1
|
Mandiwa C, Namondwe B. Assessment of quality of antenatal care services and associated factors in Malawi: Insights from a nationwide household survey. PLoS One 2024; 19:e0305294. [PMID: 38865367 PMCID: PMC11168649 DOI: 10.1371/journal.pone.0305294] [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: 10/25/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Provision of quality antenatal care (ANC) to pregnant women is essential for reducing maternal and newborn mortality. ANC provides an opportunity for early identification of conditions that increase the risk of adverse pregnancy outcomes. However, there is limited evidence regarding the quality of ANC received by women in Malawi. This study aimed to assess the quality of ANC and associated factors in Malawi. MATERIALS AND METHODS National representative data from the 2019-2020 Malawi Multiple Indicator Cluster Survey was used for this cross-sectional study. A total of 6,287 weighted sample of women aged 15 to 49 years who had a live birth and received ANC at least once within two years preceding the survey were included in the analysis. Descriptive statistics were used to estimate the magnitude of quality ANC and multivariable logistic regression was computed to identify associated factors. RESULTS Of the 6,287 women, only 12.6% (95% CI: 11.4-13.9) received quality ANC. The likelihood of receiving quality ANC was significantly higher among women who had four to seven ANC contacts (AOR = 2.10; 95% CI: 1.79-2.49), made at least eight ANC contacts (AOR = 3.40; 95% CI: 1.90-6.09) and started ANC within the first trimester (AOR = 1.30; 95% CI: 1.10-1.53). On the other hand, women who had only primary education (AOR = 0.62; 95% CI:0.48-0.82) and had five or more births (AOR = 0.56; 95% CI: 0.40-0.78) were less likely to receive quality ANC. CONCLUSION The findings reveal that quality of ANC in Malawi is low. These findings suggest the need for targeted interventions aimed at improving access to and utilization of ANC services among women with lower education and higher parity. Strengthening efforts to promote early ANC initiation and increasing the number of ANC contacts could significantly enhance the quality of ANC received by women in Malawi.
Collapse
Affiliation(s)
- Chrispin Mandiwa
- PhD Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | | |
Collapse
|
2
|
Aboagye RG, Okyere J, Seidu AA, Ahinkorah BO, Budu E, Yaya S. Does women's empowerment and socio-economic status predict adequacy of antenatal care in sub-Saharan Africa? Int Health 2024; 16:165-173. [PMID: 36916325 PMCID: PMC10911537 DOI: 10.1093/inthealth/ihad016] [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: 10/23/2022] [Revised: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Quality and adequate antenatal care (ANC) are key strategies necessary to achieve Sustainable Development Goal 3.1. However, in sub-Saharan Africa (SSA), there is a paucity of evidence on the role women's empowerment and socio-economic status play in ANC attendance. This study aimed to examine whether women's empowerment and socio-economic status predict the adequacy of ANC in SSA. METHODS Data from the recent Demographic and Health Surveys (DHSs) of 10 countries in SSA were used for the study. We included countries with a survey dataset compiled between 2018 and 2020. We included 57 265 women with complete observations on variables of interest in the study. Frequencies and percentages were used to summarize the results of the coverage of adequate ANC services across the 10 countries. A multivariable binary multilevel regression analysis was employed to examine the association between women's empowerment and socio-economic status indicators and the adequacy of ANC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to present the findings of the regression analysis. RESULTS The average prevalence of adequate ANC in SSA was 10.4%. This ranged from 0.2% in Rwanda to 24.5% in Liberia. Women with medium (aOR 1.24 [CI 1.10 to 1.40]) and high (aOR 1.24 [CI 1.07 to 1.43]) decision-making power had higher odds of adequate ANC compared to those with low decision-making power. Women with higher levels of education (aOR 1.63 [CI 1.36 to 1.95]) as well as partners with higher education levels (aOR 1.34 [CI 1.14 to 1.56]) had the highest odds of adequate ANC compared to those with no formal education. Additionally, those working (aOR 1.35 [95% CI 1.23 to 1.49]) and those in the richest wealth category (aOR 2.29 [CI 1.90 to 2.76]) had higher odds of adequate ANC compared to those who are not working and those in the poorest wealth category. Those with high justification of violence against women (aOR 0.84 [CI 0.73 to 0.97]) had lower odds of adequate ANC compared to those with low justification of violence against women. CONCLUSIONS Adequacy of ANC was low across all 10 countries we included in this study. It is evident from the study that women's empowerment and socio-economic status significantly predicted the adequacy of ANC. As such, promoting women's empowerment programs without intensive improvements in women's socio-economic status would yield ineffective results. However, when women's empowerment programs are combined with active improvements in socio-economic status, then women will be encouraged to seek adequate ANC.
Collapse
Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Eugene Budu
- Research Unit, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- George Institute for Global Health, Imperial College London, London, UK
| |
Collapse
|
3
|
Onambele L, Guillen-Aguinaga S, Guillen-Aguinaga L, Ortega-Leon W, Montejo R, Alas-Brun R, Aguinaga-Ontoso E, Aguinaga-Ontoso I, Guillen-Grima F. Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach. EPIDEMIOLOGIA 2023; 4:322-351. [PMID: 37754279 PMCID: PMC10528291 DOI: 10.3390/epidemiologia4030032] [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: 06/29/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.
Collapse
Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon;
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | - Laura Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Department of Nursing, Suldal Sykehjem, 4230 Sands, Norway
| | - Wilfrido Ortega-Leon
- Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28871 Alcalá de Henares, Spain;
| | - Rocio Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 413 46 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden
| | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
| | | | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain; (S.G.-A.); (L.G.-A.); (R.A.-B.)
- Area of Epidemiology and Public Health, Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Determinants of Maternal Mortality in Southern Africa: A Macro-Level Analysis. WOMEN 2023. [DOI: 10.3390/women3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
This study sought to investigate the macro determinants of maternal mortality in Southern African Development Community (SADC) states. The study drew on the fact that maternal mortality remains a major public health issue in developing countries. The Millennium Development Goals (MDGs) were adopted by UN member states in 2000, and one of them was to reduce maternal deaths by three-quarters by 2015. While the Millennium Development Goals increased efforts, the goal was not met in the countries with the highest death rates. The World Health Organisation (WHO) estimates that every single day about 810 women die from pregnancy or childbirth-related complications around the world. This is despite several international initiatives being adopted to reduce maternal mortality. The study was quantitative, and it used secondary data to achieve its objective. A panel data estimation (Generalized Method of Moments) covering the period from 2005–2019 was used to examine how various factors affect maternal mortality. The analysis included the following variables: education, fertility, GDP per capita, institutional quality, health expenditure and HIV infection. The econometric analysis reveals a significant positive impact of fertility, GDP per capita and HIV on maternal mortality. This implies that when fertility, GDP per capita and HIV are increasing, maternal mortality also increases. The analysis also showed that education has a negative relationship with maternal mortality. This implies that when literacy levels (education) increase, maternal mortality decreases. Based on the results, this study emphasizes that, in order to improve maternal health and consequently reduce maternal mortality, access to family planning (to reduce fertility), access to early prenatal care and promoting women’s access to education should be a priority in government policies.
Collapse
|
6
|
Adde KS, Ameyaw EK, Dickson KS, Paintsil JA, Oladimeji O, Yaya S. Women's empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries. Reprod Health 2022; 19:222. [PMID: 36474291 PMCID: PMC9727987 DOI: 10.1186/s12978-022-01532-5] [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: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries. METHODS We utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25. RESULTS The study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28-1.62) and short-acting (aOR = 2.00, CI 1.79-2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09-1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09-2.17) of using long-acting methods than their counterparts with low knowledge level. CONCLUSION Our findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women.
Collapse
Affiliation(s)
- Kenneth Setorwu Adde
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- grid.411382.d0000 0004 1770 0716Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong ,L & E Research Consult Ltd, Upper West Region, Ghana
| | - Kwamena Sekyi Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Jones Arkoh Paintsil
- grid.413081.f0000 0001 2322 8567Department of Economic Studies, School of Economics, University of Cape Coast, Cape Coast, Ghana
| | - Olanrewaju Oladimeji
- grid.412870.80000 0001 0447 7939Department of Public Health, Walter Sisulu University, Mthatha, Eastern Cape 5099 South Africa
| | - Sanni Yaya
- grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK ,grid.28046.380000 0001 2182 2255School of International Development and Global Studies, University of Ottawa, Ottawa, ON Canada
| |
Collapse
|
7
|
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: 11] [Impact Index Per Article: 5.5] [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.
Collapse
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
| |
Collapse
|