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Ahmed R, Gebre S, Demelash M, Belachew T, Mohammed A, Musema A, Sultan M. The continuum of care for maternal health in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0305780. [PMID: 39024369 PMCID: PMC11257265 DOI: 10.1371/journal.pone.0305780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/04/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The continuum of care for maternal health (COCM) is a critical strategy for addressing preventable causes of maternal and perinatal mortality. Despite notable progress in reducing maternal and infant deaths globally, the problem persists, particularly in low-resource settings. Additionally, significant disparities in the provision of continuous care exist both between continents and within countries on the same continent. This study aimed to assess the pooled prevalence of completion across the maternity care continuum in Africa and investigate the associated factors. METHODS Relevant articles were accessed through the EMBASE, CINAHL, Cochrane Library, PubMed, HINARI, and Google Scholar databases. Funnel plots and Egger's test were employed to assess publication bias, while the I-squared test was used to evaluate study heterogeneity. The inclusion criteria were limited to observational studies conducted exclusively in Africa. The quality of these studies was assessed using the JBI checklist. Data extraction from the included studies was performed using Microsoft Excel and then analysed using Stata 16 software. RESULTS A total of 23 studies involving 74,880 mothers met the inclusion criteria. The overall prevalence of women who successfully completed the COCM was 20.9% [95% CI: 16.9-25.0]. Our analysis revealed several factors associated with this outcome, including urban residency [OR: 2.3; 95% CI: 1.6-3.2], the highest wealth index level [OR: 2.1; 95% CI: 1.4-3.0], primiparous status [OR: 1.3; 95% CI: 2.2-5.1], planned pregnancy [OR: 3.0; 95% CI: 2.3-3.7], and exposure to mass media [OR: 2.7; 95% CI: 1.9-3.8]. CONCLUSION The study revealed that only 20.9% of women fully completed the COCM. It also identified several factors associated with completion of the COCM, such as residing in urban areas, possessing a higher wealth index, being a first-time mother, experiencing a planned pregnancy, and having access to mass media. Based on the study's findings, it is recommended that targeted interventions be implemented in rural areas, financial assistance be provided to women with lower wealth index levels, educational campaigns be conducted through mass media, early antenatal care be promoted, and family planning services be strengthened. REVIEW REGISTRATION PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42020205736).
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Affiliation(s)
- Ritbano Ahmed
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Solomon Gebre
- Department of Laboratory, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Minychil Demelash
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tamiru Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abdurezak Mohammed
- Department of Laboratory, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abdulhakim Musema
- Department of Laboratory, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Mohammed Sultan
- Department of Statistics, Collage of Natural and Computational Science, Wachemo University, Hosanna, Ethiopia
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Alemayehu G, Birhanu S, Alemayehu A, Mulatu T. Completion and predictors of maternity continuum of care among women in the post-partum period in Gedeb district, southern Ethiopia: A community based cross-sectional study. PLoS One 2024; 19:e0303380. [PMID: 38885256 PMCID: PMC11182525 DOI: 10.1371/journal.pone.0303380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Maternal and neonatal complications related to pregnancy and childbirth pose a significant risk of morbidity and mortality to both the mother and the child. Despite its benefits in reducing maternal and neonatal mortality and morbidity associated with pregnancy and childbirth, the majority of Ethiopian mothers were dropped from the maternal continuum of care. Furthermore, there is a dearth of data regarding the status of the maternal continuum of care and its underlying factors in southern Ethiopia. OBJECTIVE This study aimed to assess the completion of the maternity continuum of care and its predictors among postpartum women who had given birth in the previous six months in the Gedeb district of Gedio Zone, southern Ethiopia. METHODS A community-based cross-sectional survey was conducted among 625 postpartum women selected by simple random sampling from June 1 to 30, 2022. The data was collected through face-to-face interviews using pretested, structured questionnaires. The association between the explanatory variables and the maternity continuum of care was examined using bivariate and multivariable logistic regression models. The adjusted odds ratio (AOR) with a 95% confidence interval was employed to measure the strength of association and the level of significance was set at p<0.05. RESULTS In this study, only 32.00% (95% CI: 28.45, 35.77) of the women completed the maternal continuum of care. Attending primary education (AOR = 2.09; 95% CI: 1.23, 3.55), secondary and above education (AOR = 1.97; 95% CI: 1.01, 3.87), receiving counseling during ANC (AOR = 1.89; 95% CI: 1.22, 2.92), being well prepared for birth and complications readiness (AOR = 4.13; 95% CI: 2.23, 7.62), and having good knowledge of pregnancy danger signs (AOR = 4.13; 95% CI: 2.60, 6.55) were all significantly associated with completing the maternity continuum of care. CONCLUSION Nearly one-third of the women completed the maternity continuum of care. Enhancing women's knowledge, offering counseling during prenatal visits, ensuring women's awareness of pregnancy danger signs, and implementing health promotion programs targeted at enhancing birth preparedness and complications readiness for all are crucial.
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Affiliation(s)
- Gemechu Alemayehu
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Simon Birhanu
- College of Health Science, Debark University, Debark, Ethiopia
| | - Afework Alemayehu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Saito A, Kondo M. Continuum of care for maternal and child health and child undernutrition in Angola. BMC Public Health 2024; 24:680. [PMID: 38439029 PMCID: PMC10910721 DOI: 10.1186/s12889-024-18144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status. METHODS We used nationally representative data from the Angola 2015-2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels. RESULTS The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight. CONCLUSIONS The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
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Affiliation(s)
- Akiko Saito
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan
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Habte A, Tamene A, Tesfaye L. Towards a positive postnatal experience in Sub-Saharan African countries: the receipt of adequate services during the immediate postpartum period: a multilevel analysis. Front Public Health 2023; 11:1272888. [PMID: 38155886 PMCID: PMC10753759 DOI: 10.3389/fpubh.2023.1272888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Background Existing studies in the Sub-Saharan African (SSA) region have focused mainly on the frequency of postnatal visits, with little emphasis on the adequacy of care provided during visits. Hence, this study aimed to investigate the magnitude of receiving an adequate number of World Health Organization-recommended contents of care during the immediate postpartum visit, and its predictors in SSA countries. Methods The appended women file of the most recent (2016-2021) standardized Demographic and Health Survey report of eighteen Sub-Saharan African countries with a weighted sample of 56,673 women was used for the study. The influence of each predictor on the uptake of adequate postnatal care has been examined using multilevel mixed-effects logistic regression. Significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI). Results The pooled prevalence of adequate postnatal care service uptake was found to be 42.94% (95% CI: 34.14, 49.13). Living in the southern sub-region (aOR = 3.08 95% CI: 2.50, 3.80), institutional delivery (aOR = 3.15; 95% CI: 2.90, 3.43), early initiation of ANC (aOR = 1.74; 95% CI: 1.45, 2.09), quality of antenatal care (aOR = 1.59; 95% CI: 1.42, 1.78), Caesarean delivery (aOR = 1.59; 95% CI: 1.42, 1.78), autonomy in decision-making (aOR = 1.30; 95% CI: 1.11, 1.39), high acceptance toward wife beating attitude (aOR = 0.83; 95% CI: 0.73, 0.94), and reading newspapers (aOR = 1.37; 95% CI: 1.21, 1.56) were identified as predictors of receiving adequate postnatal services during the immediate postpartum period. Conclusion The findings revealed low coverage of adequate postnatal care service uptake in the region. The Federal Ministry of Health and healthcare managers in each country should coordinate their efforts to develop interventions that promote women's empowerment to enhance their autonomy in decision-making and to reduce attitudes towards wife beating. Healthcare providers ought to strive to provide skilled delivery services and early initiation of antenatal care.
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Affiliation(s)
- Aklilu Habte
- School of Public Health College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. Int J Equity Health 2023; 22:239. [PMID: 37978385 PMCID: PMC10656898 DOI: 10.1186/s12939-023-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ensuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa. METHODS We analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care. RESULTS We included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care. CONCLUSIONS Persistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Health Systems and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Abdo R, Demelash M, Seid AM, Mussema A. First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors. BMC Pregnancy Childbirth 2023; 23:742. [PMID: 37858033 PMCID: PMC10585910 DOI: 10.1186/s12884-023-06034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa. METHODS Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger's test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis. RESULTS A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3-41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5-3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2-1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4-2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2-2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5-2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7-2.1; I2 = 94.4%). CONCLUSION Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).
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Affiliation(s)
- Ritbano Abdo
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
| | - Minychil Demelash
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abdulrezak Mohammed Seid
- Department of Medical Laboratory, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Abdulhakim Mussema
- Department of Medical Laboratory, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Birhanu F, Yitbarek K, Woldie M. Client retention in the continuum of maternal health services in Ethiopia. BMC Health Serv Res 2023; 23:569. [PMID: 37268946 DOI: 10.1186/s12913-023-09602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Even though the global maternal mortality has shown an impressive decline over the last three decades, the problem is still pressing in low-income countries. To bring this to an end, women in a continuum of maternity care should be retained. This study aimed to assess the status of Ethiopian women's retention in the continuum of maternity care with their possible predictors. METHODS We used data from the 2019 Ethiopian Mini-Demographic and Health Survey. The outcome variable in this study was retention in the continuum of maternity care, which consists of at least four ANC contacts, delivery in a health facility, and postnatal check within 48 h of delivery. We analyzed the data using STATA version 14 and a binary logistic regression model was used. In the multiple logistic regression model, variables with a p-value ≤ 0.05 were considered as significantly associated with the outcome variable. A weighted analysis was also done. RESULTS Of the 3917 women included in this study, only 20.8% of women completed all of the recommended services. Besides, the use of maternal health services favors women living in the biggest city administrations, followed by women living in agrarian regions; however, those living in the pastoralist area were disadvantaged. Having four or more ANC was explained by the maternal secondary level of education [AOR: 2.54; 95% CI: 1.42, 4.54], wealth status [AOR: 2.59; 95% CI: 1.45, 4.62], early initiation of ANC [AOR: 3.29; 95% CI: 2.55, 4.24], and being in a union [AOR: 1.95; 95% CI: 1.16,3.29]. After having four ANC, factor-affecting delivery in a health facility was wealth status [AOR: 8.64; 95% CI: 4.07, 18.36]. The overall completion of care was associated with women's higher level of education [AOR: 2.12; 95% CI: 1.08, 4.25], richest wealth status [AOR: 5.16; 95% CI: 2.65, 10.07], timeliness of the first ANC visit [AOR: 2.17; 95% CI: 1.66, 2.85], and third birth order [AOR: 0.58; 95% CI: 0.35, 0.97]. CONCLUSIONS Despite the efforts by the Ethiopian government and other stakeholders, the overall completion of care was quite low. There is also a clear inequality because of women's background characteristics and regional variation. Strategies aiming to empower women through improved educational experience and economic standing have to be implemented in collaboration with other relevant sectors.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, P.O.B. 260, Mizan-Aman, Ethiopia.
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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Chen JW, Shlobin NA, Bhebhe A, Zhao S, Shannon CN, Sichizya K, Bonfield CM, Reynolds RA. Local conceptions of the role of folate in neural tube defects in Zambia. J Neurosurg Pediatr 2023; 31:268-274. [PMID: 36681960 DOI: 10.3171/2022.11.peds22217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In sub-Saharan Africa, neural tube defects (NTDs) are the second most common birth defect, occurring eight times more frequently than in the US. The objective of this study was to assess baseline Zambian caregiver understanding of folate and NTDs and the effectiveness of an NTD prevention educational program. METHODS This prospective survey-based study included Zambian caregivers of children born with NTDs who completed pre- and post-educational program surveys between January 2020 and January 2021. The verbal survey was administered in English or local Zambian dialects. The 1-hour educational program administered by local Zambian research nurses sought to facilitate understanding of the direct relationship between prenatal folate supplementation and NTDs. RESULTS Sixty-one eligible caregivers with a median age of 20 (IQR 24-29) years completed the survey. Participants were predominantly from regions outside of Lusaka Province (68%, 41/60) rather than the capital city, Lusaka (32%, 19/60). Most had received prenatal care (91%, 57/61), and 80% (47/59) reported folate use in pregnancy. Of the mothers who took folate during pregnancy, 24% (11/45) reported use within the first 4 weeks after conception, while 76% (34/45) started thereafter. Myelomeningocele was the most common NTD (74%, 32/43), followed by meningocele (14%, 6/43). Prior to the educational program, 52% (29/56) of caregivers reported that NTDs were caused by a vitamin deficiency, which improved to 98% (55/56) after the program (p < 0.001). Furthermore, only 54% (33/61) of caregivers believed that folate should be taken before conception on the baseline survey evaluation, which improved to 95% (58/61, p < 0.001) after the program. All survey participants (58/58) found the educational session helpful. CONCLUSIONS This study found that a high proportion of Zambian caregivers had received prenatal care and even had taken folate during pregnancy, but none had taken it prior to pregnancy. An educational program effectively improved understanding about the role and timing of perinatal folate administration in NTD prevention. This result also emphasizes the need for folate fortification and folate education for not only mothers but also primary care providers.
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Affiliation(s)
- Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville, Tennessee
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Nathan A Shlobin
- 3Northwestern University School of Medicine, Northwestern University, Chicago, Illinois
| | - Arnold Bhebhe
- 4Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Shilin Zhao
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
- 5Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- 6Department of Neurological Surgery, University of Alabama, Birmingham, Alabama
| | | | - Christopher M Bonfield
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
- Departments of8Neurological Surgery and
- 9Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Yalew M, Molla A, Bogale GG, Birhane T, Arefaynie M, Damtie Y, Kefale B, Adane B. Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis. BMC Womens Health 2023; 23:79. [PMID: 36823622 PMCID: PMC9948476 DOI: 10.1186/s12905-023-02229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.
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Affiliation(s)
- Melaku Yalew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
| | - Asiressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getahun Gebre Bogale
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Birhane
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Sserwanja Q, Mukunya D, Musaba MW, Mutisya LM, Kamara K, Ziaei S. Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey. BMC Health Serv Res 2023; 23:109. [PMID: 36732806 PMCID: PMC9893537 DOI: 10.1186/s12913-023-09122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone. METHODS We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities. RESULTS The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization. CONCLUSION These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Public Health, Busitema University, Mbale, Uganda ,Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Linet M. Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Kassim Kamara
- grid.463455.50000 0004 1799 20697National Disease Surveillance Programme, Ministry of Health and Sanitation, Free Town, Sierra Leone
| | - Shirin Ziaei
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Sheffel A, Tampe T, Katwan E, Moran AC. Development of indicators for integrated antenatal care service provision: a feasibility study in Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone. BMJ Open 2023; 13:e065358. [PMID: 36731934 PMCID: PMC9896237 DOI: 10.1136/bmjopen-2022-065358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES While service integration has gained prominence as an objective of many global initiatives, there is no widely recognised single definition of integration nor a clear understanding of how programmes are integrated into health systems to achieve improved health outcomes. This study aims to review measurement approaches for integrated antenatal care (ANC) services, propose and operationalise indicators for measuring ANC service integration and inform an integrated ANC indicator recommendation for use in low-income and middle-income countries (LMICs). DESIGN Feasibility study. SETTING Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone. METHODS Our six-step approach included: (1) conceptualise ANC service integration models; (2) conduct a targeted literature review on measurement of ANC service integration; (3) develop criteria for ANC service integration indicators; (4) propose indicators for ANC service integration; (5) use extant data to operationalise the indicators; and (6) synthesise information to make an integrated ANC indicator recommendation for use in LMICs. RESULTS Given the multidimensionality of integration, we outlined three models for conceptualising ANC service integration: integrated health systems, continuity of care and coordinated care. Looking across ANC service integration estimates, there were large differences between estimates for ANC service integration depending on the model used, and in some countries, the ANC integration indicator definition within a model. No one integrated ANC indicator was consistently the highest estimate for ANC service integration. However, continuity of care was consistently the lowest estimate for ANC service integration. CONCLUSIONS Integrated ANC services are foundational to ensuring universal health coverage. However, our findings demonstrate the complexities in monitoring indicators of ANC service quality using extant data in LMICs. Given the challenges, it is recommended that countries focus on monitoring measures of service quality. In addition, efforts should be made to improve data collection tools and routine health information systems to better capture measures of service integration.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tova Tampe
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneve, Switzerland
| | - Elizabeth Katwan
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneve, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneve, Switzerland
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Gebremedhin AF, Dawson A, Hayen A. Determinants of continuum of care for maternal, newborn, and child health services in Ethiopia: Analysis of the modified composite coverage index using a quantile regression approach. PLoS One 2023; 18:e0280629. [PMID: 36662768 PMCID: PMC9858465 DOI: 10.1371/journal.pone.0280629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Maternal and child mortality remain unacceptably high in the Sustainable Development Goals era. Continuum of care has become a key strategy for improving the health of mothers and newborns. Previous research on the continuum of care in Ethiopia is often limited to maternal health services. Maternal and child health services are inseparably linked, and an integrated approach to care is essential. This study assessed the continuum of maternal, newborn, and child health care and associated factors in Ethiopia. The analysis was based on the 2016 Ethiopian Demographic and Health Survey data. We restricted our analysis to women with their most recent children-alive and living with their mother- aged 12-23 months at the time of the survey (n = 1891). The modified composite coverage index, constructed from twelve maternal and child health services, was calculated as an indicator of the continuum of care. Bivariable and multivariable quantile regression were used to analyse the relationship between the predictors and specific quantiles of the composite coverage index. The effect of each variable was examined at the 10th, 25th, 50th, 75th, and 95th quantiles. The results showed that the average composite coverage index value was 39%. The overall completion rate of the continuum of care was low (2%). Four % of the women did not receive any of the services along the continuum of care. Postnatal care for newborns had the lowest coverage (12%). This study provides evidence that factors such as the educational status of women, region, residence, socio-economic status, perceived distance to a health facility, pregnancy intention, mode of delivery, parity, and early antenatal care initiation influence the continuum of care differently across levels of the composite coverage index. The findings call for integrated and targeted strategies that aim to improve the continuum of care considering the determinants.
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Affiliation(s)
- Aster Ferede Gebremedhin
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
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Buli TD, Wakgari N, Ganfure G, Wondimu F, Dube DL, Moti G, Doba YS. Completion of the continuum of maternity care and associated factors among women who gave birth in the last 6 months in Chelia district, West Shoa zone, Ethiopia: A community-based cross-sectional study. Front Public Health 2023; 10:1026236. [PMID: 36684973 PMCID: PMC9845613 DOI: 10.3389/fpubh.2022.1026236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background The continuum of maternity care is a continuity of care that a woman receives during pregnancy, childbirth, and the postpartum period from skilled providers in a comprehensive and integrated manner. Despite existing evidence regarding maternal healthcare services discretely, the continuum of maternity care and its associated factors are not well-known in Ethiopia. Objective This study assessed the completion of the maternity continuum of care and associated factors among women who gave birth 6 months prior to the study in the Chelia district. Methods A community-based cross-sectional study with a stratified random sampling technique was conducted among 428 mothers at 10 randomly selected kebeles. Pretested and structured questionnaires were used to collect data. Bi-variable and multivariable logistic regression analyzes were performed to identify associated factors. Adjusted odds ratio with its 95% confidence interval was used to determine the degree of association, and statistical significance was declared at a p-value of <0.05. Results In this study, 92 (21.5%) mothers completed the continuum of maternity care. Secondary and above education of mothers (AOR = 4.20, 95% CI:1.26-13.97), ≤30 min spent on walking by foot (AOR = 4.00, 95% CI: 1.67-9.58), using an ambulance to reach health facility (AOR = 3.68, 95% CI: 1.23-11.06), para ≥5 mothers (AOR = 0.21, 95% CI: 0.05-0.90), planned pregnancy (AOR = 3.29, 95% CI: 1.02-10.57), attending pregnant women's conference (AOR = 13.96, 95% CI: 6.22-31.30), early antenatal care booking (AOR = 3.30, 95% CI: 1.54-7.05), accompanied by partners (AOR = 3.64, 95% CI: 1.76-7.53), and informed to return for postnatal care (AOR = 3.57, 95% CI: 1.47-8.70) were the factors identified. Conclusion In this study, completion of the maternity continuum of care was low. Therefore, appropriate strategic interventions that retain women in the continuum of maternity care by targeting those factors were recommended to increase the uptake of the continuum of maternity care.
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Affiliation(s)
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gemechu Ganfure
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Fikadu Wondimu
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dereje Lemma Dube
- Department of Obstetrics and Gynecology, Ambo University Referral Hospital, Ambo, Ethiopia
| | - Gonfa Moti
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Yonas Sagni Doba
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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14
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Tenaw SG, Tsega D, Zewudie BT, Chekole B, Eniyew MA, Mesfin Y. Completion of the maternal continuum of care and its association with antenatal care attendance during previous pregnancy among women in rural areas of the Gurage Zone, Southwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e066536. [PMID: 36351709 PMCID: PMC9644349 DOI: 10.1136/bmjopen-2022-066536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The maternal continuum of care is a cost-effective intervention to prevent pregnancy and childbirth-related maternal and neonatal mortality and morbidity. This study aimed to investigate the prevalence of completion of the maternal continuum of care and its association with antenatal care (ANC) attendance during previous pregnancy among women in rural kebeles of Gurage Zone, Southwest Ethiopia. DESIGN A community-based cross-sectional study. SETTING The study took place in 12 rural kebeles of the Gurage Zone from 1 April 2022 to 12 May 2022. PARTICIPANTS Randomly selected 497 women who gave birth in the previous 12 months in rural kebeles of the Gurage Zone. OUTCOME The outcome of this study was the prevalence of completion of the maternal continuum of care. RESULTS Overall, the prevalence of completion of the maternal continuum of care was 15.5% (95% CI: 12.55% to 18.9%). After adjusting for potential confounders, having ANC attendance during a previous pregnancy (adjusted OR (AOR): 2.01; 95% CI: 1.07 to 3.76) was positively associated with the completion of the maternal continuum of care. In addition, having access to ambulance service as a means of transportation (AOR: 6.01; 95% CI: 3.16 to 11.39) and exposure to mass media (AOR: 2.43; 95% CI: 1.27 to 4.68) were positively associated with completion of the maternal continuum of care. CONCLUSION The prevalence of completion of the maternity continuum of care was unacceptably low in this study. This result indicates that the women did not receive the maximum possible health benefit from existing maternal healthcare services. The completion of the maternal continuum of care was affected by ANC attendance in a previous pregnancy. Therefore, interventions that can strengthen ANC are crucial in the maternal continuum of the care pathway.
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Affiliation(s)
| | - Daniel Tsega
- Midwifery, Wolkite University, Welkite, Ethiopia
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15
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Sserwanja Q, Gatasi G, Musaba MW. Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey. BMC Pregnancy Childbirth 2022; 22:781. [PMID: 36261801 PMCID: PMC9583497 DOI: 10.1186/s12884-022-05109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda. METHODS We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression. RESULTS Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95). CONCLUSION We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.
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Affiliation(s)
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Ministry of Education, Southeast University, 210009, Nanjing, Jiangsu Province, China
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
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Sserwanja Q, Musaba MW, Kamara K, Mutisya LM, Mukunya D. Status of the latest 2016 World Health Organization recommended frequency of antenatal care contacts in Sierra Leone: a nationally representative survey. BMC Health Serv Res 2022; 22:1208. [PMID: 36171575 PMCID: PMC9520872 DOI: 10.1186/s12913-022-08594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Timely and increased frequency of quality antenatal care (ANC) contacts is one of the key strategies aimed at decreasing maternal and neonatal deaths. In 2016, the World Health Organization (WHO) revised the ANC guidelines to recommend at least eight ANC contacts instead of four. This study aimed to determine the proportion of women who received eight or more ANC contacts and associated factors in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 5,432 women aged 15 to 49 years who had a live birth, within three years preceding the survey. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to identify factors associated with utilisation of eight or more ANC contacts using SPSS version 25 complex samples package. Results Out of 5,432 women, 2,399 (44.8%) (95% CI: 43.1–45.7) had their first ANC contact in the first trimester and 1,197 (22.0%) (95% CI: 21.2–23.4) had eight or more ANC contacts. Women who had their first ANC contact after first trimester (adjusted odds ratio, aOR, 0.58, 95% CI 0.49–0.68) and women aged 15 to 19 years had less odds of having eight or more contacts (aOR 0.64, 95% CI 0.45 to 0.91). Working (aOR 1.33, 95%CI 1.10 to 1.62) and wealthier women had higher odds of having eight or more contacts compared to poorer ones and those not working respectively. Women residing in the southern region, those using internet and less parous (less than five) women were associated with higher odds of having eight or more ANC contacts. Women who had no big problem obtaining permission to go health facilities also had higher odds of having eight or more ANC contacts compared to those who had big problems. Conclusion Sierra Leone’s adoption of eight or more ANC contacts is low and less than half of the women initiate ANC in the first trimester. To ensure increased access to recommended ANC visits, timely ANC should be encouraged. Attributes of women empowerment such as workings status, socio-economic status, and decision-making should also be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08594-y.
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Affiliation(s)
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - David Mukunya
- Department of Public Health, Busitema University, Mbale, Uganda.,Department of Research, Nikao Medical Center, Kampala, Uganda
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Kawuki J, Gatasi G, Sserwanja Q. Prevalence of adequate postnatal care and associated factors in Rwanda: evidence from the Rwanda demographic health survey 2020. Arch Public Health 2022; 80:208. [PMID: 36114556 PMCID: PMC9482265 DOI: 10.1186/s13690-022-00964-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/02/2022] [Indexed: 12/30/2022] Open
Abstract
Background Although quality postnatal care (PNC) is a known significant intervention for curbing maternal and newborn morbidity and mortality, it is underutilized in most developing countries including Rwanda. Thus, it is crucial to identify factors that facilitate or occlude receipt of adequate PNC. This study aimed at assessing the prevalence of adequate PNC content and the associated factors in Rwanda. Methods We used weighted data from the Rwanda Demographic and Health Survey (RDHS) of 2020, comprising of 4456 women aged 15–49 years, who were selected using multistage sampling. Adequate PNC was considered if a woman had received all of the five components; having the cord examined, temperature of the baby measured, counselling on newborn danger signs, counselling on breastfeeding and having an observed breastfeeding session. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS version 25. Results Out of the 4456 women, 1974 (44.3, 95% confidence interval (CI): 43.0–45.9) had received all the PNC components. Having no radio exposure (adjusted odds ratio (AOR) =1.41, 95% CI: 1.18–1.68), visited by a fieldworker (AOR = 1.35, 95% CI: 1.16–1.57), no big problem with distance to a health facility (AOR = 1.50, 95% CI:1.24–1.81), and residing in the Southern region (AOR = 1.75, 95% CI: 1.42–2.15) were associated with higher odds of adequate PNC compared to their respective counterparts. However, having no exposure to newspapers/magazines (AOR = 0.74, 95% CI: 0.61–0.89), parity of less than 2 (AOR = 0.67, 95% CI: 0.51–0.86), being a working mother (AOR = 0.73, 95% CI: 0.62–0.85), no big problem with permission to seek healthcare (AOR = 0.54, 95% CI: 0.36–0.82), antenatal care (ANC) frequency of less than 4 times (AOR = 0.79, 95% CI: 0.62–0.85), inadequate ANC quality (AOR = 0.56, 95% CI: 0.46–0.68), and getting ANC in a public facility (AOR = 0.57, 95% CI: 0.38–0.85) were associated with lower odds of adequate PNC. Conclusions Less than half of the mothers in Rwanda had received adequate PNC, and this was associated with various factors. The results, thus, suggested context-specific evidence for consideration when rethinking policies to improve adequate PNC, including a need for intensified PNC education and counselling during ANC visits, continued medical education and training of PNC providers, and strengthening of maternal leave policies for working mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00964-6.
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18
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Sserwanja Q, Mutisya LM, Nuwabaine L, Kamara K, Mutebi RK, Musaba MW. Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey. ARCHIVES OF PUBLIC HEALTH = ARCHIVES BELGES DE SANTE PUBLIQUE 2022; 80:186. [PMID: 35945622 PMCID: PMC9364565 DOI: 10.1186/s13690-022-00946-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/27/2022] [Indexed: 12/26/2022]
Abstract
Introduction Globally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to assess the level of and factors associated with continuum of maternal and newborn care in Sierra Leone. Method This study analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey. Analysis was restricted to women who had a live birth in the 5 years preceding the survey (n = 7326). Complete continuum of care was considered when a woman reported having had at least eight antenatal care contacts, skilled birth attendance and mother and baby had at least one postnatal check-up. Bi-variable and multivariable logistic regression were performed using the statistical package for the social sciences software version 25. Results Only 17.9% (95% CI: 17.4–19.1) of the women utilized complete continuum of care for maternal and newborn health services in Sierra Leone. About 22% (95% CI: 21.3–23.1) utilized 8 or more antenatal care contacts, 88% (95% CI: 87.9–89.4) had skilled birth attendance while 90.7% (95% CI: 90.2–91.5) and 90.4% (95% CI: 89.9–91.2) of mothers and neonates utilized postnatal care respectively. Having started antenatal care within the first trimester (aOR 1.71, 95% CI: 1.46–2.00), being resident in the Southern region (aOR 1.85, 95% CI: 1.23–2.80), belonging to richer wealth quintile (aOR 1.76, 95% CI: 1.27–2.44), using internet (aOR 1.49, 95% CI: 1.12–1.98) and having no big problems seeking permission to access healthcare (aOR 1.34, 95% CI: 1.06–1.69) were significantly associated with utilization of continuum of care. Conclusion The overall completion of continuum of maternal care is low, with ANC being the lowest utilized component of continuum of care. These findings call for urgent attention for maternal health stakeholders to develop and implement tailored interventions prioritizing women empowerment, access to affordable internet services, timely initiation of ANC contacts, women in developed regions such as the Western and those from poor households.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Ronald K Mutebi
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.,Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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19
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Sserwanja Q, Nuwabaine L, Gatasi G, Wandabwa JN, Musaba MW. Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020. BMC Health Serv Res 2022; 22:812. [PMID: 35733151 PMCID: PMC9217119 DOI: 10.1186/s12913-022-08169-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. Methods We analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. Results Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95). Conclusion The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08169-x.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
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Sserwanja Q, Sepenu AS, Mwamba D, Mukunya D. Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey. BMJ Open 2022; 12:e052684. [PMID: 35701065 PMCID: PMC9198694 DOI: 10.1136/bmjopen-2021-052684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Teenage pregnancies and childbirths are associated with negative health outcomes. Access to health information enables adolescents to make appropriate decisions. However, the relationship between access to health information through mass media and teenage pregnancy has not received much attention in existing literature. We therefore examined the association between access to mass media and teenage pregnancy in Zambia. DESIGN Cross-sectional. SETTING Zambia. PARTICIPANTS Weighted sample of 3000 adolescents aged 15-19 years. OUTCOME MEASURE Teenage pregnancy that included adolescents who were currently pregnant or had had an abortion or had given birth in the last 5 years preceding the survey. RESULTS Out of 3000 adolescents, 897 (29.9%, 95% CI: 28.1% to 31.3%) were pregnant or had ever been pregnant. Majority of the adolescents resided in rural areas (55.9%) and had secondary education (53.6%). Adolescents who had exposure to internet, newspapers or magazines, radio and television were 10.5%, 22.6%, 43.1% and 43.1%, respectively. Adolescents who had daily access to newspapers or magazines (adjusted OR (AOR): 0.33, 95% CI: 0.13 to 0.82) or using internet (AOR: 0.54, 95% CI: 0.30 to 0.95) were less likely to be pregnant or to have had a pregnancy compared with those with no access to newspapers and internet, respectively. CONCLUSION Our study suggests that internet use and reading of newspapers or magazines may trigger behavioural change as an effective approach to reducing teenage pregnancy. Behavioural change communicators can implement mass media campaigns using newspapers, magazines and the internet to publicise adolescent health messages that can encourage adolescents to adopt healthy behaviours and prevent teenage pregnancies.
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Affiliation(s)
| | | | - Daniel Mwamba
- Programs Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - David Mukunya
- Department of Public Health, Busitema University, Tororo, Uganda
- Research Department, Sanyu Africa Research Institute, Mbale, Uganda
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21
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Dona A, Tulicha T, Arsicha A, Dabaro D. Factors influencing utilization of early postnatal care services among postpartum women in Yirgalem town, Sidama Regional State, Ethiopia. SAGE Open Med 2022; 10:20503121221088098. [PMID: 35342635 PMCID: PMC8943538 DOI: 10.1177/20503121221088098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Providing postnatal care services at right time could help to reduce maternal
and newborn deaths. Thus, this study aimed to assess the factors influencing
the utilization of early postnatal care services among postpartum women in
Yirgalem town, Sidama Regional State, Ethiopia. Methods: A community-based cross-sectional study was done using structured and
interviewer-administered questionnaires among randomly selected 306
postpartum women. Data were cleaned, coded, and entered into EpiData-3.1,
and exported to Statistical Package for Social Science-21 for analysis.
Descriptive statistics, bivariable, and multivariable logistic regression
analysis were done. A p-value ⩽ 0.05 was used to consider statistically
significant variables. Results: Generally, 202 (66.7%) visited a health facility for postpartum care. The
prevalence of early postnatal care service utilization was 45.5% (95%
confidence interval = 39.9–50.5). Mainly practiced services were physical
examination (37%) and family planning (31%) services. Having formal
education (adjusted odds ratio = 3.6; 95% confidence interval = 1.7–7.4),
having antenatal care (adjusted odds ratio = 3.5; 95% confidence
interval = 1.6–7.6), institutional delivery (adjusted odds ratio = 2.3; 95%
confidence interval = 1.2–4.7), and getting advice from healthcare provider
(adjusted odds ratio = 18.69; 95% confidence interval = 9.19–37.99) were
factors significantly associated with early postnatal care service
utilization. Conclusion: The practice of early postnatal care needs more attention in the study area.
Improving the educational status of the women, strengthening healthcare
providers’ counseling on the benefits of postnatal care, and inspiring
pregnant women to use antenatal care and institutional delivery services
will improve the use of postnatal care services on time.
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Affiliation(s)
- Aregahegn Dona
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Tsedeke Tulicha
- College of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Admasu Arsicha
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Desalegn Dabaro
- Department of Social and Population Health, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
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Sserwanja Q, Mufumba I, Kamara K, Musaba MW. Rural-urban correlates of skilled birth attendance utilisation in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey. BMJ Open 2022; 12:e056825. [PMID: 35351721 PMCID: PMC8961150 DOI: 10.1136/bmjopen-2021-056825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Understanding the rural-urban context-specific correlates of skilled birth attendance (SBA) is important to designing relevant strategies and programmes. This analysis aimed to assess for the rural-urban correlates of SBA in Sierra Leone. SETTING The latest nationally representative Sierra Leone Demographic and Health Survey of 2019. PARTICIPANTS The study included a weighted sample of 7326 women aged 15-49 years. Each of them had a live birth within 5 years prior to the survey (4531 in rural areas and 2795 women in urban areas). PRIMARY AND SECONDARY OUTCOME MEASURE SBA (primary) and predictors of SBA (secondary). RESULTS SBA was higher in urban areas at 94.9% (95% CI 94.1% to 95.7%) compared with 84.2% (95% CI 83.8% to 85.9%) in rural areas. Rural women resident in the Southern, Northern and Eastern regions, with postprimary education (adjusted OR (aOR) 1.8; 95% CI 1.3 to 2.5), exposure to mass media (aOR 1.5; 95% CI 1.1 to 1.9), not having difficulties with distance to the nearest health facility (aOR 2.3; 95% CI 1.7 to 3.0) were associated with higher odds of SBA. Urban women resident in the Southern, Eastern region, with households having less than seven members (aOR 1.5; 95% CI 1.1 to 2.3), exposure to mass media (aOR 1.8; 95% CI 1.1 to 2.9) and not having difficulties with distance to the nearest health facility (aOR 1.6; 95% CI 1.1 to 2.5) were associated with higher odds of SBA. CONCLUSION Given the observed differences, improving SBA requires programmes and strategies that are context-specific.
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Affiliation(s)
| | - Ivan Mufumba
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- CHILD Research Laboratory, Global Health Uganda, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Milton W Musaba
- Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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Continuum of care for maternal health in Uganda: A national cross-sectional study. PLoS One 2022; 17:e0264190. [PMID: 35202413 PMCID: PMC8870527 DOI: 10.1371/journal.pone.0264190] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction A continuum of maternal care approach can reduce gaps and missed opportunities experienced by women and newborns. We determined the level of coverage and factors associated with the continuum of maternal care in Uganda. Methods We used weighted data from the Uganda Demographic and Health Survey (UDHS) 2016. We included 10,152 women aged 15 to 49 years, who had had a live birth within five years preceding the survey. Stratified two-stage cluster sampling design was used to select participants. Continuum of maternal care was considered when a woman had at least four antenatal care (ANC) visits, had delivered in a health facility and they had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression analysis to determine factors associated with completion of the continuum of maternal care using SPSS version 25. Results The level of coverage of complete continuum of maternal care was 10.7% (1,091) (95% CI: 10.0–11.2). About 59.9% (6,080) (95% CI: 59.0–60.8) had four or more antenatal visits while 76.6% (7,780) (95% CI: 75.8–77.5) delivered in a health facility and 22.5% (2,280) (95% CI: 21.5–23.2) attended at least one postnatal care visit within six weeks. The following factors were associated with continuum of maternal care; initiating ANC in the first trimester (AOR 1.49, 95% CI: 1.23–1.79), having secondary level of education (AOR 1.60, 95% CI: 1.15–2.22) and tertiary level of education (AOR 2.08 95% CI: 1.38–3.13) compared to no formal education, being resident in Central Uganda (AOR 1.44, 95% CI:1.11–1.89), Northern Uganda (AOR 1.35, 95% CI: 1.06–1.71) and Western Uganda (AOR 0.61, 95% CI: 0.45–0.82) compared to Eastern Uganda, and exposure to newspapers and magazines. Conclusion The level of coverage of the complete continuum of maternal care was low and varied across regions. It was associated with easily modifiable factors such as early initiation of ANC, exposure to mass media and level of education. Interventions to improve utilisation of the continuum of maternal care should leverage mass media to promote services, especially among the least educated and the residents of Western Uganda.
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Sserwanja Q, Nabbuye R, Kawuki J. Dimensions of women empowerment on access to antenatal care in Uganda: A further analysis of the Uganda demographic health survey 2016. Int J Health Plann Manage 2022; 37:1736-1753. [PMID: 35178763 DOI: 10.1002/hpm.3439] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality. Most of the recent studies in Uganda have focussed on antenatal care (ANC) frequency and the associated factors with no focus on the effect of women empowerment. Our study aims at examining the prevalence of optimal access to ANC by considering the timing of initiation, type of ANC provider and ANC frequency and their association with women empowerment. METHODS We used Uganda Demographic and Health Survey 2016 data of 9957 women aged 15-49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and access to ANC using Statistical package for the social sciences version 25. RESULTS Out of 9957 women, 2953 (29.7%: 95% CI: 28.5.0-30.2) had initiated ANC in first trimester, 6080 (61.1%: 95% CI: 60.4-62.3) had 4 or more ANC contacts, and 9880 (99.2%: 95% CI: 99.0-99.3) had received ANC from a skilled provider. Overall, 2399 (24.1%: 95% CI: 23.0-24.6) had optimal access to ANC. Economic empowerment and exposure to media were the only women empowerment indices that were positively associated with optimal access to ANC. Other factors that were significant include; region, wealth index, age, level of education and working status. CONCLUSION To ensure increased access to ANC, policy-makers and other stakeholders should prioritise the use of mass media in maternal health programs, equitable allocation of the limited financial resources with a focus on older, poor and uneducated women.
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Affiliation(s)
| | | | - Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Centre for Health Behaviours Research, the Chinese University of Hong Kong, Hong Kong, China
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25
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Sserwanja Q, Nuwabaine L, Kamara K, Musaba MW. Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey. BMC Public Health 2022; 22:102. [PMID: 35031038 PMCID: PMC8760783 DOI: 10.1186/s12889-022-12494-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12494-5.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
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Sserwanja Q, Mutisya LM, Musaba MW. Exposure to different types of mass media and timing of antenatal care initiation: insights from the 2016 Uganda Demographic and Health Survey. BMC Womens Health 2022; 22:10. [PMID: 35012537 PMCID: PMC8751065 DOI: 10.1186/s12905-022-01594-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early initiation of antenatal care (ANC) within the first trimester is highly recommended in the current 2016 World Health Organization (WHO) guidelines. Mass media has the potential to promote early initiation of ANC because it has been used successfully in several programs. However, there is paucity of literature on the effect of exposure to different types of media on the timing of ANC initiation in Uganda. Our study aimed at exploring associations between exposure to different types of mass media and timing of ANC initiation among women in Uganda. METHODS We used a cross sectional study design, to conduct a secondary analysis of data collected in the 2016 Uganda Demographic and Health Survey (UDHS). We included weighted data of all the 10,152 women of reproductive age (15-49 years). Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the association between exposure to different types of mass media and early initiation of ANC. RESULTS Almost a third of the women (2953/10,152, 29.1%, 95% CI 27.9-29.6) initiated their first ANC contact in the first trimester. Women who listened to radio at least once a week (adjusted OR (aOR 1.14, 95% CI 1.01-1.30) and those who watched television less than once a week (aOR 1.28, 95% CI 1.07-1.53) had higher odds of initiating ANC earlier compared to their counterparts not exposed to radio and television respectively. CONCLUSION Exposure to radio and television is associated with timing of ANC initiation in Uganda. Importantly, the two types of mass media have the potential to reach women with low levels of education and encourage them to utilize maternal health services. The Ugandan government needs to prioritize and intensify the use of radio and television to promote the benefits associated with timing of ANC initiation.
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Affiliation(s)
- Quraish Sserwanja
- Programs Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - Linet M. Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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