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Rahaman M, Roy A, Chouhan P, Malik NI, Bashir S, Ahmed F, Tang K. Contextualizing the standard maternal continuum of care in Pakistan: an application of revised recommendation of the World Health Organization. Front Public Health 2024; 11:1261790. [PMID: 38274538 PMCID: PMC10809265 DOI: 10.3389/fpubh.2023.1261790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Objective This study utilizes recent nationally representative data to contextualize the standard maternal continuum of care (SMCoC) in Pakistan. The revised SMCoC framework encompasses at least eight antenatal care visits, skilled birth attendants during delivery, and postnatal care within 48 h of childbirth. Methods The study used a sample of 3,887 ever-married women aged 15-49 from the latest Pakistan Demographic and Health Survey (PDHS) conducted in 2017-18. Several statistical methods were employed: descriptive statistics, bivariate, multilevel logistic regression models, and Fairlie decomposition analysis. Results Only 12% of women had accessed full SMCoC services in Pakistan. Education and the wealth quintile emerged as pivotal factors influencing the utilization of SMCoC. The likelihood of full SMCC utilization was more likely among higher educated women (OR: 3.37; 95% CI: 2.16-5.25) and those belonging to the wealthiest household wealth quintile (OR: 4.95; 95% CI: 2.33-5.51). Media exposure, autonomy, healthcare accessibility, residence, and region were also identified as significant predictors of SMCoC utilization among women. Conclusion In conclusion, while most women did not utilize full SMCoC services in Pakistan, the pattern is substantially varied by background characteristics. Education, wealth quintile, mass media exposure, and autonomy were significant factors, along with geographical aspects such as healthcare accessibility and region. The study underscores the need for a multifaceted approach to ensure equitable access to full SMCoC services for women in Pakistan, addressing individual, socioeconomic, and geographical factors.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration and Urban Studies, International Institute for Population Sciences, Mumbai, India
| | - Avijit Roy
- Department of Geography, Malda College, Malda, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, India
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Shamshad Bashir
- Department of Psychology, Lahore Garrison University, Lahore, Pakistan
| | - Farooq Ahmed
- Department of Anthropology, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Belay DG, Alemu MB, Aragaw FM, Asratie MH. Time to initiation of antenatal care visit and its predictors among reproductive age women in Ethiopia: Gompertz inverse Gaussian shared frailty model. Front Glob Womens Health 2023; 4:917895. [PMID: 37854167 PMCID: PMC10579888 DOI: 10.3389/fgwh.2023.917895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Background Early initiation of antenatal care (ANC) is essential for the early detection of pregnancy-related problems and unfavorable pregnancy outcomes. However, a significant number of mothers do not initiate ANC at the recommended time. Therefore, this study aimed to determine the median time of ANC initiation and its predictors among reproductive-age women in Ethiopia. Methods We used the Ethiopian Demographic and Health Survey (EDHS) 2016 data set. The proportional hazard assumption was assessed using Schoenfeld residual test and log-log plot. A life table was used to determine the median survival time (time of ANC initiation). The Gompertz inverse Gaussian shared frailty model was the best-fitting model for identifying the predictors for the early initiation of ANC booking. Finally, the adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was used to determine the significance of predictors. Results A total of 7,501 reproductive-aged women gave recent birth in the last 5 years preceding the survey. Nearly three in five women [61.95% (95% CI: 60.85-63.04%)] booked their first ANC visit with a median time of 4.4 months. Women who attended primary education (AHR = 1.10, 95% CI: 1.01-1.20), secondary and above (AHR = 1.26, 95% CI: 1.11-1.44), media exposure (AHR = 1.07, 95% CI: 1.00-1.16), rich wealthy (AHR = 1.17, 95% CI: 1.06-1.30), grand multiparous (AHR = 0.82, 95% CI: 0.72-0.93), unwanted pregnancy (AHR = 0.88, 95% CI: 0.81-0.96), small periphery region (AHR = 0.58, 95% CI: 0.51-0.67), and rural residence (AHR = 0.86, 95% CI: 0.75-0.99) were significantly associated with first ANC visit. Conclusion According to this study, a significant number of women missed their first ANC visit. The education status of women, place of residence, region, wealth index, media exposure, unintended pregnancy, and multi-parity were significantly associated with the time of initiation of the first ANC visit. Therefore, policymakers should focus on improving the socioeconomic status (education, media coverage, and wealth) of reproductive-aged women by prioritizing women who live in small periphery regions and rural residences to improve the early initiation of ANC.
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Affiliation(s)
- Daniel Gashaneh Belay
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Birhanu Alemu
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lira Huq N, Ahmed A, Tahrin Islam T, Rahman F, Hanson M, Sayeed A, Nusrat N, Mazumder T, Golam Rasul K, Rahman Turza M, Abul Hasnath Siddique R, Hossain Sheikh A, Moshfiqur Rahman S, El Arifeen S. Community-based integrated intervention for skilled maternal health care utilization in riverine remote areas, Bangladesh. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100892. [PMID: 37542931 DOI: 10.1016/j.srhc.2023.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Despite the decrease in maternal mortality ratio, many women in Bangladesh are still at high-risk of death due to pregnancy-related morbidities. Increasing the rate of skilled maternal healthcare service utilization is effective to reduce maternal mortality rate. This paper examines the intervention effect of an integrated community-based maternal healthcare project implemented by a non-government organization, Friendship, aiming to provide maternal health services to women living in the remote riverine regions of Bangladesh. METHODS We examined the skilled maternal healthcare service utilization before and after project implementation of the mothers with birth experience of 0-6 months from the intervention (N = 1,304) and comparison areas (N = 1,304). A difference-in-differences logistic model measured the effect of the intervention. RESULTS After the intervention, mothers were three times more likely to receive ≥ 4 ANC visits from skilled providers (AOR: 2.9; 95 % CI: 2.1-4.2), 1.5 times more likely to have skilled birth attendants during deliveries (AOR: 1.5; 95 % CI: 1.1-2.1) and 1.5 times more likely to seek at least one PNC within 42 days after delivery (AOR: 1.5; 95 % CI: 1.1-2.2) as compared to the comparison group. CONCLUSION The intervention showed positive effect on improving the ANC coverage, skilled delivery, and PNC among the mothers residing the remote riverine areas. Therefore, it opens up the opportunity for adaptation of such integrated community and facility-based interventions by other LMICs.
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Affiliation(s)
- Nafisa Lira Huq
- BRAC James P Grant School of Public Health, Dhaka 1213, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden.
| | - Tanjeena Tahrin Islam
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Fariya Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Molly Hanson
- Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Abu Sayeed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Nowrin Nusrat
- North Carolina State University, Raleigh, NC 27695, United States
| | - Tapas Mazumder
- Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia
| | - Kazi Golam Rasul
- Friendship, Ka-14/2A, Baridhara North Road, (Kalachandpur), Dhaka 1212, Bangladesh
| | | | | | - Abul Hossain Sheikh
- Friendship, Ka-14/2A, Baridhara North Road, (Kalachandpur), Dhaka 1212, Bangladesh
| | - Syed Moshfiqur Rahman
- Department of Women's and Children's Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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Ahmed KT, Karimuzzaman M, Mahmud S, Rahman L, Hossain MM, Rahman A. Influencing factors associated with maternal delivery at home in urban areas: a cross-sectional analysis of the Bangladesh Demographic and Health Survey 2017-2018 data. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:83. [PMID: 37605266 PMCID: PMC10440937 DOI: 10.1186/s41043-023-00428-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The associated factors and patterns of giving birth in home settings of rural areas have been extensively studied in Bangladeshi literature. However, urban areas still need to be explored, particularly with recent data. Therefore, the authors aimed to investigate the influential determinants of delivery at home in urban areas of Bangladesh. MATERIALS AND METHODS In this study, 1699 urban-dwelling women who had given birth within the previous 60 months of the survey and lived in urban areas were used. The secondary data were extracted from the latest Bangladesh Demographic and Health Survey 2017-2018. Descriptive statistics and logistic regression were applied along with the association among selected variables were examined by the Chi-square test. RESULTS Findings depict that 36.49% of women who lived in urban areas of Bangladesh delivered at home, whereas, 63.51% delivered at different govt. and private health care facilities. Women who lived in Chittagong [adjusted odds ratio (AOR) = 2.11, 95% CI 1.24-3.60], Barisal [AOR = 2.05, 95% CI 1.16-3.64] and Sylhet [AOR = 1.92, 95% CI 1.08-3.43] divisions have more likelihood to deliver at home (36.85%). Urban women following Christian religion [AOR = 10.71, 95% CI 1.32-86.68] have higher odds of delivering child at home (0.47%). Urban women having three or more children before her latest delivery (22.37%) and who are employed (29.37%) have more likelihood to deliver at home. However, women aged between 25 and 34 years (43.50%), who have higher education (25.90%), play the role of household head (9.06%), have parity of more than two births (2.24%), and read daily newspapers (68.69%) had a lower chance of delivery at home. Furthermore, women from wealthier families (89.12%) and more antenatal care (ANC) visits (94.93%) were less likely to have a delivery at home. CONCLUSION Despite significant progress in women and reproductive health in Bangladesh, the proportion of delivery in the home in urban areas is alarming and should be emphasized more. The authors believe the identified factors will help design interventions and policy development on this issue.
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Affiliation(s)
| | - Md Karimuzzaman
- DREXEL Dornsife School of Public Health, DREXEL University, Philadelphia, PA, USA
| | - Shohel Mahmud
- Department of Statistics, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh
| | - Labiba Rahman
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Md Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
- School of Mathematics, Statistics, and Physics, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia
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Begum A, Hamid SA. Maternal healthcare utilization in rural Bangladesh: A comparative analysis between high and low disaster-prone areas. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001409. [PMID: 37523343 PMCID: PMC10389743 DOI: 10.1371/journal.pgph.0001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/30/2023] [Indexed: 08/02/2023]
Abstract
This study examined the disparity in antenatal care (ANC) visits and institutional delivery between high-disaster-prone (HDP) and low-disaster-prone (LDP) areas, defined based on multi-hazards, in Bangladesh and assessed the influencing factors using Andersen's behavioral model. In this study, cross-sectional data of 345 mothers, who had live birth the year preceding the survey, were used from the second-round multipurpose survey of a longitudinal research project conducted in May-June 2011. Hierarchical multinomial logistic and binary logistic models were respectively used to assess the determinants of ANC contacts and choice of childbirth place. We found very low utilization of 4+ ANC visits in both HDP (20%) and LDP (15%) areas. The difference is also not significant. The strong influencing factors of receiving 4+ ANC were mother's education, household size, income, and proximity to health facility. The level of institutional delivery was also low (21%), and no significant difference between HDP (15.2%) and LDP (25.7%) was found. However, in the case of institutional delivery, significant (p-value ≤ .01) difference was found in C-section between HDP (42%) and LDP (79%). A significant (p-value ≤ .05) difference was also found in the attendance of graduate doctors/gynecologists between HDP (58%) and LDP (88%). Mothers of HDP areas were 52 percent less likely to choose institutional delivery compared to those of LDP areas. Moreover, there was 30 percent less likelihood of choosing institutional delivery with an increase in distance to the nearest health facility. Specific demand-side (e.g., awareness raising, expanding maternal voucher scheme, covering more mothers under maternal allowance, and facilitating more income-generating activities especially off-farm ones) and supply-side interventions (e.g., providing training to local traditional birth attendants, and deployment of boat-based medical teams in coastal and char areas) need to be undertaken to increase institutional delivery, especially in HDP areas. However, the ultimate solution depends on adopting long-term measures to prepare facilities ready by filling the vacant posts and reducing absenteeism. Public-private partnerships modality can also be introduced especially in the HDP areas. Policy attention is needed to introduce such interventions.
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Affiliation(s)
- Afroza Begum
- Department of Statistics, University of Chittagong, Chittagong, Bangladesh
| | - Syed Abdul Hamid
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
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Chilot D, Aragaw FM, Belay DG, Asratie MH, Merid MW, Kibret AA, Teshager NW, Alem AZ. Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching. Front Med (Lausanne) 2023; 10:1107008. [PMID: 37547614 PMCID: PMC10401271 DOI: 10.3389/fmed.2023.1107008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. Methods We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. Result After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. Conclusion and recommendation This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.
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Affiliation(s)
- Dagmawi Chilot
- Department of Human Physiology, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women and Family Health, College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Nahom Worku Teshager
- Department of Pediatrics and Child Health, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Negero MG, Sibbritt D, Dawson A. Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data. BMC Public Health 2023; 23:1174. [PMID: 37337146 DOI: 10.1186/s12889-023-15938-8] [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: 05/06/2022] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future. METHODS Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design. RESULTS Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49. CONCLUSIONS We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.
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Affiliation(s)
- Melese Girmaye Negero
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Winters S, Pitchik HO, Akter F, Yeasmin F, Jahir T, Huda TMN, Rahman M, Winch PJ, Luby SP, Fernald LCH. How does women's empowerment relate to antenatal care attendance? A cross-sectional analysis among rural women in Bangladesh. BMC Pregnancy Childbirth 2023; 23:436. [PMID: 37312017 PMCID: PMC10262442 DOI: 10.1186/s12884-023-05737-9] [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: 07/06/2022] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status. METHODS We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects. RESULTS Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status. CONCLUSIONS Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.
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Affiliation(s)
- Solis Winters
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA.
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Fahmida Akter
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Farzana Yeasmin
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Tania Jahir
- College of Medicine, Nursing, & Health Sciences, University of Galway, Galway, Ireland
| | - Tarique Md Nurul Huda
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, 52741, Saudi Arabia
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Peter J Winch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
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Oo HY, Tun T, Khaing CT, Mya KS. Institutional delivery and postnatal care utilisation among reproductive-aged women who had completed four or more antenatal care visits in Myanmar: a secondary analysis of 2015-2016 Demographic and Health Survey. BMJ Open 2023; 13:e066706. [PMID: 37137565 PMCID: PMC10163536 DOI: 10.1136/bmjopen-2022-066706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To examine the prevalence of institutional delivery and postnatal care after home delivery and to identify their determinants in Myanmar mothers who received at least four antenatal care visits. DESIGN The study used the Myanmar Demographic and Health Survey data (2015-2016), a nationally representative cross-sectional study. PARTICIPANTS The study included women aged 15-49 years who had at least one birth within the 5 years preceding the survey and completed four or more antenatal visits. OUTCOME MEASURES Institutional delivery and postnatal care after home delivery were used as outcomes. We used two separate samples, that is, 2099 women for institutional delivery and 380 mothers whose most recent birth was within 2 years before the survey and delivered at home for postnatal care utilisation. We used multivariable binary logistic regression analyses. SETTING Fourteen states/regions and Nay Pyi Taw Union Territory in Myanmar. RESULTS The prevalence of institutional delivery was 54.7% (95% CI: 51.2%, 58.2%) and postnatal care utilisation was 76% (95% CI: 70.2%, 80.9%). Women who lived in urban areas, women who had higher education, women who had higher wealth status, women who had educated husbands and women having their first childbirth were more likely to have institutional delivery than their counterparts. The institutional delivery was lower among women who live in rural areas, poor women and women with husbands who worked in agriculture than their counterparts. Postnatal care utilisation was significantly higher among women living in central plains and coastal regions, women who received all seven components of antenatal care and women who had skilled assistance at birth than their counterparts. CONCLUSIONS Policymakers should address the identified determinants to improve the service continuum and reduce maternal mortality in Myanmar.
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Affiliation(s)
| | - Thandar Tun
- Population and Family Health Department, University of Public Health, Yangon, Myanmar
| | - Cho Thet Khaing
- Department of Epidemiology, University of Public Health, Yangon, Myanmar
| | - Kyaw Swa Mya
- Department of Preventive and Social Medicine, University of Medicine, Taunggyi, Myanmar
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Association of Ultrasonography and Health Education during Antenatal Visits among Pregnant Women to Reduce Unnecessary Caesarean Section in Bangladesh: Study Protocol for a Cluster Randomized Control Trial. Methods Protoc 2022; 5:mps5060101. [PMID: 36548143 PMCID: PMC9786003 DOI: 10.3390/mps5060101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The rate of caesarean section (C/S) has been increasing globally. The proposed study aims to evaluate the effects of ultrasonography (USG) and health education in reducing unnecessary C/S among pregnant women. The secondary objectives are to increase antenatal care (ANC) and post-natal care (PNC) visit rates, increase USG use, increase institutional (hospitals and clinics) delivery, reduce delivery related complications and reduce the number of still births. This is a prospective, open-label, two-arm cluster randomized controlled trial (RCT). A total of 288 pregnant women are enrolled from two urban and two rural hospitals in Bangladesh. Women were screened during their first ANC visits, then written informed consent was taken from the participants. Women in intervention hospitals receive eight ANC visits, two additional USG, and health education eight times during their ANC visits. In contrast, participants at control hospitals receive usual care consisting of four ANC visits and two USG during their ANC visits. The primary outcome is to compare the rate of unnecessary C/S during PNC visits. This study obtained approval from the Institutional Review Board of North South University (2021/OR-NSU/IRB/0804), Bangladesh in November 2021 and was registered in clinicalTrails.gov (#NCT05135026).
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11
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Rahman M, Saha P, Uddin J. Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy. BMC Pregnancy Childbirth 2022; 22:255. [PMID: 35346100 PMCID: PMC8961925 DOI: 10.1186/s12884-022-04588-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant. Methods We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04588-0.
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Affiliation(s)
- Mostafizur Rahman
- Department of Science and Humanities, Bangabandhu Sheikh Mujibur Rahman Aviation and Aerospace University, Old Airport, Tejgaon, Dhaka, 1215, Bangladesh.
| | - Priom Saha
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Jalal Uddin
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Mwebesa E, Kagaayi J, Ssebagereka A, Nakafeero M, Ssenkusu JM, Guwatudde D, Tumwesigye NM. Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis. BMC Pregnancy Childbirth 2022; 22:7. [PMID: 34979981 PMCID: PMC8722208 DOI: 10.1186/s12884-021-04354-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Maternal mortality remains a global public health issue, more predominantly in developing countries, and is associated with poor maternal health services utilization. Antenatal care (ANC) visits are positively associated with facility delivery and postnatal care (PNC) utilization. However, ANC in itself may not lead to such association but due to differences that exist among users (women). The purpose of this study, therefore, is to examine the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC using Propensity Score Matched Analysis (PSMA). Methods The present study utilized the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Women aged 15 – 49 years who had given birth three years preceding the survey were considered for this study. Propensity score-matched analysis was used to analyze the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC. Results The results revealed a significant and positive effect of four or more ANC visits on facility delivery [ATT (Average Treatment Effect of the Treated) = 0.118, 95% CI: 0.063 – 0.173] and early PNC [ATT = 0.099, 95% CI: 0.076 – 0.121]. It also found a positive and significant effect of facility-based delivery on early PNC [ATT = 0.518, 95% CI: 0.489 – 0.547]. Conclusion Policies geared towards the provision of four or more ANC visits are an effective intervention towards improved facility-based delivery and early PNC utilisation in Uganda.
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Affiliation(s)
- Edson Mwebesa
- Makerere University School of Public Health, Kampala, Uganda.
| | - Joseph Kagaayi
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Mary Nakafeero
- Makerere University School of Public Health, Kampala, Uganda
| | - John M Ssenkusu
- Makerere University School of Public Health, Kampala, Uganda
| | - David Guwatudde
- Makerere University School of Public Health, Kampala, Uganda
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13
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. The large-scale community-based programme 'Suchana' improved maternal healthcare practices in north-eastern Bangladesh: Findings from a cluster randomized pre-post study. MATERNAL & CHILD NUTRITION 2022; 18:e13258. [PMID: 34467636 PMCID: PMC8710100 DOI: 10.1111/mcn.13258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large-scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron-folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron-folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger-scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh.
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Affiliation(s)
- Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - S M Tanvir Ahmed
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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14
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Ahmed MS. Trend in the utilization of antenatal care during pregnancy among the adolescents in Bangladesh: Evidence from national survey data 2012/2013 and 2019. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Md. Sabbir Ahmed
- Department of Community Health and Hygiene Faculty of Nutrition and Food Science Patuakhali Science and Technology University Patuakhali Bangladesh
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15
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Islam MA, Tabassum T. Does antenatal and post-natal program reduce infant mortality? A meta-analytical review on 24 developing countries based on Demographic and Health Survey data. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100616. [PMID: 33799165 DOI: 10.1016/j.srhc.2021.100616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study intended to reveal the effectiveness of Antenatal Care (ANC) and Postnatal care (PNC) services on infant mortality in 24 developing countries by utilizing the recent Demographic and Health Survey (DHS) data. DESIGN This study utilized the most recent DHS data from 2013 to 2019 of 24 different developing countries. Meta-analysis techniques were was implemented to congregate cross-sectional studies to integrate data from 24 countries to fulfill the study's objective. ParticipantsChildren's Recode (KR) data was used as this study is based on infants aged 0-11 months. RESULTS Results of this study uncovered for 24 developing countries that taking ANC and PNC had a statistically significant association in lowering infant death. These two covariates were found to significantly impact all 24 developing countries' infant mortality (OR: 0.356, 95% CI: 0.311; 0.407 for taking ANC and OR: 0.302, 95% CI: 0.243; 0.375 for taking PNC). Additionally, taking ANC was more effective in Asian countries, while taking PNC was more effective for African countries. CONCLUSION In this study, taking ANC and PNC services was significant in reducing the risk of infant mortality in developing countries. So, anticipation and advancement in health care services ought to be taken to lessen the chance of infant mortality.
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Affiliation(s)
| | - Tarana Tabassum
- Statistics Discipline, Khulna University, Khulna 9208, Bangladesh.
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16
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Seidu AA, Ahinkorah BO, Agbaglo E, Oduro JK, Amoah A, Yaya S. Factors associated with the utilisation of skilled delivery services in Papua New Guinea: evidence from the 2016-2018 Demographic and Health Survey. Int Health 2021; 14:64-73. [PMID: 33684205 PMCID: PMC8769953 DOI: 10.1093/inthealth/ihab007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/03/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We sought to determine the prevalence and factors associated with the use of skilled assistance during delivery in Papua New Guinea. METHODS We analysed nationally representative data from 5210 women in Papua New Guinea using the 2016-2018 Demographic and Health survey. Both bivariate and multivariable analyses were performed. Statistical significance was set at p<0.05. RESULTS The prevalence of skilled assistance during delivery was 57.6%. The richest women (adjusted OR [AOR]=3.503, 95% CI 2.477 to 4.954), working women (AOR=1.221, 95% CI 1.037 to 1.439), women with primary (AOR=1.342, 95% CI 1.099 to 1.639), secondary or higher education (AOR=2.030, 95% CI 1.529 to 2.695), women whose partners had a secondary or higher level of education (AOR=1.712, 95% CI 1.343 to 2.181], women who indicated distance was not a big problem in terms of healthcare (AOR=1.424, 95% CI 1.181 to 1.718), women who had ≥4 antenatal care (ANC) visits (AOR=10.63, 95% CI 8.608 to 13.140), women from the Islands region (AOR=1.305, 95% CI 1.045 to 1.628), those who read newspapers or magazines (AOR=1.310, 95% CI 1.027 to 1.669) and women who watched television (AOR=1.477, 95% CI 1.054 to 2.069) less than once a week had higher odds of utilising skilled attendants during delivery. On the contrary, women in the Momase region (AOR=0.543, 95% CI 0.438 to 0.672), women in rural areas (AOR=0.409, 95% CI 0.306 to 0.546), as well as women with a parity of 3 (AOR=0.666, 95% CI 0.505 to 0.878) or ≥4 (AOR=0.645, 95% CI 0.490 to 0.850) had lower odds of utilising skilled attendance during delivery. CONCLUSION There is relatively low use of skilled delivery services in Papua New Guinea. Wealth, employment status, educational level, parity and number of ANC visits, as well as access to healthcare and place of residence, influence the utilisation of skilled delivery services.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Vertinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Joseph Kojo Oduro
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abigail Amoah
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON KIN 6N5, Canada.,The George Institute for Global Health, Imperial College London, London W120BZ, UK
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17
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Nigussie T, Yaekob R, Geremew M, Asefa A. Predictors of Intention to Use Maternity Waiting Home Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia Using the Theory of Planned Behavior. Int J Womens Health 2020; 12:901-910. [PMID: 33149701 PMCID: PMC7602906 DOI: 10.2147/ijwh.s267730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ending preventable maternal mortality remains an unfinished agenda and one of the world's most critical challenges. Skilled care at birth is one of the crucial strategies that help to prevent deaths that occur during delivery. Maternity waiting homes have been endorsed to facilitate access to skilled care during intra-partum and post-partum periods for women living in rural areas. However, the majority of pregnant mothers in Ethiopia do not use this service; hence, this study aimed to assess the predictors of intention to use maternity waiting home. METHODS A community-based cross-sectional study was conducted from March 15 to June 20, 2018 in Bench Maji Zone, Southwest Ethiopia. A multistage sampling technique was used. The data were collected by trained data collectors using a structured pre-tested questionnaire. Data were entered into the epi data manager version 4.0.2.101 and exported to SPSS version 21 for analysis. The correlation among constructs of the theory of planned behavior was estimated. A hierarchical linear regression was used to identify predictors of intention to use maternity waiting home, and α value of less than 5% was used as a level of significance. RESULTS A total of 829 women were interviewed. The mean age of respondents was 27.1 (±5.2) years. Thirty-nine percent of the respondents used maternity waiting home previously. The attitude (β =0.12, p<0.001), subjective norm (β =0.47, p<0.001), perceived behavioral control (β =0.42, p<0.001), and ANC use during current pregnancy (β =0.07, p=0.030) were predictors of intension to use maternity waiting homes. R square was calculated to be 81%. CONCLUSION The intention to use maternity waiting homes was significantly associated with antenatal care use, attitude, subjective norm, and perceived behavioral control. Thus, multidimensional interventions are important to increase the intension to use MWH.
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Affiliation(s)
- Tadesse Nigussie
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Rahel Yaekob
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mesfin Geremew
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Adane Asefa
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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18
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Muluneh AG, Kassa GM, Alemayehu GA, Merid MW. High dropout rate from maternity continuum of care after antenatal care booking and its associated factors among reproductive age women in Ethiopia, Evidence from Demographic and Health Survey 2016. PLoS One 2020; 15:e0234741. [PMID: 32530948 PMCID: PMC7292400 DOI: 10.1371/journal.pone.0234741] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022] Open
Abstract
Background Maternal continuums of care were vital to reducing maternal and neonatal mortalities. While the dropout rate remains high and limited studies were found on risk factors associated with a high dropout rate of the maternal continuum of care. Objective This study aimed to assess the magnitude of dropout rate and its associated factors of maternity continuum of care in Ethiopia, 2016 Methods An in-depth secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016 data. A total of 4,693 women who were booked for antenatal care visit were included to the final analysis. A community-based cross-sectional study design and a pre-tested and standardized questionnaire were used to collect the survey data. Data were weighted using women data weighting variables. Chi-square and multicollinearity assumptions were checked for independent variables. Bi-variable and multivariable logistics regression used to identify associated factors with a cut of the p-value of 0.2 and 0.05 respectively. Adjusted Odds Ratio (AOR) with 95%CI was reported for the final model. Results Of the total 4,693 women who were booked for antenatal care visits, 2,092(44.58%), 2,183 (46.52%), and 4,086(87.07%) dropped from a recommended number of ANC, Institutional delivery and postnatal care visit respectively. Only 308 (6.56%, 95%CI: 5.89, 7.31) women used all the complete continuum of care. Not married, and poorest wealth index were significantly associated with dropout from ANC visit. Being a protestant religious follower was significantly associated with dropout from PNC after antenatal care booking. While not exposed to media, distance from health facility as a big problem, protestant affiliation, parity of 2 to 4 and above4, Wealth index of the poorest, poorer, middle, and richer significantly associated with dropout from institutional delivery. Not being informed about pregnancy complications during their ANC visit was significantly associated with dropout from ANC, PNC, and institutional delivery. Conclusions Dropout of women from the maternity continuum of care after antenatal care booking was a public health problem in Ethiopia. Socio-demographic, pregnancy, and health service-related factors were significant determinants of dropout from the maternity continuum of care. Improving the family wealth index, increasing access to health facilities, media exposure, and giving more information during the antenatal care visit is important to reduce the dropout rate from the maternity continuum of care.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail: ,
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Asrade Alemayehu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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19
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Wuneh AD, Medhanyie AA, Bezabih AM, Persson LÅ, Schellenberg J, Okwaraji YB. Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia. Int J Equity Health 2019; 18:201. [PMID: 31870447 PMCID: PMC6929360 DOI: 10.1186/s12939-019-1111-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 12/03/2022] Open
Abstract
Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.
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Affiliation(s)
- Alem Desta Wuneh
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Lars Åke Persson
- London School of Hygiene &Tropical Medicine, London, UK.,Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Yemisrach Behailu Okwaraji
- London School of Hygiene &Tropical Medicine, London, UK.,Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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20
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Jo Y, Alland K, Ali H, Mehra S, LeFevre AE, Pak SE, Shaikh S, Christian P, Labrique AB. Antenatal care in rural Bangladesh: current state of costs, content and recommendations for effective service delivery. BMC Health Serv Res 2019; 19:861. [PMID: 31752841 PMCID: PMC6869180 DOI: 10.1186/s12913-019-4696-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background Measurement of antenatal care (ANC) service coverage is often limited to the number of contacts or type of providers, reflecting a gap in the assessment of quality as well as cost estimations and health impact. The study aims to determine service subcomponents and provider and patient costs of ANC services and compares them between community (i.e. satellite clinics) and facility care (i.e. primary and secondary health centers) settings in rural Bangladesh. Methods Service contents and cost data were collected by one researcher and four interviewers in various community and facility health care settings in Gaibandha district between September and December 2016. We conducted structured interviews with organization managers, observational studies of ANC service provision (n = 70) for service contents and provider costs (service and drug costs) and exit interviews with pregnant women (n = 70) for patient costs (direct and indirect costs) in health clinics at community and facility levels. Fisher’s exact tests were used to determine any different patient characteristics between community and facility settings. ANC service contents were assessed by 63 subitems categorized into 11 groups and compared within and across community and facility settings. Provider and patient costs were collected in Bangladesh taka and analyzed as 2016 US Dollars (0.013 exchange rate). Results We found generally similar provider and patient characteristics between the community and facility settings except in clients’ gestational age. High compliance (> 50%) of service subcomponents were observed in blood pressure monitoring, weight measurement, iron and folate supplementation given, and tetanus vaccine, while lower compliance of service subcomponents (< 50%) were observed in some physical examinations such as edema and ultrasonogram and routine tests such as blood test and urine test. Average unit costs of ANC service provision were about double at the facility level ($2.75) compared with community-based care ($1.62). ANC patient costs at facilities ($2.66) were about three times higher than in the community ($0.78). Conclusion The study reveals a delay in pregnant women’s initial ANC care seeking, gaps in compliance of ANC subcomponents and difference of provider and patient costs between facility and community settings.
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Affiliation(s)
- Youngji Jo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Kelsey Alland
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Hasmot Ali
- JiVitA Program, Johns Hopkins University, Gaibandha, Rangpur, Bangladesh
| | - Sucheta Mehra
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Amnesty E LeFevre
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Semee Esther Pak
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Saijuddin Shaikh
- JiVitA Program, Johns Hopkins University, Gaibandha, Rangpur, Bangladesh
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Alain B Labrique
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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