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Daniels-Donkor SS, Afaya A, Daliri DB, Laari TT, Salia SM, Avane MA, Afaya RA, Yakong VN, Ayanore MA, Alhassan RK. Factors associated with timely initiation of antenatal care among reproductive age women in The Gambia: a multilevel fixed effects analysis. Arch Public Health 2024; 82:73. [PMID: 38760806 PMCID: PMC11100154 DOI: 10.1186/s13690-024-01247-y] [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: 01/25/2023] [Accepted: 01/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. METHODS A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019-2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05. RESULTS The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30-34 [aOR = 1.79, 95% CI = 1.30-2.47], those who were married [aOR = 2.69, 95% CI = 1.85-3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas. CONCLUSION Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia.
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Affiliation(s)
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
| | - Dennis Bomansang Daliri
- Department of Global Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Solomon Mohammed Salia
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Mabel Apaanye Avane
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Richard Adongo Afaya
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Vida Nyagre Yakong
- Department of Midwifery and Women's Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- University of Dundee, Scotland United Kingdom, Dundee, Scotland, UK
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Oladipo IA, Akinwaare MO. Trends and patterns of maternal deaths from 2015 to 2019, associated factors and pregnancy outcomes in rural Lagos, Nigeria: a cross-sectional study. Pan Afr Med J 2023; 44:185. [PMID: 37484584 PMCID: PMC10362660 DOI: 10.11604/pamj.2023.44.185.37567] [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: 09/28/2022] [Accepted: 01/01/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction maternal mortality is still a problem attracting global attention, with an estimate of 289,000 maternal deaths annually. Over half of these deaths occur in sub-Saharan Africa, with Nigeria accounting for 14% of the global maternal deaths. This study assessed the trends and patterns of maternal deaths, associated factors, and pregnancy outcomes in a rural area in Lagos, Nigeria. Methods this study adopted a cross-sectional descriptive research design. A retrospective assessment of all maternal deaths that occurred at Epe Local Government Area (LGA) from 2015 to 2019 was done. A validated checklist was used to retrieve information from the records of 96 deceased. Ethical approval was obtained for the study. Data collected were analyzed using SPSS version 20.0. Analyses were done using descriptive and inferential statistics at a significance level of 0.05. Results highest number of maternal deaths 24 (23%) were recorded in the year 2015. The maternal mortality ratio was 1,645 per 100,000 live births. The highest direct cause of maternal death was eclampsia (27.1%), while the highest indirect cause was anemia (5.2%). Chances of maternal death increased with nonregistered pregnancy (71.9%), and non-institutional delivery (79.2%). Poor pregnancy outcomes include; stillbirth (60.4%), and preterm babies (62.5%). Statistical associations were found between maternal deaths and parity (p = 0.004). Conclusion the maternal mortality ratio in rural areas is still very high and far from the proposed global target of 70 per 100,000. These maternal deaths are linked to direct and indirect causes. Maternal deaths could result in poor pregnancy outcomes.
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Olamijulo JA, Olorunfemi G, Osman H. Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study. Niger Postgrad Med J 2022; 29:325-333. [PMID: 36308262 DOI: 10.4103/npmj.npmj_180_22] [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] [Indexed: 06/16/2023]
Abstract
BACKGROUND An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. AIM This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. METHODS We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. RESULTS Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. CONCLUSION The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.
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Affiliation(s)
- Joseph Ayodeji Olamijulo
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa
| | - Halimat Osman
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Olamijulo JA, Olorunfemi G, Okunola H. Trends and causes of maternal death at the Lagos University teaching hospital, Lagos, Nigeria (2007-2019). BMC Pregnancy Childbirth 2022; 22:360. [PMID: 35468759 PMCID: PMC9036837 DOI: 10.1186/s12884-022-04649-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Nigeria has one of the worst global maternal mortality ratios (MMR). Institutional audit is invaluable in providing useful information for formulating preventive interventions. Objective To evaluate the trends, causes and socio-demographic characteristics of maternal mortality at a tertiary institution in South-western Nigeria over a period of 13 years (2007–2019). Methodology Cross sectional and temporal trend analysis of maternal deaths were conducted using chart reviews from 2007 to 2019. Socio-biological characteristics, booking status and ranking of clinical causes of maternal deaths were derived from patients’ chart review (2007–2019). Bivariate analysis and Annual percent change (APC) of the observed trends was respectively conducted using Stata version 17 and Joinpoint version 4.5.0.1 software respectively. Results In the period 2007–2019, the mean age at maternal death was 30.8 ± 5.9 years and 88.8% of mortalities occurred among the “unbooked” women. The leading causes of direct maternal mortality were Hypertension (27.0%), Sepsis (20.6%) and haemorrhage (18.7%), while anaemia in pregnancy (3.2%), Human Immunodeficiency Virus (3.2%) and Sickle Cell Disease (2.4%) were the leading indirect causes of maternal mortality Joinpoint estimates showed a statistically significant increase in MMR of about 3.4% per annum from 2211 per 100,000 live births in 2007 to 3555.6 per 100,000 live births in 2019 (APC: +3.4%, P-value < 0.001). Conclusion Contrary to some other reports, there was an increase in the institutional MMR between 2007 and 2019 even though the leading causes of death remained similar. Targeted interventions based on accurate data are urgently required in order to achieve the Sustainable Development Goal (SDG) 3.1. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04649-4.
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Affiliation(s)
- Joseph A Olamijulo
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria. .,Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Halimat Okunola
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Maternal and Child Health Services in Rural Settings of The Gambia: Contextual Determinants of Postnatal Care from Mothers’ Perspectives—A Community-Based Analytical Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3558676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Maternal and child health in The Gambia is a trending public health burden. The postnatal period is critical and vital to the lives and health of the maternal mothers and their newborns, and pieces of evidence deduced that a majority of maternal and newborn deaths occur during this period. Hence, this research aimed to assess the prevalence and determinants of postnatal care utilization across women in rural Gambia. Methods. A community-based cross-sectional design was conducted in January 2020, with 265 women of childbearing age were recruited from the selected households in rural communities across the Upper River Region (URR), Gambia, using multistage sampling technique. A structured-interview questionnaire was developed to elicit contextual sociodemographic characteristics regarding the use of postnatal care. Percentages, chi-square/Fisher’s exact test for variables with
value ≤0.15 were considered for inclusion into the logistic regression model. The significance level was set at
. The adjusted odds ratios (aOR) with 95% confidence interval (CI) were computed to declare significance. Results. The study revealed that 90% of women utilize postnatal care (PNC) services in the rural settings of URR, Gambia. Factors such as women’s occupation, location, number of pregnancies, attending in last pregnancy, current uptake of family planning, and complication(s) in last labor were found to be associated with PNC utilization. Women who attended antenatal care (ANC) services in their last pregnancy were 10.8 times (aOR = 10.795, 95% CI: 1.025–113.694), current users of FP were 10.7 times (aOR = 10.708, 95% CI: 1.379–83.152), women’s number of pregnancies increases by a factor of 4.6 times (aOR = 4.649, 95% CI: 1.518–14.243) more likely to utilize PNC while women’s number of children alive were less likely by 76.1% (aOR = 0.239, 95% CI: 0.071–0.810) as compared to those who were not utilizing PNC services. Conclusion. The findings showed that attending ANC services, current uptake of FP, women’s number of pregnancies, and number of children alive were associated with PNC. Strengthening women empowerment and designing responsive ANC programs especially for rural women to improve PNC services are required.
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Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health 2021; 11:04048. [PMID: 34737857 PMCID: PMC8542378 DOI: 10.7189/jogh.11.04048] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, South Africa.,Department of Obstetrics and Gynaecology, Victoria Falls Hospital, Zimbabwe
| | - Michael Nyakura
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick Machekano
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, South Africa
| | - Robert Pattinson
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Abstract
BACKGROUND/AIMS Ectopic pregnancy is a gynaecological emergency with significant burden of maternal mortality and morbidity in the tropics. The incidence reported in the literature range from 1:60 to 1:250 pregnancies. The aim was to determine incidence and risk factors of ectopic pregnancy in the Gambia. METHODOLOGY A longitudinal study of ectopic pregnancy at Gambian tertiary hospital from January 2016 to April 2018. Data was collected from patients' folders, entered into SPSS version 20 and analysed with descriptive statistics. The test of variation and significance was by ANOVA and Chi-square respectively with error margin set at 0.05 and confidence interval of 95%. RESULTS A total number of 2562 pregnancies were recorded, 43 were ectopic pregnancies. The estimated incidence was 0.2%. Majority of the patients were between 26 - 35 years (56%), primiparous (32%), heterogeneous marriage (82%) and housewives (86%). Occupation was not associated with ruptured or unruptured ectopic pregnancy (p-0.421). Low parity was associated with more ectopic pregnancy than high parity (p-0.001). The commonest clinical feature was abdominal pain (65.1%), whilst the most prominent risk factors were pelvic inflammatory disease (27.9%) and previous abortion (23.3%). Ectopic pregnancy was seasonal. CONCLUSION The incidence rate of 0.2% was in the range reported in the literature. Low parity, previous abortion and pelvic inflammatory disease were the risk factors.
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Affiliation(s)
- Matthew Anyanwu
- Edward Francis Small Teaching Hospital (EFSTH), Banjul The Gambia
- School of Medical and Allied Health Sciences, university of The Gambia
- College of Medicine American International University West Africa
| | - Grace Titilope
- School of Medical and Allied Health Sciences, university of The Gambia
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Ruiz-Cantero MT, Guijarro-Garvi M, Bean DR, Martínez-Riera JR, Fernández-Sáez J. Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries. Health Place 2019; 57:313-320. [PMID: 31146194 PMCID: PMC6873917 DOI: 10.1016/j.healthplace.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/16/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance-a political determinant scarcely explored in the literature-in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality-which persists despite economic development-all governance dimensions are essential and represent interdependent cornerstones.
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Affiliation(s)
| | - Marta Guijarro-Garvi
- Public Health Research Group, University of Alicante, Spain; Department of Economics, University of Cantabria, Spain.
| | - Donna Rose Bean
- School of Nursing & Health Studies, University of Miami, USA.
| | | | - José Fernández-Sáez
- Public Health Research Group, University of Alicante, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i, Gurina (IDIAPJGol), Spain.
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