Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review

Healthcare professionals' experience of teenage pregnancy and motherhood in Haiti

OBJECTIVES

The aim of this study was to explore healthcare professionals' experience of pregnant and motherhood in adolescence in Haiti.

METHODS

The methodology for collecting and analyzing qualitative data was based on John Dewey's social survey. The study was conducted in nine health institutions in the North and North-East departments of Haiti from October 2020 to January 2021. Data were collected through individual semi-structured interviews with 15 healthcare professionals. All interviews were audio-recorded. The recordings were listened to carefully and transcribed in verbatim form. After checking and validation, the verbatims in Word format were exported to QDA Miner software version 6.0.5 for coding. The data were analyzed using Paillé and Mucchielli thematic analyses.

RESULTS

Health professionals such as gynecologists, nurses, midwives, nursing assistants, matrons and health workers took part in the study. These study participants indicate that teenage pregnancy and motherhood are social and public health problems whose negative consequences affect teenage girls, children, healthcare professionals, the healthcare system, and Haitian society in general. The services offered to adolescent girls are medical, educational, psychological, economic, and social in nature. When caring for pregnant adolescents during the transition to motherhood, healthcare professionals face many challenges that are linked to the socio-economic status and physiological reality of adolescents, as well as the healthcare system.

CONCLUSIONS

Programs involving home care visits should also be set up to offer ongoing support to pregnant or parenting teenagers. The distribution of food aid or materials such as clothing, hygiene products and baby kits should also be considered.

The timing of antenatal care access for adolescent pregnancies in Cape Town, South Africa

BACKGROUND

 Late antenatal care (ANC)-seeking among pregnant adolescents threatens their health outcomes, and the health outcomes of their new-borns. South Africa has experienced a rapid increase in adolescent pregnancies during the COVID-19 pandemic, adding to the existing concerns around adolescent pregnancy care-seeking behaviour.

AIM

 The main aim of this study was to investigate the causes and covariates of late ANC access among adolescents in the Cape Town Metropole, South Africa.

SETTING

 Three public healthcare facilities in the Cape Town Metropole, 2018-2019.

METHODS

 A retrospective, cross-sectional study on ANC seeking behaviour was conducted, surveying 202 adolescents. Late attendance was defined as attending ≥ 3 months. For this study, adolescents were defined as women aged 16-18 years. The sample was restricted to adolescents who used public healthcare facilities or who did not attend at all. Data were analysed using univariate, bivariate and multivariate methods.

RESULTS

 A total of 50.8% (n = 99/195) of the pregnant adolescents in the sample had their first ANC visit 3 months. 14.9% (n = 29/195) did not attend at all. Major contributors to delayed care-seeking include poor pregnancy identification (n = 45/99, 45.5%), and a lack of information about ANC. Age, education, and alcohol consumption were significant predictors of delayed care-seeking.

CONCLUSION

 Delayed ANC attendance contributes to negative long-term health outcomes for pregnant adolescents and their new-borns. Improving access to pregnancy tests in the public sector could benefit adolescents with earlier pregnancy identification. Adolescents need to be made aware of their care seeking options.Contribution: There is evidence of long-term health impacts of late ANC attendance by pregnant adolescents, but there is an absence of evidence on the timing and barriers of late care-seeking behaviour. In this study, late ANC attendance among adolescents was associated with late pregnancy identification and poor knowledge of care options.

Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action

Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.

Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers' schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi: the PROMOTE Project pilot randomized controlled trial protocol

INTRODUCTION

Girls' and women's health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health.

INTERVENTIONS

The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers' clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months.

METHODS

We will conduct a baseline survey among adolescent mothers aged 10-19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers' clubs only); arm two (adolescent mothers' clubs + subsidized childcare), and arm three (adolescent mothers' clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions.

DISCUSSION

Our research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings. Trial registration number AEARCTR-0009115, May 15, 2022.

Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis

BACKGROUND

Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania.

METHODS

We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care.

RESULTS

Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births.

CONCLUSIONS

Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.

Factors Associated with Maternal Healthcare Utilization Before and After Delivery Among Migrant Pregnant Women in China: An Observational Study

Background

Effective healthcare utilization throughout pregnancy is essential in protecting mother and child health, but the maternal healthcare utilization and its associated factors among migrant women are still underexplored.

Methods

The data came from the 2018 China Migrants Dynamic Survey. Our analysis included 6337 pregnant migrant women. Prenatal healthcare utilization comprises receiving at least 5 antenatal care (ANC) times and establishing the maternal health record within the first 12 weeks of pregnancy. Postnatal healthcare utilization refers to whether an individual received a postpartum visit and a physical health examination within 28 days and 42 days following delivery. A multivariate binary logit model was employed to investigate the factors related to maternal healthcare utilization.

Results

67.15% of the 6337 participants established health records within the first 12 weeks of pregnancy, and 88.35% received at least five ANC visits. 76.88% and 84.20% of migrant pregnant women received a postpartum visit and a health examination respectively. Age was positively correlated with receiving at least five ANC visits (OR:1.245, 95% CI: 1.038-1.493), a postpartum visit within 28 days (OR: 1.272, 95% CI: 1.107-1.460) and a physical examination within 42 days after delivery (OR=1.174, 95% CI: 1.002-1.376). Education, household income, health insurance and maternal health education were positively associated with prenatal and postnatal healthcare utilization (P<0.05). Number of Children negatively correlated with ANC times (OR: 0.742, 95% CI: 0.613-0.898) and receiving health examination after delivery (OR: 0.720, 95% CI: 0.610-0.849).

Conclusion

There is still potential for improvement in the maternal healthcare utilization, particularly in postnatal healthcare. Strengthening the follow-up, focusing on those who are younger, have lower socioeconomic status, and are members of ethnic minorities, and continuing to strengthen maternal health education for them can promote the maternal healthcare utilization before and after delivery.

Determinants of antenatal care utilization - contacts and screenings - in Sao Tome & Principe: a hospital-based cross-sectional study

BACKGROUND

Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion.

METHODS

A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05.

RESULTS

A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3-52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5-56.7). Age 20-34 [AOR 2.27 (95% CI: 1.28-4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21-5.20), p = 0.013] when comparing with women aged 14-19 years, urban residence [AOR 1.98 (95% CI: 1.28-3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6-4.2), p < 0.001] were the determinants of adequate ANC utilization.

CONCLUSION

Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

BACKGROUND

Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC.

METHODS

Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies.

RESULTS

Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs.

CONCLUSION

Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately.

PROSPERO REGISTRATION NUMBER

CRD42019139183.

Factors associated with diet diversity among infants and young children in the Eastern and Southern Africa region

This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6-23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6-11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin-A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.

Growth failure among children of adolescent mothers at ages 0-5 and 6-12 years in India

Adolescent motherhood has been linked with poor health outcomes at birth for children, including high neonatal mortality, low birthweight, and small-for-gestational-age rates. However, longer-term growth outcomes in the children of adolescent mothers in low-resource settings remain inadequately studied. We used longitudinal data from the India Human Development Surveys, 2004-2005 and 2011-2012 (n = 12,182) and employed regression and propensity score matching analysis to compare the following growth indicators of children born to adolescent mothers (ages 19 years or below) with those born to older mothers. Growth indicators included height and weight during ages 0-5 years and 6-12 years and change in height and weight between the two periods. In regression-based estimates, children born to adolescent mothers were 0.01 m shorter and weighed 0.2 kg less than children of older mothers at ages 0-5 years. At ages 6-12 years, those born to adolescent mothers were 0.02 m shorter and weighed 0.97 kg less. The height difference between the two groups increased by 0.01 m and the weight difference grew by 0.77 kg over time. Height and weight difference between the two groups worsened among boys over time, while for girls, only the weight gap worsened. The results were similar when using propensity score matching methods. Public policies for reducing child marriage, combined with targeted health, nutrition, and well-being programs for adolescent mothers, are essential for both preventing adolescent childbearing and reducing its impact on growth failure among children in India.

Differential Associated Factors for Inadequate Receipt of Components and Non-Use of Antenatal Care Services among Adolescent, Young, and Older Women in Nigeria

Nigerian women continue to die in childbirth due to inadequate health services such as antenatal care (ANC). Among other factors, the inadequate receipt or non-use of ANC appears to be associated with the age of women, remoteness, and poor households. This cross-sectional study aimed to compare the factors associated with inadequate receipt of the components and non-use of ANC among pregnant adolescents, and young and older women in Nigeria. Data for this study were from the 2018 Nigeria Demographic and Health Survey (NDHS) and covered a weighted total of 21,911 eligible women. Survey multinomial logistic regression analyses that adjusted for cluster, and survey weights were conducted to examine factors associated with adolescent, young, and older women. Adolescent women reported a higher prevalence of inadequate receipts and non-use of ANC than young and older women. Increased odds of inadequate receipt of the components of ANC were associated with residence in the North-East region and rural areas for all three categories of women. For adolescent women, the increased odds of inadequate receipt of the components of ANC were associated with delivering a baby at home and a big problem with distance to health facilities. Limited education or no schooling was associated with the increased odds of receiving inadequate ANC among older women. Implementing interventions to improve maternal and child health care should focus on the factors associated with the increased odds of receipt of inadequate or non-use of ANC services among Nigerian adolescent women, particularly those living in rural areas in the North-East region.

Factors associated with unskilled birth attendance among women in sub-Saharan Africa: A multivariate-geospatial analysis of demographic and health surveys

BACKGROUND

Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA.

METHODS

The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data.

RESULTS

There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance.

CONCLUSION

Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities.

Who goes back to school after birth? Factors associated with postpartum school return among adolescent mothers in the Eastern Cape, South Africa

Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high . This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare.

Household Poverty-Wealth and Decision-Making Autonomy as Predictors of Reproductive and Maternal Health Services Utilization among Rural Women in Nigeria: Evidence from a National Survey

Background

Adequate reproductive and maternal healthcare services utilization are significant in reducing maternal deaths, however, the prevalence rate of contraceptive use remains low, with inadequate maternal health services utilization among rural women in Nigeria. This study examined the influence of household poverty-wealth and decision-making autonomy on reproductive and maternal health services utilization among rural women in Nigeria.

Methods

The study analyzed data from a weighted sample of 13,151 currently married and cohabiting rural women. Descriptive and analytical statistics including multivariate binary logistic regression were conducted using Stata software.

Results

An overwhelming majority of rural women (90.8%) have not used modern contraceptive methods, with poor utilization of maternal health services. About 25% who delivered at home received skilled postnatal checks during the first 2 days after childbirth. Household poverty-wealth significantly reduced the likelihood of using modern contraceptives (aOR: 0.66, 95% CI: 0.52-0.84), having at least four ANC visits (aOR: 0.43, 95% CI: 0.36-0.51), delivering in a health facility (aOR: 0.35, 95% CI: 0.29-0.42) and receiving a skilled postnatal check (aOR: 0.36, 95% CI: 0.15-0.88). Women's decision-making autonomy regarding their healthcare significantly increased the use of modern contraceptives and the number of ANC visits, while women's autonomy on how their earnings are spent positively influenced the use of maternal healthcare services.

Conclusions

In conclusion, the use of reproductive and maternal health services among rural women was associated with household poverty-wealth and decision-making autonomy. Government should formulate more pragmatic policies that will create awareness and promote universal access to reproductive and maternal healthcare services.

Barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda: a qualitative study

BACKGROUND

In Uganda, the uptake of maternal health services is very low, with only 41.1% of pregnant adolescent girls attending the eight antenatal visits that are recommended by the World Health Organisation. Uptake of maternal health services is essential in reducing the current level of adolescent pregnancies as well as its adverse effects on adolescent mothers and their babies, such as preterm deliveries, prolonged labour, death during pregnancy, and childbirth. No previous study has described pregnant adolescents' experiences with maternal health services in Uganda.

OBJECTIVE

This study aimed to describe the barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda.

METHODS

Data were collected in the Naguru Teenage Information and Health Centre in Uganda through individual interviews involving 31 pregnant adolescents. The transcribed interviews were inductively analysed through content analysis.

RESULTS

The pregnant adolescents described difficulty in reaching, as well as lack of financial support to visit, the Naguru Teenage Information and Health Centre, which is a clinic providing youth friendly services. Feelings of being discriminated against and disrespected by health workers, and lack of privacy when receiving health services was major barriers that hindered their access to maternal health services. Pregnant adolescents' access to these services can be enhanced by improving health workers' working conditions, accelerating community and health worker awareness on ways to mitigate these barriers, and developing policies that encourage men's involvement in maternal health services.

CONCLUSION

Adolescents in Uganda face considerable barriers to accessing improved and quality maternal health services. To mitigate these barriers, according to the adolescents, considerable efforts are required to tackle health workers' working conditions and sensitise the community on the importance of, as well as securing the availability of, maternal health services for pregnant adolescents. Future research should focus on pregnant adolescents who receive family support.

Trends and factors contributing to health facility delivery among adolescent women in Ethiopia: multivariate decomposition analysis

BACKGROUND

Although an increase in health facility delivery in Ethiopia over time, adolescent women giving birth at health facilities is still low. Health facility delivery is crucial to improving the health of women and their newborns' health by providing safe delivery services. We aimed to examine the trend change and identify factors contributing to health facility delivery in Ethiopia.

METHODS

We analyzed the data on adolescent women obtained from three Ethiopian Demographic and Health Surveys. A total of weighted samples were 575 in 2005, 492 in 2011, and 378 in 2016. Data management and further statistical analysis were done using STATA 14. Trends and multivariate decomposition analysis were used to examine the trends in health facility delivery over time and the factors contributing to the change in health facility delivery.

RESULTS

This study showed that the prevalence of health facility delivery among adolescent women in Ethiopia increased significantly from 4.6% (95% CI 3.2-6.7) in 2005 to 38.7% (95% CI 33.9-43.7) in 2016. Decomposition analysis revealed that around 78.4% of the total change in health facility delivery over time was due to the changes in the composition of adolescent women and approximately 21.6% was due to the changes in their behavior. In this study, maternal age, place of residency, wealth index, maternal education, frequency of ANC visits, number of living children, and region were significant factors contributing to an increase in health facility delivery over the study periods.

CONCLUSION

The prevalence of health facility delivery for adolescent women in Ethiopia has increased significantly over time. Approximately 78.4% increase in health facility delivery was due to adolescent women's compositional changes. Public health interventions targeting rural residents and uneducated women would help to increase the prevalence of health facility delivery.

Pregnancy among adolescent girls in humanitarian settings: a case in refugee camp of Gambella regional state, community-based cross-sectional study, Southwest Ethiopia, 2021

OBJECTIVE

The aim of this study was to assess the prevalence of pregnancy and associated factors among adolescent girls in Nguenyyiel Refugee Camp.

DESIGN

Cross-sectional study was employed to conduct this study.

SETTING

A community-based cross-sectional study was done in Nguenyyiel Refugee Camp.

PARTICIPANTS

Four hundred and fourteen adolescent girls participated in this study. The systematic random sampling technique was used to select respondents. Data were collected using a well-structured and pretested questionnaire. Pregnancy test was done using the human chorionic gonadotropin test. Bivariate and multivariate logistic regression analysis was run to identify factors associated with adolescent pregnancy.

RESULTS

The prevalence of pregnancy among adolescent girls in the Nguenyyiel Refugee Camp was 21.7% (95% CI: 17.6% to 25.6%). Factors associated with adolescent pregnancy were age (17-19 years) (AOR): 2.79; 95% CI: 1.55 to 5.05; educational status: primary education (AOR: 7.69; 95% CI: 3.55 to 16.68) and no formal education (AOR: 3.42; 95% CI: 1.59 to 7.36); and household living arrangement: living with none of the biological parents (AOR: 2.14; 95% CI: 1.02 to 4.49) and living with either of the biological parent (AOR: 3.71; 95% CI: 1.76 to 7.81).

CONCLUSIONS AND RECOMMENDATIONS

This study showed that there is a high prevalence of pregnancy among adolescent girls in the study setting. Age (17-19 years), educational status and household living arrangement (living with none of the biological parents and living with either of the biological parents) were among the factors significantly associated with adolescent pregnancy. Hence, health workers and other stakeholders in the camps should focus on strengthening adolescent sexual health education giving special attention to late adolescents, uneducated and living without biological family.

Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies

Adolescent pregnancy is a major health and social concern in South Asia. The aim of this study is to systematically review evidence on the factors associated with adolescent pregnancy in South Asia. This study was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four electronic databases: EMBASE, PubMed, CINAHL, and Scopus were searched for relevant studies on factors associated with adolescent pregnancy in South Asia published in English between January 2000 and July 2022. The quality of the included studies was assessed using 12 criteria from The National Institute of Health (NIH) Study Quality Assessment Tools for observational studies. Of the 166 articles retrieved, only 15 studies met the eligibility criteria and were included in the final analysis. Consistent factors associated with adolescent pregnancy in South Asia were low maternal education, low socioeconomic status, rural residency, and ethnic minorities. To prevent adolescent pregnancy in South Asia, concerted effort towards promoting health equity by addressing the predisposing factors associated with adolescent pregnancy is essential. This systematic review was registered with PROSPERO [CRD42022340344].

Prevalence and Sociodemographic Profiles of Grand Multipara in Abu Dhabi, United Arab Emirates

The literature shows that grand multipara mothers are major contributors to poor maternal and perinatal health compared to multipara mothers. Data regarding parity profiles are essential, especially in rapidly transforming countries such as the United Arab Emirates (UAE). This study aimed to investigate the prevalence and factors associated with multipara mothers compared to multipara mothers in Abu Dhabi, UAE. The data were collected from seven health care centers located in Abu Dhabi.From1818 enrolled mothers, the prevalence of grand multipara was 135(7.4%, 95% Confidence Interval (CI) = 7.2, 7.6). In logistic regression analysis, factors associated positively with grand multipara were a higher maternal age (Adjusted Odd Ratio (AOR) = 1.28, 95% CI = 1.21, 1.34), Arab mothers (AOR = 5.66, 95% CI 2.81, 11.40), overweight pre-pregnancy (AOR = 2.01, 95% CI = 1.26, 3.21), and limited family support for breastfeeding (AOR = 2.05, 95% CI = 1.21, 3.50). The prevalence of grand multipara was low compared to previous researching the UAE. Sociodemographic factors were more prominent and associated with grand multipara mothers compared to obstetrical ones. Therefore, more programs (nutritional, physical activities, and psychosocial) are needed to improve maternal and perinatal health to support grand multipara mothers. Further, research is required to explore the difference in parity based on nationalities, especially from a sociocultural point of view.

Uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in Uganda: a national survey

Background

In spite of the missed opportunities of sulfadoxine-pyrimethamine (IPTp-SP) in Uganda, scanty literature exist on malaria in pregnancy. To date, empirical national study utilizing the 2018-19 Uganda Malaria Indicator Survey to explore predictors of attaining three or more doses of IPTp-SP in the country is non-existent. This study investigated the factors affecting uptake of three or more IPTp-SP doses as recommended by the World Health Organization.

Methods

Data from the 2018–2019 Uganda Malaria Indicator Survey (2018-19 UMIS) was analysed. Adequate uptake of intermittent preventive therapy with IPTp-SP was the dependent variable for this study. Weighted frequencies and percentages were used to present the proportion of women who had adequate IPTp-SP uptake or otherwise with respect to the independent variables. A three-level multilevel logistic regression was fitted. The Bayesian Deviance Information Criterion (DIC) was used in determining the goodness of fit of all the models.

Results

Less than half of the surveyed women had three or more IPTp-SP doses during their last pregnancies (45.3%). Women aged 15–19 had less odds of receiving at least three IPTp-SP doses compared to those aged 45–49 [aOR = 0.42, Crl = 0.33–0.98]. Poor women [aOR = 0.80, Crl = 0.78–0.91] were less likely to have three or more doses of IPTp-SP relative to rich women. Most disadvantaged regions were aligned with less likelihood of three or more IPTp-SP uptake [aOR = 0.59, CI = 0.48–0.78] compared to least disadvantaged regions. The variation in uptake of three or more IPTp-SP doses was substantial at the community level [σ² = 1. 86; Crl = 11.12–2.18] than regional level [σ² = 1.13; Crl = 1.06–1.20]. About 18% and 47% disparity in IPTp-SP uptake are linked to region and community level factors respectively.

Conclusion

IPTp-SP interventions need to reflect broader community and region level factors in order to wane the high malaria prevalence in Uganda. Contextually responsive behavioural change communication interventions are required to invoke women’s passion to achieve the recommended dosage.

Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies

Background

Fertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published.

Aim

To synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.

Methods

An extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument.

Results

After screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents’ relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services.

Conclusions

Adolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05022-1.

Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes?

BACKGROUND

Adolescent childbirth is a major public health problem in Sao Tome and Principe (STP). Adolescent pregnancy and childbirth can carry a risk of morbidity associated with the physiological and sociological characteristics of teenage girls. This study aims to identify the main adverse obstetric and perinatal outcomes for adolescent pregnancies in the Hospital Dr. Ayres de Menezes (HAM), the only hospital in STP.

METHODS

An institution-based cross-sectional study. Pregnant women ≤ 19 years of age (n = 104) were compared to non-adolescent women (n = 414). The obstetric and perinatal outcomes were compared between groups using the t test. Odds ratio (OR) were calculated through Cochran's and Mantel-Haenszel statistics test for odds ratio equal to 1, 95% confidence intervals (CI) and p values (p < 0.05) were considered significant.

RESULTS

The adverse perinatal outcomes imputable to adolescent births were foetal distress with low first minute Apgar score < 7 (OR 1.94, 95% CI 1.18-3.18, p = 0.009) and performance of neonatal resuscitation manoeuvres (OR 2.4, 95% CI 1.07-5.38, p = 0.032). Compared to older mothers, teenage girls were likely to have a non-statistically significant threefold higher risk of having an obstructed labour (OR 3.40, 95% CI 0.89-12.94, p = 0.07). Other perinatal outcomes as neonatal asphyxia, risk for cerebral palsy, premature birth, early neonatal infection, and neonatal death were identical between groups as well as maternal anaemia, mode of delivery or other obstetrical outcomes.

CONCLUSION

Adolescent pregnancies were associated with worse perinatal outcomes as foetal distress and higher need for neonatal resuscitation manoeuvres. This study may support STP health authorities in their efforts to make Sustainable Development Goals 3 (good health and wellbeing), 4 (quality education) and 5 (gender equality) a reality by 2030, since it identifies specific problems that need to be addressed to improve maternal adolescent health.

Unmarried Adolescents’ Experiences of Using Reproductive and Maternal Health Services in Nigeria and Uganda: A Qualitative Study

Adolescents’ access and use of reproductive and maternal health (RMH) services is a critical part of the global strategy for achieving the Sustainable Development Goals (SDGs). However, previous studies have shown that a complex range of factors, including restrictive policies and punitive laws, limit adolescents from accessing a full range of RMH services in Sub-Saharan Africa (SSA). Our study explores the experiences of unmarried adolescents’ access and use of RMH services in Nigeria and Uganda to understand the extent to which the diverse policy environment in both countries enables or hinders adolescents’ access to and use of RMH services. Our qualitative research design involved eight focus group discussions (FGDs) in Nigeria and in Uganda, 14 in-depth interviews, and eight FGDs among adolescents. The data were analysed thematically and organised according to the WHO’s five broad dimensions for assessing youth-friendly health services. Our findings show that RMH services were inequitably delivered in both countries. Adolescents were restricted from accessing services based on age and marital status. Being unmarried and having no partner, especially in Uganda, was a cause for discrimination during antenatal appointments. We also observed that the expectations of adolescents were not adequately met. Service providers tended to be impolite, judgemental, and unwilling to provide services, especially contraceptives, to younger and unmarried adolescents. Our findings suggest that the existence of a youth-friendly health policy does not translate into effective youth-friendly service provision. This underscores the need for further studies to understand the complexities surrounding this by using a realist evaluation method to examine how adolescent and youth-friendly health services can be designed to improve uptake of reproductive and maternal health services among adolescents in Sub-Saharan Africa.

Effect of adolescent pregnancy on child mortality in 46 countries

INTRODUCTION

Adolescent pregnancy is a known health risk to mother and child. Statements and reports of health outcomes typically group mothers under 20 years old together. Few studies examined this risk at a finer age resolution, none of them comprehensively, and with differing results.

METHODS

We analysed Demographic and Health Surveys data from 2004 to 2018 in sub-Saharan Africa (SSA) and South Asia, on firstborn children of mothers 25 years old or younger. We examined the association between maternal age and stillbirths, and neonatal mortality rate (NNMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR), using mixed-effects logistic regression adjusting for major demographic variables and exploring the impact of maternal health-seeking.

RESULTS

In both regions and across all endpoints, mortality rates of children born to mothers aged <16 years, 16-17 years and 18-19 years at first birth were about 2-4 times, 1.5-2 times and 1.2-1.5 times higher, respectively, than among firstborn children of mothers aged 23-25. Absolute mortality rates declined over time, but the age gradient remained similar across time periods and regions. Adjusting for rural/urban residence and maternal education, in SSA in 2014-2018 having a <16-year-old mother was associated with ORs of 3.71 (95% CI: 2.50 to 5.51) for stillbirth, 1.92 (1.60-2.30) for NNMR, 2.13 (1.85-2.46) for IMR and 2.39 (2.13-2.68) for U5MR, compared with having a mother aged 23-25. In South Asia, in 2014-2018 ORs were 5.12 (2.85-9.20) for stillbirth, 2.46 (2.03-2.97) for NNMR, 2.62 (2.22-3.08) for IMR and 2.59 (2.22-3.03) for U5MR. Part of the effect on NNMR and IMR may be mediated by a lower maternal health-seeking rate.

CONCLUSIONS

Adolescent pregnancy is associated with dramatically worse child survival and mitigated by health-seeking behaviour, likely reflecting a combination of biological and social factors. Refining maternal age reporting will avoid masking the increased risk to children born to very young adolescent mothers. Collection of additional biological and social data may better reveal mediators of this relationship. Targeted intervention strategies to reduce unintended pregnancy at earlier ages may also improve child survival.

Adolescent pregnancy in Sao Tome and Principe: a cross-sectional hospital-based study

Background

Pregnancy starts early in Sao Tome and Principe (STP) and rates of adolescent pregnancy increased 16% in recent years reaching a 27.3% prevalence. This study aimed to understand the pregnant adolescents’ characteristics and factors associated to early childbearing in STP.

Methods

A cross-sectional hospital-based study was undertaken in Hospital Dr. Ayres de Menezes between 2016 and 2018 with a randomly selected total sample size of 518 mothers. Mothers’ clinical records and interviews were used to collect relevant data. The results among adolescent girls 19 years of age and younger (n=104) were compared to adult mothers (n=414). A subgroup analysis of adolescent pregnant girls was also conducted. Statistically significance was considered at a p-value ≤0.05. Data were analysed using SPSS software.

Results

The study revealed that 20.1% were adolescent mothers. Pregnancy at a very early age (≤15) was experienced by 7.7%. The characteristics founded to be positively associated with adolescent pregnancy were: 1) being single (OR 0.39, 95% CI=0.2–0.6, p≤0.001); 2) having a relationship with the baby´s father for a period of less than one year (OR 0.16, 95% CI=0.09-0.3, p≤0.001); 3) lack of the baby´s father support (OR 0.41, 95% CI=0.2–0.7, p=0.002); 4) not using a contraceptive method (OR 0.33, 95% CI=0.2–0.5, p≤0.001), and 5) inappropriate knowledge concerning the identification of the newborn’s danger signs (OR 15.7, 95% CI= 9–26, p≤0.001). Comparing pregnancy at very early age (≤15) to late (>18 and ≤19) adolescents, main differences were that previous contraceptives were not used at all in girls ≤15 years compared to 9.8% of late childbearing subgroup.

Conclusions

Unfavourable factors linked to adolescent pregnancies were absence of a contraceptive method, getting pregnant in the early first months of one relationship and to be single. Gap age difference between adolescents’ partners, polygamous sexual relationships, previous abortion and having already other living children were also identified. Adolescents also had inappropriate knowledge of the identification of the newborns’ danger signs. Before being sexually active, adolescents critically need sexual and reproductive health information provided by a healthy community and through school programmes on sexual education. Schools should promote girl’s empowerment and awareness and, at the same time, reinforce boy’s role in fatherhood and shared responsibilities. The government should work on the prevention of early sexual initiation, as well as on improving family planning programmes to protect them from pregnancy with special focus for the very early adolescent girls. None of these goals can be achieved if the government doesn’t, simultaneously, improve educational and economic opportunities for girls.

Do Predictors of Health Facility Delivery Among Reproductive-Age Women Differ by Health Insurance Enrollment? A Multi-Level Analysis of Nigeria's Data

This study aims to compare determinants of health facility delivery for women under a health insurance scheme and those not under a health insurance scheme. Secondary data drawn from the National Demographic and Health Survey was used for the analysis. The characteristics of the women were presented with simple proportions. Binary multilevel logistic regression was used to examine the determinants of health facilities for women who enrolled in health insurance and those who did not. All statistical analyses were set at 5% level of significant level (p = 0.24). The result showed that 2.1% of the women were under a health insurance scheme. Disparity exists in health insurance ownership as a higher proportion of those enrolled in health insurance were those with higher education attainment, in urban parts of the country, and those situated on higher wealth quintiles. There is a significant difference between those with and those without health insurance. It implies that a higher proportion of women who enrolled in health insurance delivered in health facility delivery compared to those who do not. The unique determinants of health facility delivery for women under health insurance were parity and birth order, while unique determinants of health facility delivery for women not enrolled in health schemes were employment status, marriage type, and geopolitical zones. Uniform predictors of health facility delivery for both groups of women were maternal education, household wealth quintiles, autonomy on healthcare, number of antenatal contacts, residential status, community-level poverty, community-level media use, and community-level literacy. Intervention programs designed to improve health facility delivery should expand educational opportunities for women, improve household socioeconomic conditions, target rural women, and encourage women to undertake a minimum of four antenatal contacts.

Pregnant adolescents and nurses perspectives on accessibility and utilization of maternal and child health information in Ohangwena Region, Namibia

BACKGROUND

Adolescent reproductive health is still a challenge in Low and Middle Income Come Countries (LMICs). However, the reasons for the inability of most pregnant adolescent girls to access and utilize maternal and child health information (MCHI) are not well-documented. This is despite the policy guidelines promoting the provision of this necessary information to pregnant adolescents in order to prepare them for delivery. This provision is one of the strategies envisaged to improve their attendance of ANC visits and their maternal and child health.

METHOD

Data were generated from 12 adolescent pregnant girls aged 15 to 19 years and eight nurses from four different health centres in the Ohangwena Region of Namibia, using semi-structured in-depth interviews. The study was conducted over the period of three months (December 2018 to March 2019). The data were grouped into clusters aided by NVivo computer software version 12. Data were organized and condensed in small units, prior to being coded, categorized, and finally grouped into main themes and sub-themes.

RESULTS

Results revealed that long travel hours to reach the nearest clinics was amongst the leading challenges affecting accessibility and utilization of MCHI for pregnant adolescent girls. This was exacerbated by poor support with transport fare, poor road infrastructure and non-availability of transport, and these factors were key barriers to accessibility and utilization of clinic services. Other barriers pertained to the family dynamics, such as disclosing the pregnancy to the family members prior to commencing antenatal care (ANC) visits and harsh treatment from family members after the disclosure.

CONCLUSION

The pregnant adolescent girls were concerned about their inability to access and utilize MCHI, thereby making them susceptible to maternal complications. Health educational interventions should prioritize both the adolescent girls and their families for proper support, especially since the reactions of families on the pregnancy of their adolescent girls often negatively affect accessibility and utilization of maternal and child health services. Moreover, further research on adolescents' needs during pregnancy should be expanded to include their parents, in order to better inform policymakers.

Equity in antenatal care visits among adolescent mothers: An analysis of 54 country levels trend and projection of coverage from 2000 to 2030

Background

Ensuring utilization of antenatal care (ANC) services by adolescent mothers (ages 10-19) is an enormous challenge in low-and middle-income countries (LMICs). This study provides the first comprehensive analysis of ANC visits among adolescent and adult mothers.

Methods

Using all available Demographic and Health Survey and Multiple Indicator Cluster Surveys between 2000 and 2019 in 54 LMICs, we estimated proportion of ANC visits among women. Bayesian hierarchical regression models were used to estimate trend, projection, and determinants of single and four ANC visits (ANC1 and ANC4) independently. Equity analysis were performed to assess the magnitude of wealth-based and urban-rural inequalities in access to ANC visits.

Results

Compared to women aged 36-49 years, coverage of ANC1 and ANC4 are expected to increase significantly for adolescent mothers and women aged 20-35 years. This increase was observed at the national level, as well as both urban and rural areas in most countries between 2000 and 2030. By 2030, the coverage of ANC1 is predicted to reach 80% or more in all countries except Angola, Central African Republic and Togo, whereas only 16 countries are predicted to reach 80% or more for ANC4. According to wealth quintile, the lowest inequalities with highest coverage of 80% or more ANC4 will be observed in Armenia, Cambodia, Dominican Republic, Ghana, Maldives, Indonesia, and Sao Tome and Principe in 2030. Determinant analysis found increased odds of receiving ANC visits during pregnancy for adolescent mothers with higher educational levels, frequency of listening/watching mass media, and various household socio-economic status factors.

Conclusions

This study calls for advanced, innovative and cost-effective approaches to increase ANC coverage among adolescent mothers, particularly in rural areas and/or in low socioeconomic groups.

Disparities in three critical maternal health indicators amongst Muslims: Vis-a-vis the results reflected on National Health Mission

Background

The post national health mission era has been recognized for India’s accelerating improvement in maternal health care utilization. Concurrent investigations with the purview of examining inequalities in maternal care utilisation have rigorously examined across various socio-economic groups, focusing on Muslim women. The present study examined socio-economic differentials in maternal health care utilisation among Muslims and the delineated factors which are contributing for these inequalities.

Methods

Study used the data from National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16. the present study applied concentration index and Wagstaff-type decomposition analysis to measure and decompose the inequality in maternal health services.

Results

This study found that utilisation of full antenatal care (full ANC), skilled attendants at birth (SBAs) and postnatal care was increased during 2005-06 to 2015-16. However, the least improvement was observed in full antenatal care whereas substantial improvement was achieved in utilising skilled attendants at birth. Further, the poor and non-poor gap in maternal health care utilisation mostly prevailed among the educated, urban resident, other backward castes among Muslims. The inequality has been declined largely in SBA utilisation compared to full ANC and PNC, especially in the southern India. Higher education, mass media exposure, higher birth order and urban residence contribute and explain most of these inequalities in maternal care among Muslim women

Conclusions

Despite the fact that free and cash benefitted health programmes, wealth, mass media exposure and education etc welfare programs benefitted a large number of citizens, it also produced most of the inequalities among Muslims in India. The results focus on the significance of wealth, education, and mass media exposure in bridging the socioeconomic gap in maternal health care utilization among Muslims.

Trends in antenatal care visits and associated factors in Ghana from 2006 to 2018

Introduction

Given that maternal mortality is a major global health concern, multiple measures including antenatal care visits have been promoted by the global community. However, most pregnant women in Ghana and other sub-Saharan African countries do not attain the recommended timelines, in addition to a slower progress towards meeting the required minimum of eight visits stipulated by the World Health Organization. Therefore, this study explored the trends in antenatal care visits and the associated factors in Ghana from 2006 to 2018 using the Multiple Indicator Cluster Surveys.

Methods

The study used women datasets (N = 7795) aged 15 to 49 years from three waves (2006, 2011, and 2017-2018) of the Ghana Multiple Indicator Cluster Surveys (GMICS). STATA version 14 was used for data analyses. Univariable analyses, bivariable analyses with chi-square test of independence, and multivariable analyses with robust multinomial logistic regression models were fitted.

Results

The study found a consistent increase in the proportion of women having adequate and optimal antenatal attendance from 2006 to 2018 across the women’s sociodemographic segments. For instance, the proportion of mothers achieving adequate antenatal care (4 to 7 antenatal care visits) increased from 49.3% in 2006 to 49.98% in 2011 to 58.61% in 2017-2018. In the multivariable model, women with upward attainment of formal education, health insurance coverage, increasing household wealth, and residing in the Upper East Region were consistently associated with a higher likelihood of adequate and/or optimal antenatal care attendance from 2006 to 2018.

Conclusion

Women who are less likely to achieve optimal antenatal care visits should be targeted by policies towards reducing maternal mortalities and other birth complications. Poverty-reduction policies, promoting maternal and girl-child education, improving general livelihood in rural settings, expanding health insurance coverage and infrastructural access, harnessing community-level structures, and innovative measures such as telehealth and telemedicine are required to increase antenatal care utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04404-9.

Effects of deworming medication on anaemia among children aged 6-59 months in sub-Saharan Africa

BACKGROUND

Despite the limited knowledge regarding the effects of deworming medication (DM) on nutritional indicators in sub-Saharan Africa (SSA), deworming programmes continue to be implemented in resource-limited countries. Therefore, the current study aimed to examine the effects of DM on anaemia among children aged 6-59 months in SSA.

METHODS

The analysis was performed using data obtained from 17 demographic and health surveys (DHSs) conducted in SSA. Children were considered to be anaemic if their haemoglobin (Hb) concentration was less than 11.0 g/dl, adjusting for altitude. To account for both multiple measures at the cluster level and the clustering of children within the same country, generalized linear mixed models were used to analyse the anaemia outcomes in 50,075 children aged 6-59 months.

RESULTS

Overall, anaemia was reported in 61.8% of the children, and their median Hb concentration was 10.5 g/dl (interquartile range 9.4-11.5). The prevalence of anaemia ranged from 34.5% in Rwanda to 81.1% in Mali. Multivariate analyses showed that children who did not receive DM had increased odds of being anaemic (adjusted odds ratio [aOR]: 1.11; 95% confidence interval [CI] 1.07-1.16).

CONCLUSIONS

The current study revealed that DM can decrease the risk of anaemia among preschool-age children (pre-SAC) in SSA. Thus, tailored public health programmes aimed at reducing childhood anaemia need to consider deworming. However, longitudinal studies are needed to validate the association that has been reported in this cross-sectional study.

Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa

Background

Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them.

Methods

Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval.

Results

Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years.

Conclusion

Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.

Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey

Despite global progress towards antenatal care (ANC) uptake, ANC utilization in a number of countries in sub-Saharan Africa, such as Nigeria, is low. Although several studies have identified the determinants and factors associated with ANC services utilization in Nigeria, there is a gap in knowledge about the spatial patterns in ANC use. Therefore, this study aims to map the spatial distribution and factors associated with ANC visits in Nigeria. A cross-sectional dataset was obtained from the 2018 Nigeria Demographic and Health Survey. A total of 20,003 women aged 15-49 were considered in this study. Both spatial and multilevel analyses were carried out. The results were presented in spatial maps and adjusted odds ratios (aOR) at a 95% confidence interval (CI). Hot spot areas (high proportion of an incomplete ANC visit) were located in Sokoto, Kebbi, Zamfara, Katsina, Kano, Jigawa, Bauchi, Niger, Borno, Gombe, and Bayelsa. Regional disparities in incomplete ANC visits were found in this study. Maternal age, maternal education, partner's level of education, working status, ethnicity, parity, religion, exposure to media, place of residence, wealth index, region, and community literacy level were factors associated with incomplete ANC. There is a need to consider these factors in the design and strengthening of existing interventions (e.g., mini-clinics) aimed at increasing ANC visits to help attain maternal health-related Sustainable Development Goals by 2030. The regional disparities in incomplete ANC visits also need to be considered by encouraging pregnant women in hotspot areas to attend ANC visits.

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age

The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.

Maternal age at first childbirth and under-five morbidity in sub-Saharan Africa: analysis of cross-sectional data of 32 countries

BACKGROUND

The prevalence of childhood morbidity remains high in low-and middle-income countries, including sub-Saharan Africa (SSA). In this study, the association between maternal age at first childbirth and under-five morbidity in SSA was examined.

METHODS

This was a cross-sectional study involving nationally-representative data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA from 2010 to 2019. A sample size of 311,603 mothers of children under-five was considered. The outcome variable for this study was under-five morbidity. This variable was derived from the experience of fever, cough, and diarrhoea among children under-five. Both multilevel and binary logistic regression models were used to test the hypothesis that adolescent childbirth is associated with under-five morbidity. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95 % confidence intervals (CIs).

RESULTS

Children born to mothers whose first childbirth occurred at < 20 years were 16 % times more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years [cOR = 1.16; CI = 1.13-1.19], and this persisted but with reduced odds after controlling for covariates [aOR = 1.10; CI = 1.07-1.12]. At the country level, children born to mothers whose first childbirth occurred at < 20 years were more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years in Angola, Burundi, Congo DR, Guinea, Kenya, and Uganda.

CONCLUSIONS

In this study, an association between adolescent childbirth and morbidity in children under five in SSA has been established. The study concludes that under-five morbidity is higher among children born to mothers whose first childbirth occurred before 20 years compared to those whose mothers' first childbirth occurred at 20 years and above. The findings indicate that in order to reduce under-five morbidity, there is the need to deal with adolescent childbearing through cultural and social change, coupled with engagement of adolescents and stakeholders in adolescent sexual and reproductive health programmes.

Outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe: a prospective descriptive study

BACKGROUND

Between the years 2000 and 2017, the global maternal mortality rate dropped by 38% however, 94% of maternal deaths still emanated from low-to middle-income countries. Rural women are at a significantly higher risk of dying from pregnancy when compared to their urban counterparts. Early detection of complications and prompt referral to higher levels of care can reduce the associated maternal and perinatal mortality. This study aimed to determine the maternal and perinatal outcomes of pregnancy-related referrals from rural health facilities to central hospitals in Harare, Zimbabwe.

METHODS

A prospective descriptive study was conducted using a sample of 206 patients. All mothers who were referred from rural healthcare facilities were recruited for participation. Data were extracted from patient notes using a structured questionnaire and missing information was obtained from the mother after she had recovered. Bivariate analysis was done using IBM SPSS.

RESULTS

The average age of study participants was 27.4 ± 7.7 years. 87.4% had booked for antenatal care and 81.6% presented to the tertiary facility with their referral notes. The major reasons for referring patients were previous cesarean section (20.4%) and hypertensive disorders in pregnancy (18.4%). There were nine maternal deaths thus a case fatality rate of 4.4% while the perinatal mortality rate was 151/1000 live births. Young mothers were at a higher risk of having adverse perinatal outcomes while primiparous mothers were more likely to have a blood transfusion. Mothers who traveled for > 100 km to the tertiary facility and those who did not attend any antenatal visit were more likely to need blood transfusion. Delivering at the rural health facility was significantly associated with receiving a blood transfusion at the tertiary facility. Mothers who did not attend antenatal visits were more likely to have negative perinatal outcomes.

CONCLUSION

The proportion of obstetric patients being referred from rural facilities to tertiary institutions for complications reveals how primary and secondary healthcare facilities in Zimbabwe are falling short of offering the services they should be offering. Equipping these facilities with skilled human resources as well as contemporary equipment could help decongest the central hospitals consequently reducing the adverse maternal and perinatal outcomes.

Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique

Background

Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally..

Methods

A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model.

Results

Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death.

Conclusions

In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10568-4.

Determinants of completing recommended antenatal care utilization in sub-Saharan from 2006 to 2018: evidence from 36 countries using Demographic and Health Surveys

Background

Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA.

Methods

We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates.

Results

The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa.

Conclusion

The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.

An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference (P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

Trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016

INTRODUCTION

Previous studies have shown that home delivery assisted by unskilled individuals contributes to maternal and neonatal deaths in developing countries. It also increases the risks of long-term maternal morbidities such as uterine prolapse, pelvic inflammatory disease, fistula, incontinence and infertility. This study aimed to determine the trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016.

METHODS

This study USED used the Ethiopia Demographic and Health Survey data for the years 2000 (n = 10,873), 2005 (n = 9,861), 2011 (n = 11,654) and 2016 (n = 10,641) to estimate the trends in the use of unskilled birth attendants. Multinomial logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent and outcome outcome variables.

RESULTS

The analysis revealed that while births attended by Traditional Birth Attendants (TBAs) increased from 28% in 2000 to 42% in 2016, home deliveries decreased slightly from 94% to 73%. Rural residence is associated with increased odds of using unskilled birth attendants. High and middle household wealth, educational status of the women and their partners (>primary), four or more antenatal care (ANC) visits, having any form of employment and mass media engagement were significantly associated with decreased odds of unskilled birth attendant utilization during child birth in Ethiopia.

CONCLUSIONS

The results of this analysis show that the proportion of Ethiopian women giving birth without a skilled attendant is high. Interventions aiming to improve skilled attendance during childbirth should focus on the individual, community and need factors of Anderson's behavioural model.

Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa

Background

Antenatal care utilization is one of the means for reducing the high maternal mortality rates in sub-Saharan Africa. This study examined the association between barriers to healthcare access and implementation of the 2016 WHO antenatal care services model among pregnant women seeking antenatal care in selected countries in sub-Saharan Africa.

Methods

This study considered only Demographic and Health Survey data collected in 2018 in sub-Saharan Africa. Hence, the Demographic and Health Survey data of four countries in sub-Saharan Africa (Nigeria, Mali, Guinea and Zambia) were used. A sample of 6761 from Nigeria, 1973 from Mali, 1690 from Guinea and 1570 from Zambia was considered. Antenatal care visits, categorized as < 8 visits or ≥8 visits, and time of the first antenatal care visit, categorized as ≤3 months or > 3 months (as per the WHO recommendations) were the outcome variables for this study. Both descriptive statistics and ordinal logistic regression were used to analyze the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values < 0.05 were used for the interpretation of results.

Results

With timing of antenatal care visits, getting money needed for treatment (aOR = 1.38, 95% CI = 1.03–1.92) influenced early timing of antenatal care visits in Mali whereas getting permission to visit the health facility (aOR = 1.62, 95% CI = 1.15–2.33) motivated women to have early timing of antenatal care visits in Guinea. We found that women who considered getting money needed for treatment as not a big problem in Nigeria were more likely to have the recommended number of antenatal care visits (aOR = 1.38, 95% CI= 1.11–1.73). On the contrary, in Guinea, Zambia and Mali, getting permission to visit health facilities, getting money for treatment, distance to the health facility and not wanting to go alone were not barriers to having ≥ 8 antenatal care visits.

Conclusion

Our study has emphasized the role played by barriers to healthcare access in antenatal care utilization across sub-Saharan African countries. There is the need for governmental and non-governmental organizations to ensure that policies geared towards improving the quality of antenatal care and promoting good interaction between health care seekers and health care providers are integrated within the health system.

Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data

BACKGROUND

Globally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea.

METHODS

Data for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression.

RESULTS

The results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and those whose partners had secondary/higher level of education (AOR=1.46, CI=1.22-1.75), women in the richest wealth quintile (AOR=5.09, CI=3.70-7.00), those with planned pregnancies (AOR=1.50, CI=1.23-1.81), Muslim women (AOR=1.65, CI=1.38-2.12), those who take healthcare decisions alone (AOR=1.53, CI=1.24-1.89), and those who listened to radio less than once a week (AOR= 1.30, CI=1.10-1.53) had higher odds of antenatal care uptake. Also, women with secondary/higher level of education (AOR=1.83, CI=1.25-2.68), those whose partners had secondary/higher level of education (AOR=1.40, CI=1.11-1.76), those in the richest wealth quintile (AOR=10.79, CI=6.64-17.51), those with planned pregnancies (AOR=1.25, CI=1.03-1.52), Christian women (AOR=4.13, CI=3.17-5.39), those living in urban areas (AOR=3.00, CI=2.29-3.94), women with one birth (AOR= 1.58, CI=1.20-2.06), those who take healthcare decisions alone (AOR=1.87, CI=1.46-2.39), those who read newspaper at least once a week (AOR= 1.19, CI=1.01-1.40), those who watched television at least once week (AOR=1.69, CI=1.30-2.19), and those in female-headed households (AOR=1.52, CI=1.20-1.92) were more likely to utilize the services of skilled birth attendants.

CONCLUSION

The study proved that various socio-economic and contextual factors influence antenatal care and skilled birth attendance in Guinea. These findings suggest the need to design community-based interventions (e.g., miniature local ANC clinics, early screening services) that prioritize women's education and vocational training, media accessibility, especially among the poor, and those residing in rural settings. Such interventions should not ignore the influence of other socio-cultural norms that hinder the utilization of antenatal care and skilled birth attendance services in Guinea.

Prevalence and determinants of the place of delivery among reproductive age women in sub-Saharan Africa

Introduction

Maternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA.

Materials and methods

This was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA.

Results

The overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57–0.61) of delivering at a health facility compared with urban women.

Conclusions

Our findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women.

Correlates of antenatal care usage among adolescent mothers in Nigeria: a pooled data analysis

This study examined selected correlates of timing and frequency of antenatal care visits among adolescent mothers aged 15-19 in Nigeria. Data from the women's recode dataset of the Nigeria Demographic and Health Surveys between 2003 and 2018 were pooled, with a sample size of 4,775. Multivariate data analysis was carried out using binary logistic regression. It was found that being educated (aOR = 1.54; CI = 1.14-2.08; aOR = 1.64; CI = 1.11-2.42); higher wealth status (aOR = 1.88; CI = 1.45-2.43; aOR = 1.92; CI = 1.33-2.76); contributing to health decision-making (aOR = 1.44, CI = 1.15-1.81); having an educated partner (aOR = 1.73; CI = 1.31-2.30; aOR = 2.44; CI = 1.84-3.25); and living in the South West region (aOR = 3.68; CI = 1.72-7.87) were associated with higher complete antenatal care utilization. Having difficulty getting permission to go to the health facility (aOR = 0.75, CI = 0.57-0.99) and with the distance to the health facility (aOR = 0.61, CI = 0.49-0.75) were associated with lower likelihood of ANCU. Respondents with secondary and higher education were more likely to start ANC early (aOR = 1.57, CI = 1.05-2.34), but Muslim mothers (aOR = 0.61, CI = 0.40-0.32) and those living in the North West (aOR = 0.43, CI = 0.26-0.71), South-South (aOR = 0.30, CI = 0.17-0.53) and South West (aOR = 0.29, CI = 0.12-0.69) were less likely to begin ANC early. Therefore, interventions to increase antenatal care must be region-specific, and focus attention on lower status adolescent mothers with less autonomy.

Determinants of Access to Health Care Among Women in East African Countries: A Multilevel Analysis of Recent Demographic and Health Surveys from 2008 to 2017

BACKGROUND

Access to essential health care is one of the major factors associated with maternal mortality. In developing countries, improving women's access to health care has significantly reduced maternal death. Therefore, this study aimed to identify the determinants of access to health care among women in East African countries based on 2008 to 2017 Demographic and Health Surveys (DHSs).

METHODS

This study used secondary data from 2008 to 2017 DHSs of 12 East African countries. A two-level mixed-effects logistic regression analysis was employed to determine the variables associated with women's access to maternal health care. The adjusted odds ratios (AORs), 95% CI, and P-value were computed. Variables with P<0.05 were considered as determinants of access to maternal health care.

RESULTS

A total of 148,483 study participants were included in this study. Women who accessed health care were 64,218 (42.91%) in the region. The study revealed that access to women's health care was positively associated with factors; being educated women, having an educated husband, being from households with middle and richest wealth status, and living in different countries compared to Comoros. The study also revealed that living in a rural setting and having unplanned pregnancy were barriers to access to health care.

CONCLUSION AND RECOMMENDATION

Women in East Africa countries have poor access to maternal health care. Residence, maternal education, husband education, income, and planned pregnancy were the predictors of access to health care. Therefore, there should be a common strategy to enhance the accessibility of health service utilization among women in the region and financial support for the poor that enables women to use health services. For better health care access, increasing the awareness of women and their partners about the significance of utilization of healthcare service focusing on uneducated persons are crucial activities.

Individual-, household-, and community-level factors associated with eight or more antenatal care contacts in Nigeria: Evidence from Demographic and Health Survey

INTRODUCTION

Antenatal care (ANC) is a vital mechanism for women to obtain close attention during pregnancy and prevent death-related issues. Moreover, it improves the involvement of women in the continuum of health care and to survive high-risk pregnancies. This study was conducted to determine the prevalence of and identify the associated factors of eight or more ANC contacts in Nigeria.

METHODS

We used a nationally representative cross-sectional data from Nigeria Demographic and Health Survey-2018. A total sample of 7,936 women were included in this study. Prevalence was measured in percentages and the factors for eight or more ANC contacts were examined using multilevel multivariable binary logistic regression model. The level of significance was set at P<0.05.

RESULTS

The prevalence of eight or more ANC contacts in Nigeria was approximately 17.4% (95% CI: 16.1%-18.7%). Women with at least secondary education were 2.46 times as likely to have eight or more ANC contacts, when compared with women with no formal education. Women who use media were 2.37 times as likely to have eight or more ANC contacts, when compared with women who do not use media. For every unit increase in the time (month) of ANC initiation, there was 53% reduction in the odds of eight or more ANC contacts. Rural women had 60% reduction in the odds of eight or more ANC contacts, when compared with their urban counterparts. Women from North East and North West had 74% and 79% reduction respectively in the odds of eight or more ANC contacts, whereas women from South East, South South and South West were 2.68, 5.00 and 14.22 times respectively as likely to have eight or more ANC contacts when compared with women from North Central.

CONCLUSION

The coverage of eight or more ANC contacts was low and can be influenced by individual-, household-, and community-level factors. There should be concerted efforts to improve maternal socioeconomic status, as well as create awareness among key population for optimal utilization of ANC.