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Inusah AW, Alhassan NA, Charadan AMS, Marzo RR, Ziblim SD. Influence of Sociodemographic Factors and Obstetric History on Choice of Place of Delivery: A Retrospective Study Among Post-Natal Women in Ghana. Int J MCH AIDS 2023; 12:e639. [PMID: 38312497 PMCID: PMC10753403 DOI: 10.21106/ijma.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background and Objectives Even though Ghana has recorded an appreciable level of facility delivery compared to other countries in sub-Saharan Africa, the country still has a lot of regional and community variations in facility delivery where professional maternal health care is guaranteed. This study assessed the main factors associated with facility delivery in the Sagnarigu Municipal Assembly of the Northern Region of Ghana. Methods Using a simple random sampling method, a retrospective community-based cross-sectional study was conducted from July 12, 2021 to October 17, 2021, among 306 postnatal women within 15 to 49 years who had delivered within the last six months. We conducted descriptive analyses, and the Pearson chi-square test of association between the sociodemographic factors and obstetrics history with the outcome variable, choice of place of birth. Lastly, significant variables in the chi-square test were entered into adjusted multivariate logistics regression to determine their association with the place of delivery. Data analysis was performed using the Statistical Package for Social Sciences version-25, with statistical significance set at a p-value of 0.05. Results The study reported a facility delivery rate of 82%, which is slightly higher than the national target (80%). We observed that age group [AOR 2.34 (1.07-5.14)], marital status [AOR 0.31 (0.12-0.81)], ethnicity [AOR 3.78 (1.18-12.13)], and couple's occupation [AOR 24.74 (2.51-243.91)] were the significant sociodemographic factors influencing facility delivery. The number of antenatal care (ANC) attendance [AOR 8.73 (3.41 - 22.2)] and previous pregnancy complications [AOR 2.4 (1.11 - 5.7)] were the significant obstetrics factors influencing facility delivery. Conclusion and Global Health Implications We found that specific sociodemographic and obstetric factors significantly influence the choice of place of delivery in the study area. To address this, the study recommends targeted interventions that focus on providing support and resources for women from different age groups, marital statuses, ethnicities, and occupational backgrounds to access facility delivery services. Additionally, improving ANC attendance and effectively managing pregnancy complications were highlighted as important measures to encourage facility-based deliveries.
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Affiliation(s)
- Abdul-Wahab Inusah
- Department of Global and International Health, School of Public Health, University for Development Studies, Box TL1350 Tamale, Ghana
| | | | - Ana Maria Simono Charadan
- Department of Obstetrics and Gynaecology, School of Medicine, Health, University for Development Studies, Box TL1350 Tamale, Ghana
| | - Roy Rillera Marzo
- Department of Community Medicine, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Subang Jaya, Selangor, Malaysia
| | - Shamsu-Deen Ziblim
- Directorate of Academic Planning & Quality Assurance (DAPQA) University for Development Studies, Box TL 1350 Tamale, Ghana
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Moreira LR, Blumenberg C, Caicedo Velasquez BE, Ewerling F, Balandrán A, Vidaletti LP, Varela AR, Hellwig F, Ponce de Leon RG, Barros AJ, Silveira MF, Wehrmeister FC. The role of gender inequality and health expenditure on the coverage of demand for family planning satisfied by modern contraceptives: a multilevel analysis of cross-sectional studies in 14 LAC countries. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100435. [PMID: 36950033 PMCID: PMC10025422 DOI: 10.1016/j.lana.2023.100435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
Abstract
Background Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. Methods Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. Findings DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman's education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. Interpretation Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. Funding Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Laísa Rodrigues Moreira
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Corresponding author. Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
| | - Cauane Blumenberg
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Beatriz Elena Caicedo Velasquez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia
| | - Fernanda Ewerling
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Alejandra Balandrán
- Inter-american Conference on Social Security, Direction of Health Systems Evaluation & Research, San Ramón s/n, San Jerónimo Lídice, 10200, Mexico City, Mexico
| | - Luis Paulo Vidaletti
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | | | - Franciele Hellwig
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/ WHO), Montevideo, Uruguay
| | - Aluisio J.D. Barros
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Mariangela Freitas Silveira
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Fernando C. Wehrmeister
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Institute for Global Public Health (IGPH), Rady Faculty of Health Sciences, Community Health Sciences, R070 Med Rehab Bldg, 771 McDermot Avenue, University of Manitoba (Bannatyne Campus), Winnipeg, Manitoba, R3E 0T6, Canada
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Kumbeni MT, Afaya A, Apanga PA. An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana. HEALTH ECONOMICS REVIEW 2023; 13:8. [PMID: 36708413 PMCID: PMC9883869 DOI: 10.1186/s13561-023-00423-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The free maternal healthcare policy was introduced in Ghana in 2008 under the national health insurance scheme as a social intervention to improve access to maternal health services. This study investigated the prevalence of out of pocket (OOP) payment among pregnant women with valid national health insurance who sought skilled delivery services at public sector health facilities in Ghana. The study also assessed the health system factors associated with OOP payment. METHODS We used data from the Ghana Maternal Health Survey (GMHS), which was conducted in 2017. The study comprised 7681 women who delivered at a public sector health facility and had valid national health insurance at the time of delivery. We used multivariable logistic regression analysis to assess factors associated with OOP payment, whiles accounting for clustering, stratification, and sampling weights. RESULTS The prevalence of OOP payment for skilled delivery services was 19.0%. After adjustment at multivariable level, hospital delivery services (adjusted Odds Ratio [aOR] = 1.23, 95% Confidence Interval [CI] = 1.00, 1.52), caesarean section (aOR = 1.73, 95% CI = 1.36, 2.20), and receiving intravenous infusion during delivery (aOR = 1.31, 95% CI = 1.08, 1.60) were associated with higher odds of OOP payment. Women who were discharged home 2 to 7 days after delivery had 19% lower odds of OOP payment compared to those who were discharged within 24 hours after delivery. CONCLUSION This study provides evidence of high prevalence of OOP payment among women who had skilled delivery services in public sector health facilities although such women had valid national health insurance. Government may need to institute measures to reduce OOP payment in public sector facilities especially at the hospitals and for women undergoing caesarean sections.
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Affiliation(s)
- Maxwell Tii Kumbeni
- Department of Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis, USA.
| | - Agani Afaya
- Mo Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Aghapour E, Basakha M, Kamal SHM, Pourreza A. Inequality in private healthcare expenditure: A 36-year trend study of Iranian households. J Prev Med Public Health 2022; 55:379-388. [PMID: 35940193 PMCID: PMC9371783 DOI: 10.3961/jpmph.22.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.
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Affiliation(s)
- Ehsan Aghapour
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Mehdi Basakha
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran,
Iran
| | - Abolghasem Pourreza
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran,
Iran
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Ekholuenetale M, Nzoputam CI, Barrow A. Effects of socioeconomic factors and booking time on the WHO recommended eight antenatal care contacts in Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000136. [PMID: 36962339 PMCID: PMC10022028 DOI: 10.1371/journal.pgph.0000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022]
Abstract
Antenatal care (ANC) is an important intervention that has been linked to reduce maternal and newborn adverse outcomes. However, the long years of war in Liberia may have contributed to the poor health indices including the uptake of maternal health care services. The objective of this study was to determine the marginal interaction effects between booking time and socioeconomic factors in eight or more ANC contacts. A total sample of 4,185 women who had given birth were included in this study. The 2020 Liberia Demographic and Health Survey (LDHS) dataset was analyzed. The outcome variable was eight or more ANC contacts. Percentage and Chi-square test were used in univariate and bivariate analyses respectively. The marginal interaction effects between booking time and socioeconomic factors of eight or more ANC contacts were estimated. The statistical significance was determined at 5%. The weighted prevalence of eight or more ANC contacts was 26.6% (95% CI: 23.8%, 29.6%). The uptake of eight or more ANC contacts increased steadily by increasing women's level of education and household wealth index. Women with higher educational attainment had a prevalence of 49.0% (95%CI: 36.5%, 61.6%) and those in the richest households had an estimated prevalence of 31.4% (95%CI: 24.9%, 38.8%) respectively. Furthermore, the urban dwellers had a weighted eight or more ANC contacts prevalence of 29.0% (95%CI: 24.6%, 34.0%). The key finding is increased marginal interaction effects for higher education and early booking (48.4%), richest households and early booking (35.4%), and urban residential status and early booking (36.2%) respectively. Overall, the prevalence of eight or more ANC contacts was low. However, we found higher coverage of eight or more ANC contacts among women who initiated ANC within the first trimester and among those with higher socioeconomic status. We recommend the Liberian government to design and/or support programmes targeted at promoting early ANC initiation and supporting the disadvantaged women such as the uneducated, poor and those living in rural or remote settings.
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Affiliation(s)
- Michael Ekholuenetale
- Faculty of Public Health, Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chimezie Igwegbe Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, Nigeria
- Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
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Dagrou A, Chimhutu V. I Buy Medicines From the Streets Because I Am Poor: A Qualitative Account on why the Informal Market for Medicines Thrive in Ivory Coast. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221086585. [PMID: 35311389 PMCID: PMC8941685 DOI: 10.1177/00469580221086585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The informal market for medicines has been growing. In Ivory Coast, this informal
market is an unofficial core part of the health system. Given the risks
associated with the informal market for medicines, it is important to understand
why this market continues to grow. It becomes even more important in the context
of COVID-19, as a huge chunk of falsified medical products end up at the
informal market. A qualitative case study design was chosen for this study, with
in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods
for data collection. 20 IDIs and 3 FGDs were conducted. Participants in this
study are sellers, buyers, and pharmaceutical experts. We found out that the
informal market for medicines thrives because it is highly accessible,
convenient, affordable, and that it is used for various social, cultural, and
religious reasons. The study concludes that although this informal market
presents a clear danger to public health, it is thriving. For authorities to
address this public health challenge, there is need for a holistic and
multi-pronged approach, which includes addressing health systems factors and
strengthening regulatory framework.
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Affiliation(s)
- Armel Dagrou
- University of Bergen, Department of Health Promotion and Development, Bergen, Norway
| | - Victor Chimhutu
- University of Bergen, Department of Health Promotion and Development, Bergen, Norway
- Inland Norway University of Applied Sciences, Department of Public Health and Sports Sciences, Elverum, Norway
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