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Bigirinama RN, Mothupi MC, Mwene-Batu PL, Kozuki N, Chiribagula CZ, Chimanuka CM, Ngaboyeka GA, Bisimwa GB. Prioritization of maternal and newborn health policies and their implementation in the eastern conflict affected areas of the Democratic Republic of Congo: a political economy analysis. Health Res Policy Syst 2024; 22:55. [PMID: 38689347 PMCID: PMC11061947 DOI: 10.1186/s12961-024-01138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Maternal and neonatal mortality remains a major concern in the Democratic Republic of Congo (DRC), and the country's protracted crisis context exacerbates the problem. This political economy analysis examines the maternal and newborn health (MNH) prioritization in the DRC, focussing specifically on the conflict-affected regions of North and South Kivu. The aim is to understand the factors that facilitate or hinder the prioritization of MNH policy development and implementation by the Congolese government and other key actors at national level and in the provinces of North and South Kivu. METHODS Using a health policy triangle framework, data collection consisted of in-depth interviews with key actors at different levels of the health system, combined with a desk review. Qualitative data were analysed using inductive and then deductive approaches, exploring the content, process, actor dynamics, contextual factors and gender-related factors influencing MNH policy development and implementation. RESULTS The study highlighted the challenges of prioritizing policies in the face of competing health and security emergencies, limited resources and governance issues. The universal health coverage policy seems to offer hope for improving access to MNH services. Results also revealed the importance of international partnerships and global financial mechanisms in the development of MNH strategies. They reveal huge gender disparities in the MNH sector at all levels, and the need to consider cultural factors that can positively or negatively impact the success of MNH policies in crisis zones. CONCLUSIONS MNH is a high priority in DRC, yet implementation faces hurdles due to financial constraints, political influences, conflicts and gender disparities. Addressing these challenges requires tailored community-based strategies, political engagement, support for health personnel and empowerment of women in crisis areas for better MNH outcomes.
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Affiliation(s)
- Rosine Nshobole Bigirinama
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo.
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | | | - Pacifique Lyabayungu Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université de Kaziba, Bukavu, Democratic Republic of Congo
| | - Naoko Kozuki
- Airbel Impact Lab, International Rescue Committee, Washington, DC, United States of America
| | - Christian Zalinga Chiribagula
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
| | - Christine Murhim'alika Chimanuka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Gaylord Amani Ngaboyeka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Ghislain Balaluka Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
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Sunguya BF, Ngowi JE, Njiro BJ, Munishi C, Ndumwa HP, Kengia J, Kapologwe NA, Deng L, Timbrell A, Kitinya WJ, Mlunde LB. Lessons learnt and best practices in scaling up an emergency transportation system to tackle maternal and neonatal mortality: a qualitative study of key stakeholders in Shinyanga, Tanzania. BMJ Open 2024; 14:e073859. [PMID: 38373858 PMCID: PMC10882369 DOI: 10.1136/bmjopen-2023-073859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE This study aimed to document lessons learnt and best practices for scaling up an innovative emergency transportation system, drawing insights from the m-mama programme implemented in Shinyanga, Tanzania. The m-mama pilot programme was implemented in phases from 2014 to 2016 in two districts and later scaled up to include all districts in Shinyanga region in 2017. The programme employed an emergency transportation system and technical and operational support of the health system to address the three delays leading to maternal and neonatal mortality. DESIGN Cross-sectional, qualitative research with key healthcare system stakeholders from the national, regional and district levels. SETTING The study was conducted in Kahama and Kishapu districts in Shinyanga, Tanzania. The two districts were selected purposefully to represent the programme implementation districts' rural and urban or semiurban settings. PARTICIPANTS District, regional and national stakeholders involved in implementing the m-mama pilot programme in Shinyanga were interviewed between February and March 2022. RESULTS Lessons learnt from implementing the m-mama programme were grouped into four key themes: community engagement, emergency transportation system, government engagement, and challenges and constraints in technical implementation. Stakeholder engagement and collaboration at all levels, community involvement in implementation, adherence to local contexts and effective government partnerships were identified as key drivers for programme success. Coordination, supervision and infrastructure enhancement were crucial in implementing the emergency transportation system. CONCLUSIONS Facilitating community involvement, understanding the local context and adapting to existing structures can enhance programme ownership and utilisation. The government serves as the central coordinator, overseeing resource mobilisation and distribution. A well-executed and coordinated emergency transportation system holds promise in addressing delays and curbing maternal and neonatal mortality. Collaborative knowledge-sharing among implementers is essential for identifying best practices and gaining insights into practical strategies for addressing anticipated challenges.
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Affiliation(s)
- Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrieth Peter Ndumwa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James Kengia
- United Republic of Tanzania President's Office, Dar es Salaam, Tanzania
| | - Ntuli A Kapologwe
- United Republic of Tanzania President's Office, Dar es Salaam, Tanzania
| | | | | | | | - Linda B Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Gelaw KA, Atalay YA, Zerefu F, Gebeyehu NA. Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia. Front Glob Womens Health 2024; 4:1236242. [PMID: 38273874 PMCID: PMC10808602 DOI: 10.3389/fgwh.2023.1236242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Background Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia. Method and materials A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant. Results The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility. Conclusion The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.
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Affiliation(s)
- Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
| | - Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Firehiwot Zerefu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, WolaitaSodo, Ethiopia
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Tampah-Naah AM, Yendaw E, Sumankuuro J. Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis. BMC Womens Health 2023; 23:550. [PMID: 37875940 PMCID: PMC10594689 DOI: 10.1186/s12905-023-02684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Modern contraceptive refers to "a product or medical procedure that interferes with reproduction from acts of sexual intercourse". The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana. METHODS We examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15-49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05. RESULTS In the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097-1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065-1.289), middle (AOR = 1.24; 95% CI = 1.118-1.385), and fourth (AOR = 1.25; 95% CI = 1.113-1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042-1.830), rural-middle (AOR = 1.45; 95% CI = 1.084-1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128-2.059), and rural-high (AOR = 1.42; 95% CI = 1.019-1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20-24 (AOR = 2.33; 95% CI = 2.054-2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981-1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385-1.736), Central (AOR = 1.48; 95% CI = 1.296-1.682) and Eastern (AOR = 1.48; 95% CI = 1.289-1.695) regions significantly predicted modern contraceptive use. CONCLUSION Modern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.
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Affiliation(s)
- Anthony Mwinilanaa Tampah-Naah
- Department of Geography, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Post Office Box WA64, Ghana.
| | - Elijah Yendaw
- Department of Governance and Development Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Environment, Migration and International Relations, Simon Diedong Dombo, University of Business and Integrated Development Studies, Wa, Ghana
| | - Joshua Sumankuuro
- Department of Public Policy and Management, Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Allied Health, Exercise and Sports Sciences, Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Oyedele OK, Fagbamigbe AF, Akinyemi OJ, Adebowale AS. Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming. BMC Pregnancy Childbirth 2023; 23:36. [PMID: 36653764 PMCID: PMC9847068 DOI: 10.1186/s12884-023-05372-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Completing maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria. METHODS A cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p < 0.10), multivariable binary logistic regression and complementary-log-log model quantifies association at a 95% confidence interval (α = 0.05). RESULTS Coverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR = 1.27, 95%CI = 1.01-1.62), average wealth index (AOR = 1.83, 95%CI = 1.48 -2.25), southern geopolitical zone (AOR = 1.61, 95%CI = 1.29-2.01), making health decision alone (AOR = 1.39, 95%CI = 1.16-1.66), having nurse as ANC provider (AOR = 3.53, 95%CI = 2.01-6.17) and taking at least two dose of tetanus toxoid vaccine (AOR = 1.25, 95%CI = 1.06-1.62) while women in rural residence (AOR = 0.78, 95%CI = 0.68-0.90) and initiation of ANC as late as third trimester (AOR = 0.44, 95%CI = 0.34-0.58) negatively influenced continuation and completion. CONCLUSIONS 6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.
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Affiliation(s)
- Oyewole Kazeem Oyedele
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria ,grid.421160.0International Research Centre of Excellence, Institute of Human Virology, Nigeria, Abuja (FCT), Nigeria
| | - Adeniyi Francis Fagbamigbe
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Odunayo Joshua Akinyemi
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- grid.9582.60000 0004 1794 5983Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria ,grid.25881.360000 0000 9769 2525Faculty of Humanities, Population Health and Research Entity, North West University, Mafikeng, South Africa
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Kassa BG, Tiruneh GA, Solomon AA. Delay in reaching health facilities and its associated factors among mothers giving birth in South Gondar zone hospitals, Northwest Ethiopia, 2020: A facility-based cross-sectional study. Front Glob Womens Health 2023; 4:916978. [PMID: 37020903 PMCID: PMC10068871 DOI: 10.3389/fgwh.2023.916978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
Background Delays in reaching health facilities are one of three models identified as major contributors to maternal mortality and morbidity in developing countries, including Ethiopia. However, little is known about the prevalence and associated factors of delays in reaching healthcare facilities in Ethiopia, particularly in rural areas. Objective The aim of this study was to assess the prevalence of delays in reaching health facilities and associated factors among mothers who gave birth in South Gondar zone hospitals, Northwest Ethiopia, 2020. Methods A cross-sectional study design was used from 28 November to 25 December 2020, with 417 mothers who had recently given birth participating in the study, selected through a simple random sampling technique. Data were collected using a face-to-face interview with pretested structured questionnaires. The EpiData software (version 3.1) was used to record collected data and then exported to SPSS (version 23) for statistical analysis. Bivariable and multivariable analyses were conducted, and the odds ratio with 95% CI was used to identify factors associated with delays in reaching health facilities. The statistical significance was declared at p < .05. Results The prevalence of delay in reaching health facilities among mothers who gave birth in South Gondar zone hospitals were 50.6%. Mothers who had no antenatal care (ANC) visits [adjusted odd ratio (AOR) = 3.16, 95% CI = 1.52, 6.56], an unplanned pregnancy (AOR = 1.78, 95% CI = 1.16, 2.72), and a distance from home to a health facility greater than 5 km (AOR = 1.69, 95% CI = 1.08, 2.65) were positively associated with delays in reaching health facilities. Conclusions The prevalence of delays in reaching health facilities was higher in the study area. Women's empowerment through health education about ANC follow-up, choice of family planning methods, and creating accessibility to health facilities are essential measures to minimize delays in reaching health facilities.
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Affiliation(s)
- Bekalu Getnet Kassa
- Department of Midwifery, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Bekalu Getnet Kassa
| | | | - Abayneh Aklilu Solomon
- Department of Women and Family Health, School of Midwifery, College of Health Science, University of Gondar, Gondar, Ethiopia
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Sumankuuro J, Domapielle MK, Derbile EK. The what's, where's and why's of miscarriage: evidence from the 2017 Ghana Maternal Health Survey. Public Health 2022; 213:34-46. [PMID: 36334582 DOI: 10.1016/j.puhe.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Miscarriage remains a significant public health challenge in most low- and middle-income settings, including Ghana. We thus examined the sociodemographic and maternal characteristics associated with miscarriage in Ghana using the 2017 Maternal Health Survey dataset. STUDY DESIGN This was a cross-sectional quantitative study. METHODS We quantitatively analysed Ghana Maternal and Health Survey dataset. Demographic and Health Survey (DHS) collected the data using survey techniques. Approximately 25,062 women within the active reproductive ages of 15-49 years were involved in the survey. We analysed the data using binary and multivariate logistic regression models at a 95% confidence level. The findings were reported using the World Health Organisation's Conceptual Social Determinants of Health framework. RESULTS We found that the prevalence of miscarriage was 15.6%. Education, religion and ethnicity were the most significant structural factors associated with miscarriage. We also found that women of all ages (20-49 years), starting antenatal care (ANC) in the fifth month of gestation, residing in rural area, having history of abortion (aOR = 0.622, 95% CI = 0.570-0.679, P < 0.001), and not using mobile phone during complications (adjusted odds ratio = 0.601, 95% confidence interval = 0.556-0.651, P < 0.001) were key intermediary determinants of miscarriage. The analysis found increased odds of miscarriage among women who had no mobile phone and could not access the same during obstetric complications. CONCLUSIONS The study concludes that country-policy frameworks on maternal and neonatal health care do not go far enough in providing specific solutions for preventing miscarriage. To reverse this trend, we recommend targeted ANC, including enhanced twenty-four-hour primary emergency obstetric care within 5 km, advocacy, and education as a lever to increasing utilisation of ANC, and removal of indirect financial barriers to maternal health care. We further recommend a qualitative research to understand some of the findings and explore the feasibility of promoting mobile phone technology to address maternal health problems, particularly obstetric care for women in hard-to-reach rural communities.
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Affiliation(s)
- J Sumankuuro
- Faculty of Public Policy and Governance, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana; Centre for Health Policy, School of Public Health, Faculty of Science, University of Witwatersrand, Johannesburg, South Africa; School of Community Health, Faculty of Science, Charles Sturt University, NSW, Australia; School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, South Africa.
| | - M K Domapielle
- Faculty of Public Policy and Governance, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana.
| | - E K Derbile
- Faculty of Planning and Land Management, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana.
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Tesfay N, Tariku R, Zenebe A, Mohammed F, Woldeyohannes F. Area of focus to handle delays related to maternal death in Ethiopia. PLoS One 2022; 17:e0274909. [PMID: 36121828 PMCID: PMC9484697 DOI: 10.1371/journal.pone.0274909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.
Methods
The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.
Result
Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.
Conclusion
Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fetiya Mohammed
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Ngotie TK, Kaura DKM, Mash R. Exploring experiences with sensitivity to cultural practices among birth attendants in Kenya: A phenomenological study. Afr J Prim Health Care Fam Med 2022; 14:e1-e14. [PMID: 36073123 PMCID: PMC9453142 DOI: 10.4102/phcfm.v14i1.3322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/02/2022] Open
Abstract
Background Aim Setting Methods Results Conclusion
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Affiliation(s)
- Teckla K Ngotie
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Community and Reproductive Health, School of Nursing Sciences, Kenyatta University, Nairobi.
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Sumankuuro J, Baatiema L, Crockett J, Young J. Women's use of non-conventional herbal uterotonic in pregnancy and labour: evidence from birth attendants. BMC Pregnancy Childbirth 2022; 22:600. [PMID: 35896986 PMCID: PMC9327204 DOI: 10.1186/s12884-022-04934-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana. Methods This was an exploratory qualitative study that investigated traditional birth attendants (n = 17) and healthcare providers' (n = 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants. Results Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth. Conclusion The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
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Affiliation(s)
- Joshua Sumankuuro
- Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana. .,Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia. .,School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
| | - Leonard Baatiema
- Department of Health Policy and Management, University of Ghana, Accra, Ghana.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Harvard University, Boston, USA
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Laksono AD, Wulandari RD, Widya Sukoco NE, Suharmiati S. Husband’s involvement in wife’s antenatal care visits in Indonesia: What factors are related? J Public Health Res 2022. [DOI: 10.1177/22799036221104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Involving husbands in maternal and child health programs can reduce maternal morbidity and mortality. The study aimed to analyze the factors related to the husband’s involvement in antenatal care (ANC) visits in Indonesia. Methods: The study was a cross-sectional study. The research employed secondary data from the 2017 Indonesian Demographic and Health Survey. The analysis units were wives aged 15–49 years old, married, and pregnant in the past 5 years, and the final samples obtained were 14,319 respondents. In addition to the husband’s involvement were residence, age, education, occupation, wealth, and parity. The study used a binary logistic regression test in the final stage. Results: Husbands who lived in urban areas have odds of being involved in ANC visits 1.2 times greater than those in rural areas. The better the husband’s education was, the more involved they were in ANC. The results show husbands who work in any field were better at being involved in ANC. Poorer husbands had odds of being engaged in ANC visits 2.0 times more likely than the husbands’ lowest group. The most prosperous husbands have odds of being involved in ANC visits 5.4 times than the poorest husbands. The husbands’ wealth is better, the more the husbands were engaged in ANC. The more children were born, the less frequent the husbands’ involvement in ANC is. Conclusion: The study concluded five variables associated with husbands’ participation in ANC in Indonesia, including residence, education, occupation, wealth, and parity.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
| | - Ratna Dwi Wulandari
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Dalinjong PA, Wang AY, Homer CSE. Challenges and Suggestions to Promote Maternal Service Provision and Utilization Under the Free Maternal Health Policy in Ghana: Perspectives of Health Directors and Facility Managers. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONTo promote service uptake and reduce maternal deaths, a policy was implemented under Ghana’s National Health Insurance Scheme in 2008. This study explored the benefits and limitations of the policy, health system challenges, and community-level challenges resulting in suggestions to mitigate the challenges.METHODSThe study design was cross-sectional, utilizing qualitative data collection. It was carried out in the Kassena-Nankana East Municipality, Ghana, involving in-depth interviews (IDIs) with directors of Ghana Health Service and facility managers. A total of eight IDIs were conducted. Data were transcribed, read, and analyzed based on themes which were presented using key quotes.RESULTSThe policy promoted the use of services. Nonetheless, challenges existed as a result of limited service coverage, inadequate human resources and infrastructure, lack of medications and equipment, lack of transport, and the influence of religion, culture, and family members. There was a need to strategize so that women with a low socioeconomic status would receive service over those of a high socioeconomic status. Other suggestions included the inclusion of family planning services, accreditation of private facilities, provision of a shift system for specialists to move to rural areas, and provision of incentives for health personnel in rural areas. It was also suggested that health personnel make known their challenges as well as to provide education on women’s rights and service expectations. The provision of transport vouchers to women as well as alternative arrangements to be made with private transport owners were also suggested.CONCLUSIONImplementing the suggestions may improve service provision and utilization leading to the reduction of maternal deaths and contributing towards achieving universal health coverage.
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Carpio-Arias TV, Verdezoto N, Guijarro-Garvi M, Abril-Ulloa V, Mackintosh N, Eslambolchilar P, Ruíz-Cantero MT. Healthcare professionals' experiences and perceptions regarding health care of indigenous pregnant women in Ecuador. BMC Pregnancy Childbirth 2022; 22:101. [PMID: 35120490 PMCID: PMC8815715 DOI: 10.1186/s12884-022-04432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights. METHODS We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting. RESULTS We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare. CONCLUSIONS Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.
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Affiliation(s)
- Tannia Valeria Carpio-Arias
- Research Group on Food and Human Nutrition (GIANH), Faculty of Public Health, Higher Polytechnic School of Chimborazo, Pan-American Sur Km 1 1/2, Riobamba, Ecuador
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Human-centered Computing Group, Cardiff University, Cardiff, UK
| | - Marta Guijarro-Garvi
- Department of Economics, University of Cantabria, Cantabria, Spain
- Public Health Research Group, University of Alicante, Alicante, Spain
| | - Victoria Abril-Ulloa
- Research Group on Public Health, Nutrition and Physical Activity in the Life Cycle, University of Cuenca, Cuenca, Ecuador
| | - Nicola Mackintosh
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Parisa Eslambolchilar
- School of Computer Science and Informatics, Human-centered Computing Group, Cardiff University, Cardiff, UK
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15
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Essien SK, Chireh B, Melese KG, Essien JK. Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000100. [PMID: 36962163 PMCID: PMC10021428 DOI: 10.1371/journal.pgph.0000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana's demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01-1.54), place of delivery (AOR = 1.18, 95% Cl 1.02-1.37), child's size below average (AOR = 1.14; 95% Cl 1.03-1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43-1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00-3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kidest Getu Melese
- Department of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Ngotie TK, Kaura DKM, Mash B. Awareness of cultural practices by skilled birth attendants during pregnancy and birth in Kenya: An interpretive phenomenological study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Dun-Dery F, Meissner P, Beiersmann C, Kuunibe N, Winkler V, Albrecht J, Müller O. Uptake challenges of intermittent preventive malaria therapy among pregnant women and their health care providers in the Upper West Region of Ghana: A mixed-methods study. Parasite Epidemiol Control 2021; 15:e00222. [PMID: 34632123 PMCID: PMC8488310 DOI: 10.1016/j.parepi.2021.e00222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/04/2021] [Accepted: 08/15/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malaria in pregnancy remains a major public health problem in endemic countries, especially in sub-Saharan Africa (SSA). Existing interventions such as intermittent preventive therapy in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) are effective against placental malaria. However, low uptake of this intervention is a challenge in SSA. This study assessed factors affecting IPTp-SP uptake among pregnant women as well as their health care providers, including health system-related factors. METHODS From November 2018 until May 2019 a mixed-methods study was conducted in one urban and one rural district of the Upper West Region of Ghana. A multi-stage sampling technique was used to recruit 740 3rd trimester pregnant women and 74 health service providers from 37 antenatal care (ANC) facilities. Quantitative data was collected through a standard questionnaire from pregnant women and ANC service providers. Three focus group discussions (FGDs) were conducted in each district with pregnant women who had defaulted on their IPTp doses to collect information about the challenges in accessing IPTp-SP. The primary outcome was the uptake of IPTp-SP during antenatal care visits. In addition, the health care provider and health system-related factors on the administration of SP were assessed, as well as details of folic acid (FA) supplementation. Data were analysed using descriptive statistics and Poisson regression. RESULTS Responses from 697 pregnant women were analysed. Of these, 184 (26.4%) had taken the third dose of SP (SP3) in line with international guidelines. IPTp-SP uptake was low and significantly associated with the number of maternal ANC contacts and their gestational age at 1st ANC contact. Most pregnant women were regularly co-administered SP together with 5 mg of FA, in contrast to the international recommendations of 0.4 mg FA. The main challenges to IPTp-SP uptake were missed ANC contacts, knowledge deficiencies among pregnant women of the importance of IPTp, and frequent drug stock outs, which was confirmed both from the ANC providers as well as from the pregnant women. Further challenges reported were provider negligence/absenteeism, adverse drug reactions, and mobile residency of pregnant women. CONCLUSIONS The uptake of IPTp-SP in the study area is still very low, which is partly explained by frequent drug stock outs at health facilities, staff absenteeism, knowledge deficiencies among pregnant women, and missed ANC contacts. The high dosing of co-administered FA is against international recommendations. These observations need to be addressed by the national public health authorities.
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Affiliation(s)
- Frederick Dun-Dery
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Peter Meissner
- University Hospital Ulm, Dep. of Pediatrics and Adolescent Medicine, Ulm University, Eythstraße 24, 89075 Ulm, Germany
| | - Claudia Beiersmann
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Naasegnibe Kuunibe
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Volker Winkler
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jahn Albrecht
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Olaf Müller
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Kim ET, Ali M, Adam H, Abubakr-Bibilazu S, Gallis JA, Lillie M, Hembling J, McEwan E, Baumgartner JN. The Effects of Antenatal Depression and Women's Perception of Having Poor Health on Maternal Health Service Utilization in Northern Ghana. Matern Child Health J 2021; 25:1697-1706. [PMID: 34405361 DOI: 10.1007/s10995-021-03216-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the effects of antenatal depression and women's perceived health during the antenatal period on maternal health service utilization in rural northern Ghana; including how the effect of antenatal depression on service use might be modified by women's perceived health. METHODS Probable antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9). Linear regression was used for the outcome of number of antenatal care (ANC) visits, and logistic regression was used for the outcomes of facility delivery, postnatal care (PNC) within 7 days and completion of continuum of care. Continuum of care was defined as having had four or more ANC visits, delivered at a health facility and had PNC visit within 7 days. RESULTS Antenatal depression had very small or no association with maternal health service utilization. Women with self-perceived fair or poor health were significantly less likely to use PNC within 7 days and less likely to complete the continuum of care. As for effect modification, we found that for women with probable moderate or severe antenatal depression (a score of 10 or greater), those with perceived fair or poor health used fewer ANC visits and were less likely to use PNC within 7 days than those with perceived excellent, very good or good health. CONCLUSIONS Women experiencing moderate or severe antenatal depression and/or who self-perceive as having poor health should be identified and targeted for additional support to access and utilize maternal health services.
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Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Mohammed Ali
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Haliq Adam
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Safiyatu Abubakr-Bibilazu
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - John A Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Rd, Suite 1102 Hock Plaza, Durham, NC, 27710, USA
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - John Hembling
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Elena McEwan
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, Chapel Hill, NC, 27599, USA
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Appiah F, Owusu BA, Ackah JA, Ayerakwah PA, Bediako VB, Ameyaw EK. Individual and community-level factors associated with home birth: a mixed effects regression analysis of 2017-2018 Benin demographic and health survey. BMC Pregnancy Childbirth 2021; 21:547. [PMID: 34380466 PMCID: PMC8359262 DOI: 10.1186/s12884-021-04014-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Home birth is a common contributor to maternal and neonatal deaths particularly in low and middle-income countries (LMICs). We generally refer to home births as all births that occurred at the home setting. In Benin, home birth is phenomenal among some category of women. We therefore analysed individual and community-level factors influencing home birth in Benin. Methods Data was extracted from the 2017–2018 Benin Demographic and Health Survey females’ file. The survey used stratified sampling technique to recruit 15,928 women aged 15–49. This study was restricted to 7758 women in their reproductive age who had complete data. The outcome variable was home birth among women. A mixed effect regression analysis was performed using 18 individual and community level explanatory variables. Alpha threshold was fixed at 0.05 confidence interval (CI). All analyses were done using STATA (v14.0). The results were presented in adjusted odds ratios (AORs). Results We found that 14% (n = 1099) of the respondents delivered at home. The odds of home births was high among cohabiting women compared with the married [AOR = 1.57, CI = 1.21–2.04] and women at parity 5 or more compared with those at parity 1–2 [AOR = 1.29, CI = 1.01–1.66]. The odds declined among the richest [AOR = 0.07, CI = 0.02–0.24], and those with formal education compared with those without formal education [AOR = 0.71, CI = 0.54–0.93]. Similarly, it was less probable for women whose partners had formal education relative to those whose partners had no formal education [AOR = 0.62, CI = 0.49–0.79]. The tendency of home birth was low for women who did not have problem in getting permission to seek medical care [AOR = 0.62, CI = 0.50–0.77], had access to mass media [AOR = 0.78, CI = 0.60–0.99], attained the recommended ANC visits [AOR = 0.33, CI = 0.18–0.63], belonged to a community of high literacy level [AOR = 0.24, CI = 0.14–0.41], and those from communities of high socio-economic status (SES) [AOR = 0.25, CI = 0.14–0.46]. Conclusion The significant predictors of home birth are wealth status, education, marital status, parity, partner’s education, access to mass media, getting permission to go for medical care, ANC visit, community literacy level and community SES. To achieve maternal and child health related goals including SDG 3 and 10, the government of Benin and all stakeholders must prioritise these factors in their quest to promote facility-based delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04014-x.
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Affiliation(s)
- Francis Appiah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Berekum College of Education, Berekum, Bono Region, Ghana
| | | | - Josephine Akua Ackah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Vincent Bio Bediako
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, Australia
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Wulandari RD, Laksono AD, Rohmah N. Urban-rural disparities of antenatal care in South East Asia: a case study in the Philippines and Indonesia. BMC Public Health 2021; 21:1221. [PMID: 34167514 PMCID: PMC8229737 DOI: 10.1186/s12889-021-11318-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. Methods The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15–49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. Results The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC’s use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. Conclusions The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.
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Affiliation(s)
- Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga Surabaya, Campus C Mulyorejo, Surabaya, 60115, Indonesia.
| | - Agung Dwi Laksono
- National Institute of Health Research and Development of The Ministry of Health of the Republic of Indonesia, Percetakan Negara 29, Jakarta, 10560, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, Gumuk Kerang, Karangrejo, Kec. Sumbersari, Jawa Timur, Kabupaten Jember, East Java, 68124, Indonesia
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Rent S, Bakari A, Plange-Rhule G, Bockarie Y, Kukora S, Moyer CA. Provider perspectives on Asram in Ghana. J Biosoc Sci 2021; 54:1-13. [PMID: 33866977 DOI: 10.1017/s0021932021000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neonatal mortality is one of the leading causes of under-five mortality globally, with the majority of these deaths occurring in low- and middle-income countries. In Ghana, there is a belief in an array of newborn conditions, called Asram, that are thought to have a spiritual, rather than physical, cause. These conditions are predominantly managed by traditional healers as they are considered unable to be treated by allopathic medical providers. Through a series of semi-structured qualitative interviews of medical providers in Kumasi, Ghana, conducted in July-August 2018, this study sought to elucidate perspectives of allopathic medical providers about Asram, including the perceived implications of traditional newborn care patterns on newborn health and higher-level neonatal care. Twenty health care providers participated and represented a tertiary care hospital and a district hospital. Medical providers were universally aware of Asram but varied on the latitude they gave this belief system within the arena of newborn care. Some providers rationalized the existence of Asram in the backdrop of high neonatal mortality rates and long-standing belief systems. Others highlighted their frustration with Asram, citing delays in care and complications due to traditional medical treatments. Providers utilized varying approaches to bridge culture gaps with families in their care and emphasized the importance of open communication with the shared goal of improved newborn health and survival. This study describes the importance of providers being aware of socio-cultural constructs within which pregnant women operate and suggests a focus on the shared goal of timely and effective newborn care in Ghana.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Ashura Bakari
- Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | | | | | - Stephanie Kukora
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Cheryl A Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Mahmoodi Z, Arabi M, Kabir K, Yazdkhasti M, Kamrani MA, Tourzani ZM, Esmaelzadeh S. Educational needs on safe motherhood from the perspective of suburban women: A qualitative study. Heliyon 2021; 7:e06582. [PMID: 33869834 PMCID: PMC8035507 DOI: 10.1016/j.heliyon.2021.e06582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/08/2021] [Accepted: 03/19/2021] [Indexed: 11/08/2022] Open
Abstract
Background Maternal mortality resulting from pregnancy and delivery complications is a sensitive indicator of women's status in the society, access to care services, and sufficiency and quality of healthcare and is the major indicator of a country's developmental status. The present study aimed at determination of educational needs regarding safe motherhood from suburban women's perspective. Method This qualitative study with conventional content analysis approach was conducted in suburban healthcare centers of Alborz University of medical sciences from 23 October to 22 December 2019. The participants included 15 eligible Iranian suburban women who were selected through purposive sampling. The data were collected via in-depth semi-structured interviews and focus groups. Data were analyzes with MAXQDA10 software. Results Three main themes emerged from the analysis of the data (barriers against safe pregnancy, accountability multidimensional training, and threats and opportunities of distance learning), six categories, 11 subcategories and 547 codes. Discussion The results indicated that suburban women were less probable to be present in healthcare centers and receive the required information compared to their peers due to their conditions; provision of accessible training services appropriated to their conditions can greatly contribute to elimination of these problems.
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Affiliation(s)
- Zohreh Mahmoodi
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohsen Arabi
- Physiology, Pharmacology and Medical Physics, Department, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kourosh Kabir
- Community Medicine and Epidemiology Department, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mansoureh Yazdkhasti
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnaz Akbari Kamrani
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zahra Mehdizadeh Tourzani
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh
- Reproductive Health Department, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Ameyaw EK, Dickson KS, Adde KS. Are Ghanaian women meeting the WHO recommended maternal healthcare (MCH) utilisation? Evidence from a national survey. BMC Pregnancy Childbirth 2021; 21:161. [PMID: 33622274 PMCID: PMC7903775 DOI: 10.1186/s12884-021-03643-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background To achieve the Sustainable Development Goal target 3.1, the World Health Organisation recommends that all pregnant women receive antenatal care (ANC) from skilled providers, utilise the services of a skilled birth attendant at birth and receive their first postnatal care (PNC) within the first 24 h after birth. In this paper, we examined the maternal characteristics that determine utilisation of skilled ANC, skilled birth attendance (SBA), and PNC within the first 24 h after delivery in Ghana. Methods We used data from the 2014 Ghana Demographic and Health Survey. Women aged 15-49 with birth history not exceeding five before the survey were included in the study. A total of 2839 women were included. Binary logistic regression was employed at a 95% level of significance to determine the association between maternal factors and maternal healthcare (MCH) utilisation. Bivariate and multivariate regression was subsequently used to assess the drivers. Results High proportion of women had ANC (93.2%) with skilled providers compared to the proportion that had SBA (76.9%) and PNC within the first 24 h after delivery (25.8%). Only 21.2% utilised all three components of MCH. Women who were covered by national health insurance scheme (NHIS) had a higher likelihood (AOR = 1.31, CI = 1.04 – 1.64) of utilising all three components of MCH as compared to those who were not covered by NHIS. Women with poorer wealth status (AOR = 0.72, CI = 0.53 – 0.97) and those living with partners (AOR = 0.65, CI = 0.49 – 0.86) were less likely to utilise all three MCH components compared to women with poorest wealth status and the married respectively. Conclusion The realisation that poorer women, those unsubscribed to NHIS and women living with partners have a lower likelihood of utilising the WHO recommended MCH strongly suggest that it is crucial for the Ministry of Health and the Ghana Health Service to take pragmatic steps to increase education about the importance of having ANC with a skilled provider, SBA, and benefits of having the first 24 h recommended PNC.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kenneth Setorwu Adde
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Adama EA, Sundin D, Bayes S. Sociocultural Practices Affecting the Care of Preterm Infants in the Ghanaian Community. J Transcult Nurs 2020; 32:458-465. [PMID: 33225863 PMCID: PMC8404725 DOI: 10.1177/1043659620975098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction Although culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community. Method Narrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants’ homes. Results Analysis of data resulted in three threads/themes—respect for the elderly, use of herbal medicines, and communal living. Discussion Community and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival.
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Affiliation(s)
| | - Deborah Sundin
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sara Bayes
- Edith Cowan University, Joondalup, Western Australia, Australia
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Lorenze DL. Women's Lived Experiences of Giving Birth in Ghana: A Metasynthesis of the Literature. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDThe purpose of this metasynthesis is to analyze women's lived experiences of giving birth in Ghana during and after the Millennium Development Goals (MDGs), when health policy in Ghana was changed to urge women to birth in health services with skilled attendants.METHODAn interpretive phenomenological framework guided the review of the literature. Three electronic databases were searched as well as reference lists and author searches. Articles that met the screening criteria for inclusion were coded and thematically analyzed, then drawn together to construct the essence of women's experiences of giving birth in Ghana.RESULTSSeven themes were constructed from the data and these were poor quality health services, maltreatment by midwives, mixed emotions about pregnancy and childbirth, supernatural fears, women wanting safe births with skilled birth attendants, uncertainty about reaching a health facility, and decision-making hierarchy. There were three counter themes and these were women wanting a home birth with a traditional midwife, defiance against dominant decision-makers by some women, and a belief that “not all nurses are bad.”CONCLUSIONGhanaian women have heeded the MDGs and health policy messages to birth with skilled attendants, but in reality, they are not always accessible, available, appropriate, or of high quality. Maternal health services still need much improvement including more resources such as staff, essential services, medicines, and quality assurance standards.
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Sumankuuro J, Wulifan JK, Angko W, Crockett J, Derbile EK, Ganle JK. Predictors of maternal mortality in Ghana: evidence from the 2017 GMHS Verbal Autopsy data. Int J Health Plann Manage 2020; 35:1512-1531. [PMID: 32901986 DOI: 10.1002/hpm.3054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal mortality remains a significant public health challenge in many low and middle-income countries, including Ghana. From Ghana's 2017 Maternal Health Survey verbal autopsy data, we examined the predictors of maternal mortality in Ghana. METHODS A total of 1240 deaths of women aged 15-49 were involved in the survey across all regions in Ghana. Binary and multivariate logistic regression analyses were employed; confidence level was set at 95%. RESULTS The results show that the prevalence of maternal death was 13.2% (164/1240). After adjusting for potential covariates, women aged 20-29 years (aOR = 4.270, 95%CI= 1.864 - 9.781, p=0.001), bled during labour/delivery (aOR= 0.241, 95%CI = 0.059 - 0.992, p=0.049), and those who used traditional/herbal medicines during pregnancy were more likely to die compared to non-users (aOR= 3.461, 95%CI = 1.651 - 7.258, p=0.001). CONCLUSION Our findings highlight the need to intensify maternal education regarding the value to be gained by increasing skilled healthcare during complications in pregnancy to allow effective management of complications during labour/delivery. Also, education for pregnant women and their families on possible adverse effects of using unapproved traditional/herbal medicines during pregnancy as well as a need to seek timely care before the onset of labour to allow healthcare providers ample opportunity to address labour and birth complications, is urgently required.
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Affiliation(s)
- Joshua Sumankuuro
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Policy and Governance, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana.,School of Community Health, Faculty of Science, Charles Sturt University, Australia
| | - Joseph K Wulifan
- School of Business and Law, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - William Angko
- School of Business and Law, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Australia
| | - Emmanuel K Derbile
- School of Public Policy and Governance, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - John K Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Laksono AD, Rukmini R, Wulandari RD. Regional disparities in antenatal care utilization in Indonesia. PLoS One 2020; 15:e0224006. [PMID: 32053621 PMCID: PMC7018075 DOI: 10.1371/journal.pone.0224006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/11/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Affiliation(s)
- Agung Dwi Laksono
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
| | - Rukmini Rukmini
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
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