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Addie O, Seun-Addie KF, Adejoh SO, Olorunlana A. Assessing the Link between Maternal Transport Modes and Childhood Mortality in Nigeria. Matern Child Health J 2024; 28:1651-1661. [PMID: 38878259 DOI: 10.1007/s10995-024-03963-x] [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] [Accepted: 06/01/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES The study explored the association between maternal transport modes and childhood mortalities in Nigeria. METHOD Utilizing data and definitions from the 2018 Nigeria Demographic and Health Survey report, the ten-year early mortality rates of the five childhood mortalities and the percentage of live births in the 5 years before the survey, transported by eight identified means of transportation, were statistically correlated for each of Nigeria's 36 states and the federal capital territory (FCT) in the R environment at a significance level of α < 0.05. RESULTS In the spatial distribution of the five childhood mortalities, a notable north-south dichotomy was observed, contrasting with the spatial spread of maternal transport modes. The five childhood mortalities exhibited a significant, moderately positive correlation with transportation by Private Car or Truck, while their associations with Public Transport or Bus and Walking were notably moderate but negative. CONCLUSION FOR PRACTICE While the use of private cars or trucks should be encouraged as a means of maternal transport, public transport should be better organized to provide efficient services to women who need such services for maternal and child healthcare. Additionally, steps should be taken to reduce travel distances to health facilities to manageable distances for mothers.
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Affiliation(s)
- Oluwaseun Addie
- Department of Geography, University of Ibadan, Ibadan, Nigeria
| | | | - Samuel Ojima Adejoh
- Department of Social Work, University of Lagos, Lagos, Nigeria.
- Department of Social Work, University of Free State, Bloemfontein, South Africa.
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Malata MP, Jenny A, Walker D, Gadama LA. Women's experiences of maternal near miss: Qualitative findings from Malawi. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101012. [PMID: 39126910 DOI: 10.1016/j.srhc.2024.101012] [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: 06/24/2023] [Revised: 07/11/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE This study explored the experiences of women with maternal near miss and their perceptions of the quality of care they received in three facilities in Malawi. METHODS This study employed a qualitative phenomenological approach. Data were collected using in depth interviews and analysed using thematic content analysis. The data were collected in three hospitals between September and November 2020. The purposively selected participants were 18 women meeting criteria for maternal near miss related to obstetric haemorrhage (6), hypertensive disorders (7), sepsis (2) and ruptured ectopic pregnancy (3). RESULTS Women's experiences of maternal near miss fell under four broad themes; (a) realisation of the near miss; (b) religious beliefs and interpretation of near miss; (c) social and economic aspects of maternal near miss; and d) perceptions of quality of care. Women's initial emotional responses were fear and anxiety but were soon overshadowed by the fear for their babies' wellbeing. Most women perceived the care they received as timely, adequate, and respectful, yet many women also expressed that their service providers did not provide an opportunity to openly discuss their condition. CONCLUSIONS The experience of near miss goes beyond the immediate physical discomforts and has psychological, economic, and social consequences for women and their families. Despite women's perception of care as respectful, there are still communication gaps with their service providers. Campaigns to improve the communication between providers and patients and their families in situation of severe morbidity warrant consideration.
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Affiliation(s)
| | - Alisa Jenny
- University of California San Francisco, 550 16(th) St, 3(rd) Floor, San Francisco, CA 94158, USA.
| | - Dilys Walker
- University of California San Francisco, 550 16(th) St, 3(rd) Floor, San Francisco, CA 94158, USA.
| | - Luis Aaron Gadama
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri Blantyre 3, Malawi.
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Damerow SM, Adrian HV, Indjai B, Cá EJC, Maaløe N, Fisker AB, Sørensen JB. Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis. BMC Pregnancy Childbirth 2024; 24:478. [PMID: 39003482 PMCID: PMC11245816 DOI: 10.1186/s12884-024-06669-8] [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: 11/18/2023] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
Guinea-Bissau has among the world's highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.
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Affiliation(s)
- Sabine Margarete Damerow
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Studiestræde 6, Copenhagen K, 1455, Denmark.
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
| | | | - Bucar Indjai
- National Institute for Studies and Research (INEP), Bissau, Guinea-Bissau
| | | | - Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - Herlev Hospital, Copenhagen, Denmark
| | - Ane Bærent Fisker
- Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Studiestræde 6, Copenhagen K, 1455, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Agyemang-Duah W, Braimah JA, Asante D, Appiah JO, Peprah P, Awuviry-Newton K, Mensah AA, Ofori-Amoah J, Opoku K. Family Support, Perceived Physical Activeness and Chronic Non-Communicable Diseases as Determinants of Formal Healthcare Utilization Among Older Adults with Low Income and Health Insurance Subscription in Ghana. J Aging Soc Policy 2024; 36:658-674. [PMID: 37724601 DOI: 10.1080/08959420.2023.2255488] [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: 08/12/2022] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
Evidence suggests that enrollment in a health insurance scheme is associated with higher levels of formal healthcare utilization among older adults, especially those with low income in sub-Saharan Africa (SSA), including Ghana. This study examines the prevalence of formal healthcare utilization and associated factors among older adults with low income and health insurance subscription enrolled in a social intervention program (known as the Livelihood Empowerment Against Poverty [LEAP] program) in Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted in 2018 among 200 older adults aged 65 years and above enrolled in the LEAP program. The results showed that almost 9 in 10 (87%) older adults utilized formal healthcare services for their health problems. Older adults who received family support, rated themselves to be physically active and had non-communicable diseases (NCDs) were more significantly likely to utilise formal health care services than their counter parts. We recommend that health policies and programs for older adults with low income and health insurance subscription under the LEAP program should consider the roles of family support, physical activeness and NCDs in influencing their use of formal healthcare services.
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Affiliation(s)
| | | | - Dennis Asante
- College of Medicine & Public Health, Rural and Remote Health, Flinders University, Renmark, South Australia
| | - Joseph Oduro Appiah
- School of Environmental Planning, University of Northern British Columbia, Prince George, BC, Canada
| | - Prince Peprah
- Social Policy Research Centre, Centre for Primary Health Care and Equity, The University of New South Wales, Sydney, Australia
| | - Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Health, University of Newcastle, Callaghan, Australia
| | - Anthony Acquah Mensah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kwabena Opoku
- Social Science Department, Okomfo Anokye Senior High School, Wiamoase-Ashanti Region, Ghana
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Abiiro GA, Abdul-Latif AM, Akaateba D, Braimah KRL, Alhassan M, Hadfield K, Hadfield K. A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana. Midwifery 2024; 134:104014. [PMID: 38669757 DOI: 10.1016/j.midw.2024.104014] [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: 10/12/2022] [Revised: 03/12/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Despite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana. METHODS We conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data. RESULTS At the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges. CONCLUSION Pregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.
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Affiliation(s)
- Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana; Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - Abdul-Malik Abdul-Latif
- Institute of Interdisciplinary research and consultancy services, University for Development Studies, Tamale(,) Ghana
| | | | - Killian Ramatu Laale Braimah
- Department for Social and Behavioural Change, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Mustapha Alhassan
- Department for Social and Behavioural Change, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Kristin Hadfield
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Koyaara AD, Adjei BN, Boadu EA, Dassah ET. Community-Based Health Planning and Services (CHPS) concept and access to healthcare delivery in Sefwi Wiawso Municipal, Ghana. BMC Health Serv Res 2024; 24:742. [PMID: 38886752 PMCID: PMC11184852 DOI: 10.1186/s12913-024-11179-6] [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: 04/14/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND In spite of the successes of the community-based health planning and services (CHPS) policy since its inception in the mid-1990s in Ghana, data pertaining to the implementation and use of CHPS facilities in Sefwi Wiawso Municipal is scant. We assessed access to healthcare delivery and factors influencing the use of CHPS in Sefwi Wiawso Municipal. METHODS An analytical community-based cross-sectional study was conducted in the Sefwi Wiawo Municipal from September to October 2020. Respondents for the study were recruited through multi-stage sampling. Information was collected on their socio-demographic characteristics, knowledge and use of CHPS facilities through interviews using a structured pre-tested questionnaire. Factors influencing the use of CHPS facilities were assessed using univariable and multivariable logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P ≤ 0.05 was considered statistically significant. RESULTS A total of 483 respondents were recruited for the study. The mean age of the respondents was 43.0 ± 16.3 years, and over 70% were females or married/cohabiting with their partners. Most respondents (88.2%) knew about the CHPS concept and more than half (53.4%) accessed healthcare in the CHPS facilities. Most respondents rated the quality of health services (> 65%) and staff attitude (77.2%) very positively. Significant factors influencing the use of the CHPS facilities were; knowledge of the CHPS concept (AOR 6.57, 95% CI 1.57-27.43; p = 0.01), longer waiting time for a vehicle to the facility, and shorter waiting time at the facility before being provided with care. People who waited for 30-60 min (AOR 2.76, 95% CI 1.08-7.07; p = 0.01) or over an hour (AOR 10.91, 95% CI 3.71-32.06; p = 0.01) before getting a vehicle to the facility, while patients who waited for less than 30 min (AOR 5.74, 95% CI 1.28-25.67; p = 0.03) or 30-60 min (AOR 2.60, 95% CI 0.57-11.78; p = 0.03) at the CHPS facility before receiving care were more likely to access care at the CHPS facilities. CONCLUSION Knowledge, and use of healthcare services at the CHPS facilities were high in this population. Interventions aimed at reducing waiting time at the CHPS facilities could greatly increase use of healthcare services at these facilities.
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Affiliation(s)
- Abraham D Koyaara
- Municipal Health Directorate-Ghana Health Service, Sefwi Wiawso, Western North, Ghana.
| | - Benjamin Noble Adjei
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Adjei Boadu
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward T Dassah
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Zewde HK. Determinants of severe maternal outcome in Keren hospital, Eritrea: An unmatched case-control study. PLoS One 2024; 19:e0299663. [PMID: 38739618 PMCID: PMC11090357 DOI: 10.1371/journal.pone.0299663] [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: 10/16/2022] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In the past few decades, several studies on the determinants and risk factors of severe maternal outcome (SMO) have been conducted in various developing countries. Even though the rate of maternal mortality in Eritrea is among the highest in the world, little is known regarding the determinants of SMO in the country. Thus, the aim of this study was to identify determinants of SMO among women admitted to Keren Provincial Referral Hospital. METHODS A facility based unmatched case-control study was conducted in Keren Hospital. Women who encountered SMO event from January 2018 to December 2020 were identified retrospectively from medical records using the sub-Saharan Africa maternal near miss (MNM) data abstraction tool. For each case of SMO, two women with obstetric complication who failed to meet the sub-Saharan MNM criteria were included as controls. Bivariate and multivariate logistic regression analyses were employed using SPSS version-22 to identify factors associated with SMO. RESULTS In this study, 701 cases of SMO and 1,402 controls were included. The following factors were independently associated with SMO: not attending ANC follow up (AOR: 4.53; CI: 3.15-6.53), caesarean section in the current pregnancy (AOR: 3.75; CI: 2.69-5.24), referral from lower level facilities (AOR: 11.8; CI: 9.1-15.32), residing more than 30 kilometers away from the hospital (AOR: 2.97; CI: 2.29-3.85), history of anemia (AOR: 2.36; CI: 1.83-3.03), and previous caesarean section (AOR: 3.49; CI: 2.17-5.62). CONCLUSION In this study, lack of ANC follow up, caesarean section in the current pregnancy, referral from lower facilities, distance from nearest health facility, history of anaemia and previous caesarean section were associated with SMO. Thus, improved transportation facilities, robust referral protocol and equitable distribution of emergency facilities can play vital role in reducing SMO in the hospital.
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Affiliation(s)
- Henos Kiflom Zewde
- Departement of Family and Community Health, Ministry of Health Anseba Province, Keren, Anseba, Eritrea
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Ukachukwu AEK, Njeru PN, Ayodele OA, Ahmad MH, Onyia CU, Morgan E, Ekweogwu OC, Usman B, Badejo OA, Dawang Y, Orhorhoro OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Petitt Z, Oboh EC, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Fuller AT, Haglund MM, Chikani MC, Adeolu AA, Adeleye AO. A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050. World Neurosurg 2024; 185:e16-e29. [PMID: 38741324 DOI: 10.1016/j.wneu.2023.10.146] [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: 06/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | | | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Ayodamola Otun
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Kidia K, Machando D, Dzoro V, Chibanda D, Abas M, Manda E, Mutengerere A, Nyandoro T, Chawarika M, Majichi D, van Dijk JH, Jack H. Rural Friendship Bench: A qualitative study in Zaka district, Zimbabwe. Soc Sci Med 2024; 348:116791. [PMID: 38522147 PMCID: PMC11221631 DOI: 10.1016/j.socscimed.2024.116791] [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: 06/15/2022] [Revised: 09/07/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND We piloted the Friendship Bench-an evidence-based, urban-area task sharing intervention for common mental disorders-in rural Zimbabwe. The intervention combines problem solving therapy with income generating activities. This study sought to understand the intervention's implementation in terms of acceptability, feasibility, and sustainability as well as local attitudes towards mental wellbeing in rural Zimbabwe. METHODS Using four separate semi-structured interview guides, we conducted in-depth interviews (N = 32) with patients (n = 9), village health workers (n = 12), nurses (n = 6), and community leaders (n = 5). We analyzed our data using thematic analysis with a diverse coding team using an integrative deductive-inductive approach. RESULTS Five themes emerged: 1) explanatory models for mental illness, 2) clinical workflow and emphasis on documentation, 3) positive feedback about the Friendship Bench, 4) accessibility, and 5) feasibility. CONCLUSION In its current format, our intervention was acceptable but neither feasible nor sustainable. Sociocultural context is critical in the development of rural task sharing interventions for mental health. We thus recommend a robust pilot and adaptation phase when scaling task sharing interventions in rural sub-Saharan Africa to elevate community voices, leverage existing social structures, and embed interventions as deeply into communities as possible.
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Affiliation(s)
- K Kidia
- Kushinga, Harare, Zimbabwe; Division of Global Health Equity, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | - D Chibanda
- Friendship Bench, Harare, Zimbabwe; London School of Hygiene and Tropical Medicine, London, UK
| | - M Abas
- King's College London, London, UK
| | - E Manda
- Friendship Bench, Harare, Zimbabwe
| | | | | | | | - D Majichi
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - H Jack
- University of Washington, Seattle, WA, USA
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Shrestha S, Maharjan R, Bajracharya S, Jha N, Mali S, Thapa B, Suwal PS, Prajapati D, Karmacharya BM, Shrestha A. Challenges in Effective Referral of Cardiovascular Diseases in Nepal: A Qualitative Study from Health Workers' and Patients' Perspective. Cardiol Res Pract 2024; 2024:5583709. [PMID: 38476339 PMCID: PMC10932621 DOI: 10.1155/2024/5583709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Abstract
Background Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives.
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Affiliation(s)
- Soniya Shrestha
- School of Public Health, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
| | - Rashmi Maharjan
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
- CVD Translational Research Program, Kathmandu University School of Medical Sciences, Kavre, Dhulikhel, Nepal
- Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Kavre, Dhulikhel, Nepal
| | - Swornim Bajracharya
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
| | - Niharika Jha
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
| | - Sushmita Mali
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
| | - Bobby Thapa
- CVD Translational Research Program, Kathmandu University School of Medical Sciences, Kavre, Dhulikhel, Nepal
- Department of Nursing, Nepalgunj Nursing Campus, Tribhuvan University, Nepalgunj, Nepal
| | - Punya Shori Suwal
- CVD Translational Research Program, Kathmandu University School of Medical Sciences, Kavre, Dhulikhel, Nepal
- Nepal Institute of Health Sciences, Jorpati, Kathmandu, Nepal
| | - Dipanker Prajapati
- CVD Translational Research Program, Kathmandu University School of Medical Sciences, Kavre, Dhulikhel, Nepal
- Shahid Gangalal National Heart Centre, Kathmandu, Nepal
- National Academy of Medical Sciences, Kathmandu, Nepal
| | - Biraj Man Karmacharya
- Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Dhulikhel, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, USA
- Institute for Implementation Science and Health, Kathmandu, Nepal
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Jahan F, Parvez SM, Rahman M, Billah SM, Yeasmin F, Jahir T, Hasan R, Darmstadt GL, Arifeen SE, Hoque MM, Shahidullah M, Islam MS, Ashrafee S, Foote EM. Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh. BMC Pediatr 2024; 24:123. [PMID: 38360716 PMCID: PMC10868082 DOI: 10.1186/s12887-024-04584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead to an increase in indicated treatment rates for newborns with hyperbilirubinemia. We aimed to investigate the operational feasibility and acceptability of a CHW-led home phototherapy intervention in a rural sub-district of Bangladesh for families and CHWs where home delivery was common and a treatment facility for neonatal hyperbilirubinemia was often more than two hours from households. We enrolled 23 newborns who were ≥ 2 kg in weight and ≥ 35 weeks gestational age, without clinical danger signs, and met the American Academy of Pediatric treatment criteria for phototherapy for hyperbilirubinemia. We employed a mixed-method investigation to evaluate the feasibility and acceptability of home phototherapy through surveys, in-depth interviews and focus group discussions with CHWs, mothers, and grandparents. Mothers and family members found home phototherapy worked well, saved them money, and was convenient and easy to operate. CHWs found it feasible to deploy home phototherapy and identified hands-on training, mHealth job aids, a manageable workload, and prenatal education as facilitating factors for implementation. Feasibility and acceptability concerns were limited amongst parents and included: a lack of confidence in CHWs' skills, fear of putting newborn infants in a phototherapy device, and unreliable home power supply. CHW-led home phototherapy was acceptable to families and CHWs in rural Bangladesh. Further investigation should be done to determine the impact of home phototherapy on treatment rates and on preventing morbidity associated with neonatal hyperbilirubinemia. Clinical Trial (CT) registration ID: NCT03933423, full protocol can be accessed at https://doi.org/10.1186/s13102-024-00824-6 . Name of the trial registry: clinicaltrials.gov. Clinical Trial (CT) registration Date: 01/05/2019.
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Affiliation(s)
- Farjana Jahan
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sarker Masud Parvez
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Mahbubur Rahman
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Farzana Yeasmin
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Tania Jahir
- College of Medicine, Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rezaul Hasan
- Environmental Health and WASH, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Mahbubul Hoque
- Department of Neonatology, Bangladesh, Children Hospital & Institute, Dhaka, Bangladesh
| | | | - Muhammad Shariful Islam
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Sabina Ashrafee
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI), Directorate General of Health Services, Dhaka, Bangladesh
| | - Eric M Foote
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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12
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Tikouk J, Ait Boubkr A. Transportation and Access to Healthcare in Morocco: An Exploratory Study of Guelmim-Oued Noun Region. Ann Glob Health 2024; 90:11. [PMID: 38344006 PMCID: PMC10854410 DOI: 10.5334/aogh.4063] [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: 01/19/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024] Open
Abstract
Objective The aim of this study was to examine the correlation between accessibility to healthcare facilities and transportation in the Guelmim Oued Noun region of Morocco, where transportation barriers continue to pose a major challenge to accessing healthcare, despite efforts aimed at reducing access barriers. Methods Data collection for this study involved the administration of a survey among 328 outpatients residing in the Guelmim Oued Noun region, Morocco. The utilization of canonical correlation served as the analytical method, employed to quantify and assess the relationship between transportation related barriers and the access of healthcare services in the specified region. Results Our research reveals that transportation factors account for approximately 25% of the variation in access to healthcare services. The number of transportation modes utilized by outpatients and the affordability of transportation were found to be significant contributors to the transportation dimension. These findings confirm the significant relationship between transportation and access to healthcare facilities in the region under investigation. Conclusion Further research is recommended to specifically address transportation barriers to healthcare access services among socially excluded populations, with a focus on promoting mobility inclusivity.
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Affiliation(s)
- Jamal Tikouk
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
| | - Asmaa Ait Boubkr
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
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Njuguna C, Tola HH, Maina BN, Magambo KN, Phoebe N, Mgamb EA, Tibananuka E, Turyashemererwa FM, Rubangakene M, Richard K, Opong G, Richard S, Opesen C, Mateeba T, Muyingo E, George U, Namukose S, Woldemariam YT. Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study. BMC Public Health 2024; 24:390. [PMID: 38321413 PMCID: PMC10848454 DOI: 10.1186/s12889-024-17830-5] [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: 09/23/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda.
| | - Habteyes Hailu Tola
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Benson Ngugi Maina
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kwikiriza Nicholas Magambo
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Nabunya Phoebe
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Elizabeth Adhiambo Mgamb
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Evelyne Tibananuka
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Florence M Turyashemererwa
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Moses Rubangakene
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Kisubika Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - George Opong
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Ssekitoleko Richard
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Chris Opesen
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
| | - Tim Mateeba
- Ministry of Health of Uganda, Kampala, Uganda
| | | | | | | | - Yonas Tegegn Woldemariam
- World Health Organization Uganda Country Office, Plot 60 Prince Charles Drive, Kampala, Kololo, P. O. Box: 24578, Uganda
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Poulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae005. [PMID: 38756556 PMCID: PMC10986301 DOI: 10.1093/haschl/qxae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 05/18/2024]
Abstract
Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.
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Affiliation(s)
| | - Gloria Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Dorian Royal
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | | | - Tiffany Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Tyra Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Kofi Sarkodee
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Sharon Attipoe-Dorcoo
- TERSHA LLC, Alpharetta, GA 30005, United States
- Healthcare Administration Program, College of Business, Texas Woman's University, Denton, TX 76204, United States
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Pamungkas DR, O'Sullivan B, McGrail M, Chater B. Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review. Health Res Policy Syst 2023; 21:129. [PMID: 38049824 PMCID: PMC10694960 DOI: 10.1186/s12961-023-01078-3] [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: 01/11/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. OBJECTIVE This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. METHODS This study collected peer-reviewed materials published in 15-year period (2005-2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). RESULTS The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). CONCLUSION This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening.
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Affiliation(s)
- Dewi Retno Pamungkas
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia.
| | - Belinda O'Sullivan
- Toowoomba Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, QLD, Australia.
- Murray Primary Health Network, Bendigo, VIC, Australia.
| | - Matthew McGrail
- Rockhampton Regional Clinical Unit, Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, QLD, Australia
| | - Bruce Chater
- Mayne Academy of Rural and Remote Medicine, Rural and Remote Medicine Clinical Unit, Medical School, Faculty of Medicine, The University of Queensland, Theodore, QLD, Australia
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Bekyieriya E, Isang S, Baguune B. Mobile health technology in providing maternal health services - Awareness and challenges faced by pregnant women in upper West region of Ghana. PUBLIC HEALTH IN PRACTICE 2023; 6:100407. [PMID: 37449294 PMCID: PMC10336575 DOI: 10.1016/j.puhip.2023.100407] [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: 11/10/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives The study assessed awareness on Mobile Health (mhealth) Technology as well as challenges pregnant women encounter in the utilization of mhealth technology to improve maternal health in rural settings in the Upper West Region (UWR) of Ghana. Study design The study was an exploratory design that employed the qualitative method of data collection. Methods Semi-structured interview guide was used to conduct six (6) Focus Group Discussions (FGDs) and nine (9) Key Informant Interviews (KIIs) among pregnant women and health workers respectively from three (3) selected rural districts in the Upper West Region. Data was collected in August 2020. Thematic analysis was conducted and some statements from participants were presented verbatim to illustrate the themes realized. Results Participants were aware of the mhealth intervention that had been implemented by Savanna Signatures in their districts. Major sources of information on the mhealth services were from durbars, health education sessions and health care providers. Challenges faced by pregnant women, in the mhealth technology intervention were; financial challenges, lack of mobile network connectivity, lack of electricity in some rural areas, low female literacy rate at household level and cultural barriers. Conclusion The Savanna Signatures mhealth intervention is widely known but some challenges exist that impede the smooth implementation of the intervention. The mhealth technology intervention implementers should partner with other sectors and policy makers to address the challenges identified by the study.
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Affiliation(s)
- E. Bekyieriya
- REJ Institute, Research and ICT Consultancy Services, P.O. Box TL1139, Tamale, Ghana
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
| | - S. Isang
- Ghana School of Law, Kwame Nkrumah University Science Technology, Kumasi, Ghana
| | - B. Baguune
- School of Hygiene, Environmental Health Programme, Ministry of Health, Tamale, Ghana
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Miller H, Rudolfson N, Nkurunziza T, Cherian T, Kayitesi D, Mazimpaka C, Kateera F, Riviello R, Hedt-Gauthier B. Long travel times from health center to hospital reduce caesarean section access: a study from Kirehe District, Rwanda. Pan Afr Med J 2023; 46:30. [PMID: 38107338 PMCID: PMC10724031 DOI: 10.11604/pamj.2023.46.30.25504] [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: 08/11/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2023] Open
Abstract
Introduction timely access to safe cesarean section (c-section) delivery can save the lives of mothers and neonates. This paper explores how distance affects c-section access in rural sub-Saharan Africa, where women in labor present to health centers before being referred to district hospitals for surgical care. Methods this study included all adult women delivering via c-section between April 2017 and March 2018 in Kirehe District, Rwanda. We assessed the association between travel times and village-level c-section rates. Results the estimated travel time from home-to-health center was 26 minutes (IQR: 13, 41) and from health center-to-hospital was 43 minutes (IQR: 2, 59). There was no significant association between travel time from home-to-health center and c-section rates (RR=1.01, p=0.42), but the association was significant for health center-to-hospital travel times (RR=0.96, p=0.01); for every 15-minute increase in travel time, there was a 4% decrease in c-sections for a health center catchment area. Conclusion in the context of decentralized health services, minimizing health center to hospital referral barriers is of utmost importance for improving c-section access in rural sub-Saharan Africa.
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Affiliation(s)
- Hillary Miller
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Niclas Rudolfson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
- Word Health Organization Collaborating Center for Surgery and Public Health, Department of Clinical Sciences Lund University, Lund, Sweden
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Theoneste Nkurunziza
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Teena Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
| | | | | | | | - Robert Riviello
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
- Center for Surgery and Public Health, Brigham and Women´s Hospital, Boston, United States of America
| | - Bethany Hedt-Gauthier
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
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Mohammed K, Abubakari AR, Amoak D, Antabe R, Luginaah I. Geographic disparities in the time to under-five mortality in Ghana. PLoS One 2023; 18:e0291328. [PMID: 37699020 PMCID: PMC10497139 DOI: 10.1371/journal.pone.0291328] [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: 10/12/2022] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
Globally, there has been tremendous advancement in medicine and child healthcare with increased life expectancy. That notwithstanding, the risk of under-five mortality ─ children dying before their fifth birthday remains relatively high in countries in Sub-Saharan Africa such as Ghana. In Ghana, under-five mortality remains a major public health problem that requires significant policy interventions. Using data from the 2017 Maternal Health Survey (n = 4785), we examined the geographic disparities in the time to under-five mortality in Ghana. The Kaplan Meier estimator showed significant (Log-rank: p< 0.001) rural-urban differences in the time to under-five mortality in Ghana. A disaggregated cox proportional hazards analysis showed that despite wide consensus that children in urban areas have a high survival rate, children in urban areas in northern regions of Ghana, especially the Upper West (HR = 4.40, p < 0.05) and Upper East (HR = 5.37, p < 0.01) Regions were significantly at increased risk of dying before the age of five compared to children in urban areas in the Greater Accra Region. A rural-urban comparison showed that children born in rural areas in all the other regions of Ghana were at a higher risk of dying before the age of five when compared to their counterparts in the rural areas of Greater Accra Region. Other factors such as sex of child, mothers' age and use of the internet, number of household members, ethnicity and household wealth were significantly associated with the timing of under-five mortality in Ghana. Healthcare policies and programs such as immunizations and affordable child healthcare services should be prioritized especially in rural areas of regions with a high risk of child mortality. Also, there is a need to improve healthcare delivery in urban areas, particularly in northern Ghana, where deplorable healthcare service infrastructure and delivery coupled with high poverty rates put children at risk of dying before their fifth birthday.
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Affiliation(s)
- Kamaldeen Mohammed
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Abdul Razak Abubakari
- Department of Population and Reproductive Health, University for Development Studies, Tamale, Ghana
| | - Daniel Amoak
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario. Canada
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, London, Ontario, Canada
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Kassim AB, Newton SK, Dormechele W, Rahinatu BB, Yanbom CT, Yankson IK, Otupiri E. Effects of a community-level intervention on maternal health care utilization in a resource-poor setting of Northern Ghana. BMC Public Health 2023; 23:1491. [PMID: 37542227 PMCID: PMC10403908 DOI: 10.1186/s12889-023-16376-2] [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: 09/29/2022] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND This study aimed to assess the effects of health education and community-level participatory interventions at the community level and the use of community maternal health promoters on the utilization of maternal health care services in poor rural settings of northern Ghana. METHODS A randomized controlled survey design was conducted from June 2019 to July 2020 in two rural districts of northern Ghana. A multistage cluster sampling technique was used to select the participants. Data were collected from a repeated cross-sectional household survey. Descriptive analysis, bivariate and covariates adjusted simple logistic regression analyses were performed using STATA version 16 statistical software. RESULTS At post-intervention, the two groups differed significantly in terms of ANC (p = 0.001), skilled delivery (SD) (p = 0.003), and PNC (p < 0.0001). Women who received health education on obstetric danger signs had improved knowledge by 50% at the end of the study. Women who received the health education intervention (HEI) on practices related to ANC and skilled delivery had increased odds to utilize ANC (AOR = 4.18; 95% CI = 2.48-7.04) and SD (AOR = 3.90; 95% CI = 1.83-8.29) services. Institutional delivery and PNC attendance for at least four times significantly increased from 88.5 to 97.5% (p < 0.0001), and 77.3-96.7% (p < 0.0001) respectively at postintervention. Women who had received the HEI were significantly more likely to have good knowledge about obstetric danger signs (AOR = 10.17; 95% CI = 6.59-15.69), and BPCR (AOR = 2.10; 95% CI = 1.36-3.24). Women who had obtained tertiary education were significantly more likely to make at least four visits to ANC (AOR = 2.38; 95% CI = 0.09-1.67). CONCLUSIONS This study suggests that the use of health education and participatory sessions led by community-based facilitators could be a potentially effective intervention to improve the knowledge of women about obstetric danger signs and encourage the uptake of maternity care services in resource-poor settings of Ghana.
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Affiliation(s)
| | - Sam Kofi Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Easmon Otupiri
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Antabe R, Luginaah NA, Kangmennaang J, Mkandawire P. Determinants of cervical cancer screening among women living with HIV in Zimbabwe. Health Promot Int 2023; 38:daad073. [PMID: 37440254 DOI: 10.1093/heapro/daad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
In sub-Saharan Africa (SSA), cervical cancer (CC) is the second leading cause of cancer-related deaths, with human immunodeficiency virus (HIV) seropositive women being particularly vulnerable. Despite the benefits of early CC screening in reducing HIV-related CC deaths, CC screening uptake remains limited, with wide disparities in access across SSA. As part of a larger study, this paper examines the determinants of CC screening among HIV-seropositive women of reproductive age (15-49 years) in Zimbabwe. Using the 2015 Zimbabwe Demographic and Health Survey, we conducted multilevel analyses of CC screening among 1490 HIV-seropositive women, nested in 400 clusters. Our findings revealed that, even though 74% of HIV-seropositive women knew about CC, only 17.6% of them reported ever screening for it. Women who held misconceptions about HIV (OR = 0.47, p = 0.01) were less likely to screen for CC compared to those with accurate knowledge about HIV and CC. HIV-seropositive women with secondary or higher education were more likely to screen (OR = 1.39, p = 0.04) for CC compared to those with a primary or lower level of education. Age was positively associated with screening for CC. Furthermore, locational factors, including province and rural-urban residence, were associated with CC screening. Based on these findings, we call for integrated care and management of HIV and non-communicable diseases in Southern Africa, specifically, Zimbabwe due to the legacy of HIV in the region.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada
| | - Nasong A Luginaah
- Faculty of Science, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen's University, 28 Division St., Kingston, ON K7L 3N6, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, 1315 Dunton Tower, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
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Osseo-Asare AD. "Don't use herbs in labor!": Plants, pharmaceuticals, and the unmaking of traditional birth attendants in Ghana, 1970-2000. Soc Sci Med 2023; 329:115980. [PMID: 37311306 DOI: 10.1016/j.socscimed.2023.115980] [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: 05/27/2022] [Revised: 04/13/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
This article considers efforts in the West African country of Ghana to improve maternal care through a network of trained "Traditional Birth Attendants," or TBAs in the late twentieth century. It reconsiders the rise and fall of TBAs through the lens of increasing global access to essential medicines like oxytocin and misoprostol which reduced confidence in herbal medications for pregnancy complications. Interviews with policy makers and birth attendants reflecting on their involvement in TBA programs from the 1970s as well as analysis of archival documents and training manuals shows how pharmaceuticals rose in prominence at the same time birth attendants maintained medicinal plant knowledge. Over time, Ghanaian policymakers encouraged TBAs to avoid using herbs while caring for women during pregnancy. By the early 2000s, government went so far as to ban TBAs, and urged everyone to deliver with a skilled birth attendant (SBA) such as a nurse midwife or obstetrician more conversant in biomedical interventions including pharmaceuticals. This retrospective account of TBAs across several decades suggests that once Ghanaian officials had strengthened access to standardized pharmaceuticals, they lost confidence in traditional birth attendants and the herbal remedies they cultivated. Access to pharmaceuticals shaped the difference between skilled and- "unskilled" or "traditional"-birth attendants.
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Elsey H, Abboah-Offei M, Vidyasagaran AL, Anaseba D, Wallace L, Nwameme A, Gyasi A, Ayim A, Ansah-Ofei A, Amedzro N, Dovlo D, Agongo E, Awoonor-Williams K, Agyepong I. Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why. Front Public Health 2023; 11:1105495. [PMID: 37435526 PMCID: PMC10332345 DOI: 10.3389/fpubh.2023.1105495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/11/2023] [Indexed: 07/13/2023] Open
Abstract
Background Despite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub-Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme. Methods We conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understand the different impacts and implementation lessons of the CHPS programme. Results N = 58 out of n = 117 full text studies retrieved met the inclusion criteria, of which n = 28 were quantitative, n = 27 were qualitative studies and n = 3 were mixed methods. The geographical spread of studies highlighted uneven distribution, with the majority conducted in the Upper East Region. The CHPS programme is built on a significant body of evidence and has been found effective in reducing under-5 mortality, particularly for the poorest and least educated, increasing use and acceptance of family planning and reduction in fertility. The presence of a CHPS zone in addition to a health facility resulted in increased odds of skilled birth attendant care by 56%. Factors influencing effective implementation included trust, community engagement and motivation of community nurses through salaries, career progression, training and respect. Particular challenges to implementation were found in remote rural and urban contexts. Conclusions The clear specification of CHPS combined with a conducive national policy environment has aided scale-up. Strengthened health financing strategies, review of service provision to prepare and respond to pandemics, prevalence of non-communicable diseases and adaptation to changing community contexts, particularly urbanization, are required for successful delivery and future scale-up of CHPS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214006, identifier: CRD42020214006.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Mary Abboah-Offei
- School of Health and Life Sciences, University of the West of Scotland (London Campus), London, United Kingdom
| | | | - Dominic Anaseba
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Lauren Wallace
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua Gyasi
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Andrews Ayim
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Nina Amedzro
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Delanyo Dovlo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Erasmus Agongo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Irene Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
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Sangy MT, Duaso M, Feeley C, Walker S. Barriers and facilitators to the implementation of midwife-led care for childbearing women in low- and middle-income countries: A mixed-methods systematic review. Midwifery 2023; 122:103696. [PMID: 37099826 DOI: 10.1016/j.midw.2023.103696] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Evidence from high-income countries demonstrate improvements in maternal and neonatal health with midwife-led care. Midwife-led care is pivotal to meet the United Nations' Sustainable Development Goals. Despite this, successful implementation of midwife-led care in low- and middle-income countries (LMICs) has been limited. It is therefore necessary to understand the factors that influence the implementation of midwife-led care. AIM This systematic review aimed to synthesize the evidence on barriers and facilitators to the implementation of midwife-led care for childbearing women in LMICs from the perspectives of care recipients, providers and wider stakeholders. METHODS A mixed-methods systematic review was conducted of primary research studies that expressed the views of those involved in or affected by the implementation of midwife-led care in LMICs. Reporting followed PRISMA guidelines. MEDLINE, EMBASE, PsychINFO, CINAHL, Maternity and Infant Care database (MIDIRS), Global Health and Web of Science databases were systematically searched. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was analysed and synthesized using the Supporting the Use of Research Evidence (SURE) framework to identify barriers and enabling factors to implementing midwife-led care. FINDINGS A total of 31 studies from 21 LMICs were included. At the care recipient level, women need adequate knowledge and confidence about midwife-led care to utilise services. At the care provider level, strengthening midwifery education and practice by employing experienced educators and supervisors is essential. Findings also suggest that increased collaboration between funders, professional organisations, practitioners, communities, and the government is necessary for successful implementation. However, adequate and sustained funding for midwife-led care programs is often lacking and political instability contributes to poor implementation in LMICs. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH There are several enabling factors which increase the success and sustainability of the midwife-led model of care in LMICs. However, current practice guidelines and strategic frameworks need to better reflect the infrastructure and resource limitations of health settings in LMICs.
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Affiliation(s)
- Marie Therese Sangy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings' College, London, UK.
| | - Maria Duaso
- Senior Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Claire Feeley
- Lecturer (Research & Teaching), Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Shawn Walker
- Senior Research Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
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Amoak D, Dhillon S, Antabe R, Sano Y, Luginaah I. Factors Associated with Deworming Medication Utilization among Pregnant Women in Benin: Evidence from the Demographic and Health Survey. Trop Med Infect Dis 2023; 8:tropicalmed8030166. [PMID: 36977167 PMCID: PMC10053996 DOI: 10.3390/tropicalmed8030166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Deworming medication utilization is a useful strategy to reduce the burden of anemia among pregnant women. Yet, we know very little about the prevalence and correlates of deworming medication utilization among pregnant women in sub-Saharan Africa, including Benin. To address this void in the literature, we used the 2017–2018 Benin Demographic and Health Survey and applied logistic regression analysis to explore the demographic, socioeconomic, and healthcare factors associated with deworming medication utilization in Benin. We found that deworming medication coverage was 65% at the national level. We observed that women aged 35–49 years were less likely to use deworming medication compared to those aged 15–24 years (OR = 0.79, p < 0.01). Compared to Christian women, Muslim women (OR = 0.70, p < 0.01) and women of other religions (OR = 0.51, p < 0.01) were also less likely to use deworming medication. Moreover, women with lower levels of education and household wealth, as well as unemployed women, were less likely to use deworming medication in comparison to their educated, richer, and employed counterparts. Women who visited ANC fewer than eight times were also less likely to use deworming medication compared to their counterparts who did so eight times or more (OR = 0.65, p < 0.001). Based on these findings, we discussed several implications for policymakers.
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Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, ON N6A 5C2, Canada
| | - Satveer Dhillon
- Department of Geography and Environment, Western University, London, ON N6A 5C2, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Scarborough, ON M1C 1A4, Canada
| | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON P1B 8L7, Canada
- Correspondence:
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, ON N6A 5C2, Canada
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Texting for life: a mobile phone application to connect pregnant women with emergency transport and obstetric care in rural Nigeria. BMC Pregnancy Childbirth 2023; 23:139. [PMID: 36882709 PMCID: PMC9993601 DOI: 10.1186/s12884-023-05424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Difficulty in transportation to access skilled providers has been cited repeatedly as a major barrier to utilization of emergency obstetric care in Nigeria. OBJECTIVE The objective of this paper is to describe the design, implementation, and outcomes of a mobile phone technology aimed at rapidly reaching rural Nigerian women who experience pregnancy complications with emergency transportation and access to providers. METHOD The project was implemented in 20 communities in two predominantly rural Local Government Areas (LGAs) of Edo State, in southern Nigeria, as part of a larger implementation project aimed at improving the access of rural women to skilled pregnancy care. The digital health innovation named Text4Life, allowed women to send a brief message from their mobile phone to a server linked to Primary Health Care (PHC) facilities and to access pre-registered transport owners. Pregnant women were registered and taught to text short messages to a server from their mobile phones or those of a friend or relative when they experience complications. RESULTS Over 18 months, 56 women out of 1620 registered women (3.5%) texted the server requesting emergency transportation. Of this number, 51 were successfully transported to the PHC facilities, 46 were successfully treated at the PHC, and five were referred to higher-level care facilities. No maternal deaths occurred during the period, while four perinatal deaths were recorded. CONCLUSION We conclude that a rapid short message sent from a mobile phone to a central server and connected to transport providers and health facility managers is effective in increasing the access of pregnant women to skilled emergency obstetric services in rural Nigeria.
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Amu H, Aboagye RG, Dowou RK, Kongnyuy EJ, Adoma PO, Memiah P, Tarkang EE, Bain LE. Towards achievement of Sustainable Development Goal 3: multilevel analyses of demographic and health survey data on health insurance coverage and maternal healthcare utilisation in sub-Saharan Africa. Int Health 2023; 15:134-149. [PMID: 35439814 PMCID: PMC9977256 DOI: 10.1093/inthealth/ihac017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improving maternal health and achieving universal health coverage (UHC) are important expectations in the global Sustainable Development Goals (SDGs) agenda. While health insurance has been shown as effective in the utilisation of maternal healthcare, there is a paucity of literature on this relationship in sub-Saharan Africa (SSA). We examined the relationship between health insurance coverage and maternal healthcare utilisation using demographic and health survey data. METHODS This was a cross-sectional study of 195 651 women aged 15-49 y from 28 countries in SSA. We adopted bivariable and multivariable analyses comprising χ2 test and multilevel binary logistic regression in analysing the data. RESULTS The prevalence of maternal healthcare utilisation was 58, 70.6 and 40.7% for antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC), respectively. The prevalence of health insurance coverage was 6.4%. Women covered by health insurance were more likely to utilise ANC (adjusted OR [aOR]=1.48, 95% CI 1.41 to 1.54), SBA (aOR=1.37, 95% CI 1.30 to 1.45) and PNC (aOR=1.42, 95% CI 1.37 to 1.48). CONCLUSION Health insurance coverage was an important predictor of maternal healthcare utilisation in our study. To accelerate progress towards the achievement of SDG 3 targets related to the reduction of maternal mortality and achievement of UHC, countries should adopt interventions to increase maternal insurance coverage, which may lead to higher maternal healthcare access and utilisation during pregnancy.
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Affiliation(s)
- Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Prince Owusu Adoma
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health (LIIRH), College of Social Science, University of Lincoln, Lincoln, UK
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Bittaye H, Mooney JP, Afferri A, Balen J, Kay V. Introducing assisted reproductive technologies in The Gambia, a survey on the perspectives of Gambian healthcare professionals and medical students. BMC Health Serv Res 2023; 23:203. [PMID: 36855053 PMCID: PMC9979844 DOI: 10.1186/s12913-023-09171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Infertility remains a global reproductive health burden with the highest prevalence in low and middle-income countries. In sub-Saharan Africa, the ability to procreate holds great societal importance. Couples, and particularly women, with infertility can face devastating challenges, leading to social stigma, isolation and/or divorce. However, attention to addressing infertility is lacking in sub-Saharan Africa. In The Gambia, where this study is based, little is known about the potential for introduction of assisted reproductive technologies (ART) in the public health sector. METHODS A quantitative survey was conducted using detailed questionnaires on infertility services available, staff knowledge, perceived barriers, and personal motivation to support assisted reproductive technologies. Data was collected electronically between April and June 2021 from healthcare providers (n = 70) in eleven health facilities throughout the country, as well as from medical students (n = 55) enrolled at The University of The Gambia. RESULTS Basic infertility services were found to be lacking in the rural areas. Furthermore, 39% of staff (n = 27) providing fertility care had not receive any formal training on the topic. However, 91% of staff (n = 64) showed interest in acquiring additional knowledge and had a positive attitude towards supporting the introduction of ART. Perceived challenges of doing so included: (i) the competing importance of other health priorities; and (ii) religious and cultural barriers. CONCLUSION This survey highlights that expansion of infertility services is needed, especially in rural areas. Staff perceived the introduction of ART as important, but this should be coupled with specialized training, as most medical staff had not received any formal infertility training. Future care providers (current medical students) showed both interest in ART and reported having received some basic training in infertility management. Given the reported lack of infrastructure and services, additional targeted investment in infertility care, including ART, will be needed to improve reproductive health for all, countrywide.
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Affiliation(s)
| | - Jason P. Mooney
- grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Anna Afferri
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julie Balen
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Vanessa Kay
- grid.8241.f0000 0004 0397 2876School of Medicine, University of Dundee, Dundee, UK
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Yalley AA, Abioye D, Appiah SCY, Hoeffler A. Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana. Front Public Health 2023; 11:988961. [PMID: 36860379 PMCID: PMC9968731 DOI: 10.3389/fpubh.2023.988961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Background Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana. Methodology A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills. Findings We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant. Conclusion The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.
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Affiliation(s)
- Abena Asefuaba Yalley
- Department of Politics, Zukunftskolleg, University of Konstanz, Konstanz, Germany,Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany,*Correspondence: Abena Asefuaba Yalley ✉
| | - Dare Abioye
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | - Anke Hoeffler
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
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Enumah ZO, Rafiq MY, Juma O, Manyama F, Ngude H, Stevens K, Sakran J. Access to Health Services Among Forced Migrants in Tanzania: A Cluster Randomized Cross Sectional Study of 3560 Congolese and Burundian Refugees. J Immigr Minor Health 2023; 25:115-122. [PMID: 36040581 DOI: 10.1007/s10903-022-01387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
Despite significant advances in the understanding of the global burden of surgical disease, limited research focuses on access to health and surgical services among refugees, especially in east Africa. The goal of this study was to describe patterns of access to transportation to health services among Congolese and Burundian refugees in Tanzania. We utilized cluster random sampling to perform a large, cross-sectional study in Nyarugusu refugee camp, Tanzania using an adapted version of the Surgeon Overseas Assessment Tool (SOSAS). We randomly selected 132 clusters out of 1472 clusters, randomly selected two people from all households in those clusters. Data analysis was performed in STATA (Stata Version 16, College Station, TX). A total of 3560 participants were included in the study including 1863 Congolese refugees and 1697 Burundian refugees. The majority of refugees reported they were generally healthy (n = 2792, 79.3%). The most common period of waiting to be seen at the health center was between three and 5 h (n = 1502, 45.8%), and over half of all refugees waited between 3 and 12 h to be seen. There was heterogeneity in other intra-camp referral networks (e.g. to and from traditional healer and hospital). Finally, a low percentage (3%) of participants reported leaving the refugee camp to seek health care elsewhere, and Congolese refugees were more likely to pursue self-referral in this manner. To our knowledge, this is the largest study focused on access to transportation among refugees in Tanzania and sub-Saharan Africa. Most participants reported financial difficulty always affording transportation costs with significant wait times occurring once arrived at the hospital. Our study does suggest that some independent health care seeking did occur outside of the camp-based services. Future research may focus more specifically on barriers to timely servicing of patients and patterns of self-referral.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Zachary Obinna] Last Name [Enumah] and Author 2 Given name: [Mohamed Yunus] Last Name [Rafiq]. Also, kindly confirm the details in the metadata are correct.Confirmed.
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Affiliation(s)
- Zachary Obinna Enumah
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | | | - Omar Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Frank Manyama
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Kent Stevens
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Joseph Sakran
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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Stewart CL, Hall JA. Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi. PLoS One 2022; 17:e0279613. [PMID: 36584165 PMCID: PMC9803273 DOI: 10.1371/journal.pone.0279613] [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: 07/21/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care-the integrated delivery of antenatal, delivery and postnatal care-has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi. METHODS 4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable-continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare. RESULTS Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04-0.96), having at least one live child (OR = 0.87, 95%CI = 0.84-0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50-0.82) or abuse (OR = 0.81, 95%CI = 0.69-0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08-1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11-1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80-1.49) increased utilisation. CONCLUSION Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.
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Affiliation(s)
- Catherine Louise Stewart
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
| | - Jennifer Anne Hall
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
- * E-mail:
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Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey. Vaccines (Basel) 2022; 11:vaccines11010077. [PMID: 36679921 PMCID: PMC9861428 DOI: 10.3390/vaccines11010077] [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: 11/30/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Tetanus toxoid vaccination is critical for improving maternal and child health. Yet, the prevalence and correlates of maternal tetanus toxoid vaccination coverage remain largely underexplored in Benin where infant and child mortality rates are high. Using the 2017−18 Benin Demographic and Health Survey, we apply logistic regression analysis to address this void in the literature. We find that overall maternal vaccination coverage is 69%. A range of demographic, health care, and socioeconomic factors are associated with maternal tetanus toxoid vaccination coverage. Women aged 20−34 (OR = 0.84, p < 0.05) and 35−49 (OR = 0.63, p < 0.01) are less likely to receive tetanus toxoid vaccination in comparison to those aged 15−19. Health care factors are also significantly associated with maternal tetanus toxoid vaccination, indicating that women who deliver at home (OR = 0.20, p < 0.001) and visit antenatal care fewer than eight times (OR = 0.62, p < 0.001) are less likely to receive tetanus toxoid vaccination than their counterparts who deliver in a health facility and visit antenatal care eight times or more. We also find that women with secondary (OR = 0.54, p < 0.05), primary (OR = 0.47, p < 0.01), and no education (OR = 0.47, p < 0.01) are less likely to receive tetanus toxoid vaccination compared to their counterparts with higher education. Based on these findings, we discuss several implications for policymakers.
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Taye BT, Zerihun MS, Kitaw TM, Demisse TL, Worku SA, Fitie GW, Ambaw YL, Amare NS, Behulu GK, Ferede AA, Kebede AA. Women’s traditional birth attendant utilization at birth and its associated factors in Angolella Tara, Ethiopia. PLoS One 2022; 17:e0277504. [PMID: 36367902 PMCID: PMC9651568 DOI: 10.1371/journal.pone.0277504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background In developing countries, home delivery without a skilled birth attendant is a common practice. It has been evidenced that unattended birth is linked with serious life-threatening complications for both the women and the newborn. Institutional delivery with a skilled birth assistance could reduce 20–30% of neonatal mortality. This study aimed to assess traditional birth attendants’ (TBAs) utilization and associated factors for women who gave birth in the last two years in Angolella Tara District, Ethiopia. Methods A community-based cross-sectional study was employed among 416 women who gave birth in the last two years at rural Angolella Tara District. Study participants were recruited by using a simple random sampling technique. Data were collected using a structured, pretested, and interviewer-administered questionnaire. Epi Data 4.6 and SPSS version 25 were used for data entry and analysis, respectively. A multivariable logistic regression model was fitted to identify factors associated with women’s utilization of traditional birth attendants. The level of significance in the last model was determined at a p-value of <0.05. Result Overall, 131 (31.5%) participants were used traditional birth attendants in their recent birth. Unmarried marital status (AOR 2.63; 95% CI: 1.16, 5.97), age at first marriage (AOR 2.31; 95%CI: 1.30, 4.09), time to reach health facility (AOR = 3.46; 95% CI: 1.94, 6.17), know danger sign of pregnancy and childbirth (AOR = 5.59, 95% CI; 2.89, 10.81), positive attitude towards traditional birth attendants (AOR = 2.56 95% CI; 1.21,5.52), had antenatal care follow-up (AOR: 0.11 95% CI 0.058, 0.21), and listening radio (AOR = 0.43; 95% CI: 0.18, 0.99) were significantly associated factors with the use of traditional birth attendants. Conclusion Nearly one-third of women used traditional birth attendant services for their recent birth. TBAs availability and accessibility in the community, and respect for culture and tradition, problems regarding infrastructure, delay or unavailability of ambulance upon call, and some participants knowing only TBAs for birth assistance were reasons for preference of TBAs. Therefore, effort should be made by care providers and policymakers to ensure that modern health care services are accessible for women in a friendly and culturally sensitive manner. In addition, advocacy through mass media about the importance of maternal health service utilization, particularly antenatal care would be important.
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Affiliation(s)
- Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
- * E-mail:
| | - Mulualem Silesh Zerihun
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tebabere Moltot Kitaw
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tesfanesh Lemma Demisse
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Adanew Worku
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Girma Wogie Fitie
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yeshinat Lakew Ambaw
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Nakachew Sewnet Amare
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Geremew Kindie Behulu
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Addisu Andualem Ferede
- Department of Midwifery, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tesfay N, Tariku R, Zenebe A, Mohammed F, Woldeyohannes F. Area of focus to handle delays related to maternal death in Ethiopia. PLoS One 2022; 17:e0274909. [PMID: 36121828 PMCID: PMC9484697 DOI: 10.1371/journal.pone.0274909] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.
Methods
The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.
Result
Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.
Conclusion
Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
- * E-mail:
| | - Rozina Tariku
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fetiya Mohammed
- Center of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Imo CK, De Wet-Billings N, Isiugo-Abanihe UC. The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Arch Public Health 2022; 80:206. [PMID: 36100949 PMCID: PMC9472384 DOI: 10.1186/s13690-022-00968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria. Methods The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1. Results The results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M. Conclusions The study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.
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Dotse-Gborgbortsi W, Nilsen K, Ofosu A, Matthews Z, Tejedor-Garavito N, Wright J, Tatem AJ. Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana. BMC Pregnancy Childbirth 2022; 22:672. [PMID: 36045351 PMCID: PMC9429654 DOI: 10.1186/s12884-022-04998-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare. Methods Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems. Results Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments. Conclusion Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04998-0.
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Woldegiorgis MA, Meyer D, Hiller JE, Mekonnen W, Bhowmik J. Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy. Int Health 2022; 14:421-433. [PMID: 32043526 PMCID: PMC9248058 DOI: 10.1093/inthealth/ihz117] [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] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the inter-relationships among key RH indicators and their relationship with women's literacy in sub-Saharan Africa (SSA). METHODS Data were sourced from the most recent demographic and health survey conducted between 2010 and 2016 in 391 provinces of 29 SSA countries. We examined seven RH indicators along with women's literacy. The unit of analysis was at the provincial level. Structural equation modelling was used to examine the strength of relationships among these indicators and with women's literacy, using the total standardized effect sizes. Significance tests and 95% confidence intervals (CIs) for these effects were calculated using a bias-corrected bootstrap method. RESULTS RH indicators are strongly interrelated and are associated with women's literacy. The strongest relationship is observed between women's literacy rate and the contraception prevalence rate, with a total standardized effect size of 0.79 (95% CI 0.74-0.83). The model of inter-relationships developed in this study may guide the design, implementation and evaluation of RH policies and programmes. CONCLUSIONS The key challenge in reducing fertility in SSA is to reduce people fertility desire. This could mainly be addressed by enhancing integrated approaches especially between the education and health sectors.
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Affiliation(s)
- Mulu Abraha Woldegiorgis
- Burnet Institute, Public Health, Melbourne, Australia
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
| | - Denny Meyer
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
| | - Janet E Hiller
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
- University of Adelaide, School of Public Health, Adelaide, Australia
| | | | - Jahar Bhowmik
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
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Shakur‐Still H, Grassin‐Delyle S, Muhunthan K, Ahmadzia HK, Faraoni D, Arribas M, Roberts I. Alternative routes to intravenous tranexamic acid for postpartum hemorrhage: A systematic search and narrative review. Int J Gynaecol Obstet 2022; 158 Suppl 1:40-45. [PMID: 35762806 PMCID: PMC9327714 DOI: 10.1002/ijgo.14201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To review available data on tranexamic acid (TXA) plasma concentration needed to inhibit fibrinolysis and the time to achieve this concentration when giving TXA by different routes in humans. To identify ongoing trials assessing alternatives to intravenous TXA administration. METHODS We updated two previous systematic reviews by searching MEDLINE, EMBASE, OviSP, and ISI Web of Science from database inception to July 2021. We also searched the WHO International Clinical Trials Registry Platform for ongoing trials to July 2021. Titles and abstracts were screened for relevant trials. Two reviewers independently reviewed and agreed the trials to be included. RESULTS Plasma TXA concentrations over 10 mg/L provide near maximal inhibition of fibrinolysis, with concentrations over 5 mg/L providing partial inhibition. Oral TXA tablets take about 1 h to reach a plasma concentration of 5 mg/L in postpartum women. Studies in healthy volunteers and shocked trauma patients show that intramuscular TXA achieves a plasma level of over 10 mg/L within 15 min. One trial is ongoing to determine the pharmacokinetics of intramuscular and oral solution TXA in pregnant women. CONCLUSION Intramuscular TXA in healthy volunteers and shocked trauma patients reaches therapeutic concentration rapidly. Oral TXA tablets take too long to reach the minimum therapeutic concentration in postpartum women.
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Affiliation(s)
| | - Stanislas Grassin‐Delyle
- Département des maladies des voies respiratoiresHôpital FochSuresnesFrance
- Infection et inflammation, Département de Biotechnologie de la Santé, UVSQ, INSERMUniversité Paris‐SaclayMontigny le BretonneuxFrance
| | | | - Homa K. Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - David Faraoni
- Department of Anesthesiology, Perioperative and Pain Medicine, Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Texas Children’s HospitalBaylor College of MedicineHoustonTexasUSA
| | - Monica Arribas
- Clinical Trials UnitLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ian Roberts
- Clinical Trials UnitLondon School of Hygiene and Tropical MedicineLondonUK
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Chowdhury MAK, Karim F, Hasan MM, Ali NB, Khan ANS, Siraj MS, Ahasan SMM, Hoque DME. Bottleneck analysis of maternal and newborn health services in hard-to-reach areas of Bangladesh using ‘TANAHASHI’ framework’: An explanatory mixed-method study. PLoS One 2022; 17:e0268029. [PMID: 35551544 PMCID: PMC9098042 DOI: 10.1371/journal.pone.0268029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Maternal and Newborn Health (MNH) is of paramount importance in the realm of attaining sustainable development goals that also focuses on universal health coverage (UHC). The study aimed at identifying and exploring the bottlenecks in MNH services in Hard-to-reach (HtR) areas of Bangladesh using the Tanahashi framework exploring the possible remedial approaches. The study was conducted in four different types of HtR areas (hilly, coastal, lowlands, and river islands) by utilizing a sequential explanatory mixed-method design. Overall, we collected information from 20 health facilities and 2,989 households by interviewing 2,768 recently delivered women (RDW) with a structured questionnaire and qualitative interviews (n = 55) of facility managers, local stakeholders, RDWs, and health care providers (HCP). The quantitative data were analyzed principally for descriptive statistics and the qualitative data was analyzed by utilizing the thematic approach. Antenatal care, under-5 care, and family planning services were available in almost all the facilities. However, Normal vaginal deliveries were performed in 55.6% of the union-level facilities. Only 40% of sub-district level facilities had provision for C-sections. Blood transfusion services were available in only 20.1% of facilities, whereas laboratory services were obtainable in 51.7% of facilities. Overall, the bottlenecks were identified in cases of availability of drugs, human resources, transportation, lack of knowledge regarding different essential services and health components, out of pocket expenditure etc. There have been several remedial approaches suggested from both the demand and supply side that included incentives for care providers for staying in these areas, a coordinated transport/referral system, and health education campaigns. More research works are warranted in HtR areas, especially to test the proposed interventions. Meanwhile, the government should take the necessary steps to overcome the bottlenecks identified.
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Affiliation(s)
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Mehedi Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Shahjahan Siraj
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
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Owen MD, Ismail HM, Goodman D, Batakji M, Kim SM, Olufolabi A, Srofenyoh EK. Use of WhatsApp messaging technology to strengthen obstetric referrals in the Greater Accra Region, Ghana: Findings from a feasibility study. PLoS One 2022; 17:e0266932. [PMID: 35482758 PMCID: PMC9049345 DOI: 10.1371/journal.pone.0266932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
In Ghana, the high-risk obstetric referral system is inadequate. Delay is common and patients often arrive to receiving hospitals in compromised states. An effective referral system should include an adequately resourced referral hospital, communication across sectors, accountability, transport, monitoring capability and policy support, which are currently lacking. A pilot program was undertaken to facilitate communication between hospital staffs. Additionally, data was collected to better understand and characterize obstetric referrals in Accra. Thirteen institutions were selected based on referral volume to implement the use of pre-referral treatment guidelines and WhatsApp as a mobile technology communication platform (Platform). Participants included healthcare workers from 8 health centers, 4 district hospitals, the Greater Accra Regional Hospital (GARH), administrators, doctors from other tertiary hospitals in Accra and medical consultants abroad. Facilities were provided smartphones and guidelines on using WhatsApp for advice on patient care or referral. Data were collected on WhatsApp communications among participants (March-August 2017). During this period, 618 cases were posted on the Platform and users increased from 69 to 81. The median response time was 17 min, a receiving hospital was identified 511 (82.7%) times and pre-referral treatment was initiated in 341 (55.2%). Subsequently, data collected on 597 referrals to GARH (September-November 2017) included 319 (53.4%) from Platform and 278 (46.6%) from non-Platform hospitals. Of these, 515 (86.3%) were urgent referrals; the median (interquartile range) referral to arrival time was 293 (111–1887) minutes without variation by facility grouping. Taxis were utilized for transportation in 80.2%; however, referral time shortened when patients arrived by ambulance and with a midwife. Only 23.5% of urgent referrals arrived within two hours. This project demonstrates that WhatsApp can be used as a communication tool for high-risk obstetric referrals and highlights the need to continue to improve urban referral processes due to identified delays which may contribute to poor outcomes.
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Affiliation(s)
- Medge D. Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Hebah M. Ismail
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- * E-mail:
| | - David Goodman
- Winnie Palmer Hospital for Women and Babies, Orlando, FL, United States of America
| | - Mariam Batakji
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Sung Min Kim
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Adeyemi Olufolabi
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States of America
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Gebremeskel AT, Omonaiye O, Yaya S. Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review. BMJ Glob Health 2022; 7:bmjgh-2021-008162. [PMID: 35393287 PMCID: PMC8991040 DOI: 10.1136/bmjgh-2021-008162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/26/2022] [Indexed: 12/29/2022] Open
Abstract
Background Countries in sub-Saharan Africa (SSA) continue to have the highest maternal and under-five child deaths in the world. The ongoing COVID-19 pandemic is amplifying the problems and overwhelming already fragile health systems. Community health workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in improving maternal and child health (MCH). However, evidence is limited on multilevel determinants of an effective CHWs programme using CHWs’ perspective. The objective of this systematic review is to examine perceived barriers to and enablers of different levels of the determinants of the CHWs’ engagement to enhance MCH equity and a resilient community health system in SSA. Methods We systematically conducted a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Qualitative studies that presented information on perceived barriers to and facilitators of effectiveness of CHWs in SSA were eligible for inclusion. Quality appraisal was conducted according to the Critical Appraisal Skills Programme qualitative study checklist. We used a framework analysis to identify key findings. Findings From the database search, 1561 articles were identified. Nine articles met the inclusion criteria and were included in the final review. Using socio-ecological framework, we identified the determinants of CHWs’ effectiveness at 4 levels: individual/CHWs, interpersonal, community and health system logistics. Under each level, we identified themes of perceived barriers such as competency gaps, lack of collaboration, fragmentation of empowerment programmes. In terms of facilitators, we identified themes such as CHW empowerment, interpersonal effectiveness, community trust, integration of CHWs into health systems and technology. Conclusion Evidence from this review revealed that effectiveness of CHW/MCH programme is determined by multilevel contextual factors. The socio-ecological framework can provide a lens of understanding diverse context that impedes or enhances CHWs’ engagement and effectiveness at different levels. Hence, there is a need for health programme policy makers and practitioners to adopt a multilevel CHW/MCH programme guided by the socio-ecological framework to transform CHW programmes. The framework can help to address the barriers and scale up the facilitators to ensuring MCH equity and a resilient community health system in SSA.
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Affiliation(s)
- Akalewold T Gebremeskel
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne-Burwood Campus, Burwood, Victoria, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada .,The George Institute for Global Health, Imperial College London, London, UK
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Steele V, Patterson K, Berrang-Ford L, King N, Kulkarni M, Lwasa S, Namanya DB, Harper SL. Antenatal Care Research in East Africa During the Millennium Development Goals Initiative: A Scoping Review. Matern Child Health J 2022; 26:469-480. [PMID: 35028892 DOI: 10.1007/s10995-021-03355-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The global burden of maternal mortality remains high and inequitably distributed between countries. Antenatal care (ANC) was identified as critical component in achieving the Millennium Development Goal of improving maternal health. This scoping review aimed to summarize trends and critically explore research about ANC attendance for East African women conducted during the Millennium Development Goals initiative, with a specific focus on barriers to ANC access. METHODS Using a scoping review methodology, aggregator databases were searched for relevant articles. Articles were screened by independent reviewers using a priori inclusion criteria. Eligible articles were retained for data charting and analysis. RESULTS Following screening, 211 articles were analyzed. The number of relevant articles increased over time; utilized primarily quantitative methods; and involved authors with affiliations from various African countries. Many interrelated physical, social, and cultural factors influenced women's seeking, reaching, and receiving of quality ANC. The extent of studies identified suggest that ANC is a priority research area, yet key gaps in the literature exist. Limited qualitative research, and few articles examining ANC experiences of women from vulnerable groups (e.g. adolescents, women with a disability, and Indigenous women) were identified. DISCUSSION These context-specific findings are important considering the Sustainable Development Goals aim to nearly triple the maternal mortality reductions by 2030. In order to achieve this goal, interventions should focus on improving the quality of ANC care and patient-provider interactions. Furthermore, additional qualitative research examining vulnerable populations of women and exploring the inclusion of men in ANC would help inform interventions intended to improve ANC attendance in East Africa.
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Affiliation(s)
- Vivienne Steele
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Lea Berrang-Ford
- Priestley Centre for Climate Change, Leeds University, Leeds, LS2 9JT, York, UK
| | - Nia King
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3L4, Canada.
| | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, P.O. Box 7062, Kampala, Uganda
| | | | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada. .,School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 1C9, Canada.
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Lee H, Maffioli EM, Veliz PT, Sakala I, Chiboola NM, Lori JR. Direct and opportunity costs related to utilizing maternity waiting homes in rural Zambia. Midwifery 2021; 105:103211. [PMID: 34894428 PMCID: PMC8811481 DOI: 10.1016/j.midw.2021.103211] [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: 05/04/2020] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Lack of financial resources is a critical barrier to utilising Maternity Waiting Homes (MWHs) in low-income countries (LICs). Food and user fees are most frequent expenditures for women utilising MWHs in rural Zambia. Being away from various household chores, the loss of income generating activities (IGAs), may also be a financial constraint in utilising MWHs.
Aim To assess the direct and opportunity costs involved in utilising maternity waiting homes. Method A cross-sectional admission survey administered to women who used ten maternity waiting homes across two rural districts in Zambia. A total of 3,796 women participated in the survey. Descriptive analysis was conducted on three domains of the data: demographic characteristics of women, direct costs, and opportunity costs. Findings Waiting to deliver (86.3%), safe birth (70.8%), and distance (56.0%) were the most frequent reasons women reported for using a maternity waiting home. In terms of direct costs, roughly 65% of the women brought seven days or fewer days' worth of food to the maternity waiting homes, with salt, mealie meals, and vegetables being the most frequently brought items. Only 5.8% of the women spent money on transport. More than half of the women reported paying user fees that ranged from 1 to 5 or more kwacha (US$0.10- 0.52). In terms of opportunity costs, 52% of the women participated in some form of income generating activities (IGAs) when at home. Approximately 35% of the women reported they lost earned income (1 to 50 or more kwacha) by staying at a maternity waiting home. Conclusion A large proportion of women paid for food and user fees to access a maternity waiting home, while a low number of women paid for transport. Even though it is difficult to assign monetary value to women's household chores, being away from these responsibilities and the potential loss of earned income appear to remain a cost to accessing maternity waiting homes. More research is needed to understand how to overcome these financial constraints and assist women in utilising a maternity waiting home.
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Affiliation(s)
- HaEun Lee
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States.
| | - Elisa M Maffioli
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Philip T Veliz
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
| | - Isaac Sakala
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Nchimunya M Chiboola
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Jody R Lori
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
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Samuel O, Zewotir T, North D. Decomposing the urban-rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa. Reprod Health 2021; 18:216. [PMID: 34717668 PMCID: PMC8557532 DOI: 10.1186/s12978-021-01268-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background There has been a substantial improvement in reducing maternal mortality in the Sub-Saharan African region. The vast rural-urban gap in maternal health outcomes, however, is obscured by this average achievement. This study attempts to measure the contribution of identified risk factors to describe the average rural-urban difference in the use of antenatal care, health facilities for delivery, and health professional assistance at delivery. Method To achieve this objective, we used descriptive analysis and Fairlie non-linear decomposition method to quantify covariates’ contribution in explaining the urban–rural difference in maternal healthcare services utilisation. Result The study’s finding shows much difference between urban and rural areas in the use of maternal healthcare services. Socio-economic factors such as household wealth index, exposure to media, and educational level of women and their husbands/partners contributed the most in explaining the gap between urban and rural areas in healthcare services utilisation. Conclusions Interventions to bridge the gap between urban and rural areas in maternal healthcare services utilisation in Sub-Saharan Africa should be centred towards socio-economic empowerment. Government can enforce targeted awareness campaigns to encourage women in rural communities in Sub-Sharan Africa to take the opportunity and use the available maternal health care services to be at par with their counterparts in urban areas. Maternal health refers to the health of women throughout pregnancy, delivery, and the postnatal period. Each step should be a good experience that ensures mothers, and their infants realize their maximum health and well-being potential. In this study, we used individual, demographic, and socio-economic characteristics to measure the urban–rural discrepancies in maternal health care services in Sub-Saharan Africa. We used Information of 220 164 women of child-bearing age (15–49) gathered from National Demographic Health Surveys from 27 countries in the Sub-Sahara African region. We found 46.1% of women in rural areas had no education, 39.7% of the women in rural areas have husbands/partners with no education, and 60.1% of the women in rural areas are from households with poor wealth indexes. The use of maternal health care services found to be predominant in the urban areas than rural areas, and the measure of this difference can inform policymakers on the level of effort that needed to be put in place to balance the discrepancies and improve maternal health in general.
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Affiliation(s)
- Oduse Samuel
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, 4001, South Africa
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Mweemba C, Mapulanga M, Jacobs C, Katowa-Mukwato P, Maimbolwa M. Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design. Pan Afr Med J 2021; 40:4. [PMID: 34650654 PMCID: PMC8490167 DOI: 10.11604/pamj.2021.40.4.28423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts. Methods a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component. Results the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards. Conclusion based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.
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Affiliation(s)
- Chris Mweemba
- Department of Health Policy, Systems and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Miriam Mapulanga
- Department of Public Health, University of Lusaka, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2021. [DOI: 10.1155/2021/9911436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.
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Baada JN, Antabe R, Sano Y. Differentiated agrarian vulnerabilities and generalized national responses to COVID-19 in the Upper West Region of Ghana. JOURNAL OF AGRARIAN CHANGE 2021; 21:604-619. [PMID: 38607798 PMCID: PMC8242422 DOI: 10.1111/joac.12434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 05/28/2023]
Abstract
The experiences of COVID-19 differ at both micro and macro levels. This emphasizes the need for differentiated responses that account for the varying vulnerabilities of diverse groups regarding the pandemic. In Ghana, much of the attention on COVID-19 has been on urban centres, particularly the country's two largest metropolises in southern Ghana. This has created a gap between national level policy and the experiences of COVID-19 among rural dwellers in Ghana. This is despite evidence that the world's poorest populations will bear the brunt of COVID-19 effects, and that globally, four out of five people living below the poverty line reside in rural areas. Using the Upper West Region as a case study, we discuss the differentiated vulnerabilities that agrarian communities in Ghana face regarding the pandemic. We situate our discussions within the theories of vulnerability and feminist political economy to highlight how interlocking vulnerabilities regarding historical, environmental, geopolitical, socio-economic, health, and gendered inequalities affect the disposition of agrarian communities to cope with and recover from the COVID-19 pandemic. We call for more nuanced COVID-19 responses that account for the needs and experiences of agrarian communities in Ghana.
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Affiliation(s)
- Jemima Nomunume Baada
- Department of Gender, Sexuality and Women's StudiesUniversity of Western OntarioLondonOntarioCanada
| | - Roger Antabe
- Department of Geography and EnvironmentUniversity of Western OntarioLondonOntarioCanada
| | - Yuji Sano
- Department of SociologyUniversity of Western OntarioLondonOntarioCanada
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Expanding post-operative follow-up in rural Sierra Leone: A community-based protocol. Am J Surg 2021; 221:895-899. [DOI: 10.1016/j.amjsurg.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
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Francetic I, Tediosi F, Kuwawenaruwa A. A network analysis of patient referrals in two district health systems in Tanzania. Health Policy Plan 2021; 36:162-175. [PMID: 33367559 PMCID: PMC7996649 DOI: 10.1093/heapol/czaa138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 12/25/2022] Open
Abstract
Patient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households.
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Affiliation(s)
- Igor Francetic
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, Basel 4001, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Via Violino 11, Manno 6928, Switzerland
- Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, Basel 4001, Switzerland
| | - August Kuwawenaruwa
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, Basel 4001, Switzerland
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania
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Adongo PA, Atanga RA, Yakong VN. Demographic characteristics of women that use traditional birth attendants in Bongo District, Ghana. Eur J Midwifery 2021; 4:1. [PMID: 33537603 PMCID: PMC7839126 DOI: 10.18332/ejm/114884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/19/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Over the last decade, the government of Ghana has implemented several interventions aimed at increasing access to skilled birth-care services from trained professionals. Despite these efforts, there is a wide gap between antenatal care attendance and skilled delivery attendance, particularly in rural areas. Evidence shows that many women in rural and deprived communities in Ghana rely on traditional birth attendant (TBA) delivery services. This has created a gap where antenatal attendance is high while skilled delivery is relatively low. The purpose of this study is to identify and analyse the sociodemographic characteristics of women who use the services of TBAs in Bongo District, Ghana. METHODS Using a descriptive study design, a survey was conducted involving 330 mothers randomly selected from 1685 mothers who delivered at home by 2014 in Bongo District. The questionnaire for mothers who delivered at home by a TBA comprised 28 questions. RESULTS The results show that women who used TBA were older, without formal education, married, predominantly farmers, married to spouses who were farmers without formal education. Most of the sampled women were co-currently covered by the national health insurance. CONCLUSIONS This study describes the demographic characteristics of women who use a TBA. Therefore, ongoing efforts aimed at increasing access to and use of professional antenatal services should incorporate sociodemographic factors in the rural context.
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Affiliation(s)
- Prosper A Adongo
- Department of Community Health, University for Development Studies, Tamale, Ghana
| | - Raymond A Atanga
- Department of Development Studies, University for Development Studies, Tamale, Ghana
| | - Vida N Yakong
- Department of Community Health, University for Development Studies, Tamale, Ghana
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Kumbeni MT, Apanga PA. Institutional delivery and associated factors among women in Ghana: findings from a 2017-2018 multiple indicator cluster survey. Int Health 2021; 13:520-526. [PMID: 33539526 PMCID: PMC8643427 DOI: 10.1093/inthealth/ihab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Institutional delivery is essential in reducing maternal morbidity and mortality. We investigated the prevalence of institutional delivery and associated factors among women in Ghana. Methods National representative data from the 2017–2018 Ghana Multiple Indicator Cluster Survey was used for the analysis. The study included 3466 women, ages 15–49 y, who had a live birth in the last 2 y. Descriptive statistics were used to assess the prevalence of institutional delivery while multivariate logistic regression was used to assess the relationship between our variables of interest and institutional delivery. Results The prevalence of institutional delivery among women in Ghana was 77.89% (95% confidence interval [CI] 75.29 to 80.50). High-income households (adjusted odds ratio [aOR] 2.13 [95% CI 1.36 to 3.35]), attending antenatal care at least four times (aOR 2.37 [95% CI 1.54 to 3.65]) and knowing one's human immunodeficiency virus status (aOR 1.41 [95% CI 1.08 to 1.84]) were associated with higher odds of institutional delivery. Living in rural areas (aOR 0.43 [95% CI 0.27 to 0.67]), multiparity (aOR 0.59 [95% CI 0.41 to 0.85]) and no health insurance (aOR 0.57 [95% CI 0.44 to 0.74]) were associated with lower odds of institutional delivery. Conclusions The government of Ghana may need to focus on increasing health insurance utilization and antenatal care attendance in order to increase the coverage of institutional delivery.
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Affiliation(s)
- Maxwell T Kumbeni
- Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana
| | - Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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