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Jiao B, Iversen I, Sato R, Pecenka C, Khan S, Baral R, Kruk ME, Arsenault C, Verguet S. Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries. PLoS Med 2024; 21:e1004421. [PMID: 38968303 PMCID: PMC11226092 DOI: 10.1371/journal.pmed.1004421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs). METHODS AND FINDINGS We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes. CONCLUSIONS Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.
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Affiliation(s)
- Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Isabelle Iversen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Sadaf Khan
- PATH, Seattle, Washington, United States of America
| | - Ranju Baral
- PATH, Seattle, Washington, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Jung S, Chi H, Eom YJ, Subramanian S, Kim R. Multilevel analysis of determinants in postnatal care utilisation among mother-newborn pairs in India, 2019-21. J Glob Health 2024; 14:04085. [PMID: 38721673 PMCID: PMC11079700 DOI: 10.7189/jogh.14.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India. Methods Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories. Results Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories. Conclusions Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.
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Affiliation(s)
- Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Olakkengil M, Said S, Abdalla O, Hofmann R, Hedt-Gauthier B, Fulcher I. Are populations of postpartum women differentially served by community health worker programs: an observational cohort study from Zanzibar, Tanzania. BMC Pregnancy Childbirth 2024; 24:183. [PMID: 38454323 PMCID: PMC10921749 DOI: 10.1186/s12884-024-06356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Although community health worker (CHW) programs focus on improving access to healthcare, some individuals may not receive the intended quality or quantity of an intervention. The objective of this research was to examine if certain populations of pregnant women differentially experience the implementation of a community health worker-led maternal health intervention in Zanzibar. METHODS We included pregnant women enrolled in the Safer Deliveries (Uzazi Salama) program, which operated in 10 of 11 districts in Zanzibar, Tanzania between January 1, 2017, and June 19, 2019 (N = 33,914). The outcomes of interest were receipt of the entire postpartum intervention (three CHW visits) and time to first postpartum CHW visit (days). Visits by CHWs were done at the women's home, however, a telehealth option existed for women who were unable to be reached in-person. We conducted statistical tests to investigate the bivariate associations between our outcomes and each demographic and health characteristic. We used multivariate logistic regression to estimate the relationships between covariates and the outcomes and multivariate linear regression to estimate the association between covariates and the average time until first postpartum visit. RESULTS Higher parity (OR = 0.85; P = 0.014; 95%CI: 0.75-0.97), unknown or unreported HIV status (OR = 0.64; p < 0.001; 95%CI: 0.53-0.78), and receipt of phone consultations (OR = 0.77; p < 0.001; 95%CI: 0.69-0.87) were associated with a lower odds of receiving all postpartum visits. Similarly, women with an unknown or unreported HIV status (estimated mean difference of 1.81 days; p < 0.001; 95%CI: 1.03-2.59) and those who received a phone consultation (estimated mean difference of 0.83 days; p < 0.001; 95%CI: 0.43-1.23), on average, experienced delays to first visit. In addition, current delivery at a referral hospital was associated with lower odds of receiving a postpartum visit and longer time to first visit compared to delivery at home, cottage hospital, PHCU + , or district hospital. Women from all other districts received their first visit earlier than women from Kaskazini B. There were no differences in the odds of receiving the entire postpartum intervention by sociodemographic variables, including age, education, and poverty assessment indicators. CONCLUSION The results indicate no differences in intervention contact across wealth and education levels, suggesting that the program is effectively reaching women regardless of SES. However, women with other characteristics (e.g., higher parity, unknown or unreported HIV status) had lower odds of receiving the complete intervention. Overall, this work generates knowledge on existing disparities in intervention coverage and enables future programs to develop approaches to achieve equity in health care utilization and outcomes.
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Affiliation(s)
- Michelle Olakkengil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Samira Said
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Omar Abdalla
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Rachel Hofmann
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Yimer TS, Ferede WY, Sisay FA. Utilization of early postnatal care services and associated factors among mothers who gave birth in the last 12 months in South Gondar Zone District, Amhara Regional State, Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:26. [PMID: 38355683 PMCID: PMC10867985 DOI: 10.1186/s41043-024-00524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Postnatal care is care that is provided to mothers and newborn baby after delivery. The care given after childbirth is the most critical time because most maternal and neonatal mortality occurs during this period. Utilization of this service is low in Ethiopia, and no evidence exists to describe the status of early postnatal care service utilization among women in the study area. OBJECTIVE This study aimed to assess the utilization of early postnatal care services and associated factors among mothers who gave birth in the last 12 months in the South Gondar Zone District, Amhara Region, Ethiopia, in 2021. METHOD This study was conducted in South Gondar Zone Districts from October 1 to 30, 2021. A total of 761 participants were included in this study using a simple random sampling method. The study participants were mothers who gave birth in the last 12 months. The data were collected via interview-guided semistructured questionnaires. The collected data were coded and entered into EPI Info version 7.2 and exported into SPSS version 23 for analysis. Both binary and multivariate logistic regression analyses were applied to identify factors affecting the outcome variables. The results of the final model are presented as the adjusted odds ratio (AOR) and 95% confidence interval (CI). A P value less than 0.05 was considered to indicate statistical significance. RESULTS In this study, 761 mothers participated, for a response rate of 100%. The overall prevalence of early utilization of postnatal care services was 20.6%. Mothers who live in urban areas were five times more likely to have early visits than those living in rural areas with adjusted odds ratio [AOR (95% CI) = 5.2 (3.19, 8.54)], a mothers who had a history of more than four parity had more likely to visit than the others at [AOR (95% CI) = 2.25 (1.18, 4.29)], mothers who had a history of pregnancy had two times more likely to visit than the other [AOR (95% CI) = 2.06 (1.05, 4.05)], and mothers who had delivered by instrumental vaginal delivery or cesarean section delivery and those mothers who had mass media exposure were two and five times more likely to visit, respectively [AOR (95% CI) = 2.62 (1.40, 4.91)] and [AOR (95% CI) = 5.18 (2.55, 10.52)]. CONCLUSION AND RECOMMENDATION Compared with those of other studies, the overall prevalence of early utilization of postnatal care services was low. Improving mothers' knowledge of early postnatal care visits is very important for enhancing quality of life and minimizing neonatal and maternal morbidity and mortality.
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Affiliation(s)
- Tigist Seid Yimer
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia.
| | - Wassie Yazie Ferede
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia
| | - Fillorence Ayalew Sisay
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debra Tabor, Ethiopia
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Towongo MF, Ngome E, Navaneetham K, Letamo G. Individual and community-level factors associated with women's utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis. BMC Health Serv Res 2024; 24:185. [PMID: 38336733 PMCID: PMC10858510 DOI: 10.1186/s12913-024-10636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Over time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women's utilization of postnatal care services in Uganda. METHODS Secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis. RESULTS The result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78-2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01-1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services. CONCLUSION This study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.
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Affiliation(s)
- Moses Festo Towongo
- Faculty of Social Sciences, Department of Population Studies, University of Botswana, Gaborone, Botswana.
| | - Enock Ngome
- Faculty of Social Sciences, Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Kannan Navaneetham
- Faculty of Social Sciences, Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Gobopamang Letamo
- Faculty of Social Sciences, Department of Population Studies, University of Botswana, Gaborone, Botswana
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Ashemo MY, Shiferaw D, Biru B, Feyisa BR. Prevalence and determinants of adequate postnatal care in Ethiopia: evidence from 2019 Ethiopia mini demographic and health survey. BMC Pregnancy Childbirth 2023; 23:834. [PMID: 38049724 PMCID: PMC10694903 DOI: 10.1186/s12884-023-06147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The postpartum period is critical for both the mother's and newborn child's health and survival. Rising morbidity and mortality are usually the consequence of absence of adequate, suitable, or timely care during that time period. There is lack of information on the adequacy of postnatal care in Ethiopia and this study was aimed to investigate adequacy of postnatal care and its determinants in the study area. METHODS In this study, we used a cross-sectional dataset from the 2019 Ethiopia Mini Demographic and Health Survey. A multistage stratified clustered design applied and survey weights were used to take into account the complicated sample design. A multilevel mixed effects logistic regression was fitted on 3772 women who were nested within 305 clusters. The fixed effect models were fitted and expressed as adjusted odds ratios with 95% confidence intervals, while intra-class correlation coefficients, median odds ratio, and proportional change in variance explained measures of variation. As model fitness criteria, the deviance information criterion and the Akaike information criterion were used. RESULTS This study found that only 563(16.14%, 95% CI: 16.05-16.24) women had adequate post natal care. Age of between 25-35 years old (AOR = 1.55, 95%CI = 1.04-2.31), secondary level of education (AOR = 2.23, 95%CI = 1.43-3.45), Having parity of between two and four had (AOR = 0.62, 95%CI = 0.42 0.93), having ANC follow up four and above (AOR = 1.74, 95%CI = 1.31-2.33), being residents of Oromia region (AOR = 0.10, 95CI = 0.02- 0.43) were strong predictors of adequate postnatal care. CONCLUSION The study found that prevalence of adequate PNC in Ethiopia was significantly low. To increase postnatal care adequacy, it was recommended to reinforce existing policies and strategies such as increasing number of antenatal care follow up, and scheduling mothers based on the national postnatal care follow-up protocol.
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Affiliation(s)
- Mubarek Yesse Ashemo
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
- Department of Public Health, College of Medical and Health Science, Werabe University, Werabe, Ethiopia.
| | - Desalegn Shiferaw
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Public Health, College of Medical and Health Science, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Bayise Biru
- Department of Human Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Public Health, Institute of Health, Wallaga University, Nekemte, Ethiopia
| | - Bikila Regassa Feyisa
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Public Health, Institute of Health, Wallaga University, Nekemte, Ethiopia
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Serbanescu F, Abeysekara P, Ruiz A, Schmitz M, Dominico S, Hsia J, Stupp P. Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200502. [PMID: 37640485 PMCID: PMC10461704 DOI: 10.9745/ghsp-d-22-00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use. METHODS We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment. RESULTS PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88). CONCLUSION Women's decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.
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Affiliation(s)
- Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Purni Abeysekara
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia Ruiz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jason Hsia
- Division of Population Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Stupp
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Aoki A, Mochida K, Kuramata M, Sadamori T, Sapalalo P, Tchicondingosse L, Balogun OO, Aiga H, Francisco KR, Takehara K. Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis. J Glob Health 2023; 13:04073. [PMID: 37565413 PMCID: PMC10416139 DOI: 10.7189/jogh.13.04073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Background Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women. Methods Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit. Results Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators. Conclusions Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.
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Affiliation(s)
- Ai Aoki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Keiji Mochida
- TA Networking Corp., Tokyo, Japan
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | | | | | - Pedro Sapalalo
- Domus Custodius (SU) Lda. Tchikos Agency, Luanda, Angola
| | | | | | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Human Development Department, Japan International Cooperation Agency, Tokyo, Japan
| | | | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Atuhaire P, Kiracho-Ekirapa E, Mutenyo J. How equitable is utilization of maternal health services in Uganda? Implications for achieving universal health coverage. BMC Health Serv Res 2023; 23:800. [PMID: 37496027 PMCID: PMC10369811 DOI: 10.1186/s12913-023-09749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Maternal and neonatal mortality in Uganda remain persistently high. While utilisation of maternal health services has been shown to reduce the risk of maternal death, little is known about the inequalities in utilisation of maternal health services in Uganda. This study examined the inequalities in utilisation of maternal health services between 2006 and 2016 to draw implications for achieving universal health coverage. METHODS We used the Uganda Demographic Health Survey 2006, 2011 and 2016 to analyse inequalities in utilisation of antenatal care (ANC4+), skilled birth attendance (SBA), postnatal care (PNC) and a package of maternal health services. Equity ratios, concentration curves, concentration indices and regression analysis were used in the estimations. RESULTS Inequalities in utilization of single and a package of maternal health services reduced between 2005 and 2016, but remained pro-rich. Inequalities in utilisation of package of maternal health services were greater than for a single service. Women from the richest quintile were 4 times more likely to receive a package of care compared to the poorest women, but were just 1.5 times more likely to receive ANC4 + than those in the poorest quintile. In 2006 women in urban areas were 2.6 times more likely to receive a package of all three maternal health services than their rural counterpart and they had a relative advantage of 23.4% to utilize skilled birth delivery than the poorest women. Each additional year of schooling and living in urban areas was associated with 1.2 and 1.6% point increase in utilisation of a package of care respectively. Wealth, education and living in urban areas were positively associated with utilisation of all maternal healthcare. CONCLUSION Declining inequalities in utilisation of maternal healthcare reflect a move towards achieving universal health coverage in Uganda. Pro-rich, education and urban-biased inequalities, imply the need for targeted interventions for the poor, less educated and rural women. Targeted voucher schemes, free distribution of birth kits for poorer and rural women, community-level mobilization to improve uptake of postnatal care, and promoting women's education and incomes are feasible interventions to improve utilisation of maternal health services and equity.
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Affiliation(s)
- Phiona Atuhaire
- School of Economics, College of Business and Management Sciences, Makerere University, Kampala, Uganda.
| | | | - John Mutenyo
- School of Economics, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Misu F, Alam K. Comparison of inequality in utilization of postnatal care services between Bangladesh and Pakistan: Evidence from the Demographic and Health Survey 2017-2018. BMC Pregnancy Childbirth 2023; 23:461. [PMID: 37349680 DOI: 10.1186/s12884-023-05778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan. METHODS The study used the latest Demographic and Health Survey (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated. RESULTS In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women's education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624; and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643; and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595; and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women's education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743). CONCLUSION Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.
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Affiliation(s)
- Farjana Misu
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
- Department of Statistics, Jagannath University, Dhaka, 1100, Bangladesh.
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Odimegwu C, Muchemwa M, Akinyemi JO. Systematic review of multilevel models involving contextual characteristics in African demographic research. JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
AbstractMultilevel modelling has become a popular analytical approach for many demographic and health outcomes. The objective of this paper is to systematically review studies which used multilevel modelling in demographic research in Africa in terms of the outcomes analysed, common findings, theoretical rationale, questions addressed, methodological approaches, study design and data sources. The review was conducted by searching electronic databases such as Ebsco hosts, Science Direct, ProQuest, Scopus, PubMed and Google scholar for articles published between 2010 and 2021. Search terms such as neighbourhood, social, ecological and environmental context were used. The systematic review consisted of 35 articles, with 34 being peer-reviewed journal articles and 1 technical report. Based on the systematic review community-level factors are important in explaining various demographic outcomes. The community-level factors such as distance to the health facility, geographical region, place of residence, high illiteracy rates and the availability of maternal antenatal care services influenced several child health outcomes. The interpretation of results in the reviewed studies mainly focused on fixed effects rather than random effects. It is observed that data on cultural practices, values and beliefs, are needed to enrich the robust evidence generated from multilevel models.
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Onwuka CI, Ezugwu EC, Obi SN, Onwuka C, Dim CC, Chigbu C, Asimadu E, Ezeome IV, Okeke TC, Iyoke CA. Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu. PLoS One 2023; 18:e0280315. [PMID: 36996250 PMCID: PMC10062588 DOI: 10.1371/journal.pone.0280315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 12/27/2022] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.
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Affiliation(s)
- Chidinma Ifechi Onwuka
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Samuel Nnamdi Obi
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Chidozie Onwuka
- Oral and Maxillo-facial Surgery Department, King Khalid University, Abha, Saudi Arabia
| | - Cyril Chukwudi Dim
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike Chigbu
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Eric Asimadu
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Ijeoma Victoria Ezeome
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Tochukwu Christopher Okeke
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Chukwuemeka Anthony Iyoke
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
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Hassen SS, Lelisho ME. Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district. BMC Health Serv Res 2022; 22:1318. [PMID: 36329430 PMCID: PMC9635200 DOI: 10.1186/s12913-022-08710-y] [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: 03/14/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Skilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia. Methods A community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model. Results This study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance. Conclusions This study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.
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Affiliation(s)
- Sali Suleman Hassen
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
| | - Mesfin Esayas Lelisho
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
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Beyene T, Melka AS, Yadecha B. Determinants of postnatal care service utilization among married women in rural areas in western Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:38. [PMID: 35986357 PMCID: PMC9392263 DOI: 10.1186/s41043-022-00320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 07/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Worldwide studies have shown that three-fourths of the total deaths during the neonatal period occur in the first week of the postnatal period. However, most of these deaths can be prevented with care during pregnancy, childbirth, and postnatal care. According to the 2016 Ethiopia Demographic and Health Survey report, 17% of women in Ethiopia had received postnatal care after childbirth. This study aimed to identify determinants of postnatal care service utilization among married women in rural areas in Western Ethiopia. METHODS A community-based cross-sectional study was conducted among 798 women who had given birth in the past 2 years prior to the survey between 2 and 31 January 2015. A pre-tested structured questionnaire was used to collect the data. Multivariable logistic regression was employed to determine factors affecting utilization of postnatal care. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to assess the strength of the associations. RESULTS The study showed that 188 (23.6%) women utilized postnatal care services during their last pregnancy. Women's educational level (AOR = 3.29, 95%CI = 1.89-5.73), utilization of antenatal care (AOR = 2.07, 95%CI = 1.28-3.36), awareness on the advantage of postnatal care (AOR = 2.10, 95%CI = 1.41-3.13), and knowledge of at least one danger sign during the postnatal period (AOR = 3.04, 95%CI = 2.07-4.46) showed a significant positive association with the utilization of postnatal care. CONCLUSION Educating women and creating awareness of maternal health care services during pregnancy increase the utilization of postnatal care services. Health care professionals should provide information on the importance of postnatal care for pregnant women during antenatal care visits.
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Affiliation(s)
- Tesfalidet Beyene
- College of Medical and Health Sciences, Wollega University, Nekemte, Oromia Ethiopia
- University of Newcastle, Newcastle, NSW Australia
| | - Alemu Sufa Melka
- College of Medical and Health Sciences, Wollega University, Nekemte, Oromia Ethiopia
| | - Birhanu Yadecha
- College of Medical and Health Sciences, Wollega University, Nekemte, Oromia Ethiopia
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Sserwanja Q, Nuwabaine L, Kamara K, Musaba MW. Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey. BMC Public Health 2022; 22:102. [PMID: 35031038 PMCID: PMC8760783 DOI: 10.1186/s12889-022-12494-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12494-5.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
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Sheba IT, Sarker AR, Tasnim A. Factors Associated with Post-Natal Care Utilization among the Women of Reproductive age Group: Evidence from Bangladesh Demographic and Health Survey 2017–18. Health Serv Res Manag Epidemiol 2022; 9:23333928221136393. [PMID: 36388173 PMCID: PMC9643753 DOI: 10.1177/23333928221136393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction Postnatal period is a crucial stage of illness for mothers and their newborn
children. Lack of post-natal care (PNC) services during this period is
lifethreatening for both the mother and the babies. This study aims at
examining the associated factors of PNC utilization among the mothers to
explore the opportunities to accelerate it. Methods This study utilized the latest data from Bangladesh Demographic and Health
Survey (BDHS) 2017–18, a nationally representative survey. A weighted sample
of 5043 Bangladeshi women who gave birth three years prior to the survey was
studied. Bivariate and multivariate analyses were performed to identify the
underlying factors associated with the utilization of PNC. Results Around 63% women sought PNC from any kind of provider within 24 h to 42 days
of the delivery among whom more than 48% received it from medically trained
providers. Together with several sociodemographic factors- administrative
division, place of residence, educational level, employment status, wealth
status, some maternal factors such as- antenatal care (ANC) visits, place
and mode of delivery- played a significant role in utilizing PNC services
from trained providers. Conclusion To further improve utilization of post-natal care, national and local level
action plans should be introduced to promote health facility delivery
irrespective of their place of residence. In the meantime, PNC awareness
campaigns, intervention and economic empowerment programs targeting mothers
from the poorest quintile needs to be implemented, particularly those who
are unable to attend at least four ANC visits, and have accessibility issues
to education.
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Affiliation(s)
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Afrida Tasnim
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
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Tadele A, Getinet M. Determinants of Postnatal Care Check-ups in Ethiopia: A Multi-Level Analysis. Ethiop J Health Sci 2021; 31:753-760. [PMID: 34703174 PMCID: PMC8512942 DOI: 10.4314/ejhs.v31i4.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Postnatal care is provided to women and their babies within 42 days after delivery. Although the first two days after birth was a critical time in maternal health, it was the most neglected period of maternal health services. Therefore, this study aims to determine the maternal and community-level factors of postnatal check-ups in Ethiopia Methods Ethiopian Demographic and Health Survey (EDHS) in 2016 was utilized. A total of 3,948 women aged 15–49 giving birth in the two years before the survey were included. A multi-level mixed-effects logistic regression model was employed. Result Only 17% [95% C.I; 16.46%–17.53%] of the women had a postnatal check-up (PNC) within 2 days of giving birth in Ethiopia. Institutional delivery AOR 2.14 [95% C.I 1.70, 2.0] and giving birth by cesarean section AOR 1.66 [95% CI 1.10, 2.50] were found to be maternal factors. Whereas, administrative regions (Oromia 69%, Somali 56%, Benishangul 55%, SNNPR 43%, Gambela 66%, Afar 50% and Dire Dawa 55% which less likely to utilize PNC as compared to Addis Ababa), higher community-level wealth AOR 1.44 [95% C.I 1.08, 1.2], ANC coverage AOR 1.52 [95% C.I 1.19, 1.96] and perceived distance of the health facility as a big problem AOR 0.78 [95% C.I 0.60, 0.99] were the community level factors. Conclusion Both maternal factors and community factors are found to be a significant association with PNC, however, based on the ICC maternal factors prevail the community-level factors. Therefore, public health interventions to increasing improve postnatal care services should focus on community level determinants.
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Affiliation(s)
- Afework Tadele
- Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Masrie Getinet
- Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia
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Assessment of Knowledge, Attitude, and Practice of Skilled Assistance Seeking Maternal Healthcare Services and Associated Factors among Women in West Shoa Zone, Oromia Region, Ethiopia. Nurs Res Pract 2021; 2021:8888087. [PMID: 34422412 PMCID: PMC8373502 DOI: 10.1155/2021/8888087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to assess women's knowledge, attitude, and practice towards skilled assistance seeking maternal healthcare services in West Shoa Zone, Oromia Region, Ethiopia. Methods Cross-sectional survey design was conducted from 1 February to 23 March 2018 in West Shoa Zone, Oromia, Ethiopia. A simple random sampling technique was used to select the participants. The data were collected using a pretested and structured questionnaire. Data were entered using EpiData version 3.1, and descriptive analysis and bivariate and multivariate logistic regression analyses were carried out using SPSS version 20 statistical software package. Results The study revealed that the knowledge, attitude, and practice towards skilled maternal health services were found such that 473.3 (72.4%) of the study participants had good knowledge, 180.7 (27.6%) had poor knowledge, and 400 (61.3%) had positive attitude, 254 (38.84%) had negative attitude, 460.3 (70.4%) had good practice, and 193.7 (29.6%) had poor practice towards skilled maternal health services. Factors that had a significant association with antenatal care utilization were planned pregnancy (AOR = 8.2, 95% CI = 3.39-19.78-0.87) and access to transport (AOR = 3.1, 95% CI = 1.46–6.61). Attending ANC at least once (AOR = 3.1, 95% CI = 1.13–8.41), women's education (AOR = 3.0, 95% CI = 1.18–7.84), and unplanned pregnancy (AOR = 0.3, 95% CI = 0.21–0.75) were factors associated with skilled delivery service utilization. Attending ANC at least once (AOR = 2.1, 95% CI = 1.1–4.2), birth complications (AOR = 2.2, 95% CI = 1.35–3.66), unplanned pregnancies (AOR = 0.3, 95% CI = 0.22–0.68), and awareness about skilled obstetric care (AOR = 3.7, 95% CI = 1.68–12.79) were factors associated with postnatal care utilization. Conclusions This study found that the knowledge, attitude, and practice of skilled maternal health services among the study participants are low, showing less than three-quarters of the total sample size. Therefore, this study implied that interventions are required to improve women's knowledge, attitude, and practice of skilled maternal health services in the study area. Furthermore, women's education is significantly associated with skilled delivery service utilization. Accordingly, this study recommends that improving equity among the marginalized population is needed to increase maternal health service coverage.
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Konje ET, Hatfield J, Sauve R, Kuhn S, Magoma M, Dewey D. Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach. BMC Health Serv Res 2021; 21:635. [PMID: 34215254 PMCID: PMC8252323 DOI: 10.1186/s12913-021-06695-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Maternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services. Methods A sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12. Study findings Approximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services. Conclusions Utilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06695-8.
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Affiliation(s)
- Eveline T Konje
- Department of Biostatistics and Epidemiology, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada.
| | - Jennifer Hatfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Reg Sauve
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Susan Kuhn
- Department of Paediatrics, University of Calgary, Alberta, Calgary, Canada
| | - Moke Magoma
- Engender Health Tanzania, Dar es Salaam, Tanzania
| | - Deborah Dewey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada.,Department of Paediatrics, University of Calgary, Alberta, Calgary, Canada.,Owerko Centre, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Calgary, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
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Matovelo D, Ndaki P, Yohani V, Laisser R, Bakalemwa R, Ndaboine E, Masatu Z, Mwaikambo M, Brenner JL, Wilson WM. Why don't illiterate women in rural, Northern Tanzania, access maternal healthcare? BMC Pregnancy Childbirth 2021; 21:452. [PMID: 34182949 PMCID: PMC8240192 DOI: 10.1186/s12884-021-03906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03906-2.
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Affiliation(s)
- Dismas Matovelo
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Pendo Ndaki
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Victoria Yohani
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Respicious Bakalemwa
- Bugando Medical Centre, Mwanza, Tanzania.,Department of Pediatrics, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edgar Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Zabron Masatu
- District Medical Officer, Misungwi District, Mwanza, Tanzania
| | | | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Warren M Wilson
- Departments of Anthropology & Archaeology and Community Health Sciences, University of Calgary, Calgary, Canada.
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Emgård M, Mwangi R, Mayo C, Mshana E, Nkini G, Andersson R, Msuya SE, Lepp M, Muro F, Skovbjerg S. Tanzanian primary healthcare workers' experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study. Antimicrob Resist Infect Control 2021; 10:94. [PMID: 34176486 PMCID: PMC8237496 DOI: 10.1186/s13756-021-00952-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. Methods A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. Findings Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. Conclusions To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00952-5.
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Affiliation(s)
- Matilda Emgård
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Rose Mwangi
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Celina Mayo
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Ester Mshana
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Gertrud Nkini
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Østfold University College, Fredrikstad, Norway.,School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Florida Muro
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Sokoine Road, Moshi, Tanzania.,Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Prevalence of Early Postnatal-Care Service Utilization and Its Associated Factors among Mothers in Hawassa Zuria District, Sidama Regional State, Ethiopia: A Cross-Sectional Study. Obstet Gynecol Int 2021; 2021:5596110. [PMID: 34093709 PMCID: PMC8140851 DOI: 10.1155/2021/5596110] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/05/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background A postnatal care given after childbirth is a critical care to promote health and to prevent complications of the mother and newborn. However, utilization of this service is low in Ethiopia, and little is known about its coverage and determinants. Thus, this study aimed to assess the prevalence of early postnatal-care service utilization and its associated factors among mothers in Hawassa Zuria district, Sidama Regional State, Ethiopia. Methods A cross-sectional study was conducted from 20 February to 20 March 2020 in Hawassa Zuria District among randomly selected 320 mothers. Data were collected by using interviewer-administered structured questionnaires. Data entered were into Epi data version 3.1 and exported to SPSS version 26 for analysis. Descriptive, bivariable, and multivariable logistic regression analysis with odds ratio and 95% confidence interval were conducted. A P value <0.05 was considered a statistically significant association. Finally, the results were presented by texts, tables, and figures. Result The prevalence of early postnatal-care service utilization was 29.7% (95% CI = 24.7, 35.5). Age below 25 years [AOR = 3.2 (95% CI = 1.37, 7.48)], having planned and supported pregnancy for last birth [AOR = 2.2 (95% CI = 1.13, 4.38)], having information about obstetric danger signs [AOR = 2.1 (95% CI = 1.25, 3.78)], and having positive attitude on use postnatal services [AOR = 3.5 (95% CI = 1.94, 6.32)] were factors associated with early postnatal-care utilization. Conclusion The finding revealed that early postnatal-care utilization in the study area was low. Strengthening family planning services, giving information on obstetrics danger signs, and creating awareness about postnatal care will improve uptake of the service in a timely manner.
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Krishnamoorthy Y, Majella MG. Determinants of postnatal care coverage among mothers and new-borns in India: Evidence from a nationally representative survey. Int J Health Plann Manage 2021; 36:1276-1286. [PMID: 33866592 DOI: 10.1002/hpm.3179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 03/08/2021] [Accepted: 04/07/2021] [Indexed: 11/06/2022] Open
Abstract
Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, Chennai, Tamil Nadu, India
| | - Marie Gilbert Majella
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Debie A, Tesema GA. Time to early initiation of postnatal care service utilization and its predictors among women who gave births in the last 2 years in Ethiopia: a shared frailty model. ACTA ACUST UNITED AC 2021; 79:51. [PMID: 33858514 PMCID: PMC8048056 DOI: 10.1186/s13690-021-00575-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022]
Abstract
Background Most maternal and infant deaths occurred within the first month after birth. Nearly half of the maternal deaths and more than a million newborn deaths occurred within the first day of life but these were preventable through early initiation of postnatal care (PNC) services. However, the available evidence on the level of early initiation of PNC service utilization was not adequate to inform policy decisions. Therefore, this study aimed to assess time to early initiation of postnatal care and its predictors using the 2016 Ethiopian Demography and Health Survey (EDHS) datasets. Methods Two-stage stratified cluster sampling technique by separating each region into urban and rural areas. A total weighted sample of 6364 women of the 2016 EDHS datasets who gave birth within 2 years preceding the survey was used. Time to early initiation of the PNC visit was estimated using the Kaplan-Meier (K-M) method. Shared frailty model with baseline distributions (Weibull, Gompertz, exponential, log-logistic, and lognormal) and frailty distributions (gamma and inverse Gaussian) were used by taking enumeration areas/clusters as a random effect for predictors of time to early initiation of PNC visit. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) and p-value less than 0.05 were used to declare the significant predictor variables for time to early initiation of the PNC service utilization. Results The prevalence of women who utilized PNC services within 42 days was 13.27% (95% CI, 12.46, 14.13). Among these women, only 1.73% of them had got within the first 24 h of birth; 4.66% of them received within 48–72 h and 1.74% of them also had got within 7–14 days. Variables, such as parity (AHR = 1.61, 95% CI: 1.21, 2.15), media exposure (AHR = 1.42, 95% CI: 1.21, 1.68), place of delivery (AHR = 14.36, 95% CI: 11.76, 17.53), caesarean delivery (AHR = 2.17, 95% CI: 1.60, 2.95) and antenatal care visit (AHR = 2.07, 95% CI: 1.63, 2.63) had the higher hazard for PNC services utilization. On the other hand, women who faced with healthcare access problems (AHR = 0.74, 95% CI: 0.60, 0.87) had a lower hazard of PNC service utilization. Conclusion The overall postnatal care service utilization among women in the survey was low, particularly within the first 24 h of delivery. Policy-makers and implementers should promote the utilization of antenatal care and institutional delivery using mass media to increase the continuum of maternity care. The government should also design a new approach to enhance the uptake of postnatal care services for poor households and to scale up the PNC services, including the different possibilities for women who give births at the health facilities and homes. Future researchers had better assess the capacity and accessibility of the local health systems, the level of decentralized decision making, common cultural practices, knowledge, attitude, and perception of mothers towards PNC service utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00575-7.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ayele B, Woldu M, Gebrehiwot H, Wellay T, Hadgu T, Gebretnsae H, Abrha A, Gebre-egziabher E, Hurlburt S. Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey. PLoS One 2021; 16:e0249793. [PMID: 33826670 PMCID: PMC8026072 DOI: 10.1371/journal.pone.0249793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. Methods This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. Result In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. Conclusion Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.
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Affiliation(s)
- Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
- * E-mail:
| | - Mulugeta Woldu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Tsegay Wellay
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Alemnesh Abrha
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Sarah Hurlburt
- Fenot, a Project of the Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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Mahajan N, Kaur B. Utilization of Postnatal Care among Rural Women in Punjab. Indian J Community Med 2021; 46:126-129. [PMID: 34035592 PMCID: PMC8117905 DOI: 10.4103/ijcm.ijcm_121_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The postchildbirth period presents considerable challenges in the form of health risks for the mother and the newborn, yet postnatal care (PNC) remains seldom utilized maternal and newborn health intervention. Objectives: The present study aims to study the coverage of PNC among rural women in Punjab and understand the factors that determine the utilization of PNC services. Materials and Methods: From rural areas of seven districts of Punjab, a total of 420 respondents were questioned using semi-structured interview schedule. Binary logistic regression is employed to understand the factors that influence the utilization of complete PNC. Results: The utilization of complete PNC has remained mere 25.9% in the present study. The results of multivariate logistic regression reveal that variables district, caste, birth order, and type of delivery significantly influence the utilization of complete PNC. Conclusion: The utilization of PNC component is found to be abysmal as compared to antenatal component and institutional delivery among the study group. There is a need to create awareness regarding the necessity of PNC among the women.
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Affiliation(s)
- Niharika Mahajan
- Punjab School of Economics, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Baljit Kaur
- Punjab School of Economics, Guru Nanak Dev University, Amritsar, Punjab, India
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Dankwah E, Feng C, Kirychuck S, Zeng W, Lepnurm R, Farag M. Assessing the contextual effect of community in the utilization of postnatal care services in Ghana. BMC Health Serv Res 2021; 21:40. [PMID: 33413362 PMCID: PMC7792027 DOI: 10.1186/s12913-020-06028-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives. METHODS The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. RESULTS This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44-0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability. CONCLUSION The findings of this study indicate that community-level factors have an influence on women's health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
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Affiliation(s)
- Emmanuel Dankwah
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Centre for Clinical Research, 5790 University Ave., Halifax, NS, B3H 1V7, Canada
| | - Shelley Kirychuck
- Department of Medicine, College of Medicine, Canadian Centre for Health and Safety in Agriculture (CCHSA), 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Wu Zeng
- School of Nursing & Health Studies, Georgetown University, 3700 Reservoir Rd, Washington, DC, 20007, USA
| | - Rein Lepnurm
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada. .,School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Al Tarfa Street, Zone 70, Doha, Qatar.
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He Z, Zhang C, Wang S, Bishwajit G, Yang X. Socioeconomic Determinants of Maternal HealthCare Utilisation in Zambia: 1997-2014. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211067480. [PMID: 34911372 PMCID: PMC8689614 DOI: 10.1177/00469580211067480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study aims at exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilization between 1997 and 2014. Data were analyzed using descriptive and multivariate regression methods. Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate antenatal care visit was comparatively higher among those in the lower wealth quintiles. Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilization of these services.
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Affiliation(s)
- Zhifei He
- School of Politics and Public Administration, Southwest University of Political Science and Law, Chongqing, China
| | - Caihua Zhang
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Shiming Wang
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Ghose Bishwajit
- School of International Law, Southwest University of Political Science and Law, Chongqing, China
| | - Xinglong Yang
- School of International Law, Southwest University of Political Science and Law, Chongqing, China
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Balde MD, Diallo A, Soumah AM, Sall AO, Diallo BA, Barry F, Touré AO, Barry AA, Camara S. Barriers to Utilization of Postnatal Care: A Qualitative Study in Guinea. ACTA ACUST UNITED AC 2021. [DOI: 10.4236/ojog.2021.114039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khankhell RMK, Ghotbi N, Hemat S. <Editors' Choice> Factors influencing utilization of postnatal care visits in Afghanistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:711-723. [PMID: 33311802 PMCID: PMC7719444 DOI: 10.18999/nagjms.82.4.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) defines the postnatal period as the first six weeks (42 days) after delivery and recommends four postnatal care (PNC) visits for women giving birth to a child to enable early detection and treatment of complications. However, a low utilization of PNC visits by Afghan women has contributed to a relatively high maternal mortality in Afghanistan. This study aimed to identify factors influencing the utilization of PNC visits among Afghan women by sampling nationally representative data from Afghanistan Demographic and Health Survey (AfDHS), 2015. The logistic model was used to measure the adjusted odds of utilizing PNC services among women, with a 95% confidence interval (95% CI) and a p-value of <0.05 for statistical significance. The study found that the utilization of PNC visits in Afghanistan is low; among 8,581 women (44%) who utilized PNC visits and 10,924 women (56%) who didn’t, the women’s age, place of residence, parity, education, occupation, number of antenatal care (ANC) visits, place of delivery, exposure to public media, the woman’s role in decision making and needing a permission to seek healthcare were found to be associated with the level of utilization of PNC visits. Based on the study results, health promotion interventions are recommended to increase the utilization of PNC visits.
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Affiliation(s)
| | - Nader Ghotbi
- Graduate School of Asia Pacific Studies, Ritsumeikan Asia Pacific University, Beppu, Japan
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Seid A, Ahmed M. Determinants of postnatal checkup for newborns in Ethiopia: Further analysis of 2016 Ethiopia demographic and health survey. BMC Pregnancy Childbirth 2020; 20:761. [PMID: 33287765 PMCID: PMC7720474 DOI: 10.1186/s12884-020-03468-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The absence of suitable care during the postpartum period might result in substantial ill-health and even the demise of newborns. So, identifying and intervening thus factors increase postnatal newborn care utilization thereby reducing neonatal mortality. Therefore, this study aimed to ascertain the determinants of the postnatal checkup of a newborn in Ethiopia. METHOD A cross-sectional study was accompanied using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set. The samples were designated by employing a two-stage stratified cluster sampling technique. All statistical analysis were weighted in order to take into consideration complex survey design. Bivariate and multivariate logistic regression analysis was also carried out to examine the association between use of postnatal care of newborn and selected independent variables. Adjusted odds ratios (AOR) were used to state a statistically significant suggestion. RESULT A total of 7091 samples of the reproductive age of newborn mothers were included and analyzed. According to multivariate analysis, the odds of postnatal checkups of the newborn were 2.45 times higher among mothers who had 1-3 ANC visits and 3.42 times higher among mothers who had four and above visits than mother who did not have ANC visit. The odds of postnatal checkups of the newborn were 1.4 times higher among mothers who had access to media compared to their counterparts. Likewise, the odds of postnatal checkups of the newborn were 1.67 times higher among mothers who had delivered in a health facility than who delivered at home. CONCLUSIONS This study revealed that accessed media, being rich or middle in the wealth index category, having ANC visits, and institutional delivery was positively associated with the utilization of postnatal care checkup of the newborn. Therefore, information education and communication programs should perform a critical role in inspiring mother to take their newborns for postnatal checkup after birth.
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Affiliation(s)
- Abdu Seid
- Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Mohammed Ahmed
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Langa N, Bhatta T. The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization. PLoS One 2020; 15:e0241746. [PMID: 33166310 PMCID: PMC7652341 DOI: 10.1371/journal.pone.0241746] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. METHODS Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five years before the month of the interview and living in both rural and urban Tanzania. The maternal health care utilization was assessed by four variables (i.e., antenatal care, skilled delivery assistance, the before and after discharging postnatal care). The independent variables were wealth, education, residence, parity, occupation, age, and the head of the household's sex. We used bivariate statistics and logistic regression to examine the rural-urban differences in the influence of education and wealth on maternal health care utilization. RESULTS Significantly lower use of maternal health care in rural than urban areas demonstrated a stark rural-urban divide in Tanzania. We documented socioeconomic inequalities in maternal health care utilization in the form of lower odds of the utilization of such services among women with lower levels of education and household wealth. The educational inequalities in the utilization of skilled delivery assistance (or = 0.37, 95% CI: 0.16, 0.86; p = 0.021) and (before discharge) postnatal care (or = 0.60, 95% CI: 0.38, 0.95; p = 0.030) were significantly wider in rural than urban areas. The differences in the odds of the utilization of skilled delivery assistance between women in poorer wealth quintile and women in richer household wealth quintile were also significantly wider in rural areas than in urban areas. However, the statistically significant rural-urban divides in the impacts of socioeconomic status on antenatal care and (after discharge) postnatal care were not observed. CONCLUSION This study establishes the need for consideration of the rural-urban context in the formulation of policies to reduce disparities in maternal health care utilization in Tanzania.
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Affiliation(s)
- Neema Langa
- Department of Sociology, University of Nevada, Las Vegas, Nevada, United States of America
| | - Tirth Bhatta
- Department of Sociology, University of Nevada, Las Vegas, Nevada, United States of America
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The Effect of Antenatal Care Service Utilization on Postnatal Care Service Utilization: A Systematic Review and Meta-analysis Study. J Pregnancy 2020; 2020:7363242. [PMID: 33029402 PMCID: PMC7528140 DOI: 10.1155/2020/7363242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Reduction of maternal and neonatal morbidity and mortality has continued to be a challenge in developing countries. The majority of maternal and neonatal mortality occurred during the early postpartum period. This is mostly due to low postnatal care service utilization. There is a discrepancy of evidence on the effect status of antenatal care on the improvement of postnatal care service utilization. Therefore, this review study is aimed at estimating the pooled effect of antenatal care on postnatal care service utilization. Methods We searched from PubMed and Cochrane library database, Google Scholar, and Google. Initially, we found 265 articles; after duplication was removed and screened by the relevance of the titles and abstracts, 36 studies were considered for assessment of eligibility. Finally, 14 articles passed the inclusion and exclusion criteria and are included in the meta-analysis. Study quality assessment was done using Janna Briggs Institute (JBI) critical appraisal tools. The main information was extracted from each study. Heterogeneity of studies was assessed using I 2 = 70% and more considered having high heterogeneity. The publication bias was checked using funnel plot and big test. Meta-analysis using a random effect model was conducted. A forest plot was used to show the estimated size effect of odds ratio with a 95% confidence interval. Results A total of 14 articles were included with 15,765 participants for synthesis and meta-analysis. We found that a pooled estimate of women who had antenatal care was 1.53 times more likely to have postnatal care compared with those who had no antenatal care (AOR = 1.53, 95% CI 1.38-1.70, I 2 = 0%). Conclusions This review results revealed a low utilization of postnatal care service. Antenatal care service utilization has a positive effect on postnatal care service utilization. Policymakers and programmers better considered more antenatal care service use as one strategy of enhancing the utilization of postnatal care service.
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Perin J, Koffi AK, Kalter HD, Monehin J, Adewemimo A, Quinley J, Black RE. Using propensity scores to estimate the effectiveness of maternal and newborn interventions to reduce neonatal mortality in Nigeria. BMC Pregnancy Childbirth 2020; 20:534. [PMID: 32928142 PMCID: PMC7488987 DOI: 10.1186/s12884-020-03220-3] [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: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background Nigeria is the largest country in sub-Saharan Africa, with one of the highest neonatal mortality rates and the second highest number of neonatal deaths in the world. There is broad international consensus on which interventions can most effectively reduce neonatal mortality, however, there is little direct evidence on what interventions are effective in the Nigerian setting. Methods We used the 2013 Nigeria Demographic and Health Survey (NDHS) and the follow-up 2014 Verbal and Social Autopsy study of neonatal deaths to estimate the association between neonatal survival and mothers’ and neonates’ receipt of 18 resources and interventions along the continuum of care with information available in the NDHS. We formed propensity scores to predict the probability of receiving the intervention or resource and then weighted the observations by the inverse of the propensity score to estimate the association with mortality. We examined all-cause mortality as well as mortality due to infectious causes and intrapartum related events. Results Among 19,685 livebirths and 538 neonatal deaths, we achieved adequate balance for population characteristics and maternal and neonatal health care received for 10 of 18 resources and interventions, although inference for most antenatal interventions was not possible. Of ten resources and interventions that met our criteria for balance of potential confounders, only early breastfeeding was related to decreased all-cause neonatal mortality (relative risk 0.42, 95% CI 0.32–0.52, p < 0.001). Maternal decision making and postnatal health care reduced mortality due to infectious causes, with relative risks of 0.29 (95% CI 0.09–0.88; 0.030) and 0.46 (0.22–0.95; 0.037), respectively. Early breastfeeding and delayed bathing were related to decreased mortality due to intrapartum events, although these are not likely to be causal associations. Conclusion Access to immediate postnatal care and women’s autonomous decision-making have been among the most effective interventions for reducing neonatal mortality in Nigeria. As neonatal mortality increases relative to overall child mortality, accessible interventions are necessary to make further progress for neonatal survival in Nigeria and other low resource settings.
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Affiliation(s)
- Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Alain K Koffi
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kurji J, Talbot B, Bulcha G, Bedru KH, Morankar S, Gebretsadik LA, Wordofa MA, Welch V, Labonte R, Kulkarni MA. Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia. BMC Health Serv Res 2020; 20:703. [PMID: 32736622 PMCID: PMC7394677 DOI: 10.1186/s12913-020-05572-0] [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] [Received: 11/20/2019] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women’s education levels were also assessed. Methods Using survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran’s I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations. Results Significant global spatial autocorrelation was present in ANC use (Moran’s I = 0.15, p value = 0.025), delivery care (Moran’s I = 0.17, p value = 0.01) and PNC use (Moran’s I = 0.31, p value < 0.01), but not MWH use (Moran’s I = -0.005, p value = 0.94) suggesting clustering of villages with similarly high (hot spots) and/or low (cold spots) service use. Hot spots were detected in health centre catchments in Gomma district while Kersa district had cold spots. High poverty or low education catchments generally had low levels of service use, but there were exceptions. At village level, hot and cold spots were detected for ANC, delivery care and PNC use. Household-level analyses revealed a primary cluster of elevated MWH-use not detected previously. Further investigation of spatial heterogeneity is warranted. Conclusions Sub-national variation in maternal healthcare services exists in Jimma Zone. There was relatively higher poverty and lower education in areas where service use cold spots were identified. Re-directing resources to vulnerable sub-groups and locations lagging behind will be necessary to ensure equitable progress in maternal health.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Benoit Talbot
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Gebeyehu Bulcha
- Jimma Zone Health Office, Jimma Zone, Oromia Region, Jimma, Ethiopia
| | - Kunuz Haji Bedru
- Jimma Zone Health Office, Jimma Zone, Oromia Region, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma, Ethiopia
| | | | | | - Vivian Welch
- Centre for Global Health, Bruyere Research Institute, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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Tolera H, Gebre-Egziabher T, Kloos H. Risk factors for women's non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia. Ther Adv Reprod Health 2020; 14:2633494120928340. [PMID: 32637939 PMCID: PMC7323273 DOI: 10.1177/2633494120928340] [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] [Received: 09/09/2019] [Accepted: 02/10/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia. Methods: In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services. Results: Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery. Conclusion: The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.
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Affiliation(s)
- Habtamu Tolera
- Department of Geography and Environmental Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tegegne Gebre-Egziabher
- Department of Geography and Environmental Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
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Adane B, Fisseha G, Walle G, Yalew M. Factors associated with postnatal care utilization among postpartum women in Ethiopia: a multi-level analysis of the 2016 Ethiopia demographic and health survey. Arch Public Health 2020; 78:34. [PMID: 32322394 PMCID: PMC7161122 DOI: 10.1186/s13690-020-00415-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/25/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most postpartum women and newborns do not utilize postnatal care due to less emphasis given especially in developing countries. Understanding individual and community-level factors associated with postnatal care will help to design appropriate strategies and policies for improving service utilization. Therefore, this study aimed to assess individual and community-level factors associated with postnatal care utilization in Ethiopia. METHOD This study used the Ethiopian Demographic and Health Survey (EDHS) data of 2016. A total of 4489 women who gave birth 2 years before the survey were included. Two-stage stratified cluster sampling technique was used. The analysis was done using Stata version 14.0 after checking for basic assumptions of multilevel logistic regression. Multilevel mixed-effects logistic regression was used to identify determinants of postnatal care utilization. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association. RESULTS Husband with secondary education [AOR = 0.17, 95% CI = (0.04, 0.68)], four or more antenatal care visit [AOR = 10.77, 95% CI = (2.65, 43.70)], middle wealth quintile [AOR = 3.10, 95% CI = (1.12, 8.58)] were individual level factors. Community level education [AOR = 2.53, 95% CI = (1.06, 6.06)] and community level of health service utilization [AOR = 2.32, 95% CI = (1.14, 4.73)] were the predictors at community level. CONCLUSION Wealth index, number of antenatal care visits, husband education, community level of education and health service utilization were significantly associated with PNC service utilization. Provision of quality antenatal care, improvement of the educational status of women and husband involvement in PNC are important strategies to increase PNC service utilization.
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Affiliation(s)
- Bezawit Adane
- Department of Biostatistics and Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Girmatsion Fisseha
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Getaw Walle
- Department of Biostatistics and Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Ndugga P, Namiyonga NK, Sebuwufu D. Determinants of early postnatal care attendance: analysis of the 2016 Uganda demographic and health survey. BMC Pregnancy Childbirth 2020; 20:163. [PMID: 32178635 PMCID: PMC7076947 DOI: 10.1186/s12884-020-02866-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/09/2020] [Indexed: 02/08/2023] Open
Abstract
Background The first 2 days after childbirth present the highest risk of dying for a mother. Providing postnatal care within the first 2 days after childbirth can help avert maternal mortality because it allows early detection of problems that could result in adverse maternal health outcomes. Unfortunately, knowledge of the uptake of early postnatal care (EPNC), which is imperative for informing policies aimed at reducing maternal mortality, remains low in Uganda. Therefore, the purpose of this study is to investigate the determinants of early postnatal care attendance among Ugandan women. Methods This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5471 women (age 15–49) who delivered a child in the 2 years preceding the survey. We used logistic regression to identify factors associated with use of early postnatal care. Results Our findings showed that 50% of mothers used EPNC services for their most recent delivery in the 2 years preceding the survey. Women’s residence, education level, religion, wealth status, marital status, occupation, antenatal care attendance, place of delivery, birth order, perceived accessibility of health facilities, and access to mass media messages were associated with greater use of EPNC. The percentage of women receiving EPNC was much higher among women who delivered at a health facility, either a public facility (63%) or private facility (65%), versus only 9% among women who delivered at home. Multivariate analysis showed that delivery at a health facility was the most important determinant of early postnatal care attendance. Conclusions To increase mothers’ use of EPNC services and improve maternal survival in Uganda, programs could promote and strengthen health facility delivery and ensure that EPNC services are provided to all women before discharge. Even so, the fact that only about two-thirds of women who delivered at a health facility received early postpartum care shows substantial room for improvement. Interventions should target women who deliver at home, women who attend fewer than four antenatal care visits, and women with a primary education.
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Affiliation(s)
- Patricia Ndugga
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda.
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Utilization of Postnatal Healthcare Services Delivered through Home Visitation and Health Facilities for Mothers and Newborns: An Integrative Review from Developing Countries. Indian J Pediatr 2020; 87:207-216. [PMID: 31900850 DOI: 10.1007/s12098-019-03101-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
Abstract
Despite evidence about the value of high quality postnatal services for the survival, health and wellbeing of the mother and neonate, sub-optimal use of the available services delivered through public sector remains a persistent challenge in India and most low-middle income countries. An extensive search till Dec 31, 2017 in databases including PubMed, Scopus and Science Direct was conducted and selected studies were organized, categorized and summarized for integrated review. Of the 3463 studies screened, 47 relevant studies were identified through integrated systematic process. The 'nexus' framework consisting of four domains namely: social-cultural, educational, organizational and economic-physical were used to determine the promoters and inhibitors of postnatal care-utilization. The important inhibitory factors at household and community context were myths-cultural practices, gaps in the awareness of mother and families regarding danger signs and postnatal complications and hesitancy to contact health workers due to trust deficit. There were lack of clarity about job responsibilities, poor quality of training, skills building and supervision of front line workers. Quality of home visits, and irregular incentives to health workers were other factors. The facilitating factors were mother's autonomy, young mothers, access to media and repeated and timely contact with the health worker, antenatal care (ANC) attendance and institutional deliveries, conditional cash transfer and availability of health insurance. Several factors like social mobilization, skill building and training cut across the domains of the nexus framework. The review suggested a multi-dimensional focus on implementing integrated continuum of care models covering prenatal-postnatal and infancy period.
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Kim ET, Singh K, Speizer IS, Lemani C. Influences of health facility type for delivery and experience of cesarean section on maternal and newborn postnatal care between birth and facility discharge in Malawi. BMC Health Serv Res 2020; 20:139. [PMID: 32093660 PMCID: PMC7041203 DOI: 10.1186/s12913-020-4958-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/05/2020] [Indexed: 11/14/2022] Open
Abstract
Background A number of studies in the past have looked at determinants of postnatal care. However, many of them do not distinguish between postnatal care (PNC) before discharge and after discharge for women delivering at health facilities. Conceptually and practically, factors associated with PNC before discharge and after discharge should be different. This study examines key factors for maternal and newborn PNC before discharge. Methods Data from the 2015–16 Malawi Demographic and Health Survey were used for the study. Three categorical endogenous variables examined in the study were whether or not mothers received a postnatal check between birth and facility discharge, whether or not newborns received a postnatal check between birth and facility discharge and whether or not women delivered by cesarean section. Delivery by cesarean section was considered as a mediator in the model. The main predictor of interest was type of health facility where women delivered. Other exogenous variables included were women’s age at most recent birth, number of antenatal visits, women’s education, household wealth, parity, newborn size, region of the country and residence. Simultaneous equation modeling was used to examine the associations of interest. Results 47% of the mothers and 68% of the newborns had PNC before facility discharge. The total and direct effects of delivering in private hospitals on maternal and newborn PNC before facility discharge were significantly higher than the effects of delivering in government hospitals. The total effects of delivering in government health centers or health posts on maternal and newborn PNC before facility discharge were significantly lower than the effects of delivering in government hospitals. Delivering by cesarean section compared to delivering vaginally was positively associated with maternal and newborn PNC before facility discharge. Conclusion It is important that all women and newborns receive PNC before they are discharged from the facility regardless of whether or not they had a complication. The same standard of quality PNC should be provided equitably across all types and affiliations of health facilities.
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Affiliation(s)
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Maternal healthcare services use in Mwanza Region, Tanzania: a cross-sectional baseline survey. BMC Pregnancy Childbirth 2019; 19:474. [PMID: 31805887 PMCID: PMC6896688 DOI: 10.1186/s12884-019-2653-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 02/03/2023] Open
Abstract
Background Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania. Methods A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. Results Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. Conclusion Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.
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Mbuthia F, Reid M, Fichardt A. mHealth communication to strengthen postnatal care in rural areas: a systematic review. BMC Pregnancy Childbirth 2019; 19:406. [PMID: 31694578 PMCID: PMC6836428 DOI: 10.1186/s12884-019-2531-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background Postnatal care (PNC) in rural areas is characterised by low uptake, with possible effect on maternal and neonatal mortality rates. Mobile health (mHealth) communication has been proposed to promote the uptake of health services; however, there is limited information on how mHealth can strengthen PNC in rural areas. The objective of this review was to gather the best available evidence regarding mHealth communication to strengthen PNC in rural areas. Methods Studies published between 1 January 2008 and 31 August 2018 were searched in electronic databases hosted by EBSCO Host. Reference list checking and contact with authors were also done. Critical appraisal of the eligible studies was also done. Results The results of 11 articles were synthesised to report the determinants of PNC uptake. Determinants were aligned to the Integrative Model of Behaviural Prediction (IMBP). One-way mobile phone messaging was the most common type of mHealth communication used. mHealth communication influenced mothers’ intentions, skills, and environmental constraints associated with uptake of PNC. Intentions were influenced by attitudes, perceived norms and self-efficacy. Positive attitudes, as well as changed attitudes toward PNC practices were observed. Perceived norms that were enhanced were delivery at a health facility with immediate PNC, seeking of reinforcement and professional health support of newborn care practices, and male partner support. Improved self-efficacy was demonstrated by mothers who attended scheduled appointments and they were confident with regard to newborn care practices. Skills for PNC that were improved included cord care, thermal care, appropriate breastfeeding and problem-solving. The environmental constraints faced and which were addressed in the studies included inaccessibility, unavailability and unaffordability of PNC services in rural areas. Conclusions Results from the literature included in this study show that one-way mobile phone messaging is the common type of mHealth communication used to strengthen PNC in rural areas. mHealth communication can influence intentions, skills and environmental constraints as determinants of PNC uptake. mHealth communication is recommended to strengthen PNC in rural areas. To widen the evidence, more studies in the field of mHealth communication that report a variety of both maternal and neonatal outcomes are needed.
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Affiliation(s)
- Florence Mbuthia
- Dedan Kimathi University of Technology, Kenya, PO Box 657-10100, Nyeri, Kenya.
| | - Marianne Reid
- University of the Free State, PO Box 339, Bloemfontein, 9300, Republic of South Africa
| | - Annali Fichardt
- University of the Free State, PO Box 339, Bloemfontein, 9300, Republic of South Africa
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Kurji J, Gebretsadik LA, Wordofa MA, Sudhakar M, Asefa Y, Kiros G, Mamo A, Bergen N, Asfaw S, Bedru KH, Bulcha G, Labonte R, Taljaard M, Kulkarni M. Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2019; 9:e028210. [PMID: 31467047 PMCID: PMC6720516 DOI: 10.1136/bmjopen-2018-028210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia. DESIGN Cross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses. SETTING Twenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia. PARTICIPANTS 3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016. OUTCOME MEASURE The primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman's education, woman's occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births. RESULTS Overall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use. CONCLUSIONS Utilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | | | - Morankar Sudhakar
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Getachew Kiros
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shifera Asfaw
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | | | | | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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Lam ND, Anh ND, Ha NTT, Vinh TQ, Anh VTM, Kien VD. Socioeconomic inequalities in post-natal health checks for the newborn in Vietnam. Int J Equity Health 2019; 18:128. [PMID: 31420044 PMCID: PMC6697903 DOI: 10.1186/s12939-019-1029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Abstract
Background The newborn and child death associated with inadequate post-natal health checks continued to be a significant issue across the world. This study aimed to assess the socioeconomic inequalities in post-natal health checks for the newborn in Vietnam in 2014. Methods We used the secondary data from the Multiple Indicator Cluster Survey in 2014. We included women aged 15–49 years who had a live birth within two years of the time of the interview. We estimated the concentration index to measure socioeconomic inequalities post-natal health checks for the newborn. We conducted multiple logistic regression analysis to identify factors associated with post-natal health checks for the newborn. Results Overall, the proportion of post-natal health checks for the newborn in Vietnam was 89.1%. The concentration index of post-natal health checks for the newborn was positive at 0.06. It indicated that the newborns in the rich households were more likely to get post-natal health checks as compared to in the poor households. The common factors significantly associated with the higher percentage of post-natal health checks for the newborn were women belonging to the Kinh and Hoa ethnic, higher education, and wealthier groups. Conclusion Socioeconomic inequalities in post-natal health checks for the newborn in Vietnam were not strong, but it still existed. Thus, we recommended that policy efforts to increase access to post-natal health services for poor women. In addition, there is a need to improve access to post-natal health services for women belonging to minor ethnic group and low education.
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Affiliation(s)
- Nguyen Duc Lam
- Hanoi Medical University, No1. Ton That Tung Street, Hanoi, Vietnam. .,Hanoi Obstetrics and Gynecology Hospital, No. 929 La Thanh Street, Ba Dinh District, Hanoi, Vietnam.
| | - Nguyen Duy Anh
- Hanoi Obstetrics and Gynecology Hospital, No. 929 La Thanh Street, Ba Dinh District, Hanoi, Vietnam
| | - Nguyen Thi Thu Ha
- Hanoi Obstetrics and Gynecology Hospital, No. 929 La Thanh Street, Ba Dinh District, Hanoi, Vietnam
| | - Truong Quang Vinh
- Vietnam National University, No 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Vu Thi Mai Anh
- Health Strategy and Policy Institute, A36 Lane, Ho Tung Mau St, Cau Giay District, Hanoi, Vietnam
| | - Vu Duy Kien
- OnCare Medical Technology Company Limited, No. 77/508 Lang Street, Hanoi, Vietnam
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Greenspan JA, Chebet JJ, Mpembeni R, Mosha I, Mpunga M, Winch PJ, Killewo J, Baqui AH, McMahon SA. Men's roles in care seeking for maternal and newborn health: a qualitative study applying the three delays model to male involvement in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 2019; 19:293. [PMID: 31409278 PMCID: PMC6693212 DOI: 10.1186/s12884-019-2439-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background Increasing the utilization of facility-based care for women and newborns in low-resource settings can reduce maternal and newborn morbidity and mortality. Men influence whether women and newborns receive care because they often control financial resources and household decisions. This influence can have negative effects if men misjudge or ignore danger signs or are unwilling or unable to pay for care. Men can also positively affect their families’ health by helping plan for delivery, supplementing women’s knowledge about danger signs, and supporting the use of facility-based care. Because of these positive implications, researchers have called for increased male involvement in maternal and newborn health. However, data gathered directly from men to inform programs are lacking. Methods This study draws on in-depth interviews with 27 men in Morogoro Region, Tanzania whose partners delivered in the previous 14 months. Debriefings took place throughout data collection. Interview transcripts were analyzed inductively to identify relevant themes and devise an analysis questionnaire, subsequently applied deductively to all transcripts. Results Study findings add a partner-focused dimension to the three delays model of maternal care seeking. Men in the study often, though not universally, described facilitating access to care for women and newborns at each point along this care-seeking continuum (deciding to seek care, reaching a facility, and receiving care). Specifically, men reported taking ownership of their role as decision makers and described themselves as supportive of facility-based care. Men described arranging transport and accompanying their partners to facilities, especially for non-routine care. Men also discussed purchasing supplies and medications, acting as patient advocates, and registering complaints about health services. In addition, men described barriers to their involvement including a lack of knowledge, the need to focus on income-generating activities, the cost of care, and policies limiting male involvement at facilities. Conclusion Men can leverage their influence over household resources and decision making to facilitate care seeking and navigate challenges accessing care for women and newborns. Examining these findings from men and understanding the barriers they face can help inform interventions that encourage men to be positively and proactively involved in maternal and newborn health.
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Affiliation(s)
- Jesse A Greenspan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, USA
| | - Joy J Chebet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania.
| | - Idda Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Maurus Mpunga
- Department of Labour Studies, Institute of Social Work, P.O. Box 3375, Dar-es-Salaam, Tanzania
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Shannon A McMahon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Institute of Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany
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Dol J, Kohi T, Campbell-Yeo M, Tomblin Murphy G, Aston M, Mselle L. Exploring maternal postnatal newborn care postnatal discharge education in Dar es Salaam, Tanzania: Barriers, facilitators and opportunities. Midwifery 2019; 77:137-143. [PMID: 31325744 DOI: 10.1016/j.midw.2019.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/05/2019] [Accepted: 07/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies in Tanzania have shown that mothers do not often receive the recommended number of postnatal contacts, which limits their ability to not only have health checks but also to be provided with sufficient and quality postnatal education. Educating mothers while in the hospital is important yet there remains a paucity on the experiences of mothers in a hospital setting related to newborn care education. Therefore, the objective of this study was to explore the experience of newborn care discharge education at a national hospital in Dar es Salaam, Tanzania from the perspective of mothers and nurse midwives. METHODS Using convenience sampling, participants were recruited from Muhimbili National Hospital. Eight mothers who recently gave birth and eight nurse midwives working on the postnatal and labour ward participated. In-depth semi-structured interviews were conducted in Swahili and transcribed and translated into English. Interviews were analyzed using thematic coding. RESULTS Most mothers were multiparous (75%) and averaged 29.6 years of age (SD = 5.1). Nurse midwives had an average of 10 years of experience (SD = 7.5). The primary themes identified included barriers, facilitators, and opportunities related to newborn care discharge education. Barriers included lack of standard postnatal education guidelines; community norms against hospital teaching; gaps in hospital care; and expectations of mothers' previous knowledge. Facilitators identified were that education was already being provided on some relevant newborn care topics; nurse midwives desired to teach; and mothers desired to learn and build on their previous knowledge and confidence. Opportunities to improve included developing standardized guidelines related to postnatal discharge education; training nurses how to engage mothers and families; and engaging mothers through varied learning methods. CONCLUSION While mothers received some education prior to discharge and nurses expressed a desire to teach, challenges remained in receiving sufficient education on all recommended postnatal education topics. Opportunity to improve postnatal education can be addressed through the development of standardized education and engaging mothers through preferred learning methods.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, 6299 South St., Halifax, B3H 4R2 Nova Scotia, Canada; World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Thecla Kohi
- School of Nursing, St. Joseph College of Health and Allied Sciences, Dar es Salaam, Tanzania; School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada; World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gail Tomblin Murphy
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; World Health Organization/Pan American Health Organization (WHO/PAHO) Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lilian Mselle
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Şantaş G, Erigüç G, Eryurt MA. The Impact of Internal Migration on the Maternal and Child Health Services Utilization in Turkey. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:519-528. [PMID: 31250710 DOI: 10.1080/19371918.2019.1635941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 06/09/2023]
Abstract
This study aims to determine the effect of internal migration and various socio-demographic and socio-economic factors on maternal and child health services utilization in Turkey. In this context, prenatal care, giving birth at health-care facilities, and postnatal care have been examined. The data of Turkey Demographic and Health Survey were used in the study. The best conditions for maternal and child health services utilization were those who lived in urban, then, respectively, those who were rural to urban migrants, urban to rural migrants, and rural women. Rural people constituted the most disadvantaged group in terms of health-care utilization.
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Affiliation(s)
- Gülcan Şantaş
- a Faculty of Economics & Administrative Science Department of Health Management, Yozgat Bozok University , Yozgat , Turkey
| | - Gülsün Erigüç
- b Faculty of Economics & Administrative Science Department of Health Management, Hacettepe University , Ankara , Turkey
| | - Mehmet Ali Eryurt
- c Institute of Population Studies, Hacettepe University , Ankara , Turkey
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Singh R, Neogi SB, Hazra A, Irani L, Ruducha J, Ahmad D, Kumar S, Mann N, Mavalankar D. Utilization of maternal health services and its determinants: a cross-sectional study among women in rural Uttar Pradesh, India. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:13. [PMID: 31133072 PMCID: PMC6537427 DOI: 10.1186/s41043-019-0173-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 05/17/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh (UP) and examines its determinants. METHODS Data from a baseline survey of UP Community Mobilization (UPCM) project (2013) was utilized. A cross-sectional sample of currently married women (15 to 49 years) who delivered a baby 15 months prior to the survey was included. Information was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care (ANC), delivery and postnatal care (PNC) services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. RESULTS Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group (SHG) membership had no association with the utilization of maternal health services. CONCLUSIONS Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group.
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Affiliation(s)
- Ranjana Singh
- Indian Institute of Public Health, Delhi, India
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002 India
| | - Sutapa B. Neogi
- Indian Institute of Public Health, Delhi, India
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002 India
| | | | | | | | - Danish Ahmad
- Centre for Research and Action, Faculty of Health, University of Canberra, Bruce, Canberra, Australia
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana 122002 India
- Indian Institute of Public Health, Gandhinagar, India
| | - Sampath Kumar
- Community and Rural Development and Agriculture Departments, Shillong, Meghalaya India
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49
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Chaka EE, Abdurahman AA, Nedjat S, Majdzadeh R. Utilization and Determinants of Postnatal Care Services in Ethiopia: A Systematic Review and Meta-Analysis. Ethiop J Health Sci 2019; 29:935-944. [PMID: 30700962 PMCID: PMC6341430 DOI: 10.4314/ejhs.v29i1.16] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This review aimed to determine the utilization and determinants of postnatal care use in Ethiopia. Methods PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effects model. Results Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use. Conclusion Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The review was registered on PROSPERO CRD42017060266.
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Affiliation(s)
- Eshetu E Chaka
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran.,Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo Oromia, Ethiopia
| | - Ahmed A Abdurahman
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran
| | - S Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran
| | - R Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Khan MN, Harris ML, Shifti DM, Laar AS, Loxton D. Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis. Int J Public Health 2019; 64:743-754. [PMID: 31041453 DOI: 10.1007/s00038-019-01238-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To examine the association between unintended pregnancy and maternal healthcare services utilization in low- and lower-middle-income countries. METHODS A systematic literature search of Medline, Cinahl, Embase, PsycINFO, Cochrane Library, Popline, Maternity and Infant Care, and Scopus databases published since the beginning of the Millennium Development Goals (i.e. January 2000) to June 2018 was performed. We estimated the pooled odds ratios using random effect models and performed subgroup analysis by participants and study characteristics. RESULTS A total of 38 studies were included in the meta-analysis. Our study found the occurrence of unintended pregnancy was associated with a 25-39% reduction in the use of antenatal, delivery, and postnatal healthcare services. Stratified analysis found the differences of healthcare services utilization across types of pregnancy unintendedness (e.g. mistimed, unwanted). CONCLUSIONS Integrating family planning and maternal healthcare services should be considered to encourage women with unintended pregnancies to access maternal healthcare services.
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Affiliation(s)
- Md Nuruzzaman Khan
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
| | - Melissa L Harris
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Desalegn Markos Shifti
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Alexander Suuk Laar
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Deborah Loxton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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