1
|
Hossain MZ, Rahman MM, Rahman N, Uddin MS, Siegel M. Do community-level predictors have more impact than individual/family-level predictors on receiving the desired number of ANC services in Bangladesh? Heliyon 2024; 10:e25005. [PMID: 38317940 PMCID: PMC10839952 DOI: 10.1016/j.heliyon.2024.e25005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Background Bangladesh has improved maternal and child health, but healthcare indicators and access still need enhancement. Factors that contribute to increased antenatal care (ANC) need to be explored to inform healthcare policies. The study examined whether community-level (supply-side) predictors outperform individual/family-level (demand-side) predictors for the desired number of ANC services. Methods This cross-sectional study collected primary data from 630 pregnant and lactating women (PLW) in seven upazilas in Rangpur and Nilphamari districts of Bangladesh in 2022. The individual/family and community-level factors as predictors of desired antenatal care services were investigated using a semi-structured questionnaire. Various statistical techniques including the Student t-test, z-test, Chi-square test, and logistic regression model were employed in analyzing the data. Results Out of the total 630 participants, the majority were literate women who belong to higher pregnancy order and received benefits from SSNPs. In addition to this, these women did not earn and neither were the empowered. The outcome variable was the receiving status of 4+ ANC services by PLWs, which varied by different covariates. The desired 4+ ANC service received by 73 % PLWs. The significant (p < 0.05) predictors of receiving 4+ ANC services were secondary-level education (95 % CI:0.97-7.55), knowledge on danger signs (95 % CI:1.02-1.48), empowered women (95 % CI:0.99-2.69), community clinics as place of services (95 % CI:1.52-3.49), sources of information through SMS (95 % CI:2.63-7.04) and fully functional community clinic (95 % CI:1.0-2.347). The statistical evidence through the values of pseudo R2 of the reduced models of community level (0.09), individual level (0.03) and family level (0.01) revealed that the community level predictors are more influential than individual/family level predictors. Conclusion The findings indicate that community level predictors played a dominant role in receiving the 4+ ANC services in Bangladesh. In short, the well-functioning of community clinics in tandem with government forums/bodies and awareness raising through SMS messages, are sufficient for ensuring the desired number of ANC services in rural areas of Bangladesh.
Collapse
Affiliation(s)
- Md Zakir Hossain
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh
| | - Md Mizanur Rahman
- . Cooperative for Assistance and Relief Everywhere (CARE), Bangladesh
| | - Nazneen Rahman
- Cooperative for Assistance and Relief Everywhere (CARE), USA
| | | | - Morgan Siegel
- . Cooperative for Assistance and Relief Everywhere (CARE), Austria
| |
Collapse
|
2
|
Akter S, Banna MHA, Brazendale K, Sultana MS, Kundu S, Disu TR, Alshahrani NZ, Tareq MA, Hassan MN, Islam Khan MS. Determinants of health care seeking behavior for childhood infectious diseases and malnutrition: A slum-based survey from Bangladesh. J Child Health Care 2023; 27:395-409. [PMID: 35164525 DOI: 10.1177/13674935211057714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to explore the magnitude and determinants of health care seeking behaviors for common infectious disease and malnutrition among Bangladeshi under-five children living in slum areas. A cross-sectional study of 300 children-caregiver dyads was conducted in an urban slum of Bangladesh. Data were collected via a structured questionnaire with accompanying anthropometric assessments of children administered by research staff. Multiple logistic regression was employed to identify associated factors of health care seeking behaviors. Only 44.7% and 13.0% of respondents sought care for childhood infectious diseases and malnutrition, respectively. Being a male child, 2-5 years old, having ≤5 family members, monthly family income >125$, and living in close proximity to a health facility were found to be potential determinants of health care seeking behavior for childhood infectious diseases. Mother/caregivers with poor nutritional information knowledge and who had a child 2-5 years old reported engaging in less care seeking behaviors regarding their child's malnutrition compared to their counterparts. Caregivers of children under the age of 5 years old reported low participation in health care seeking behaviors in relation to childhood infectious disease and malnutrition. Families living in slums require additional support targeting health and nutritional educational programs.
Collapse
Affiliation(s)
- Sumaiya Akter
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Hasan Al Banna
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando, FL, US
| | - Mst Sadia Sultana
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Satyajit Kundu
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | | | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Md Abu Tareq
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Nazmul Hassan
- Department of Environmental Sanitation, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| |
Collapse
|
3
|
Tawfiq E, Azimi MD, Feroz A, Hadad AS, Soroush MS, Jafari M, Yaftali MS, Saeedzai SA. Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women's knowledge of severity of illness. BMC Pregnancy Childbirth 2023; 23:561. [PMID: 37533023 PMCID: PMC10398983 DOI: 10.1186/s12884-023-05750-y] [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: 09/02/2022] [Accepted: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Little is known whether women's knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. METHODS Data were used from the Afghanistan Health Survey 2018. Women's knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0-3 ANC; ≥ 4 PNC vs. 0-3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. RESULTS Data were used from 9,190 ever-married women, aged 13-49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women's knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54-2.05), 2.28(1.99-2.61), and 2.78 (2.34-3.32) on knowledge of 1, 2, and 3-5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12-2.90), 2.22(1.42-3.48), and 3.33(2.00-5.54), respectively. In women with institutional deliveries, it was 1.49(1.32-1.68), 2.02(1.78-2.28), and 2.34(1.95-2.79), respectively. Other strong predictors were women's education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. CONCLUSION Our findings suggest that pregnant women's healthcare seeking behaviour is influenced by women's knowledge of danger signs and symptoms during pregnancy, women's education, socioeconomic status, access to media, husband's, in-laws' and relatives' decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women's knowledge, education, and social status.
Collapse
Affiliation(s)
- Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Aeraj Feroz
- Formerly the Ministry of Public Health, Kabul, Afghanistan
| | | | | | | | | | | |
Collapse
|
4
|
Haider MM, Siddique AB, Jabeen S, Hossain AT, Khan S, Rahman MM, Zohora FT, Chakraborty N, Nahar Q, Rahman AE, Jamil K, El Arifeen S. Levels, trends, causes, place and time of, care-seeking for, and barriers in preventing indirect maternal deaths in Bangladesh: An analysis of national-level household surveys. J Glob Health 2023; 13:04019. [PMID: 37114719 PMCID: PMC10363693 DOI: 10.7189/jogh.13.04019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background Eclampsia, haemorrhage, and other direct causes are the primary burden of maternal mortality in Bangladesh, often reducing attention given to indirect maternal deaths (IMDs). However, Sustainable Development Goals may not be achieved without actions to prevent IMDs. We examined the levels, trends, specific causes, timing, place, and care-seeking, and explored the barriers to IMD prevention. Methods We used three nationally representative surveys conducted in 2001, 2010, and 2016 to examine levels and trends in IMDs. The analysis of specific causes, timing, and place of IMDs, and care-seeking before the deaths was based on 37 IMDs captured in the 2016 survey. Finally, we used thematic content analysis of the open history from the 2016 survey verbal autopsy (VA) questionnaire to explore barriers to IMD prevention. Results After increasing from 51 deaths per 100 000 live births in 2001 to 71 in 2010, the indirect maternal mortality ratio (IMMR) dropped to 38 deaths per 100 000 live births in 2016. In 2016, the indirect causes shared one-fifth of the maternal deaths in Bangladesh. Stroke, cancer, heart disease, and asthma accounted for 80% of the IMDs. IMDs were concentrated in the first trimester of pregnancy (27%) and day 8-42 after delivery (32%). Public health facilities were the main places for care-seeking (48%) and death (49%). Thirty-four (92%) women who died from IMDs sought care from a health facility at least once during their terminal illness. However, most women experienced at least one of the "three delays" of health care. Other barriers were financial insolvency, care-seeking from unqualified providers, lack of health counselling, and the tendency of health facilities to avoid responsibilities. Conclusions IMMR remained unchanged at a high level during the last two decades. The high concentration of IMDs in pregnancy and the large share due to chronic health conditions indicate the need for preconception health check-ups. Awareness of maternal complications, proper care-seeking, and healthy reproductive practices may benefit. Improving regular and emergency maternal service readiness is essential.
Collapse
Affiliation(s)
- M Moinuddin Haider
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu Bakkar Siddique
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shusmita Khan
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Md Mahabubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Tuz Zohora
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nitai Chakraborty
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
5
|
Hunie Asratie M, Belay DG. Pooled Prevalence and Determinants of Completion of Maternity Continuum of Care in Sub-Saharan Africa: A Multi-Country Analysis of Recent Demographic and Health Surveys. Front Glob Womens Health 2022; 3:869552. [PMID: 35692945 PMCID: PMC9174640 DOI: 10.3389/fgwh.2022.869552] [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: 02/04/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundImproving the coverage of completion of the maternity continuum of care is the priority area of sub-Saharan African countries to achieve the sustainable development goal. Despite this, information is scant about the pooled prevalence of completion of the maternity continuum of care and its determinants in sub-Saharan African countries. Therefore, this study aimed to assess the pooled prevalence of completion of the maternity continuum of care and its determinants among women in sub-Saharan African countries.MethodsThe study was conducted based on Demographic and Health Survey (DHS) data from 33 sub-Saharan African countries from 2010 to 2020. The total sample size of 337,297 postpartum period women with children aged 0–36 months (about 3 years) was employed in the analysis by STATA version 14. A multilevel logistic regression model was fitted, and intraclass correlation coefficient (ICC), median odds ratio (MOR), proportion change in variance (PCV), and deviance were used for model fitness and comparison. Adjusted odds ratio (AOR) with its 95% confidence interval (CI) was presented. Variables with a value of p < 0.05 were declared significant determinants of completion of the maternity continuum of care.ResultsThe pooled prevalence of completion of the maternity continuum of care was 35.81%; [95% CI, 35.64%, 35.9%]. Higher educational level [AOR = 3.62; 95% CI 2.25, 4.46], wanted pregnancy [AOR = 2.51; 95% CI 1.82, 3.12], history of terminated pregnancy [AOR = 3.21; 95% CI 2.86, 4.21], distance to the nearby health facility [AOR = 2.11; 95% CI 1.68, 2.36], women as primary decision maker [AOR = 2.15; 95% CI 2.02, 2.87], nouse of traditional medication during pregnancy [AOR = 1.01; 95% CI 1.00, 1.45], antenatal care (ANC) visit within second trimester [AOR = 2.76; 95% CI 2.01, 3.47], informed about pregnancy complication [AOR = 2.73; 95% CI 2.10, 3.21], healthcare provider support [AOR = 1.77; 95% CI 1.02, 2.44], and being eastern and western African [AOR = 1.55; 95% CI 1.11, 2.44 and AOR = 2.01; 95% CI 1.88, 2.76, respectively] were determinant factors of completion of maternity continuum of care.ConclusionsThe completion of the maternity continuum of care in sub-Sahara African countries was low. Emphasis on women's education, type, history of pregnancy, distance to the nearby health facility, region, assessing the exposure of traditional medication, and informed about pregnancy complications, healthcare provider's support can improve the prevalence of completion of the maternity continuum of care.
Collapse
Affiliation(s)
- Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Melaku Hunie Asratie
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Anggondowati T, Deviany PE, Latief K, Adi AC, Nandiaty F, Achadi A, Kalter HD, Weaver EH, Rianty T, Ruby M, Wahyuni S, Riyanti A, Lisnawati N, Kusariana N, Achadi EL, Setel PW. Care-seeking and health insurance among pregnancy-related deaths: A population-based study in Jember District, East Java Province, Indonesia. PLoS One 2022; 17:e0257278. [PMID: 35320822 PMCID: PMC8942263 DOI: 10.1371/journal.pone.0257278] [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: 09/17/2020] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Despite the increased access to facility-based delivery in Indonesia, the country’s maternal mortality remains unacceptably high. Reducing maternal mortality requires a good understanding of the care-seeking pathways for maternal complications, especially with the government moving toward universal health coverage. This study examined care-seeking practices and health insurance in instances of pregnancy-related deaths in Jember District, East Java, Indonesia.
Methods
This was a community-based cross-sectional study to identify all pregnancy-related deaths in the district from January 2017 to December 2018. Follow-up verbal and social autopsy interviews were conducted to collect information on care-seeking behavior, health insurance, causes of death, and other factors.
Findings
Among 103 pregnancy-related deaths, 40% occurred after 24 hours postpartum, 36% during delivery or within the first 24 hours postpartum, and 24% occurred while pregnant. The leading causes of deaths were hemorrhage (38.8%), pregnancy-induced hypertension (20.4%), and sepsis (16.5%). Most deaths occurred in health facilities (81.6%), primarily hospitals (74.8%). Nearly all the deceased sought care from a formal health provider during their fatal illness (93.2%). Seeking any care from an informal provider during the fatal illness was more likely among women who died after 24 hours postpartum (41.0%, OR 7.4, 95% CI 1.9, 28.5, p = 0.049) or during pregnancy (29.2%, OR 4.4, 95% CI 1.0, 19.2, p = 0.003) than among those who died during delivery or within 24 hours postpartum (8.6%). There was no difference in care-seeking patterns between insured and uninsured groups.
Conclusions
The fact that women sought care and reached health facilities regardless of their insurance status provides opportunities to prevent deaths by ensuring that every woman receives timely and quality care. Accordingly, the increasing demand should be met with balanced readiness of both primary care and hospitals to provide quality care, supported by an effective referral system.
Collapse
Affiliation(s)
- Trisari Anggondowati
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- * E-mail:
| | - Poppy E. Deviany
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Annis C. Adi
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Fitri Nandiaty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Anhari Achadi
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Henry D. Kalter
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Emily H. Weaver
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tika Rianty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Mahlil Ruby
- USAID Jalin Project, Indonesia implemented by DAI Global LLC, Jakarta, Indonesia
| | - Sri Wahyuni
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Akhir Riyanti
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | - Nissa Kusariana
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Endang L. Achadi
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | |
Collapse
|
7
|
Zegeye B, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Olorunsaiye CZ, Yaya S. Disparities in use of skilled birth attendants and neonatal mortality rate in Guinea over two decades. BMC Pregnancy Childbirth 2022; 22:56. [PMID: 35062893 PMCID: PMC8783403 DOI: 10.1186/s12884-021-04370-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Maternal mortality remains high in sub-Saharan African countries, including Guinea. Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. However, within-country inequalities prevent a large proportion of women from receiving skilled birth attendance. Scarcity of evidence related to this exists in Guinea. Hence, this study investigated the magnitude and trends in socioeconomic and geographic-related inequalities in SBA in Guinea from 1999 to 2016 and neonatal mortality rate (NMR) between 1999 and 2012. METHODS We derived data from three Guinea Demographic and Health Surveys (1999, 2005 and 2012) and one Guinea Multiple Indicator Cluster Survey (2016). For analysis, we used the 2019 updated WHO Health Equity Assessment Toolkit (HEAT). We analyzed inequalities in SBA and NMR using Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D) and Ratio (R). These summary measures were computed for four equity stratifiers: wealth, education, place of residence and subnational region. We computed 95% Uncertainty Intervals (UI) for each point estimate to show whether or not observed SBA inequalities and NMR are statistically significant and whether or not disparities changed significantly over time. RESULTS A total of 14,402 for SBA and 39,348 participants for NMR were involved. Profound socioeconomic- and geographic-related inequalities in SBA were found favoring the rich (PAR = 33.27; 95% UI: 29.85-36.68), educated (PAR = 48.38; 95% UI: 46.49-50.28), urban residents (D = 47.03; 95% UI: 42.33-51.72) and regions such as Conakry (R = 3.16; 95% UI: 2.31-4.00). Moreover, wealth-driven (PAF = -21.4; 95% UI: -26.1, -16.7), education-related (PAR = -16.7; 95% UI: -19.2, -14.3), urban-rural (PAF = -11.3; 95% UI: -14.8, -7.9), subnational region (R = 2.0, 95% UI: 1.2, 2.9) and sex-based (D = 12.1, 95% UI; 3.2, 20.9) inequalities in NMR were observed between 1999 and 2012. Though the pattern of inequality in SBA varied based on summary measures, both socioeconomic and geographic-related inequalities decreased over time. CONCLUSIONS Disproportionate inequalities in SBA and NMR exist among disadvantaged women such as the poor, uneducated, rural residents, and women from regions like Mamou region. Hence, empowering women through education and economic resources, as well as prioritizing SBA for these disadvantaged groups could be key steps toward ensuring equitable SBA, reduction of NMR and advancing the health equity agenda of "no one left behind."
Collapse
Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
| |
Collapse
|
8
|
Correia LL, Machado MMT, Araújo DABS, Gomes YVC, Pinheiro MSN, Rocha HAL, Nogueira DL, Sousa GDSD, Farias-Antuñez S, Castro MC. Primary Health Care during the COVID-19 pandemic in Fortaleza, Brazil: associated factors and pattern of use by mothers and children up to 18 months of age. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220036. [DOI: 10.1590/1980-549720220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Objective: To analyze the delay or failure to seek primary health care by the mother-child dyads during the COVID-19 pandemic, a practice that has a high potential to increase maternal and child morbidity and mortality. Methods: Data from three survey rounds of the Iracema-COVID cohort study, collected 6, 12, and 18 months after birth, showed the patterns of postpartum attendance to primary health care consultation of the mother-child dyad. Crude and adjusted multinomial logistic regressions with robust variance were used to assess factors associated with nonattendance. Results: Among the 314 cohort mothers, 25% did not attend any primary health care consultation during the 18-months postpartum, while 30% of the mothers did all three. Regarding the child, 75% had regular primary health care consultations in all three survey rounds, while 4% did not attend any in their first 18 months of life. By the end of the first COVID-19 wave, the proportion of mother and child who attended the consultations had fallen by 23 and 18%, respectively. The main factors associated with nonattendance were mothers aged below 25 years, and mothers with more than one child. Conclusion: An important delay or nonattendance to primary health care consultation by the mother-child dyad was observed during the COVID-19 pandemic. Such practice, with a high potential to increase maternal and child morbidity and mortality, was particularly frequent among younger mothers and those with more than one child.
Collapse
|
9
|
"We Tried to Borrow Money, but No One Helped." Assessing the Three-Delay Model Factors Affecting the Healthcare Service Delivery among Dengue Patients during COVID-19 Surge in a Public Tertiary Hospital: A Convergent Parallel Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211851. [PMID: 34831607 PMCID: PMC8621089 DOI: 10.3390/ijerph182211851] [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: 09/27/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Identification of delay barriers to care is essential for an effective and efficient healthcare service delivery. In this study, we described the delay in care among parents of the patients seeking treatment for dengue. We also examined the factors affecting the severity of dengue (dengue with warning signs; severe dengue). A convergent parallel design mixed-method approach using Key Informant Interviews (KII) and a survey guided by the Three-Delay Model were conducted among 24 respondents at the National Children’s Hospital (NCH). Coding and thematic analysis using NVIVO and bivariable generalized linear models with a Poisson distribution and robust variance were utilized to analyze the KII transcripts and survey data, respectively. Results showed that financial constraints and previous dengue infection (first delay), mode of transportation, traffic density, and location (second delay), and hospital capacity (third delay) influenced the overall delay uncertainty in seeking care treatment for dengue infection. Furthermore, our bivariable analysis showed that travel time to NCH and place of residency, service given from previous health facilities, and parents’ educational background were associated and played a role in the severity of dengue infection. Interventions focused on the identified factors contributing to delayed care should be made to avoid unwanted clinical outcomes.
Collapse
|
10
|
Sarker AR, Sultana M, Alam K, Ali N, Sheikh N, Akram R, Morton A. Households' out-of-pocket expenditure for healthcare in Bangladesh: A health financing incidence analysis. Int J Health Plann Manage 2021; 36:2106-2117. [PMID: 34218437 DOI: 10.1002/hpm.3275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh. METHODS The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban). RESULTS The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile. CONCLUSIONS This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.
Collapse
Affiliation(s)
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Khorshed Alam
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Nausad Ali
- Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nurnabi Sheikh
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Raisul Akram
- Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
| |
Collapse
|
11
|
Islam MM, Shahjahan M. Exploring the reasons and factors influencing the choice of home delivery of births in rural Bangladesh: a community-based cross-sectional study. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-07-2020-0284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The aim of this study was to explore the reasons for preferring home as a birth delivery place and identify the socio-economic and cultural factors influencing the choice of delivery place in rural Bangladesh.
Design/methodology/approach
The data for the study come from a community-based cross-sectional study conducted among 464 mothers in a rural sub-district of Bangladesh in 2019. Respondents were selected randomly from the frame listing all mothers with inclusion criteria, using a two-stage cluster sampling design. Data were collected through a face-to-face interview. Both descriptive and inferential statistics and logistic regression models were used for data analysis.
Findings
The results indicate a very high rate (58%) of home delivery. About 20% mothers never received ANC visit. Preference for home delivery was high (63%). Mothers with no education, aged 30 and above, multi-parity, low wealth status, lack of knowledge about institutional delivery, no or <4 ANC visits, received no advice about the delivery place, no pregnancy complications, decision about health care, and prior plan for home delivery were identified as significant predictors of home delivery. Cost of services, cultural practices and attitude towards health facility, lack of a female delivery assistant, perceived fear of caesarian section, poor quality of services, and lack of knowledge about maternity services appeared as important barriers for institutional delivery.
Originality/value
Based on primary data from a rural area, this study would help understand reasons and factors affecting home delivery and developing an appropriate strategy for the improvement of institutional delivery and maternity care services in Bangladesh.
Collapse
|
12
|
Reddy PMC, Rineetha T, Sreeharshika D, Jothula KY. Health care seeking behaviour among rural women in Telangana: A cross sectional study. J Family Med Prim Care 2020; 9:4778-4783. [PMID: 33209800 PMCID: PMC7652181 DOI: 10.4103/jfmpc.jfmpc_489_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/08/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The health of women is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. Women need to breach many social barriers to empower and to get access for quality health care services. Health seeking behavior is one of the important determinants of women health. Objectives: To assess healthcare seeking behavior among rural women in Telangana. Methods: Cross-sectional study with sample size of 200 was conducted in three villages attached to a medical college. Women of aged 20 years and above were included in the study. Data was collected by predesigned pretested semi-structured questionnaire. Data was presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23. Results: Only 34.5% [95% CI: 27.9, 41.5] of the subjects seek medical care as soon as symptoms appear and 69% [95% CI: 62.1, 75.3] of the participants were aware of nearby functioning health centres. Majority (60.5%) of the subjects Visits qualified medical practitioner during illness. Conclusions: The present study found that there is still a need to create awareness about the importance of healthcare and available health centers as significant proportion of women population approached unqualified medical practitioners and seeking home remedies as first consultancy source for their health remedies.
Collapse
Affiliation(s)
- P Mani C Reddy
- Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | - T Rineetha
- Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | - D Sreeharshika
- Department of Forensic Medicine, ESIC Medical College, Sanath Nagar, Hyderabad, Telangana, India
| | - Kishore Y Jothula
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Yadadri Bhuvanagiri District, Telangana, India
| |
Collapse
|
13
|
Borde MT, Loha E, Johansson KA, Lindtjorn B. Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: A prospective cohort study. PLoS One 2019; 14:e0215195. [PMID: 31800574 PMCID: PMC6892537 DOI: 10.1371/journal.pone.0215195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.
Collapse
Affiliation(s)
- Moges Tadesse Borde
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- School of Public Health, College of Medicine and Health Sciences, Dilla, Dilla University, Ethiopia
- * E-mail:
| | - Eskindir Loha
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernt Lindtjorn
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
14
|
Un Nisa S, Shaikh AA, Kumar R. Maternal and Fetal Outcomes of Pregnancy-related Hypertensive Disorders in a Tertiary Care Hospital in Sukkur, Pakistan. Cureus 2019; 11:e5507. [PMID: 31667040 PMCID: PMC6816637 DOI: 10.7759/cureus.5507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Pregnancy-related hypertensive disorders are a significant cause of adverse maternal and fetal outcomes, especially in developing areas of the world. Preeclampsia and eclampsia are the most significant causes of maternal and perinatal morbidity and mortality. Methods We conducted a prospective observational study in the Obstetrics and Gynaecology Department of Ghulam Muhammad Meher Medical College and Hospital. One hundred twelve (n=112) women with pregnancy-related hypertensive disorders admitted for delivery were included in the study. Results The major pregnancy-related hypertensive disorder was eclampsia (n=48; 43.24%) and preeclampsia (n=28; 25.23%). Among the women who developed one or more complications during or after delivery, postpartum hemorrhage (PPH) was the most frequent (n=31; 27.6%). Conclusions Pregnancy-related hypertensive disorders are common and adversely impact maternal and fetal outcomes. Efforts should be made at both the community and hospital levels to increase awareness regarding hypertensive disorder of pregnancy and reduce its associated morbidity and mortality.
Collapse
Affiliation(s)
- Shoaib Un Nisa
- Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
| | - Altaf A Shaikh
- Internal Medicine, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
| | - Raj Kumar
- Cardiology, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
| |
Collapse
|
15
|
Yaya S, Bishwajit G, Gunawardena N. Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau. BMJ Glob Health 2019. [PMID: 31139452 DOI: 10.1136/bmjgh-2018-001341.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women's access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women's choice of health facility delivery with their SES. Methods Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15-49 years). Respondents' characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants. Results Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively. Conclusion Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women's SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
16
|
Yaya S, Bishwajit G, Gunawardena N. Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau. BMJ Glob Health 2019; 4:e001341. [PMID: 31139452 PMCID: PMC6509696 DOI: 10.1136/bmjgh-2018-001341] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women's access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women's choice of health facility delivery with their SES. Methods Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15-49 years). Respondents' characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants. Results Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively. Conclusion Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women's SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
17
|
Lassi ZS, Middleton P, Bhutta ZA, Crowther C. Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies. F1000Res 2019; 8:200. [PMID: 31069067 PMCID: PMC6480947 DOI: 10.12688/f1000research.17828.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies. Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking. Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors. Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality. Registration: PROSPERO
CRD42012003236.
Collapse
Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Philippa Middleton
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Center of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caroline Crowther
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
18
|
Mahmood I, Bergbower H, Mahmood A, Goodman A. Maternal Health Care in Cox’s Bazar, Bangladesh: A Survey of Midwifery Experience at Hope Foundation and a Review of the Literature. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojog.2019.912158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
19
|
Determinants of frequency and contents of antenatal care visits in Bangladesh: Assessing the extent of compliance with the WHO recommendations. PLoS One 2018; 13:e0204752. [PMID: 30261046 PMCID: PMC6160162 DOI: 10.1371/journal.pone.0204752] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background In addition to the number of antenatal care (ANC) visits, the items of ANC services covered by ANC visits greatly influence the effectiveness of the ANC services. Recently the World Health Organization (WHO) recommended not only to achieve a minimum of eight ANC visits, but also to use a core set of items of ANC services for safe motherhood. This study examined the levels and determinants of frequency and contents of ANC visits in Bangladesh and thus assessed the level of compliance with the WHO recommended number and the content of ANC services during pregnancy in Bangladesh. Methods The data for the study come from the 2014 Bangladesh Demographic and Health Survey (BDHS), which covereda nationally representative sample of 17,863 ever-married women aged 15–49 years. Data derived from 4,627 mothers who gave birth in the three years preceding the survey constituted the study subjects. Descriptive, inferential and multivariate statistical techniques were used for data analysis. Results On average, mothers received less than three (2.7 visits) ANC visits and only 6% receive the recommended eight or more ANC visits. About 22% of the mothers received all the prescribed basic items of ANC services. About one-fifth (21%) of the mothers never received ANC visits and thus no items of ANC services. Measurement of blood pressure was the most common item received during ANC visit as reported by 69% mothers. Blood test was the least received item (43%). Significant positive association was found between frequency of ANC visits and receiving the increased number of items of ANC services. High socio-economic status, low parity, living in urban areas and certain administrative regions, planned pregnancies, having media exposure, visiting skilled providers for ANC services and visit to public or NGO health facilities are associated with frequent ANC visits and receiving higher number of items of ANC contents. Conclusion An unsatisfactory level of coverage of and content of ANC visits have been observed in Bangladesh. Further investigation is needed to identify the causes of under-utilization of ANC services in Bangladesh. A greater understanding of the identified risk factors and incorporating them into short and long term strategies would help improve the coverage and contents and thus quality of ANC services in Bangladesh.
Collapse
|
20
|
Kibria GMA, Burrowes V, Choudhury A, Sharmeen A, Ghosh S, Kalbarczyk A. A comparison of practices, distributions and determinants of birth attendance in two divisions with highest and lowest skilled delivery attendance in Bangladesh. BMC Pregnancy Childbirth 2018; 18:122. [PMID: 29720117 PMCID: PMC5932772 DOI: 10.1186/s12884-018-1770-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivery by skilled birth attendants (SBAs) is strongly recommended to reduce maternal and neonatal mortality. The percentage of births attended by SBAs is low in Bangladesh (42% in 2014), though this rate varies widely by divisions, with the highest 58% in Khulna and only 27% in Sylhet. Comparing and critically analyzing the practices, distributions and determinants of delivery attendance in two divisions with the highest and lowest SBA attendance could help to understand the differences and to employ the findings of the high-performing division to the low-performing division. METHODS The 7th Bangladesh Demographic and Health Survey (BDHS 2014) data were analyzed. After reporting the types of delivery attendants, logistic regression analyses were applied to calculate the odds ratios of determinants of deliveries attended by SBAs. RESULTS SBAs attended 225 (58.6%) and 128 (27.4%) deliveries in Khulna and Sylhet, respectively. Khulna had higher birth attendance by qualified doctors (42.5%, n = 163) than Sylhet (15.8%, n = 74). Sylhet had higher attendance by traditional attendants (60.8%, n = 285) than Khulna (33.7%, n = 129). In both regions, attendance by community skilled birth attendants (CSBAs) was very low (< 1%). Khulna had higher percentages of women with higher education level, husbands' higher education, antenatal care (ANC) visits by SBAs, and higher wealth quintiles than Sylhet. In multivariable analyses, higher education level (adjusted odds ratio (AOR): 8.4; 95% confidence interval (CI): 1.9-36.7), ANC visits (AOR: 3.6; 95% CI: 2.0-6.5), family planning workers' visit (AOR: 3.0; 95% CI: 1.6-5.4), and belonging to richer (AOR: 2.6; 95% CI: 1.4-5.1) or richest (AOR: 3.8; 95% CI: 1.9-7.6) household wealth quintiles had significant positive associations with deliveries by SBAs in Sylhet. Similarly, ANC visits (AOR: 2.5; 95% CI: 1.4-4.6) and higher wealth quintile (AOR: 4.7; 95% CI: 1.9-11.5) were positive predictors in Khulna. CONCLUSIONS The higher proportion of educated women and their husbands, wealth status and ANC visits were associated with higher SBA utilization in Khulna compared to Sylhet. Improvement of socioeconomic status, increasing birth attendant awareness programs, providing ANC services, and family-planning workers' visits could increase the proportion of SBA-attended deliveries in Sylhet Division. CSBA program should be re-evaluated for both divisions.
Collapse
Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Vanessa Burrowes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Allysha Choudhury
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA
| | | | - Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
21
|
Islam MM, Masud MS. Health care seeking behaviour during pregnancy, delivery and the postnatal period in Bangladesh: Assessing the compliance with WHO recommendations. Midwifery 2018; 63:8-16. [PMID: 29758443 DOI: 10.1016/j.midw.2018.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 03/01/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends four antenatal care (ANC) visits, delivery in a health facility and three postnatal care (PNC) visits for women to optimize the maternal health outcomes. OBJECTIVES To examine the level and determinants of maternal health care seeking behaviour during pregnancy, delivery and the postnatal period, and assess the compliance with the WHO recommended levels of care in Bangladesh. DESIGN/SETTING The study is based on secondary analysis of the data obtained from the 2014 Bangladesh Demographic and Health Survey (BDHS). The 2014 BDHS was a cross-sectional survey of a nationally representative sample of 17,863 ever-married women aged 15-49 years. The sample was selected following a two-stage stratified cluster sampling design. PARTICIPANTS The dataset from a subsample of 4.627 ever-married women who had delivered their last birth within three years before the survey were included in the analysis to meet the objectives of the study. ANALYSIS Descriptive statistics and multinomial logistic regression model were used for data analysis. FINDINGS It has been observed that only 31% mothers had recommended four or more ANC visits, 37% births were delivered at health facilities, and 65% mothers received at least one PNC visit. Only 18.0% mothers received the WHO recommended optimal level of four or more ANC visits, births in a health facility and at least one PNC visit. Mothers aged less than 20 years, living in rural area, having no education and media exposure, multiparous, poor wealth status, husband with no education and husband's employment status appeared as significant predictors of optimal level maternal health care after adjusting for other factors. Mothers living in Sylhet, Chittagong and Barisal regions were less likely to receive the optimum level health care. KEY CONCLUSION Utilization of maternal health care during pregnancy, delivery and the postnatal period among Bangladeshi women does not reflect the complete compliance with the WHO recommendations. Further studies are needed to identify the reasons for underutilization of optimum level maternal care practice in Bangladesh. IMPLICATION FOR PRACTICE The findings underscore the need for targeted intervention for those groups of mothers who were identified as having lowest level of maternal care across the continuum of care.
Collapse
Affiliation(s)
- M Mazharul Islam
- Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Al-Khoudh, P.O. Box 36, 123 Muscat, Oman .
| | - Mohammad Shahed Masud
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, 1000, Bangladesh .
| |
Collapse
|
22
|
Feehan DM, Mahy M, Salganik MJ. The Network Survival Method for Estimating Adult Mortality: Evidence From a Survey Experiment in Rwanda. Demography 2018; 54:1503-1528. [PMID: 28741073 PMCID: PMC5547188 DOI: 10.1007/s13524-017-0594-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adult death rates are a critical indicator of population health and well-being. Wealthy countries have high-quality vital registration systems, but poor countries lack this infrastructure and must rely on estimates that are often problematic. In this article, we introduce the network survival method, a new approach for estimating adult death rates. We derive the precise conditions under which it produces consistent and unbiased estimates. Further, we develop an analytical framework for sensitivity analysis. To assess the performance of the network survival method in a realistic setting, we conducted a nationally representative survey experiment in Rwanda (n = 4,669). Network survival estimates were similar to estimates from other methods, even though the network survival estimates were made with substantially smaller samples and are based entirely on data from Rwanda, with no need for model life tables or pooling of data from other countries. Our analytic results demonstrate that the network survival method has attractive properties, and our empirical results show that this method can be used in countries where reliable estimates of adult death rates are sorely needed.
Collapse
Affiliation(s)
- Dennis M Feehan
- Department of Demography, University of California, Berkeley, Berkeley, CA, USA.
| | - Mary Mahy
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Matthew J Salganik
- Department of Sociology and Office of Population Research, Princeton University, Princeton, NJ, USA
| |
Collapse
|
23
|
Murshid NS, Murshid N. Intergenerational Transmission of Marital Violence: Results From a Nationally Representative Sample of Men. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:211-227. [PMID: 26378116 DOI: 10.1177/0886260515604413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present study assesses the association between childhood exposure to parental violence and perpetration of marital violence as adults among a representative sample of 3,396 men in Bangladesh. We used secondary analysis of survey data from the nationally representative Bangladesh Demographic and Health Survey 2007 to examine factors associated with perpetration of martial violence among 3,396 ever-married men between the ages of 16 and 50 years. Outcome measure, marital violence perpetration, was measured using a modified Conflict Tactics Scale, and predictor variables included childhood exposure to parental violence, justification of marital violence, marital duration, religion, and demographic variables. Results indicate that marital violence perpetration is significantly associated with childhood exposure to marital violence, suggesting a cycle of violence that is maintained across generations. Implications for policy and practice are discussed.
Collapse
|
24
|
Moran AC, Charlet D, Madhavan S, Aruldas K, Donaldson M, Manzi F, Okuga M, Rosales A, Sharma V, Celone M, Brandes N, Sherry JM. Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:51. [PMID: 29297390 PMCID: PMC5764055 DOI: 10.1186/s41043-017-0119-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Although maternal and newborn mortality have decreased 44 and 46% respectively between 1990 and 2015, achievement of ambitious Sustainable Development Goal targets requires accelerated progress. Mortality reduction requires a renewed focus on the continuum of maternal and newborn care from the household to the health facility. Although barriers to accessing skilled care are documented for specific contexts, there is a lack of systematic evidence on how women and families identify maternal and newborn illness and make decisions and subsequent care-seeking patterns. The focus of this multi-country study was to identify and describe illness recognition, decision-making, and care-seeking patterns across various contexts among women and newborns who survived and died to ultimately inform programmatic priorities moving forward. METHODS This study was conducted in seven countries-Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia, and Nepal. Mixed-methods were utilized including event narratives (group interviews), in-depth interviews (IDIs), focus group discussions (FDGs), rapid facility assessments, and secondary analyses of existing program data. A common protocol and tools were developed in collaboration with study teams and adapted for each site, as needed. Sample size was a minimum of five cases of each type (e.g., perceived postpartum hemorrhage, maternal death, newborn illness, and newborn death) for each study site, with a total of 84 perceived PPH, 45 maternal deaths, 83 newborn illness, 55 newborn deaths, 64 IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding within and across cases, identifying broad themes on recognition of illness, decision-making, and patterns of care seeking, and corresponding contextual factors. Technical support was provided throughout the process for capacity building, quality assurance, and consistency across sites. CONCLUSION This study provides rigorous evidence on how women and families recognize and respond to maternal and newborn illness. By using a common methodology and tools, findings not only were site-specific but also allow for comparison across contexts.
Collapse
Affiliation(s)
- Allisyn C. Moran
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | | | - Supriya Madhavan
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | | | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Monica Okuga
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Vandana Sharma
- The Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | - Neal Brandes
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | - James M. Sherry
- University Research Co., LLC, Bethesda, MD USA
- School of Public Health, City University of New York, New York, New York USA
| |
Collapse
|
25
|
Bellizzi S, Sobel HL, Ali MM. Signs of eclampsia during singleton deliveries and early neonatal mortality in low- and middle-income countries from three WHO regions. Int J Gynaecol Obstet 2017; 139:50-54. [PMID: 28704570 DOI: 10.1002/ijgo.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/25/2017] [Accepted: 07/10/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. METHODS The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees' most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions-used as an indicator for having experienced eclampsia-and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. RESULTS The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0-1.3), 1.7% (95% CI 1.5-2.1), and 1.7% (95% CI 1.5-2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4-3.2). CONCLUSION Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions.
Collapse
Affiliation(s)
- Saverio Bellizzi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Howard L Sobel
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Mohamed M Ali
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
26
|
Mutua MM, Achia TNO, Maina BW, Izugbara CO. A cross-sectional analysis of Kenyan postabortion care services using a nationally representative sample. Int J Gynaecol Obstet 2017. [PMID: 28631406 DOI: 10.1002/ijgo.12239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess quality of postabortion care (PAC) offered by Kenyan healthcare facilities. METHODS A cross-sectional survey was conducted using data from the Incidence and Magnitude of Unsafe Abortions study, conducted among 326 PAC-providing healthcare facilities throughout Kenya from March 13 to June 30, 2012. Descriptive results with weighted proportions and an ordered probit model were used. RESULTS Overall, 408 (41.8%) first-trimester PAC cases were treated using appropriate technology versus 826 (82.6%) second-trimester cases. Private healthcare facilities lagged behind public healthcare facilities on the use of appropriate technology: 264 (47.5%) public and 144 (33.1%) private facilities used such technology for first-trimester abortion, and 664 (89.6%) public versus 162 (68.8%) private for second-trimester abortions). Most healthcare facilities (251, 70.7%) had at least one provider trained in PAC. A total of 273 (80.7%) healthcare facilities reported offering contraception to all PAC patients, mainly short-acting methods. Delivery of PAC services depended on the availability of separate evacuation room (public level 2-3: odds ratio [OR] 22.93; public level 4-6: OR 77.14), and the number of family planning methods offered within the facility (public level 2-3: OR 1.38; public level 4-6 OR 1.57; private level 2-3: OR 2.27; private level 4-5: 4.89). CONCLUSION Effective monitoring of PAC services, particularly among private healthcare facilities, might improve overall quality of services.
Collapse
Affiliation(s)
- Michael M Mutua
- Research Division, African Population and Health Research Center, Nairobi, Kenya.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas N O Achia
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Beatrice W Maina
- Research Division, African Population and Health Research Center, Nairobi, Kenya
| | - Chimaraoke O Izugbara
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
27
|
Alam M, D’Este C, Banwell C, Lokuge K. The impact of mobile phone based messages on maternal and child healthcare behaviour: a retrospective cross-sectional survey in Bangladesh. BMC Health Serv Res 2017; 17:434. [PMID: 28645278 PMCID: PMC5482970 DOI: 10.1186/s12913-017-2361-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mobile phones are gradually becoming an integral part of healthcare services worldwide. We assessed the association between Aponjon mobile phone based messaging services and practices regarding childbirth and care of mother and neonates in selected areas in Bangladesh. METHODS In early 2014, 476 subscriber mothers whose last born child's age was between 3 and 18 months, were recruited to the study by Dnet from selected areas of Bangladesh. One group of mothers received the early warning messages from Aponjon during pregnancy (exposed; n = 210) while the other group of new mothers did not receive the messages during pregnancy as they had enrolled in the service after childbirth (non-exposed; n = 266). We undertook regression analyses to investigate the relationship between timing of exposure to Aponjon messages and socio-economic factors and outcomes of safe delivery, immediate breastfeeding post birth, delayed bathing of the neonate, and number of postnatal care (PNC) visits. RESULTS Women reported delivering babies at home without a skilled birth attendant (SBA) (n = 58, 12%), at home with SBA (n = 111, 23%) and at health facilities (n = 307, 65%). Most (n = 443, 93%) women breastfed babies immediately post birth. Babies were bathed after 72 h (n = 294, 62%), between 48 and 72 (n = 100, 21%) and between 0 and 47 (n = 80, 17%) hours after birth. PNC frequencies were reported as none (n = 273, 57%), 1 (n = 79, 17%), 2 (n = 54, 11%), 3 (n = 34, 7%) and 4 (n = 36, 8%). There was no significant association between exposure to Aponjon messages during pregnancy and presence of a SBA at birth, breastfeeding practices, and postnatal care visits, although delayed bathing up to 48 h was significant at the 10% but not 5% level (RRR 1.7; 95% CI 0.93-3.0; p = 0.083). Women with higher education, from higher income, older in age, with birth order 1 or 2 were more likely to birth at health facilities. Facility based delivery was an independent factor for delayed bathing and having postnatal care visits. CONCLUSIONS Low cost mobile phone messages may have the potential to positively influence maternal and child healthcare behaviours, such as delayed timing of first bath, in resource-poor settings. Further studies are needed, with adequate sample size to detect significant change.
Collapse
Affiliation(s)
- Mafruha Alam
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
28
|
Edu BC, Agan TU, Monjok E, Makowiecka K. Effect of Free Maternal Health Care Program on Health-seeking Behaviour of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study. Open Access Maced J Med Sci 2017; 5:370-382. [PMID: 28698759 PMCID: PMC5503739 DOI: 10.3889/oamjms.2017.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/20/2017] [Accepted: 06/03/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. METHOD A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. RESULTS Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. CONCLUSION Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.
Collapse
Affiliation(s)
- Betta Chimaobim Edu
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Thomas U. Agan
- Department of Obstetrics and Gynecology, University of Calabar and the University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel Monjok
- Departments of Family Medicine and Community Medicine, University of Calabar and the University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Krystyna Makowiecka
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| |
Collapse
|
29
|
Kibria GMA, Ghosh S, Hossen S, Barsha RAA, Sharmeen A, Uddin SMI. Factors affecting deliveries attended by skilled birth attendants in Bangladesh. Matern Health Neonatol Perinatol 2017; 3:7. [PMID: 28331630 PMCID: PMC5359810 DOI: 10.1186/s40748-017-0046-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background The presence of skilled birth attendants (SBAs) is crucial in childbirth to reduce the maternal mortality ratio (MMR) and to achieve the maternal mortality target of the United Nations’ Sustainable Development Goals (SDGs). The aim of this study was to investigate the factors related to childbirths attended by SBAs in Bangladesh. Methods Data from the Bangladesh Demographic and Health Survey (2014 BDHS) were analyzed. Logistic regression was applied to calculate crude odds ratios (CORs), adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p-values. Results In Bangladesh, 35.9% of deliveries were attended by SBAs, and 44.2% of those women received at least one antenatal check-up by a skilled provider. The deliveries by SBAs were less than 50% of the total deliveries in all divisions, excluding Khulna. Known pregnancy complications (AOR: 1.2; 95% CI: 1.1–1.4), higher level of education in both women (AOR: 1.7; 95% CI: 1.2–2.3) and their husbands (AOR: 1.8; 95% CI: 1.3–2.4), receiving antenatal care (ANC) by a skilled provider during the pregnancy period (AOR: 1.5; 95% CI: 1.1–2.1), and higher wealth quintiles (AOR: 3.4; 95% CI: 2.5–4.7) were all significantly associated with an increased likelihood of a delivery by SBAs (p <0.05). In contrast, women living in rural areas (AOR: 0.7; 95% CI: 0.6–0.8) and the Sylhet Division (AOR: 0.4; 95% CI: 0.3–0.5) were less likely to be delivered by SBAs. Conclusions To achieve the target of the Government of Bangladesh - 50% of deliveries to be attended by SBAs - it is important to increase ANC services and awareness programs in all seven divisions of Bangladesh. Special focus in rural areas is also required to meet this target. A new study should be conducted to explore the unexamined factors associated with the presence of SBAs during childbirth.
Collapse
Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Swagata Ghosh
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan Canada
| | - Shakir Hossen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Rifath Ara Alam Barsha
- Department of Pediatrics, Sylhet M. A. G. Osmani Medical College Hospital, ProjAHNMo- Johns Hopkins University-Bangladesh, Sylhet, Bangladesh
| | | | - S M Iftekhar Uddin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
30
|
Aboud FE, Rahman E, Kassam R, Khan J, Ali NA, Taleb F. Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh. Soc Sci Med 2017; 177:269-277. [PMID: 28190626 DOI: 10.1016/j.socscimed.2017.01.032] [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: 06/10/2016] [Revised: 01/15/2017] [Accepted: 01/20/2017] [Indexed: 11/19/2022]
Abstract
RATIONALE The time it takes for a child with suspected sepsis to receive care is critical. OBJECTIVE We evaluated care-seeking practices for sick children under 5 years in rural Bangladesh, following interpersonal communication to inform households of newly introduced supports for quality care. Based on the Delays Framework, we assessed length and source of care-seeking delays, use of formal providers, and autonomous decision-making among mothers. METHOD Using two cross-sectional rounds before and after the 3-year intervention (August 2012 and August 2015), we surveyed 400 mothers of recently sick children in 26 randomly sampled villages from 2 intervention and 2 control subdistricts, using structured questions about delays. Six to ten times during the 18-month intervention period, local workers communicated four key messages to most intervention households in 292 villages: serious symptoms of suspected sepsis in children, a call-in center number for referral advice, a reliable transport hub, and upgrades to the local hospital. RESULTS Compared to baseline, endline results demonstrated a significant difference in the total delay between the onset of child's illness and seeking external care, with intervention families having shorter delays. Over 90% of mothers informed someone in the family, mainly the husband, about the sick child before acting to seek care. Delays due to transportation and receiving provider care were short and not different. Using a benchmark of seeking external care within 24 h of onset, only 14.14% of intervention households and 13.40% of control households were "timely" in seeking care. Approximately 78% of parents, similar for the two groups, sought care from a non-formal practitioner (the village doctor). CONCLUSION The results demonstrate that the delay in deciding to seek external care is most serious, and that communication strategies at the community level are necessary to increase the uptake of improved health services.
Collapse
Affiliation(s)
| | - Ehsanur Rahman
- International Centre for Diarrheal Disease Research, Bangladesh
| | - Rosemin Kassam
- School of Population and Public Health, University of British Columbia, Canada
| | - Jasmin Khan
- International Centre for Diarrheal Disease Research, Bangladesh
| | | | - Fahmida Taleb
- International Centre for Diarrheal Disease Research, Bangladesh
| |
Collapse
|
31
|
Exploring the associations between intimate partner violence victimization during pregnancy and delayed entry into prenatal care: Evidence from a population-based study in Bangladesh. Midwifery 2017; 47:43-52. [PMID: 28237897 DOI: 10.1016/j.midw.2017.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/14/2016] [Accepted: 02/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and newborns. The aim of the study is to explore: 1) the influence of experiencing IPV during pregnancy on delayed entry into prenatal care; and 2) whether women's decision-making autonomy and the support for traditional gender roles act to mediate or moderate the relationship between IPV and delayed entry into prenatal care. DESIGN cross-sectional survey. Multivariate logistic regression models were estimated that control for various socio-demographic and pregnancy related factors to assess whether women who experienced IPV during pregnancy were more likely to delay entry into prenatal care compared with women who had not experienced IPV. The influence of traditional gender roles acceptance and decision-making autonomy were examined both as independent variables and in interaction with IPV, to assess their role as potential mediators or moderators. SETTING Chandpur district, Bangladesh. PARTICIPANTS the sample comprised of 426 Bangladeshi women, aged 15-49 years. Postpartum mothers who visited vaccinations centres to receive their children's vaccinations constitute the sampling frame. RESULTS almost 70% of the women surveyed reported patterns consistent with delayed entry into prenatal care. Accounting for the influence of other covariates, women who experienced physical IPV during pregnancy were 2.61 times more likely (95% CI [1.33, 5.09]) to have delayed entry into prenatal care than their counterparts who did not report physical IPV. Neither sexual nor psychological IPV victimization during pregnancy was linked with late entry into prenatal care. Both gender role attitudes and levels of autonomy mediate the effect of IPV on prenatal care. KEY CONCLUSIONS the results suggest that the high rates of IPV in Bangladesh have effects that can compromise women's health seeking behaviour during pregnancy, putting them and their developing fetus at risk. Specifically, Bangladeshi women who experience physical IPV during pregnancy are more likely to delay or forgo prenatal care, an effect that is further magnified by cultural ideals that emphasize women's traditional roles and limit their autonomy. IMPLICATIONS FOR PRACTICE this study reinforces the need to detect and assist women suffering IPV, not only to offer them help and support but also to increase entry into prenatal care. Healthcare professionals involved in obstetrics and midwifery need to be aware of the risk factors of IPV during pregnancy and be able to identify women who are at risk for delayed entry into prenatal care.
Collapse
|
32
|
Bellizzi S, Bassat Q, Ali MM, Sobel HL, Temmerman M. Effect of Puerperal Infections on Early Neonatal Mortality: A Secondary Analysis of Six Demographic and Health Surveys. PLoS One 2017; 12:e0170856. [PMID: 28122046 PMCID: PMC5266333 DOI: 10.1371/journal.pone.0170856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour. Methods The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990–2013 systematic analysis for the Global Burden of Disease Study. Results Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4–3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0–26.6) in Honduras to 3.6% (95% CI: 1.0–8.5) in Indonesia. Conclusions Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.
Collapse
Affiliation(s)
- Saverio Bellizzi
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
| | - Mohamed M. Ali
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
- * E-mail:
| | - Howard L. Sobel
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
| |
Collapse
|
33
|
Shahabuddin A, Nöstlinger C, Delvaux T, Sarker M, Delamou A, Bardají A, Broerse JEW, De Brouwere V. Exploring Maternal Health Care-Seeking Behavior of Married Adolescent Girls in Bangladesh: A Social-Ecological Approach. PLoS One 2017; 12:e0169109. [PMID: 28095432 PMCID: PMC5240914 DOI: 10.1371/journal.pone.0169109] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. METHODS AND FINDINGS A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls' maternal health care-seeking behavior. CONCLUSIONS In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls.
Collapse
Affiliation(s)
- Asm Shahabuddin
- Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Christiana Nöstlinger
- Unit of HIV/AIDS Policy, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Azucena Bardají
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jacqueline E. W. Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Vincent De Brouwere
- Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
34
|
Khanam R, Creanga AA, Koffi AK, Mitra DK, Mahmud A, Begum N, Moin SMI, Ram M, Quaiyum MA, Ahmed S, Saha SK, Baqui AH. Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study. PLoS One 2016; 11:e0167814. [PMID: 27997537 PMCID: PMC5172566 DOI: 10.1371/journal.pone.0167814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh. METHODS The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications. Bivariate analysis was conducted to explore association between predisposing (socio-demographic), enabling (economic), perceived need, and service related factors with care-seeking for self-reported antepartum and intrapartum complications. Multivariable multinomial logistic regression was performed to examine the association of selected factors with care-seeking for self-reported antepartum and intrapartum complications adjusting for co-variates. RESULTS Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and intrapartum complications from a trained provider was significantly higher for women with higher household wealth status, higher literacy level of both women and their husbands, and for those living close to a health facility (<10 km). Women's decision making ability to go to health centre alone was associated with untrained care only for antepartum complications, but was associated with both trained and untrained care for intrapartum complications. CONCLUSIONS Nearly 40.0% of the women who experienced either an antepartum or intrapartum complications did not seek care from any provider and 11.5% -14.9% received care from untrained providers, primarily because of economic and geographic barriers to access. Development and evaluation of context specific, cost-effective, and sustainable strategies that will address these barriers to access to care for the maternal complications will enhance care seeking from trained health care providers and improve maternal health.
Collapse
Affiliation(s)
- Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- * E-mail:
| | - Andreea A. Creanga
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alain K. Koffi
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Syed Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Malathi Ram
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Md Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Samir K. Saha
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | |
Collapse
|
35
|
Sarker AR, Sultana M, Mahumud RA, Sheikh N, Van Der Meer R, Morton A. Prevalence and Health Care-Seeking Behavior for Childhood Diarrheal Disease in Bangladesh. Glob Pediatr Health 2016; 3:2333794X16680901. [PMID: 28229092 PMCID: PMC5308522 DOI: 10.1177/2333794x16680901] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
In Bangladesh, the burden of diarrheal diseases is significant among children <5 years old. The objective of this study is to capture the prevalence of and health care–seeking behavior for childhood diarrheal diseases (CDDs) and to identify the factors associated with CDDs at a population level in Bangladesh. We use a logistic regression approach to model careseeking based on individual characteristics. The overall diarrhea prevalence among children <5 years old was found to be 5.71%. Some factors found to significantly influence the health care–seeking pattern were age and sex of the children, nutritional score, age and education of mothers, wealth index, and access to electronic media. The health care service could be improved through working in partnership with public facilities, private health care practitioners, and community-based organizations, so that all strata of the population get equitable access in cases of childhood diarrhoea.
Collapse
Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; University of Strathclyde, Glasgow, UK
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Nurnabi Sheikh
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | |
Collapse
|
36
|
Blencowe H, Calvert PhD C, Lawn JE, Cousens S, Campbell OMR. Measuring maternal, foetal and neonatal mortality: Challenges and solutions. Best Pract Res Clin Obstet Gynaecol 2016; 36:14-29. [PMID: 27439881 DOI: 10.1016/j.bpobgyn.2016.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/13/2016] [Accepted: 05/21/2016] [Indexed: 11/24/2022]
Abstract
Levels and causes of mortality in mothers and babies are intrinsically linked, occurring at the same time and often to the same mother-baby dyad, although mortality rates are substantially higher in babies. Measuring levels, trends and causes of maternal, neonatal and foetal mortality are important for understanding priority areas for interventions and tracking the success of interventions at the global, national, regional and local level. However, there are many measurement challenges. This paper provides an overview of the definitions and indicators for measuring mortality in pregnant and post-partum women (maternal and pregnancy-related mortality) and their babies (foetal and neonatal mortality). We then discuss current issues in the measurement of the levels and causes of maternal, foetal and neonatal mortality, and present options for improving measurement of these outcomes. Finally, we illustrate some important uses of mortality data, including for the development of models to estimate mortality rates at the global and national level and for audits.
Collapse
Affiliation(s)
- Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Clara Calvert PhD
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
37
|
Maternal Pregnancy Intention and Professional Antenatal Care Utilization in Bangladesh: A Nationwide Population-Based Survey. PLoS One 2016; 11:e0157760. [PMID: 27309727 PMCID: PMC4911017 DOI: 10.1371/journal.pone.0157760] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/04/2016] [Indexed: 01/21/2023] Open
Abstract
Objective To investigate the association between maternal pregnancy intention and professional antenatal and delivery care utilization. Methods Our data were derived from the 2011 nationally representative Bangladesh Demographic Health Survey. We included antenatal and delivery care utilization data of the most recent live births for women for the previous three years (n = 4672). We used multilevel logistic regression models to assess the relationship between pregnancy intention and use of professional antenatal and delivery care, with adjustment for potential confounding variables. Results Approximately 13% and 16% of children were reported by their mothers as unwanted and mistimed at the time of conception, respectively. Among the women, 55% received at least one professional antenatal care service; 21% received four or more professional antenatal services, while 32% were attended by professionals during deliveries. Mothers of children whose pregnancies had been unwanted had a greater risk for not seeking professional antenatal and professional delivery care than those whose pregnancies had been wanted [1≥ ANC from professionals: AOR: 0.66; 95% CI:0.51–0.93; 4≥ ANC from professionals: AOR:0.56; 95% CI:0.37–0.84; and delivery care from professionals: AOR: 0.70; 95% CI:0.50–0.97]. Women who were married after age 18, had secondary or higher level of education, and were from the wealthiest households were more likely to utilize antenatal and delivery care. Conclusion Unwanted pregnancy is significantly associated with lower utilization of professional antenatal and delivery care services in Bangladesh. Reducing unwanted births and promoting access to professional antenatal and delivery care are crucial for achieving the Sustainable Development Goals (SDGs) 3 in Bangladesh.
Collapse
|
38
|
Khowaja AR, Qureshi RN, Sheikh S, Zaidi S, Salam R, Sawchuck D, Vidler M, von Dadelszen P, Bhutta Z. Community's perceptions of pre-eclampsia and eclampsia in Sindh Pakistan: a qualitative study. Reprod Health 2016; 13 Suppl 1:36. [PMID: 27357953 PMCID: PMC4943481 DOI: 10.1186/s12978-016-0136-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Maternal mortality is of global public health concern and >99 % of maternal deaths occur in less developed countries. The common causes of direct maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan, pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported at the tertiary care hospital settings. This study explored community perceptions, and traditional management practices about pre-eclampsia/eclampsia. METHODS A qualitative study was conducted in Sindh Province of Pakistan from February to July 2012. Twenty-six focus groups were conducted, 19 with women of reproductive age/mothers-in-law (N = 173); and 7 with husbands/fathers-in-law (N = 65). The data were transcribed verbatim in Sindhi and Urdu, then analyzed for emerging themes and sub-themes using NVivo version 10 software. RESULTS Pre-eclampsia in pregnancy was not recognized as a disease and there was no name in the local languages to describe this. Women however, knew about high blood pressure and were aware they can develop it during pregnancy. It was widely believed that stress and weakness caused high blood pressure in pregnancy and it caused symptoms of headache. The perception of high blood pressure was not based on measurement but on symptoms. Self-medication was often used for headaches associated with high blood pressure. They were also awareness that severely high blood pressure could result in death. CONCLUSIONS Community-based participatory health education strategies are recommended to dispel myths and misperceptions regarding pre-eclampsia and eclampsia. The educational initiatives should include information on the presentation, progression of illness, danger signs associated with pregnancy, and appropriate treatment.
Collapse
Affiliation(s)
- Asif Raza Khowaja
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Rahat Najam Qureshi
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana Salam
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Diane Sawchuck
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Marianne Vidler
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Peter von Dadelszen
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Zulfiqar Bhutta
- />Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
39
|
Enuameh YAK, Okawa S, Asante KP, Kikuchi K, Mahama E, Ansah E, Tawiah C, Adjei K, Shibanuma A, Nanishi K, Yeji F, Agyekum EO, Yasuoka J, Gyapong M, Oduro AR, Quansah Asare G, Hodgson A, Jimba M, Owusu-Agyei S. Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study. PLoS One 2016; 11:e0152235. [PMID: 27031301 PMCID: PMC4816577 DOI: 10.1371/journal.pone.0152235] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/10/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana. METHODS Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models. RESULTS Of 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider's influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96-30.48), place of residence (AOR = 4.49; 95% CI 1.14-17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29-2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43-5.60). CONCLUSION In addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider's influence. Ensuring care provider's counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.
Collapse
Affiliation(s)
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Evelyn Ansah
- Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana
| | - Charlotte Tawiah
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Kwame Adjei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Francis Yeji
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | | | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Margaret Gyapong
- Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana
| | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | | |
Collapse
|
40
|
Islam Z, Sarker AR, Anwar S, Kabir H, Gazi R. Costs of integrating demand-based reproductive health commodity model into the Government and NGO service delivery systems in Bangladesh: a supply side perspective. SPRINGERPLUS 2015; 4:808. [PMID: 26722628 PMCID: PMC4689723 DOI: 10.1186/s40064-015-1610-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/13/2015] [Indexed: 11/10/2022]
Abstract
To estimate additional total cost and average cost of integrating the demand-based reproductive health commodity model into the existing Government and NGO facilities in Bangladesh. Activity based cost analysis was conducted during 2006-2008 in two low performing rural sub-districts (Nabigong and Raipur sub-district) and one urban slum area in Dhaka city, Bangladesh. Activity-based cost data were collected using ingredient approach, which comprised of listing all types of inputs by activity, quantities and prices for each input. Total cost was presented according to capital and recurrent items. The supply side perspective was considered for entire analysis. The total cost of integrating demand-based reproductive health commodity (DBRHC) model into the Government and NGO service delivery system was estimated to BDT 18,667,634 (US$274,524). The proportion of capital cost was 59 % and the recurrent cost was 41 % of the total cost. The average cost per beneficiaries was BDT 230 (US$3.38) only for introducing this model into the existing health system. The built-in interventions of DBRHC model were doable at low-cost at the selected Government and NGO settings at the grass-root level. The model has potential of further cost containment during scaling up-if the intervention costs are adjusted with the existing functionaries of the Government and NGOs.
Collapse
Affiliation(s)
- Ziaul Islam
- Health Economics and Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahela Anwar
- Health Economics and Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Humayun Kabir
- Health Economics and Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rukhsana Gazi
- Health Economics and Financing Research Group, Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
41
|
Lakew S, Tachbele E, Gelibo T. Predictors of skilled assistance seeking behavior to pregnancy complications among women at southwest Ethiopia: a cross-sectional community based study. Reprod Health 2015; 12:109. [PMID: 26613716 PMCID: PMC4662807 DOI: 10.1186/s12978-015-0102-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 11/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background In Ethiopia, about 20,000 women die each year from complications of pregnancy and child birth with many more maternal morbidities occurring for each maternal deaths. This makes Ethiopia one of the highest countries for maternal deaths in the developing world. This study attempted to assess women’s skilled assistance seeking behaviour for pregnancy complications among those who gave birth. Method A cross-sectional community based study was conducted among women who gave birth within one year regardless of their delivery place. The study was carried out in fifteen randomly selected villages at Arba Minch Zuria district, south west Ethiopia. Data was collected house-to-house using a pretested Amharic questionnaire. During the survey, 798 women were interviewed. Logistic regression model was applied to control confounders. Results Out of the total sample, 344 (43.1 %) respondents reported at least any one of the pregnancy complications faced in the recent pregnancy. The most common complications reported were malaria (57 %), nausea/vomiting (47.1 %) and severe head ache (29.1 %). of those women who faced complications, around 254 (73.8 %) sought assistance from a skilled provider. Ninety (26.2 %) of the respondents sought assistance either from unskilled provider or home based self-care. Unable to understand the seriousness of the complications, thought as unnecessary, and family disapproval were the major reasons for not seeking care from skilled providers. Belonging to monthly household income $US25- 100 (AOR = 3.4, 95 % CI; 1.04, 11.4), getting antenatal care from a skilled provider (AOR = 10.6, 95 % CI; 3.3, 34.5), Women in the age 20–34 years old (AOR = 3.8; 95 % CI, 1.2, 12.3), Availability of transport access (AOR = 72.2; 95 % CI; 17.2, 303.5) were significantly associated with seeking assistance from a skilled provider. Conclusions Nearly half (43.1 %) of the women had faced pregnancy complications to the recent birth of last one year. Majority (2/3rd) of the women who reported complications sought skilled assistance. Family, income, transport issue and antenatal care use were independent predictors for skilled assistance from skilled provider.
Collapse
Affiliation(s)
- Serawit Lakew
- Department of Nursing and Midwifery, Arba Minch College of Health Sciences, Arba Minch, South West Ethiopia.
| | - Erdaw Tachbele
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Terefe Gelibo
- Department of Public Health, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia.
| |
Collapse
|
42
|
Jesmin SS. Married Women's Justification of Intimate Partner Violence in Bangladesh: Examining Community Norm and Individual-Level Risk Factors. VIOLENCE AND VICTIMS 2015; 30:984-1003. [PMID: 26439820 DOI: 10.1891/0886-6708.vv-d-14-00066] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One-third of the women worldwide experience intimate partner violence (IPV) that increases their vulnerability to both short- and long-term physical, sexual, reproductive, and mental health problems. Surprisingly, IPV is justified by many women globally. Although the IPV literature to date is mostly focused on risk factors associated with actual occurrences, little is known on attitudinal acceptance of such violence. Also, despite the growing scholarship of community influence and health link, IPV research has relatively overlooked the effects of norms at the community level. Using a representative national sample of 13,611 married women in Bangladesh, this study examined the association of community attitudes and women's individual attitudes toward wife beating. The results revealed that women living in communities with permissive attitudes toward wife beating were more likely to justify husbands' beating (OR=4.5). Women married at a younger age, who had less than primary-level education, lived in households categorized as poor or middle class, and did not consume media appeared to be at higher risk for justifying wife beating. This research adds to a growing research body on community influences on health by examining IPV attitudes and community norms link.
Collapse
|
43
|
Hackett KM, Mukta US, Jalal CSB, Sellen DW. A qualitative study exploring perceived barriers to infant feeding and caregiving among adolescent girls and young women in rural Bangladesh. BMC Public Health 2015; 15:771. [PMID: 26259575 PMCID: PMC4531479 DOI: 10.1186/s12889-015-2115-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant feeding and caregiving by adolescent girls and young women in rural Bangladesh remains relatively understudied despite high potential vulnerability of younger mothers and their children due to poverty and high rates of early marriage and childbearing. This key knowledge gap may hamper the effectiveness of maternal, infant and child health interventions not specifically tailored to teenage mothers. This study aimed to narrow this gap by documenting key barriers to optimal infant and young child feeding and caregiving perceived by adolescent girls and young women in rural Bangladesh. METHODS Focus group discussions and in-depth semi-structured interviews were conducted with 70 adolescent girls and young women participating in a community-based adolescent empowerment program in two rural regions of northwestern Bangladesh. Participants were stratified into three groups: unmarried, married without child, and married with child(ren). Thematic analysis was performed to elucidate dominant ideas regarding challenges with child feeding and caregiving across participant strata. RESULTS Participants in all three strata and in both geographical regions attributed actual and anticipated caregiving difficulties to five major contextual factors: early marriage, maternal time allocation conflicts, rural life, short birth intervals, and poverty. Indications are that many girls and young women anticipate difficulties in feeding and caring for their future children from an early age, and often prior to motherhood. Participants articulated both perceived need and unmet demand for additional education in infant and young child feeding, childcare, and family planning techniques. CONCLUSIONS Provision during adolescence of appropriate education, services and financial aid to support best practices for infant feeding and childcare could significantly improve maternal self-efficacy, mental health, nutrition security and young childcare, nutrition and health in rural Bangladesh. Lessons learned can be applied in future programs aimed at supporting adolescent women along a continuum of care.
Collapse
Affiliation(s)
- Kristy M Hackett
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
| | - Umme S Mukta
- Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
| | | | - Daniel W Sellen
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
| |
Collapse
|
44
|
Sikder SS, Labrique AB, Craig IM, Wakil MA, Shamim AA, Ali H, Mehra S, Wu L, Shaikh S, West KP, Christian P. Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Health Serv Res 2015; 15:166. [PMID: 25985774 PMCID: PMC4459664 DOI: 10.1186/s12913-015-0832-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions. METHODS Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor). RESULTS Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers. CONCLUSIONS While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER NCT00860470 .
Collapse
Affiliation(s)
- Shegufta S Sikder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ian M Craig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Abu Ahmed Shamim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hasmot Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sucheta Mehra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lee Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
45
|
Sikder SS, Labrique AB, Shamim AA, Ali H, Mehra S, Wu L, Shaikh S, West KP, Christian P. Risk factors for reported obstetric complications and near misses in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Pregnancy Childbirth 2014; 14:347. [PMID: 25282340 PMCID: PMC4287506 DOI: 10.1186/1471-2393-14-347] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In rural Bangladesh, more than 75% of all births occur at home in the absence of skilled birth attendants. Population-based data are lacking on the burden and risk factors for obstetric complications in settings with low rates of institutional delivery. We sought to describe the prevalence of reported complications and to analyze risk factors for obstetric complications and near misses, using data from a representative, rural setting of Bangladesh. METHODS This study utilized existing data on 42,214 pregnant women enrolled in a micronutrient supplementation cohort trial between 2007 and 2011 in rural northwest Bangladesh. Based on self-report of complications, women were categorized as having obstetric complications, near misses, or non-complicated pregnancies using definitions modified from the World Health Organization. Multivariable multinomial regression was used to analyze the association of biological, socioeconomic, and psychosocial variables with obstetric complications or near misses. RESULTS Of enrolled women, 25% (n = 10,380) were classified as having at least one obstetric complication, 2% (n = 1,004) with reported near misses, and 73% (n = 30,830) with non-complicated pregnancies. Twelve percent (n = 5,232) reported hemorrhage and 8% (n = 3,259) reported sepsis. Of the 27,241 women with live births or stillbirths, 11% (n = 2,950) reported obstructed labor and 1% (n = 328) reported eclampsia. Biological risk factors including women's age less than 18 years (Relative Risk Ratio [RRR] 1.26 95%CI:1.14-1.39) and greater than 35 years (RRR 1.23 95%CI:1.09-1.38), history of stillbirth or miscarriage (RRR 1.15 95%CI:1.07-1.22), and nulliparity (RRR 1.16 95%CI:1.02-1.29) significantly increased the risk of obstetric complications. Neither partner wanting the pregnancy increased the risk of obstetric complications (RRR 1.33 95%CI:1.20-1.46). Mid-upper arm circumference <21.5 cm increased the risk of hemorrhage and sepsis. CONCLUSIONS These analyses indicate a high burden of obstetric morbidity. Maternal age, nulliparity, a history of miscarriage or stillbirth, and lack of pregnancy wantedness were associated with increased risk of obstetric complications. Policies to address early marriage, unmet need for contraception, and maternal undernutrition may help mitigate this morbidity burden in rural Bangladesh.
Collapse
Affiliation(s)
- Shegufta S Sikder
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Alain B Labrique
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Abu A Shamim
- />The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh
| | - Hasmot Ali
- />The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh
| | - Sucheta Mehra
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Lee Wu
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Saijuddin Shaikh
- />The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh
| | - Keith P West
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Parul Christian
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| |
Collapse
|
46
|
Lambon-Quayefio MP, Owoo NS. Examining the influence of antenatal care visits and skilled delivery on neonatal deaths in Ghana. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:511-522. [PMID: 24934923 DOI: 10.1007/s40258-014-0103-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60% of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality. OBJECTIVE This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana. METHODS Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits. RESULTS Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2%, while older women have an approximately 0.2% higher risk of losing their neonates than do younger women. CONCLUSION Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women's age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.
Collapse
|
47
|
Changes in the selected reproductive health indicators among married women of reproductive age in low performing areas of Bangladesh: findings from an evaluation study. BMC Public Health 2014; 14:478. [PMID: 24886357 PMCID: PMC4037281 DOI: 10.1186/1471-2458-14-478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Three-year duration Demand-Based Reproductive Commodity Project (DBRHCP) was launched in three low performing areas: rural Nabiganj (population 323,357), Raipur (population 260,983) and urban slum in Dhaka (population 141,912). Objectives: Assessing changes in knowledge among married women of reproductive age on selected reproductive health issues and to explore their service utilization patterns over the project period in selected low performing areas of Bangladesh. Methods The study adopted a pre- posts design. In the project areas, the entire chain of service provision were modified through the interventions under the DBRHCP, including training of the providers, enhanced behavioral change communication activities, follow-up and counseling, record keeping, reporting and monitoring, as well as improvement in logistics and supplies. Peer promoters were established as linkages between clients and service providers. All households were enlisted. Baseline and end line surveys were done using representative simple random sampling method, capturing changes over one year intervention period. Descriptive analysis was done using SPSS package, version 10. Proportional tests using Stata, version 8 were done to assess changes from baseline to end line. Results The overall contraceptive prevalence was markedly different in the three study areas but significantly increased in both Dhaka urban slums and Nabiganj. In the rural areas, a higher proportion of the women in endline compared to baseline obtained contraceptive methods from the public sectors. Irrespective of study sites, significantly higher proportion of women received ANC (Antenatal Care) and PNC (Post natal care) in endline compared to baseline. In all study sites higher proportions of women were aware of maternal complications at endline. Services were obtained from qualified persons for reported symptoms of sexually transmitted infections by a higher proportion of women at endline compared to baseline. There were improvements in other RH indicators, such as use of skilled birth attendants and overall utilization of health care facilities by women. Conclusions The improvements in several important RH indicators in the intervention areas suggest that the interventions affected selected outcomes reported in the study. The study findings also suggest that investment in the reproductive health sector, particularly in existing government programs, improves RH outcomes.
Collapse
|
48
|
Quaiyum A, Gazi R, Hossain S, Wirtz A, Saha NC. Feasibility, acceptability, and programme effectiveness of misoprostol for prevention of postpartum haemorrhage in rural bangladesh: a quasiexperimental study. Int J Reprod Med 2014; 2014:580949. [PMID: 25763402 PMCID: PMC4334073 DOI: 10.1155/2014/580949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 03/11/2014] [Indexed: 11/25/2022] Open
Abstract
We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH) among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum's delivery mat), a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh.
Collapse
Affiliation(s)
| | - Rukhsana Gazi
- Centre for Equity and Health Systems, icddr,b, Mohakhali C/A, Dhaka 1212, Bangladesh
| | - Shahed Hossain
- Centre for Equity and Health Systems, icddr,b, Mohakhali C/A, Dhaka 1212, Bangladesh
| | - Andrea Wirtz
- Department of Epidemiology, The Centre for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street/E7144, Baltimore, MD 21205, USA
| | | |
Collapse
|
49
|
Rahman M, Rob U, Noor FR, Bellows B. Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2013; 33:143-57. [PMID: 23661416 DOI: 10.2190/iq.33.2.d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US$3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.40 at private health facilities. Similarly, women paid one and half times more for normal (US$42.30) and cesarean deliveries (US$136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities.
Collapse
|
50
|
Determinants of pregnancy and induced and spontaneous abortion in a jointly determined framework: evidence from a country-wide, district-level household survey in India. J Biosoc Sci 2013; 46:480-517. [PMID: 23866167 DOI: 10.1017/s0021932013000369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study provides evidence on the principal determinants of pregnancy and abortion in India using a large country-wide district-level data set (DLHS 2007). The paper provides an economic framework for the analysis of pregnancy and abortion. The study distinguishes between induced and spontaneous abortion and compares the effects of their determinants. The results show that there are wide differences between induced and spontaneous abortions in terms of the sign and magnitude of the estimated effects of several of their determinants, most notably wealth, the woman's age and her desire for children. The study makes a methodological contribution by proposing a trivariate probit estimation framework that recognizes the joint dependence of pregnancy and induced and spontaneous abortion, and provides evidence in support of this joint dependence. The study reports an inverted U-shaped effect of a woman's age on her pregnancy and both forms of abortion. The turning point in each case is quite robust to the estimation framework. A significant effect of contextual variables, at the village level, constructed from the individual responses, on a woman's pregnancy is found. The effects are weaker in the case of induced abortion, and insignificant in the case of spontaneous abortion. The results are shown to be fairly robust. This paper extends the literature on the relation between son preference and fertility by examining the link between mother's son preference and desire for more children with abortion rates.
Collapse
|