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Oyugi B, Kendall S, Peckham S, Orangi S, Barasa E. Exploring the Adaptations of the Free Maternity Policy Implementation by Health Workers and County Officials in Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300083. [PMID: 37903583 PMCID: PMC10615244 DOI: 10.9745/ghsp-d-23-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND In 2017, Kenya launched the free maternity policy (FMP) that aimed to provide all pregnant women access to maternal services in private, faith-based, and levels 3-6 public institutions. We explored the adaptive strategies health care workers (HCWs) and county officials used to bridge the implementation challenges and achieve the FMP objectives. METHODS We conducted an exploratory qualitative study using Lipsky's theoretical framework in 3 facilities (levels 3, 4, and 5) in Kiambu County, Kenya. The study involved in-depth interviews (n=21) with county officials, facility in-charges and HCWs, and key informants from national and development partner agencies. Data were audio-recorded, transcribed, and analyzed using a framework thematic approach. RESULTS The results show that HCWs and county officials applied several strategies that were critical in shaping the policymaking, working practice, and professionalism and ethical aspects of the FMP. Strategies of policymaking: hospitals employed additional staff, and the county developed bylaws to strengthen the flow of funds. Strategies of working practice: hospitals and HCWs enhanced patient referrals, and facilities enhanced communication. Strategies of professionalism and ethics: nurses registered and provided service to mothers, and facilities included employees in planning and budgeting. Maladaptations included facilities having leeway to provide FMP services to populations who were excluded from the policy but had to bear the costs. Some discharged mothers immediately after birth, even before offering the fully costed policy benefits, to avoid incurring additional costs. CONCLUSIONS The role of policy implementers and the built-in flexibility and agility in implementing the FMP could enhance service delivery, manage the administrative pressures of implementation, and provide mothers with personalized, responsive service. However, despite their benefits, some resulting unintended consequences may need interventions.
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Affiliation(s)
- Boniface Oyugi
- M and E Advisory Group, Nairobi, Kenya.
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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The effect of lack of ANC visit and unwanted pregnancy on home child-birth in Ethiopia: a systematic review and meta-analysis. Sci Rep 2022; 12:1490. [PMID: 35087152 PMCID: PMC8795397 DOI: 10.1038/s41598-022-05260-5] [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] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
Although extensive efforts were made to improve maternal and child health, the magnitude of home child-birth is considerably high in Ethiopia. Therefore, this meta-analysis aimed to estimate the effect of lack of ANC visit and unwanted pregnancy on home child-birth among reproductive-age women in Ethiopia. International databases, including Cochrane Library, Google Scholar, PubMed, Global Health, HINARI, and CINAHL were searched systematically to identify studies reporting the prevalence of home child-birth and its association with lack of ANC visit and unwanted pregnancy among reproductive-age women in Ethiopia. STATA/SE version-14 was used to analyze the data and Der Simonian and Liard's method of random effect model was used to estimate the pooled effects. The heterogeneity between study and publication bias was assessed by using I-squared statistics and Egger's test respectively. A total of 19 studies with 25,228 study participants were included in this meta-analysis. The pooled prevalence of home child-birth among reproductive-age women in Ethiopia was 55.3%. Sever heterogeneity was exhibited among the included studies (I2 = 99.8, p = 0.000). The odds of home child-birth among mothers who have no ANC visit was 3.64 times higher compared to their counterparts [OR = 3.64, 95%, CI: (1.45, 9.13)]. There was significant heterogeneity among the included studies (I2 = 94%, p = 0.000). However, there was no statistical evidence of publication bias in the pooled effect of lack of ANC visit on home child-birth (P = 0.302). Women who experienced unwanted pregnancy were 3.02 times higher to give birth at home compared to women with a wanted pregnancy [OR = 3.02, 95%CI: (1.19, 7.67)]. Severe heterogeneity was exhibited (I2 = 93.1%, p = 0.000) but, there was no evidence of significant publication bias in the pooled effect of unwanted pregnancy on home child-birth (P = 0.832). The proportion of home child-birth among reproductive-age women in Ethiopia remains high. Lack of ANC visit and unwanted pregnancy had a significant effect on the practice of home child-birth. Strengthening behavioral change communication programs should be the primary focus area to improve institutional delivery service utilization among women with lack of ANC visit and unwanted pregnancy.
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Aksünger N, De Sanctis T, Waiyaiya E, van Doeveren R, van der Graaf M, Janssens W. What prevents pregnant women from adhering to the continuum of maternal care? Evidence on interrelated mechanisms from a cohort study in Kenya. BMJ Open 2022; 12:e050670. [PMID: 35039285 PMCID: PMC8765038 DOI: 10.1136/bmjopen-2021-050670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated. DESIGN A facility-based prospective cohort study. SETTING 25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega. PARTICIPANTS A total of 5 879 low-income pregnant women aged 13-49 years. OUTCOME MEASURES Ordinary least squares, Poisson and logistic regression models were employed, to predict three key determinants of the continuum of maternal care: (i) the week of enrolment at the clinic for antenatal care (ANC), (ii) the total number of ANC visits and (iii) utilisation of skilled birth attendance (SBA). The interrelationship between the three outcome variables was assessed with structural equation modeling. RESULTS Each week of delayed enrolment in ANC reduced the number of ANC visits by 3% (incidence rate ratio=0.967, 95% CI 0.965 to 0.969). A higher number of ANC visits increased the relative probability of using SBA (odds ratio=1.28, 95% CI 1.22 to 1.34). The direct association between late enrolment and SBA was positive (odds ratio=1.033, 95% CI 1.02 to 1.04). Predisposing factors (age, household head's education), enabling factors (wealth, shorter distance, rural area) and need factors (risk level of pregnancy, multigravida) were positively associated with adherence to ANC. CONCLUSION The results point towards a domino-effect and underscore the importance of enhancing the full continuum of maternal care. A larger number of ANC visits increases SBA, while early initiation of the care journey increases the number of ANC visits, thereby indirectly supporting SBA as well. These beneficial pathways counteract the direct link between enrolment and SBA, which is partly driven by pregnant teenagers who both enrol late and are at heightened risk of complications, stressing the need for specific attention to this vulnerable population.
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Affiliation(s)
- Nursena Aksünger
- School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | | | | | | | | | - Wendy Janssens
- School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
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Amadi-Mgbenka CT, Borrell LN, Jones HE, Maroko A, Bolumar F. Effect of emergency obstetric care and proximity to comprehensive facilities on facility-based delivery in Malawi and Haiti. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000184. [PMID: 36962282 PMCID: PMC10021570 DOI: 10.1371/journal.pgph.0000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/09/2022] [Indexed: 11/18/2022]
Abstract
Proximity of households to comprehensive obstetric care is a key determinant for preventing maternal mortality due to obstetric emergencies. The relationship between proximity to comprehensive care and facility delivery is further complicated by the use of varied methods in measuring facility obstetric capacity-which may misrepresent the real scenario of obstetric care availability in a service environment. We investigated the joint effects of proximity and two emergency obstetric care assessment (EmOC) methods on women's place of delivery in Malawi and Haiti. Household level and health facility data were obtained from the 2013-2018 Demographic and Health Surveys and Service Provision Assessment surveys. Records of women aged 15 to 49 years who had a childbirth in the last 5 years were linked to obstetric facilities within 5km, 10km and 15km from their households using Kernel Density Estimation. Log-binomial models were fitted to estimate the joint effects of proximity to comprehensive facilities on place of delivery and two EmOC methods (1. the facility's recent performance of signal functions only, and 2. a composite index of obstetric care), and whether this varied by urban/rural setting. Proximity to comprehensive facilities was significantly associated with facility delivery in Malawi among women living 5km of a comprehensive facility (using EmOC method 2), in addition, living further (15km) from facilities with high capacity of EmOC was associated with reduced likelihood for facility delivery in urban settings in stratified analyses. In contrast, positive associations were present in Haiti in both urban and rural settings, with the likelihood of facility delivery being higher with greater proximity of women to comprehensive facilities, regardless of methods to define EmOC. Women living within 5km of a comprehensive facility in Haiti were the most likely to deliver in facilities based on EmOC method 1 (APR: 1.81, 95% CI 1.56, 2.09). Findings from Malawi elucidates the relevance of context and suggests the need for research in diverse settings.
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Affiliation(s)
- Chioma T Amadi-Mgbenka
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America
- Universidad de Alcalá, Madrid, Spain
| | - Heidi E Jones
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Andrew Maroko
- Department of Environmental and Occupational Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America
| | - Francisco Bolumar
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America
- Universidad de Alcalá, Madrid, Spain
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Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, Rafenoarivamalala FH, Finnegan KE, Andrianirinarison JC, Rakotonirina J, Herbreteau V, Bonds MH. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy Plan 2021; 36:1659-1670. [PMID: 34331066 PMCID: PMC8597972 DOI: 10.1093/heapol/czab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
Poor geographic access can persist even when affordable and well-functioning health systems are in place, limiting efforts for universal health coverage (UHC). It is unclear how to balance support for health facilities and community health workers in UHC national strategies. The goal of this study was to evaluate how a health system strengthening (HSS) intervention aimed towards UHC affected the geographic access to primary care in a rural district of Madagascar. For this, we collected the fokontany of residence (lowest administrative unit) from nearly 300 000 outpatient consultations occurring in facilities of Ifanadiana district in 2014-2017 and in the subset of community sites supported by the HSS intervention. Distance from patients to facilities was accurately estimated following a full mapping of the district's footpaths and residential areas. We modelled per capita utilization for each fokontany through interrupted time-series analyses with control groups, accounting for non-linear relationships with distance and travel time among other factors, and we predicted facility utilization across the district under a scenario with and without HSS. Finally, we compared geographic trends in primary care when combining utilization at health facilities and community sites. We find that facility-based interventions similar to those in UHC strategies achieved high utilization rates of 1-3 consultations per person year only among populations living in close proximity to facilities. We predict that scaling only facility-based HSS programmes would result in large gaps in access, with over 75% of the population unable to reach one consultation per person year. Community health delivery, available only for children under 5 years, provided major improvements in service utilization regardless of their distance from facilities, contributing to 90% of primary care consultations in remote populations. Our results reveal the geographic limits of current UHC strategies and highlight the need to invest on professionalized community health programmes with larger scopes of service.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, University Montpellier, CNRS, IRD, 911 Avenue Agropolis, 34394 Montpellier, Montpellier, France
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
| | | | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), 40 Av De Soweto, 97410 Saint-Pierre, Réunion, France
| | | | - Mauricianot Randriamihaja
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- School of Management and Technological innovation, University of Fianarantsoa, BP 1135 Andrainjato, 301 Fianarantsoa, Madagascar
| | | | | | - Karen E Finnegan
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
| | - Jean Claude Andrianirinarison
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- National Institut of Public Health, Befelatanana, 101 Antananarivo, Madagascar
| | - Julio Rakotonirina
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- Faculty of Medicine, BP. 375, 101 Antananarivo, Madagascar
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), B.P. 86, Phnom Penh, Cambodia
| | - Matthew H Bonds
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
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Nishimwe C, Mchunu GG, Mukamusoni D. Community- based maternal and newborn interventions in Africa: Systematic review. J Clin Nurs 2021; 30:2514-2539. [PMID: 33656214 PMCID: PMC8451830 DOI: 10.1111/jocn.15737] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. BACKGROUND Most neonatal deaths (99%) occur in low- and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. METHODS The review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. RESULTS The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. CONCLUSION The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. RELEVANT TO THE CLINICAL PRACTICE Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.
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Affiliation(s)
- Clemence Nishimwe
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalHoward CollegeDurbanSouth Africa
- Health Economics and HIV/AIDS Division (HEARD)University of KwaZulu‐NatalDurbanSouth Africa
- Kibogora PolytechnicNyamashekeRwanda
| | - Gugu G. Mchunu
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalHoward CollegeDurbanSouth Africa
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Druetz T, Browne L, Bicaba F, Mitchell MI, Bicaba A. Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso. BMJ Glob Health 2021; 5:bmjgh-2020-002879. [PMID: 32978211 PMCID: PMC7520815 DOI: 10.1136/bmjgh-2020-002879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most of the literature on terrorist attacks' health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist attacks can be detrimental to access to healthcare services. The objective of this study is to assess the impact of terrorist attacks on the utilisation of maternal healthcare services by examining the case of Burkina Faso. METHODS This longitudinal quasi-experimental study uses multiple interrupted time series analysis. Utilisation of healthcare services data was extracted from the National Health Information System in Burkina Faso. Data span the period of January 2013-December 2018 and include all public primary healthcare centres and district hospitals. Terrorist attack data were extracted from the Armed Conflict Location and Event Data project. Negative binomial regression models were fitted with fixed effects to isolate the immediate and long-term effects of terrorist attacks on three outcomes (antenatal care visits, of facility deliveries and of cesarean sections). RESULTS During the next month of an attack, the incidence of assisted deliveries in healthcare facilities is significantly reduced by 3.8% (95% CI 1.3 to 6.3). Multiple attacks have immediate effects more pronounced than single attacks. Longitudinal analysis show that the incremental number of terrorist attacks is associated with a decrease of the three outcomes. For every additional attack in a commune, the incidence of cesarean sections is reduced by 7.7% (95% CI 4.7 to 10.7) while, for assisted deliveries, it is reduced by 2.5% (95% CI 1.9 to 3.1) and, for antenatal care visits, by 1.8% (95% CI 1.2 to 2.5). CONCLUSION Terrorist attacks constitute a new barrier to access of maternal healthcare in Burkina Faso. The exponential increase in terrorist activities in West Africa is expected to have negative effects on maternal health in the entire region.
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Affiliation(s)
- Thomas Druetz
- Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada .,Centre de recherche en santé publique, Montreal, Québec, Canada.,Center for Applied Malaria Research and Evaluation, New Orleans, Louisiana, USA
| | - Lalique Browne
- Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | | | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
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Ngesa AM, Kirui J, Matheka I, Otieno G, Yoos A. Utilization of free maternity services among women of child bearing age in Machakos County, Kenya. Pan Afr Med J 2021; 39:25. [PMID: 34394816 PMCID: PMC8348286 DOI: 10.11604/pamj.2021.39.25.26499] [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: 10/15/2020] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction globally, the rate of maternal mortality is unacceptably high with Kenya recording a rate of 362 maternal death per 100,000 live births. Even so, only 62% of women deliver under skilled health care. The government of Kenya introduced Free Maternity Services (FMS) to all women delivering in public health facilities as a way of increasing facility-based deliveries. Despite this, intervention, health facility deliveries in Machakos County are still low. This study aimed to identify hindrances and enablers of the FMS program in Machakos County. Methods it was a cross-sectional study conducted among postnatal women who delivered between September 2018 and September 2019 in Machakos County. A total of 394 women were enrolled. Data was collected using questionnaires and focus group discussions. Key informant interviews were conducted using nursing officer in charge of selected health facilities. Qualitative data was analyzed using chi-square and fishers exact. Multivariate logistic regression was used to determine predictors of utilization of FMS. Statistical significance was set at p < 0.05. Results utilization of FMS in Machakos County was 75.6%. Factors that were associated with utilization of FMS included marital status (p = 0.006), parity (p = 0.038), distance from health facility (p = 0.000), services offered during labour (p = 0.000), treatment of mothers by healthcare workers during labour (p = 0.000), provision of adequate food (p = 0.005), quality of service (p = 0.000) and cleanliness of the maternity ward (p = 0.000). Conclusion utilization of FMS in Machakos County is optimal. Health facilities should be supported to offer FMS by providing them with necessary supplies.
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Affiliation(s)
- Alice Mukunzu Ngesa
- School of Public Health and Applied Human Sciences, Kenyatta University, Nairobi, Kenya
| | - Joyce Kirui
- School of Public Health and Applied Human Sciences, Kenyatta University, Nairobi, Kenya.,Department of Health Management and Informatics, Kenyatta University, Nairobi, Kenya
| | - Isaac Matheka
- Department of Health and Emergency Services, Machakos County, Kenya
| | - George Otieno
- School of Public Health and Applied Human Sciences, Kenyatta University, Nairobi, Kenya.,Department of Health Management and Informatics, Kenyatta University, Nairobi, Kenya
| | - Alison Yoos
- Improving Public Health for Action (IMPACT) training program, Nairobi, Kenya
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Alem AZ, Agegnehu CD. Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2021; 11:e044060. [PMID: 33837100 PMCID: PMC8043003 DOI: 10.1136/bmjopen-2020-044060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia. DESIGN Cross-sectional study. SETTING Ethiopia. PARTICIPANTS Reproductive age group women. PRIMARY OUTCOME Unmet need for family planning. METHODS This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables. RESULTS The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning. CONCLUSION Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Mohammed T, Udoh RH, Kuupiel D. Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers' and managers' perceptions. BMC Pregnancy Childbirth 2021; 21:220. [PMID: 33740908 PMCID: PMC7977170 DOI: 10.1186/s12884-021-03701-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers' and providers' perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers' and providers' perspectives of free maternal healthcare and the quality of care in SSA. METHODS We used Askey and O'Malley's framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. RESULTS In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers' and providers' perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. CONCLUSION This study established evidence of existing literature on the quality of care based on healthcare providers' and managers' perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- The University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Tahiru Mohammed
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Roseline H. Udoh
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Kuupiel D. Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Serv Res 2020; 20:911. [PMID: 33004029 PMCID: PMC7528345 DOI: 10.1186/s12913-020-05755-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. METHODS We employed the Arskey and O'Malley's framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. CONCLUSION This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick I. Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- St. John of God College of Health, Duayaw Nkwanta, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Faculty of Business and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
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12
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Ihantamalala FA, Herbreteau V, Révillion C, Randriamihaja M, Commins J, Andréambeloson T, Rafenoarimalala FH, Randrianambinina A, Cordier LF, Bonds MH, Garchitorena A. Improving geographical accessibility modeling for operational use by local health actors. Int J Health Geogr 2020; 19:27. [PMID: 32631348 PMCID: PMC7339519 DOI: 10.1186/s12942-020-00220-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. METHODS We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. RESULTS We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs. CONCLUSION Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world.
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Affiliation(s)
- Felana Angella Ihantamalala
- NGO PIVOT, Ranomafana, Madagascar. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Saint-Pierre, La Réunion, France
| | - Mauricianot Randriamihaja
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Jérémy Commins
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Tanjona Andréambeloson
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.,MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
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Bwalya C, Simwinga M, Hensen B, Gwanu L, Hang’andu A, Mulubwa C, Phiri M, Hayes R, Fidler S, Mwinga A, Ayles H, Bond V. Social response to the delivery of HIV self-testing in households: experiences from four Zambian HPTN 071 (PopART) urban communities. AIDS Res Ther 2020; 17:32. [PMID: 32527261 PMCID: PMC7288417 DOI: 10.1186/s12981-020-00287-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Door-to-door distribution of HIV self-testing kits (HIVST) has the potential to increase uptake of HIV testing services (HTS). However, very few studies have explored the social response to and implications of door-to-door including secondary distribution of HIVST on household relations and the ability of individuals to self-test with or without supervision within households. Methods A CRT of HIVST distribution was nested within the HPTN 071 (PopART) trial, in four Zambian communities randomised to receive the PopART intervention. The nested HIVST trial aimed to increase knowledge of HIV status at population level. Between February 1 and April 30, 2017, 66 zones (clusters) within these four communities were randomly allocated to either the PopART standard of care door-to-door HTS (33 clusters) or PopART standard of care door-to-door HTS plus oral HIVST (33 clusters). In clusters randomised to HIVST, trained Community HIV care provider (CHiPs) visited households and offered individuals aged ≥ 16 and eligible for an offer of HTS the choice of HIV testing using HIVST or routine door-to-door HTS (finger-prick RDT). To document participants’ experiences with HIVST, Interviews (n = 40), observations (n = 22) and group discussions (n = 91) with household members and CHiPs were conducted. Data were coded using Atlas.ti 7 and analysed thematically. Results The usage and storage of HIVST kits was facilitated by familiarity with and trust in CHiPs, the novelty of HIVST, and demonstrations and supervision provided by CHiPs. Door-to-door distribution of HIVST kits was appreciated for being novel, convenient, private, empowering, autonomous and easy-to-use. Literacy and age influenced accurate usage of HIVST kits. The novelty of using oral fluids to test for HIV raised questions, some anxiety and doubts about the accuracy of HIVST. Although HIVST protected participants from experiencing clinic-based stigma, it did not address self-stigma. Within households, HIVST usually strengthened relationships but, amongst couples, there were a few reports of social harms. Conclusion Door-to-door distribution of HIVST as a choice for how to HIV test is appreciated at community level and provides an important testing option in the sub-Saharan context. However, it should be accompanied by counselling to manage social harms and by supporting those testing HIV-positive to link to care.
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14
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De Allegri M, Lohmann J, Souares A, Hillebrecht M, Hamadou S, Hien H, Haidara O, Robyn PJ. Responding to policy makers' evaluation needs: combining experimental and quasi-experimental approaches to estimate the impact of performance based financing in Burkina Faso. BMC Health Serv Res 2019; 19:733. [PMID: 31640694 PMCID: PMC6805435 DOI: 10.1186/s12913-019-4558-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The last two decades have seen a growing recognition of the need to expand the impact evaluation toolbox from an exclusive focus on randomized controlled trials to including quasi-experimental approaches. This appears to be particularly relevant when evaluation complex health interventions embedded in real-life settings often characterized by multiple research interests, limited researcher control, concurrently implemented policies and interventions, and other internal validity-threatening circumstances. To date, however, most studies described in the literature have employed either an exclusive experimental or an exclusive quasi-experimental approach. METHODS This paper presents the case of a study design exploiting the respective advantages of both approaches by combining experimental and quasi-experimental elements to evaluate the impact of a Performance-Based Financing (PBF) intervention in Burkina Faso. Specifically, the study employed a quasi-experimental design (pretest-posttest with comparison) with a nested experimental component (randomized controlled trial). A difference-in-differences approach was used as the main analytical strategy. DISCUSSION We aim to illustrate a way to reconcile scientific and pragmatic concerns to generate policy-relevant evidence on the intervention's impact, which is methodologically rigorous in its identification strategy but also considerate of the context within which the intervention took place. In particular, we highlight how we formulated our research questions, ultimately leading our design choices, on the basis of the knowledge needs expressed by the policy and implementing stakeholders. We discuss methodological weaknesses of the design arising from contextual constraints and the accommodation of various interests, and how we worked ex-post to address them to the best extent possible to ensure maximal accuracy and credibility of our findings. We hope that our case may be inspirational for other researchers wishing to undertake research in settings where field circumstances do not appear to be ideal for an impact evaluation. TRIAL REGISTRATION Registered with RIDIE (RIDIE-STUDY-ID- 54412a964bce8 ) on 10/17/2014.
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Affiliation(s)
- Manuela De Allegri
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Julia Lohmann
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Aurélia Souares
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Michael Hillebrecht
- Institute of Global Health, Medical Faculty, Heidelberg University, Germany; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Saidou Hamadou
- The World Bank; Nouvelle Route Bastos B. P 1128, Yaoundé, Cameroon
| | - Hervé Hien
- Centre MURAZ, 2054 Avenue Mamadou KONATE, 01 B.P. 390, Bobo-Dioulasso, 01 Burkina Faso
| | - Ousmane Haidara
- The World Bank; Health, Nutrition, Population Global Practice, 1818 H Street, NW, Washington, DC 20433 USA
| | - Paul Jacob Robyn
- The World Bank; Health, Nutrition, Population Global Practice, 1818 H Street, NW, Washington, DC 20433 USA
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15
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Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review. PLoS One 2019; 14:e0222110. [PMID: 31553722 PMCID: PMC6760778 DOI: 10.1371/journal.pone.0222110] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background The underutilization of formal, evidence-based maternal health services continues to contribute to poor maternal outcomes among women living in rural Africa. Women’s choice of the type of maternal care they receive strongly influences their utilization of maternal health services. There is therefore a need to understand rural women’s preferred choices to help set priorities for initiatives attempting to make formal maternal care more responsive to women’s needs. The aim of this review was to explore and identify women’s preferences for different sources of childbirth and postnatal care and the factors that contribute to these preferences. Methods A systematic literature search was conducted using the Ovid Medline, Embase, CINAHL, and Global Health databases. Thirty-seven studies that elicited women’s preferences for childbirth and postnatal care using qualitative methods were included in the review. A narrative synthesis was conducted to collate study findings and to report on patterns identified across findings. Results During the intrapartum period, preferences varied across communities, with some studies reporting preferences for traditional childbirth with traditional care-takers, and others reporting preferences for a formal facility-based childbirth with health professionals. During the postpartum period, the majority of relevant studies reported a preference for traditional postnatal services involving traditional rituals and customs. The factors that influenced the reported preferences were related to the perceived need for formal or traditional care providers, accessibility to maternal care, and cultural and religious norms. Conclusion Review findings identified a variety of preferences for sources of maternal care from intrapartum to postpartum. Future interventions aiming to improve access and utilization of evidence-based maternal healthcare services across rural Africa should first identify major challenges and priority needs of target populations and communities through formative research. Evidence-based services that meet rural women’s specific needs and expectations will increase the utilization of formal care and ultimately improve maternal outcomes across rural Africa.
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16
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Tanou M, Kamiya Y. Assessing the impact of geographical access to health facilities on maternal healthcare utilization: evidence from the Burkina Faso demographic and health survey 2010. BMC Public Health 2019; 19:838. [PMID: 31248393 PMCID: PMC6598277 DOI: 10.1186/s12889-019-7150-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving maternal and child health (MCH) remains a serious challenge for many developing countries. Geographical accessibility from a residence to the nearest health facility is suspected to be an important obstacle hampering the use of appropriate services for MCH especially in Sub-Sharan African countries. In Burkina Faso, a landlocked country in the Sahel region of West Africa, women's use of proper healthcare services during pregnancy and childbirth is still low. This study therefore assessed the impact of geographical access to health facilities on maternal healthcare utilization in Burkina Faso. METHODS We used the Burkina Faso demographic and health survey (DHS) 2010 dataset, with its sample of 10,364 mothers aged 15-49 years. Distance from residential areas to the closest health facility was measured by merging the DHS dataset with Geographic Information System data on the location of health centers in Burkina Faso. Multivariate logistic regressions were conducted to estimate the effects of distance on maternal healthcare utilization. RESULTS Regression results revealed that the longer the distance to the closest health center, the less likely it is that a woman will receive appropriate maternal healthcare services. The estimates show that one kilometer increase in distance to the closest health center reduces the odds that a woman will receive four or more antenatal care by 0.05 and reduces by 0.267 the odds that she will deliver her baby with the assistance of a skilled birth attendant. CONCLUSIONS Improving geographical access to health facilities increases the use of appropriate healthcare services during pregnancy and childbirth. Investment in transport infrastructure should be a prioritized target for further improvement in MCH in Burkina Faso.
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Affiliation(s)
- Mariam Tanou
- Ministry of Infrastructure, Building Lamizana, Ouagadougou, 03BP7011, Burkina Faso
| | - Yusuke Kamiya
- Ryukoku University, Faculty of Economics, 67 Tsukamoto-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8577, Japan.
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17
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Kaiser JL, Fong RM, Hamer DH, Biemba G, Ngoma T, Tusing B, Scott NA. How a woman's interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework. Soc Sci Med 2019; 220:312-321. [PMID: 30500609 PMCID: PMC6323354 DOI: 10.1016/j.socscimed.2018.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/31/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
Abstract
To reduce maternal mortality, countries must continue to seek ways to increase access to skilled care during pregnancy and delivery. In Zambia, while antenatal attendance is high, many barriers exist that prevent women from delivering with a skilled health provider. This study explores how the individuals closest to a pregnant woman in rural Zambia can influence a woman's decision to seek and her ability to access timely maternity care. At four rural health centers, a free listing (n = 167) exercise was conducted with mothers, fathers, and community elders. Focus group discussions (FGD) (n = 135) were conducted with mothers, fathers, mothers-in-law, and community health workers (CHWs) to triangulate findings. We analyzed the FGD data against a framework that overlaid the Three Delays Framework and the Social Ecological Model. Respondents cited husbands, female relatives, and CHWs as the most important influencers during a woman's maternity period. Husbands have responsibilities to procure resources, especially baby clothes, and provide the ultimate permission for a woman to attend ANC or deliver at a facility. Female relatives escort the woman to the facility, assist during her wait, provide emotional support, assist the nurse during delivery, and care for the woman after delivery. CHWs educate the woman during pregnancy about the importance of facility delivery. No specific individual has the role of assisting with the woman's household responsibilities or identifying transport to the health facility. When husbands, female relatives, or CHWs do not fulfill their roles, this presents a barrier to a woman deciding to deliver at the health facility (Delay 1) or reaching a health facility (Delay 2). An intervention to help women better plan for acquiring the needed resources and identifying the individuals to escort her and those to perform her household responsibilities could help to reduce these barriers to accessing timely maternal care.
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Affiliation(s)
- Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA.
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, USA
| | - Godfrey Biemba
- Zambia Center for Applied Health Research and Development, Plot 4186 Addis Ababa Drive, Long Acres, P.O. Box 30910, Lusaka, Zambia
| | - Thandiwe Ngoma
- Zambia Center for Applied Health Research and Development, Plot 4186 Addis Ababa Drive, Long Acres, P.O. Box 30910, Lusaka, Zambia
| | - Brittany Tusing
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA, 02118, USA
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Nguyen HT, Zombré D, Ridde V, De Allegri M. The impact of reducing and eliminating user fees on facility-based delivery: a controlled interrupted time series in Burkina Faso. Health Policy Plan 2018; 33:948-956. [PMID: 30256941 DOI: 10.1093/heapol/czy077] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2018] [Indexed: 12/17/2022] Open
Abstract
User fee reduction and removal policies have been the object of extensive research, but little rigorous evidence exists on their sustained effects in relation to use of delivery care services, and no evidence exists on the effects of partial reduction compared with full removal of user fees. We aimed to fill these knowledge gaps by assessing sustained effects of both partial reduction and complete removal of user fees on utilization of facility-based delivery. Our study took place in four districts in the Sahel region of Burkina Faso, where the national user fee reduction policy (SONU) launched in 2007 (lowering fees at point of use by 80%) co-existed with a user fee removal pilot launched in 2008. We used Health Management Information System data to construct a controlled interrupted time-series analysis and examine both immediate and sustained effects of SONU and the pilot from January 2004 to December 2014. We found that both SONU and the pilot led to a sustained increase in the use of facility-based delivery. SONU produced an accumulative increase of 31.4% (P < 0.01) over 8 years in the four study districts. The pilot further enhanced utilization and produced an additional increase of 23.2% (P < 0.001) over 6 years. These increasing trends did not continue to reach full coverage, i.e. ensuring that all women had a facility-based delivery. Instead, they stabilized 3 years and 4 years after the onset of SONU and the pilot, respectively. Our study provides further evidence that user fee reduction and removal policies are effective in increasing service use in the long term. However, they alone are not sufficient to achieve full coverage. This calls for the need to implement additional measures, targeting for instance geographical barriers and knowledge gaps, to achieve the target of all women delivering in the presence of a skilled attendant.
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Affiliation(s)
- Hoa Thi Nguyen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - David Zombré
- Department of Social and Preventive Medicine, University of Montreal Public Health Research Institute - IRSPUM, Pavillon 7101 avenue du Parc, C.P 6128 Succursale C, local 3224, Montréal, Québec, Canada
| | - Valery Ridde
- Department of Social and Preventive Medicine, University of Montreal Public Health Research Institute - IRSPUM, Pavillon 7101 avenue du Parc, C.P 6128 Succursale C, local 3224, Montréal, Québec, Canada.,IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD
| | - Manuela De Allegri
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany
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Nunu WN, Ndlovu V, Maviza A, Moyo M, Dube O. Factors associated with home births in a selected ward in Mberengwa District, Zimbabwe. Midwifery 2018; 68:15-22. [PMID: 30316175 DOI: 10.1016/j.midw.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Despite many efforts put by the Government to ensure that women give birth in health facilities under trained personnel supervision; statistics suggest that ward 2 in Mberengwa District in Zimbabwe has the highest home births. This study sought to assess factors that are associated with home births in ward 2 of Mberengwa District in Zimbabwe. DESIGN Case- control. SETTING Ward 2 in Mberengwa District in Zimbabwe. PARTICIPANTS 35 and 105 women who gave birth at home and facilities, respectively. METHODS A piloted researcher administered questionnaire was used to collect data from systematically selected respondents on factors leading to their choice of place to give birth. The home and facility births were geocoded using a Garmin etrex-30 Global Positioning System receiver and exported to Quantum Geographic Information System software for spatial analysis and mapping. RESULTS Factors associated with home births were; being uneducated (2.90, CI 1.08-7.57), unemployed (2.56, CI 1.08-6.23), could not afford facility bills (20.92, 3.19-160.31), and lack of access to Ante Natal Care (23.8, 7.04-90). 69% (24) of cases and 30% (32) of resided within the 5 km radius of health facilities. There was significant difference in levels of knowledge between cases and controls about benefits of giving birth in facilities. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE It is acknowledged that costs are a huge barrier in accessing antenatal care services. These factors together with others need to be addressed so as to improve access by pregnant women to health facilities.
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Affiliation(s)
- Wilfred Njabulo Nunu
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, P O Box Ac 939 Ascot, Corner Gwanda Road and Cecil Avenue, Bulawayo, Zimbabwe.
| | - Vuyelwa Ndlovu
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, P O Box Ac 939 Ascot, Corner Gwanda Road and Cecil Avenue, Bulawayo, Zimbabwe
| | - Auther Maviza
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, P O Box Ac 939 Ascot, Corner Gwanda Road and Cecil Avenue, Bulawayo, Zimbabwe
| | - Moreblessings Moyo
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, P O Box Ac 939 Ascot, Corner Gwanda Road and Cecil Avenue, Bulawayo, Zimbabwe
| | - Oliver Dube
- Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, P O Box Ac 939 Ascot, Corner Gwanda Road and Cecil Avenue, Bulawayo, Zimbabwe
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Amoah PA, Koduah AO, Gyasi RM. "Who'll do all these if I'm not around?": Bonding social capital and health and well-being of inpatients. Int J Qual Stud Health Well-being 2018; 13:1435108. [PMID: 29447613 PMCID: PMC5827639 DOI: 10.1080/17482631.2018.1435108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: Although social capital influences health-related decisions and behavioural patterns in many developing countries, minimal attention has been paid to the nuances of its effect on healthcare. This paper examines how bonding social capital affects healthcare delivery for inpatients in Ghana. Methods: Semi-structured in-depth interviews were used and thematic analysis method employed to analyse the data. Interviews were conducted with health professionals and relatives and close friends of inpatients in three public health facilities in Ashanti region. Results: Relatives and close friends of inpatients were a critical source of instrumental support such as provision of meals, laundry services, running errands and financial assistance as well as emotional support. These functions—that were both ‘expected’ and ‘encouraged’— reduced the burden on the health facilities, which apparently had limited resources to offer adequate care. However, the relatives of inpatients sometimes inadvertently obstructed efficient healthcare delivery through actions such as extending ‘unapproved’ alternative care to patients. Moreover, the process of contributing towards health and well-being of the sick exposed the relatives to health risks due to poor living conditions. Conclusion: A well-defined and befitting role must be devised for at least an immediate social relation of inpatients to improve the positive effects of bonding social capital on healthcare delivery.
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Affiliation(s)
- Padmore Adusei Amoah
- a Division of Graduate Studies and Asia Pacific Institute of Aging Studies , Lingnan University , Tuen Mun , Hong Kong (SAR)
| | | | - Razak Mohammed Gyasi
- c Department of Sociology and Social Policy , Lingnan University , Tuen Mun , Hong Kong (SAR)
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Tegegne TK, Chojenta C, Loxton D, Smith R, Kibret KT. The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis. PLoS One 2018; 13:e0203130. [PMID: 30161201 PMCID: PMC6117044 DOI: 10.1371/journal.pone.0203130] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Geographic access to obstetric care facilities has a significant influence on women's uptake of institutional delivery care. However, this effect was not consistent across studies. Some studies reported that geographic access to obstetric care facilities had no influence on the use of facility delivery. Therefore, this systematic review and meta-analysis synthesized and pooled the influence of geographic access on institutional delivery service uptake in low and middle-income countries. METHODS Multiple combinations of search terms were used to search articles from six databases and a hand search of reference lists performed. We included observational studies conducted in low and middle-income countries which reported the influence of geographic access on delivery care use. The pooled effects of geographic access on institutional delivery care use were calculated using a random-effects model with a 95% confidence interval. FINDINGS In this study a total of 31 studies were included. Among these studies, 15 met criteria for inclusion in the meta-analyses, while the remaining 16 were summarized using qualitative synthesis. Studies included in the analysis where women had to walk 60 minutes or less to access a health facility delivery were significantly heterogeneous. Having access to obstetric care facilities within five kilometres was significantly associated with institutional deliveries (pooled OR = 2.27; 95% CI = 1.82, 2.82). Similarly, a travelling time of 60 minutes or less was significantly associated with higher odds of health facility delivery (pooled OR = 3.30; 95% CI = 1.97, 5.53). Every one-hour and one-kilometre increase in travel time and distance, respectively, was negatively associated with institutional delivery care use. INTERPRETATION Geographic access measured in either physical distance and/or travel time was significantly associated with women's use of facility delivery. The greater the distance and/or travel time to obstetric care facilities, the greater the barrier and the lesser the service uptake.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kelemu Tilahun Kibret
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Public Health, College of Medical and Health Science, Wollega University, Nekemte, Ethiopia
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Sombié I, Méda ZC, Blaise Geswendé Savadogo L, Télesphore Somé D, Fatoumata Bamouni S, Dadjoari M, Windsouri Sawadogo R, Sanon-Ouédraogo D. [Is the fight against maternal mortality in Burkina Faso adapted to reduce the three delays?]. SANTE PUBLIQUE 2018; 30:273-282. [PMID: 30148315 DOI: 10.3917/spub.182.0273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Maternal mortality remains high in Burkina Faso despite numerous interventions designed to reduce this mortality. It therefore appeared important to analyse attempts to lower maternal mortality in Burkina Faso over the last fifteen years in order to identify the strengths and weaknesses and to improve the national programme. METHODS Analysis according to the ?three delays? model using the strengths, weaknesses, opportunities and threats method was conducted. Data sources were scientific publications as well as national gray literature. RESULTS Many studies have identified factors predisposing to the first delay, but very few effective interventions covering all of the country have been conducted to reduce this delay. The development of infrastructures, a rapid transfer system and integration of the cost of transfer into the cost of delivery subsidy were interventions designed to reduce the second delay. The promotion of blood transfusion, emergency obstetric and neonatal care, an increased number of trained health professionals, delegation of tasks, subsidy and then free delivery costs were interventions designed to reduce the third delay. The analysis globally demonstrated that interventions on the first delay were insufficient and rarely implemented and weaknesses were observed in relation to the intervention designed to act on the last two delays. CONCLUSION Due to their inadequacy and poor quality, the interventions failed to significantly reduce the three delays. Priority needs to be given to new interventions, especially community-based interventions, and reinforcement of the quality of care by health training.
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Cole CB, Pacca J, Mehl A, Tomasulo A, van der Veken L, Viola A, Ridde V. Toward communities as systems: a sequential mixed methods study to understand factors enabling implementation of a skilled birth attendance intervention in Nampula Province, Mozambique. Reprod Health 2018; 15:132. [PMID: 30075791 PMCID: PMC6091088 DOI: 10.1186/s12978-018-0574-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skilled birth attendance, institutional deliveries, and provision of quality, respectful care are key practices to improve maternal and neonatal health outcomes. In Mozambique, the government has prioritized improved service delivery and demand for these practices, alongside "humanization of the birth process." An intervention implemented in Nampula province beginning in 2009 saw marked improvement in institutional delivery rates. This study uses a sequential explanatory mixed methods case study design to explore the contextual factors that may have contributed to the observed increase in institutional deliveries. METHODS A descriptive time series analysis was conducted using clinic register data from 2009 to 2014 to assess institutional delivery coverage rates in two primary health care facilities, in two districts of Nampula province. Site selection was based on facilities exhibiting an initial increase in institutional deliveries from 2009 to 2011, similarity of health system attributes, and accessibility for study participation. Using a modified Delphi technique, two expert panels-each composed of ten stakeholders familiar with maternal health implementation at facility, district, provincial, and national levels-were convened to formulate the "story" of the implementation and to identify contextual factors to use in developing semi-structured interview guides. Thirty-four key informant interviews with facility MCH nurses, facility managers, traditional birth attendants, community leaders, and beneficiaries were then conducted and analyzed using the Consolidated Framework for Implementation Research through inductive and deductive coding. RESULTS The two sites' skilled birth attendance coverage of estimated live births reached 80 and 100%, respectively. Eight contextual and human factors were found as dominant themes. Though both sites achieved increases, implementation context differed significantly with compelling examples of both respectful and disrespectful care. In one site, facility and community actors worked together as complementary systems to sustain improved care and institutional deliveries. In the other, community actors sustained implementation and institutional deliveries largely in absence of health system counterparts. CONCLUSION Findings support global health recommendations for combined health system and community interventions for improved MNH outcomes including delivery of respectful care, and further suggest the capacity of communities to act as systems both in partnership to and independent of the formal health system.
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Affiliation(s)
- Claire B. Cole
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Julio Pacca
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Alicia Mehl
- Population Services International, 1120 19th St NW Suite 600, Washington, DC 20036 USA
| | - Anna Tomasulo
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA 02472 USA
| | - Luc van der Veken
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Adalgisa Viola
- Pathfinder International Mozambique, 135 Rua Eca De Queiros, Maputo, Mozambique
| | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
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Garchitorena A, Miller AC, Cordier LF, Rabeza VR, Randriamanambintsoa M, Razanadrakato HTR, Hall L, Gikic D, Haruna J, McCarty M, Randrianambinina A, Thomson DR, Atwood S, Rich ML, Murray MB, Ratsirarson J, Ouenzar MA, Bonds MH. Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar. BMJ Glob Health 2018; 3:e000762. [PMID: 29915670 PMCID: PMC6001915 DOI: 10.1136/bmjgh-2018-000762] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort. METHODS We carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016. RESULTS The intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period. CONCLUSION At the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on population health.
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Affiliation(s)
- Andres Garchitorena
- UMR 224 MIVEGEC, Institut de Recherche pour le Developpement, Montpellier, France
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Victor R Rabeza
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | | | | | | | - Dana R Thomson
- Social Statistics Department, University of Southampton, Southampton, UK
| | - Sidney Atwood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael L Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Josea Ratsirarson
- Ministère de la Sante Publique de Madagascar, Antananarivo, Madagascar
| | | | - Matthew H Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- PIVOT, Ranomafana, Madagascar
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Daniele MA, Ganaba R, Sarrassat S, Cousens S, Rossier C, Drabo S, Ouedraogo D, Filippi V. Involving male partners in maternity care in Burkina Faso: a randomized controlled trial. Bull World Health Organ 2018; 96:450-461. [PMID: 29962548 PMCID: PMC6022615 DOI: 10.2471/blt.17.206466] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso. Methods In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks’ gestation at five primary health centres in Bobo-Dioulasso. The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum. Findings The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confidence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3). Conclusion Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth.
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Affiliation(s)
- Marina As Daniele
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | | | - Sophie Sarrassat
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | - Simon Cousens
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
| | - Clémentine Rossier
- Institut de démographie et socioéconomie, University of Geneva, Geneva, Switzerland
| | - Seydou Drabo
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Veronique Filippi
- The London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England
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Lufumpa E, Doos L, Lindenmeyer A. Barriers and facilitators to preventive interventions for the development of obstetric fistulas among women in sub-Saharan Africa: a systematic review. BMC Pregnancy Childbirth 2018; 18:155. [PMID: 29747604 PMCID: PMC5946543 DOI: 10.1186/s12884-018-1787-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background Obstetric fistula is a debilitating childbearing injury that results from poorly managed obstructed labour, leading to the development of holes between the vagina and bladder and/or rectum. Effects of this injury are long-lasting, as women become incontinent and are often marginalised from their communities. Despite continuous occurrence of this injury in lower-income countries, it is preventable, as evidenced in high-income countries. This systematic review aims to identify and understand barriers and facilitators to interventions aimed at the prevention of obstetric fistulas in sub-Saharan African women. Methods Electronic databases and grey literature were searched. We included studies written in English that discussed interventions to prevent obstetric fistulas implemented in sub-Saharan Africa, and their associated barriers and facilitators. Quality of the studies was assessed, and data including: country of implementation, preventive interventions, and barriers and facilitators to the interventions were extracted. They were then categorised based on the Three Phase Delay Model. Results Our search yielded 537 studies, of which 18 were included from sub-Saharan countries including Ethiopia, Nigeria, and Zambia. The most noted barrier to prevention addressed the first phase of delay: the decision to seek care, particularly lack of awareness of the dangers of unsupervised labours. The most noted facilitator addressed the decision to seek care and the quality of care received at a facility, through partnerships between health facilities and governments, and other organisations that provided both financial and resource support. Conclusion Despite being categorised by the three phases of the delay model, barriers and facilitators were found to play a role in multiple phases. The topic of obstetric fistula needs to be researched more extensively, particularly the effectiveness of preventive interventions. Electronic supplementary material The online version of this article (10.1186/s12884-018-1787-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eniya Lufumpa
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Lucy Doos
- Institute for Research into Superdiversity, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Gitobu CM, Gichangi PB, Mwanda WO. The effect of Kenya's free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC Pregnancy Childbirth 2018; 18:77. [PMID: 29580207 PMCID: PMC5870237 DOI: 10.1186/s12884-018-1708-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy’s effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities. Methods A time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya. Results A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality. Conclusion The findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths. Electronic supplementary material The online version of this article (10.1186/s12884-018-1708-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C M Gitobu
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, Kenya.
| | - P B Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Ghent, Ghent, Belgium
| | - W O Mwanda
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
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Scott NA, Vian T, Kaiser JL, Ngoma T, Mataka K, Henry EG, Biemba G, Nambao M, Hamer DH. Listening to the community: Using formative research to strengthen maternity waiting homes in Zambia. PLoS One 2018; 13:e0194535. [PMID: 29543884 PMCID: PMC5854412 DOI: 10.1371/journal.pone.0194535] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/05/2018] [Indexed: 12/24/2022] Open
Abstract
Background The WHO recommends maternity waiting homes (MWH) as one intervention to improve maternal and newborn health. However, persistent structural, cultural and financial barriers in their design and implementation have resulted in mixed success in both their uptake and utilization. Guidance is needed on how to design a MWH intervention that is acceptable and sustainable. Using formative research and guided by a sustainability framework for health programs, we systematically collected data from key stakeholders and potential users in order to design a MWH intervention in Zambia that could overcome multi-dimensional barriers to accessing facility delivery, be acceptable to the community and be financially and operationally sustainable. Methods and findings We used a concurrent triangulation study design and mixed methods. We used free listing to gather input from a total of 167 randomly sampled women who were pregnant or had a child under the age of two (n = 59), men with a child under the age of two (n = 53), and community elders (n = 55) living in the catchment areas of four rural health facilities in Zambia. We conducted 17 focus group discussions (n = 135) among a purposive sample of pregnant women (n = 33), mothers-in-law (n = 32), traditional birth attendants or community maternal health promoters (n = 38), and men with a child under two (n = 32). We administered 38 semi-structured interviews with key informants who were identified by free list respondents as having a stake in the condition and use of MWHs. Lastly, we projected fixed and variable recurrent costs for operating a MWH. Respondents most frequently mentioned distance, roads, transport, and the quality of MWHs and health facilities as the major problems facing pregnant women in their communities. They also cited inadequate advanced planning for delivery and the lack of access to delivery supplies and baby clothes as other problems. Respondents identified the main problems of MWHs specifically as over-crowding, poor infrastructure, lack of amenities, safety concerns, and cultural issues. To support operational sustainability, community members were willing to participate on oversight committees and contribute labor. The annual fixed recurrent cost per 10-bed MWH was estimated as USD543, though providing food and charcoal added another $3,000USD. Respondents identified water pumps, an agriculture shop, a shop for baby clothes and general goods, and grinding mills as needs in their communities that could potentially be linked with an MWH for financial sustainability. Conclusions Findings informed the development of an intervention model for renovating existing MWH or constructing new MWH that meets community standards of safety, comfort and services offered and is aligned with government policies related to facility construction, ownership, and access to health services. The basic strategies of the new MWH model include improving community acceptability, strengthening governance and accountability, and building upon existing efforts to foster financial and operational sustainability. The proposed model addresses the problems cited by our respondents and challenges to MWHs identified by in previous studies and elicits opportunities for social enterprises that could serve the dual purpose of meeting a community need and generating revenue for the MWH.
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Affiliation(s)
- Nancy A. Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Jeanette L. Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Thandiwe Ngoma
- Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Kaluba Mataka
- Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Elizabeth G. Henry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Godfrey Biemba
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Zambia Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Mary Nambao
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
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Ridde V, Leppert G, Hien H, Robyn PJ, De Allegri M. Street-level workers' inadequate knowledge and application of exemption policies in Burkina Faso jeopardize the achievement of universal health coverage: evidence from a cross-sectional survey. Int J Equity Health 2018; 17:5. [PMID: 29310690 PMCID: PMC5759863 DOI: 10.1186/s12939-017-0717-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Street-level workers play a key role in public health policies in Africa, as they are often the ones to ensure their implementation. In Burkina Faso, the State formulated two different user-fee exemption policies for indigents, one for deliveries (2007), and one for primary healthcare (2009). The objective of this study was to measure and understand the determinants of street-level workers' knowledge and application of these exemption measures. METHODS We used cross-sectional data collected between October 2013 and March 2014. The survey targeted 1521 health workers distributed in 498 first-line centres, 18 district hospitals, 5 regional hospitals, and 11 private or other facilities across 24 districts. We used four different random effects models to identify factors associated with knowledge and application of each of the above-mentioned exemption policies. RESULTS Only 9.2% of workers surveyed knew of the directive exempting the worst-off, and only 5% implemented it. Knowledge and application of the delivery exemption were higher, with 27% of all health workers being aware of the delivery exemption directive and 24.2% applying it. Mobile health workers were found to be consistently more likely to apply both exemptions. Health workers who were facility heads were significantly more likely to know about the indigent exemption for primary health care and to apply it. Health workers in districts with higher proportions of very poor people were significantly more likely to know about and apply the delivery exemption. Nearly 60% of respondents indicated either 5% or 10% as the percentage of people they would deem adequate to target for exemption. CONCLUSION This quantitative study confirmed earlier qualitative results on the importance of training and informing health workers and monitoring the measures targeting equity, to ensure compliance with government directives. The local context (e.g., hierarchy, health system, interventions) and the ideas that street-level workers have about the policy instruments can influence their effective implementation. Methods for remunerating health workers and health centres also need to be adapted to ensure equity measures are applied to achieve universal healthcare.
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Affiliation(s)
- Valéry Ridde
- CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, 45, rue des Saints Pères, 75006 Paris, France
- IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
| | - Gerald Leppert
- German Institute for Development Evaluation (DEval), Fritz-Schäffer-Str. 26, 53113 Bonn, Germany
| | - Hervé Hien
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | - Paul Jacob Robyn
- Health, Nutrition and Population Global Practice, The World Bank, 701 18th St NW, Washington, DC 20006 USA
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev 2017; 6:110. [PMID: 28587676 PMCID: PMC5461715 DOI: 10.1186/s13643-017-0503-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Kouanda S, Bado A, Meda IB, Yameogo GS, Coulibaly A, Haddad S. Home births in the context of free health care: The case of Kaya health district in Burkina Faso. Int J Gynaecol Obstet 2017; 135 Suppl 1:S39-S44. [PMID: 27836083 DOI: 10.1016/j.ijgo.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify the factors associated with home births in the Kaya health district in Burkina Faso, where child delivery was free of charge between 2007 and 2011. METHODS Both qualitative and quantitative data were collected from the Kaya Health and Demographic Surveillance System (Kaya HDSS) among women who delivered at home or in a health facility between January 2008 and December 2010. Multilevel logistic regression was applied to quantitative data, while the qualitative data were analyzed thematically based on emerging themes, subthemes, and patterns across group and individual cases. RESULTS The findings indicate that 12% (n=311) of childbirths occurred at home (n=2560). Key factors associated with home birth were age, distance from the household to the primary health center, and prenatal visits. The qualitative analysis showed that immediate child delivery, previous experience of giving birth at home, negative experiences with health centers, fear of cesarean delivery, and lack of transport are key predictors of home births. CONCLUSION Though relevant, addressing the financial barrier to health care is not enough. Additional measures are necessary to further reduce the rate of home births.
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Affiliation(s)
- Seni Kouanda
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso.
| | - Aristide Bado
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Ivlabèhiré Bertrand Meda
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Gisèle S Yameogo
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Abou Coulibaly
- Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Slim Haddad
- Centre de Recherche du Centre Hospitalier Universitaire du Québec, Canada
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Steenland M, Robyn PJ, Compaore P, Kabore M, Tapsoba B, Zongo A, Haidara OD, Fink G. Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso. SSM Popul Health 2017; 3:179-184. [PMID: 29349214 PMCID: PMC5769027 DOI: 10.1016/j.ssmph.2017.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 11/26/2022] Open
Abstract
Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446-4.225]), 2.1 more deliveries (95% CI [0.034-4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.
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Affiliation(s)
- Maria Steenland
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Paul Jacob Robyn
- Health, Nutrition and Population Global Practice, The World Bank, 701 18th St NW, Washington, DC 20006, USA
| | - Philippe Compaore
- Direction Générale des Etudes et des Statistiques Sectorielles, Ministère de la Santé de Burkina Faso, 01 BP 7009 Ouagadougou 01, Burkina Faso
| | - Moussa Kabore
- Direction Générale des Etudes et des Statistiques Sectorielles, Ministère de la Santé de Burkina Faso, 01 BP 7009 Ouagadougou 01, Burkina Faso
| | - Boukary Tapsoba
- Direction Générale des Etudes et des Statistiques Sectorielles, Ministère de la Santé de Burkina Faso, 01 BP 7009 Ouagadougou 01, Burkina Faso
| | - Aloys Zongo
- Direction Générale des Etudes et des Statistiques Sectorielles, Ministère de la Santé de Burkina Faso, 01 BP 7009 Ouagadougou 01, Burkina Faso
| | - Ousmane Diadie Haidara
- Health, Nutrition and Population Global Practice, The World Bank, 179 Av. President Saye ZERBO, 01BP 622, Ouagdougou 01, Burkina Faso
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
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