMC6008508 DOI: 10.7189/jogh.08.010416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The utilization of maternal health care services has increased in many developing countries, but persistent wealth-related inequalities in use of maternal services remained an important public health issue. The paper examined the horizontal inequities and identified the key social determinants that can potentially explain such wealth-related inequalities in use of facility delivery services. Methods The countries studied are Bangladesh, Pakistan and Nepal. We used horizontal inequity index to measure the horizontal inequity and decomposition of concentration index method to assess the contribution of different social determinants towards the wealth-related inequality. We have used household and women data from demographic and health surveys of Bangladesh (BDHS 2014), Pakistan (PDHS 2012-13) and Nepal (NDHS 2010-11). Results All three countries showed pro-rich inequality in use of facility delivery services (Observed Concentration Index: Bangladesh = 0.235; Pakistan = 0.141; Nepal = 0.263). The study showed if the utilization were solely based on need factors there would have been little disparity between the rich and the poor (Need expected Concentration Index: Bangladesh = 0.004; Pakistan = 0.004; Nepal = 0.008). The use of facility delivery remained pro-rich in all three countries after taking the need factors into account (Horizontal inequity Index: Bangladesh = 0.231; Pakistan = 0.137; Nepal = 0.254). The decomposition analysis revealed that facility delivery is driven mostly by the social determinants of health rather than the individual health risk. Household socioeconomic condition, parental education, place of residence and parity emerged as the most important factors. Conclusions Our study reiterates the importance of addressing social determinants of health in tackling wealth-related inequalities in use of facility delivery services. Health policy makers should acknowledge the importance of social determinants in determining individual health-seeking behaviour and accordingly set their strategies to improve access to facility delivery.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Chea SK, Mwangi TW, Ndirangu KK, Abdullahi OA, Munywoki PK, Abubakar A, Hassan AS. Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya. PLoS One 2018; 13:e0194028. [PMID: 29558474 PMCID: PMC5860701 DOI: 10.1371/journal.pone.0194028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya. METHODS A cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively. RESULTS Overall, 108 (25.4%, [95% CI: 21.3-29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4-46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2-6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2-0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers. CONCLUSION A quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting.
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Affiliation(s)
- Stevenson K. Chea
- Department of Nursing Sciences, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - Tabitha W. Mwangi
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | | | - Osman A. Abdullahi
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - Patrick K. Munywoki
- Department of Nursing Sciences, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Amina Abubakar
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amin S. Hassan
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
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Mwau M, Bwana P, Kithinji L, Ogollah F, Ochieng S, Akinyi C, Adhiambo M, Ogumbo F, Sirengo M, Boeke C. Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years. PLoS One 2017; 12:e0183860. [PMID: 28850581 PMCID: PMC5574578 DOI: 10.1371/journal.pone.0183860] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage. Design Cross-sectional analysis of national early infant diagnosis (EID) database. Methods 365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression. Results 11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs. Conclusion Despite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.
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Affiliation(s)
- Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
| | - Priska Bwana
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lucy Kithinji
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Francis Ogollah
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Ochieng
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Catherine Akinyi
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Maureen Adhiambo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Fred Ogumbo
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Martin Sirengo
- National AIDS and STIs Control Program, Ministry of Health, Nairobi, Kenya
| | - Caroline Boeke
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
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Sam-Agudu NA, Isah C, Fan-Osuala C, Erekaha S, Ramadhani HO, Anaba U, Adeyemi OA, Manji-Obadiah G, Lee D, Cornelius LJ, Charurat M. Correlates of facility delivery for rural HIV-positive pregnant women enrolled in the MoMent Nigeria prospective cohort study. BMC Pregnancy Childbirth 2017; 17:227. [PMID: 28705148 PMCID: PMC5512933 DOI: 10.1186/s12884-017-1417-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low rates of maternal healthcare service utilization, including facility delivery, may impede progress in the prevention of mother-to-child transmission of HIV (PMTCT) and in reducing maternal and infant mortality. The MoMent (Mother Mentor) study investigated the impact of structured peer support on early infant diagnosis presentation and postpartum maternal retention in PMTCT care in rural Nigeria. This paper describes baseline characteristics and correlates of facility delivery among MoMent study participants. METHODS HIV-positive pregnant women were recruited at 20 rural Primary Healthcare Centers matched by antenatal care clinic volume, client HIV prevalence, and PMTCT service staffing. Baseline and delivery data were collected by participant interviews and medical record abstraction. Multivariate logistic regression with generalized estimating equation analysis was used to evaluate for correlates of facility delivery including exposure to structured (closely supervised Mentor Mother, intervention) vs unstructured (routine, control) peer support. RESULTS Of 497 women enrolled, 352 (71%) were between 21 and 30 years old, 319 (64%) were Christian, 245 (49%) had received secondary or higher education, 402 (81%) were multigravidae and 299 (60%) newly HIV-diagnosed. Delivery data was available for 445 (90%) participants, and 276 (62%) of these women delivered at a health facility. Facility delivery did not differ by type of peer support; however, it was positively associated with secondary or greater education (aOR 1.9, CI 1.1-3.2) and Christian affiliation (OR 1.4, CI 1.0-2.0) and negatively associated with primigravidity (OR 0.5; 0.3-0.9) and new HIV diagnosis (OR 0.6, CI 0.4-0.9). CONCLUSIONS Primary-level or lesser-educated HIV-infected pregnant women and those newly-diagnosed and primigravid should be prioritized for interventions to improve facility delivery rates and ultimately, healthy outcomes. Incremental gains in facility delivery from structured peer support appear limited, however the impact of duration of pre-delivery support needs further investigation. Religious influences on facility delivery and on general maternal healthcare service utilization need to be further explored. TRIAL REGISTRATION ClinicalTrials.gov number NCT01936753 , registered September 2013.
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Affiliation(s)
- Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria. .,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA. .,Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria.
| | - Christopher Isah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Chinenye Fan-Osuala
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Habib O Ramadhani
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Udochisom Anaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Olusegun A Adeyemi
- Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Grace Manji-Obadiah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 252 Herbert McCaulay Way, Abuja, Nigeria
| | - Daniel Lee
- University of Maryland School of Medicine, Baltimore, USA
| | - Llewellyn J Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, USA
| | - Manhattan Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
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Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev 2017; 6:110. [PMID: 28587676 PMCID: PMC5461715 DOI: 10.1186/s13643-017-0503-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Factors Associated with PMTCT Cascade Completion in Four African Countries. AIDS Res Treat 2016; 2016:2403936. [PMID: 27872760 PMCID: PMC5107823 DOI: 10.1155/2016/2403936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/07/2016] [Accepted: 10/10/2016] [Indexed: 01/25/2023] Open
Abstract
Background. Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low. Methods. A cross-sectional survey was performed across 26 communities in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Women who reported a pregnancy within two years were enrolled. Participant responses were used to construct the PMTCT cascade with all of the following steps required for completion: at least one antenatal visit, HIV testing performed, HIV testing result received, initiation of maternal prophylaxis, and initiation of infant prophylaxis. Factors associated with cascade completion were identified using multivariable logistic regression modeling. Results. Of 976 HIV-infected women, only 355 (36.4%) completed the PMTCT cascade. Although most women (69.2%) did not know their partner's HIV status; awareness of partner HIV status was associated with cascade completion (aOR 1.4, 95% CI 1.01–2.0). Completion was also associated with receiving an HIV diagnosis prior to pregnancy compared with HIV diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2–38.6). Conclusions. Pregnant women with HIV infection in Africa who were aware of their partner's HIV status and who were diagnosed with HIV before pregnancy were more likely to complete the PMTCT cascade.
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