1
|
Kumar R, Mehraj V, Ahmed J, Khan SA, Ali TM, Batool S, Rashid F, Pongpanich S. Barriers experienced by community midwives to provide basic emergency obstetric and newborn care in rural Pakistan. BMC Health Serv Res 2023; 23:1305. [PMID: 38012758 PMCID: PMC10683157 DOI: 10.1186/s12913-023-10273-5] [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: 03/14/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Considering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied. METHODS This was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan. RESULTS The majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant. CONCLUSION Financial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.
Collapse
Affiliation(s)
- Ramesh Kumar
- Health Services Academy, Islamabad, Pakistan.
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Vikram Mehraj
- McGill University Health Centre, Montreal, QC, H4A 3J1, Canada
| | - Jamil Ahmed
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | | | - Saima Batool
- College of Nursing, Pishin Baluchistan, Pakistan
| | - Fozia Rashid
- Shifa International Hospital, Islamabad, Pakistan
| | | |
Collapse
|
2
|
Mroz EJ, Willis T, Thomas C, Janes C, Singini D, Njungu M, Smith M. Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia. Int J Health Geogr 2023; 22:17. [PMID: 37525198 PMCID: PMC10391775 DOI: 10.1186/s12942-023-00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Seasonal floods pose a commonly-recognised barrier to women's access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women's walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
Collapse
Affiliation(s)
- Elizabeth Jade Mroz
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Thomas Willis
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Thomas
- Lincoln Centre for Water & Planetary Health, University of Lincoln, Lincoln, LN6 7DW, UK
| | - Craig Janes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwimanenwa Njungu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mark Smith
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
3
|
Nambile Cumber S, Atuhaire C, Namuli V, Bogren M, Elden H. Barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda: a qualitative study. Glob Health Action 2022; 15:2067397. [PMID: 35762835 PMCID: PMC9246142 DOI: 10.1080/16549716.2022.2067397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In Uganda, the uptake of maternal health services is very low, with only 41.1% of pregnant adolescent girls attending the eight antenatal visits that are recommended by the World Health Organisation. Uptake of maternal health services is essential in reducing the current level of adolescent pregnancies as well as its adverse effects on adolescent mothers and their babies, such as preterm deliveries, prolonged labour, death during pregnancy, and childbirth. No previous study has described pregnant adolescents' experiences with maternal health services in Uganda. OBJECTIVE This study aimed to describe the barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda. METHODS Data were collected in the Naguru Teenage Information and Health Centre in Uganda through individual interviews involving 31 pregnant adolescents. The transcribed interviews were inductively analysed through content analysis. RESULTS The pregnant adolescents described difficulty in reaching, as well as lack of financial support to visit, the Naguru Teenage Information and Health Centre, which is a clinic providing youth friendly services. Feelings of being discriminated against and disrespected by health workers, and lack of privacy when receiving health services was major barriers that hindered their access to maternal health services. Pregnant adolescents' access to these services can be enhanced by improving health workers' working conditions, accelerating community and health worker awareness on ways to mitigate these barriers, and developing policies that encourage men's involvement in maternal health services. CONCLUSION Adolescents in Uganda face considerable barriers to accessing improved and quality maternal health services. To mitigate these barriers, according to the adolescents, considerable efforts are required to tackle health workers' working conditions and sensitise the community on the importance of, as well as securing the availability of, maternal health services for pregnant adolescents. Future research should focus on pregnant adolescents who receive family support.
Collapse
Affiliation(s)
- Samuel Nambile Cumber
- Institute of Health and Care Sciences; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Section for Epidemiology and Social Medicine; Department of Public Health, Institute of Medicine (EPSO), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vivian Namuli
- Section for Epidemiology and Social Medicine; Department of Public Health, Institute of Medicine (EPSO), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of obstetrics and gynaecology, Sahlgrenska University hospital, Gothenburg, Sweden
| |
Collapse
|
4
|
Masaba BB, Mmusi-Phetoe R, Rono B, Moraa D, Moturi JK, Kabo JW, Oyugi S, Taiswa J. The healthcare system and client failures contributing to maternal mortality in rural Kenya. BMC Pregnancy Childbirth 2022; 22:903. [PMID: 36471265 PMCID: PMC9721048 DOI: 10.1186/s12884-022-05259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government's provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. METHODS An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. RESULTS Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients' ANC non-adherence. CONCLUSION In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.
Collapse
Affiliation(s)
- Brian Barasa Masaba
- grid.412801.e0000 0004 0610 3238Department of Health Studies, College of Human Sciences, School of Social Sciences, University of South Africa (UNISA), P.O. Box 392, Pretoria, South Africa
| | - Rose Mmusi-Phetoe
- grid.412801.e0000 0004 0610 3238Department of Health Studies, College of Human Sciences, School of Social Sciences, University of South Africa (UNISA), P.O. Box 392, Pretoria, South Africa
| | - Bernard Rono
- grid.33058.3d0000 0001 0155 5938Centre of Microbiology Research, Kenya Medical Research Institute (KEMRI), P.O. Box 54840-00200, Nairobi, Kenya
| | - Damaris Moraa
- School of Nursing, Kaimosi Friends University, P.O. Box 385, Kaimosi, Kenya
| | - John K. Moturi
- grid.494616.80000 0004 4669 2655School of Nursing, Kibabii University, P.O. Box 1699, Bungoma, Kenya
| | - Jane W. Kabo
- grid.494616.80000 0004 4669 2655School of Nursing, Kibabii University, P.O. Box 1699, Bungoma, Kenya
| | - Samuel Oyugi
- grid.442475.40000 0000 9025 6237Department of Clinical Nursing and Health Informatics, Masinde Muliro University of Science and Technology, P.O. Box 190, Kakamega, Kenya
| | - Jonathan Taiswa
- grid.442475.40000 0000 9025 6237Department of Clinical Nursing and Health Informatics, Masinde Muliro University of Science and Technology, P.O. Box 190, Kakamega, Kenya
| |
Collapse
|
5
|
Bain LE, Aboagye RG, Dowou RK, Kongnyuy EJ, Memiah P, Amu H. Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data. BMC Public Health 2022; 22:647. [PMID: 35379198 PMCID: PMC8981812 DOI: 10.1186/s12889-022-13037-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Maternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys. METHODS This was a cross-sectional study of 43,786 young women aged 15-24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05. RESULTS The prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80-2.29), SBA (95% CI = 4.67-7.20), and PNC (95% CI = 1.08-1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78-0.88; SBA: aOR = 0.82, 95% CI = 0.75-0.88; PNC: aOR = 0.88, 95% CI = 0.83-0.94). CONCLUSION While SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.
Collapse
Affiliation(s)
- Luchuo Engelbert Bain
- College of Social Science, Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore Maryland, USA
| | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| |
Collapse
|
6
|
Okedo-Alex IN, Akamike IC, Eze II, Onwasigwe CN. Does disrespect and abuse during childbirth differ between public and private hospitals in Southeast Nigeria. BMC Pregnancy Childbirth 2021; 21:852. [PMID: 34972518 PMCID: PMC8719415 DOI: 10.1186/s12884-021-04298-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disrespect and Abuse (D&A) during childbirth represents an important barrier to skilled birth utilization, indicating a problem with quality of care and a violation of women's human rights. This study compared prevalence of D&A during childbirth in a public and a private hospital in Southeast Nigeria. METHODS This study was a cross-sectional study among women who gave birth in two specialized health facilities: a public teaching and a private-for-profit faith-based hospital in Southeast Nigeria. In each facility, systematic random sampling was used to select 310 mothers who had given birth in the facility and were between 0-14 weeks after birth. Study participants were recruited through the immunization clinics. Semi-structured, interviewer-administered questionnaires using the Bowser and Hills classification of D&A during childbirth were used for data collection. Data were analyzed using SPSS version 20 at 95% significance level. RESULTS Mean age of the participants in the public hospital was 30.41 ± 4.4 and 29.31 ± 4.4 in the private hospital. Over three-fifths (191; 61.6%) in the public and 156 women (50.3%) in the private hospital had experienced at least one form of D&A during childbirth [cOR1.58; 95% CI 1.15, 2.18]. Abandonment and neglect [Public153 (49.4%) vs. Private: 91 (29.4%); cOR2.35; 95% CI. 1.69, 3.26] and non-consented care [Public 45 (14.5%) vs. Private 67(21.6%): cOR0.62; 95% CI. 0.41, 0.93] were the major types of D&A during childbirth. Denial of companionship was the most reported subtype of D&A during childbirth in both facilities [Public 135 (43.5%) vs. Private66 (21.3%); cOR2.85; 95% CI. 2.00, 4.06]. Rural residents were less likely to report at least one form of D&A during childbirth (aOR 0.53; CI 0.35-0.79). CONCLUSION Although prevalence was high in both facilities, overall prevalence of D&A during childbirth and most subtypes were higher in the public health facility. There is a need to identify contextual factors enabling D&A during childbirth in public and private health care settings.
Collapse
Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Chika Nwamma Onwasigwe
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| |
Collapse
|
7
|
Sidze EM, Wekesah FM, Kisia L, Abajobir A. Inequalities in Access and Utilization of Maternal, Newborn and Child Health Services in sub-Saharan Africa: A Special Focus on Urban Settings. Matern Child Health J 2021; 26:250-279. [PMID: 34652595 PMCID: PMC8888372 DOI: 10.1007/s10995-021-03250-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this paper is to share the results of a systematic review on the state of inequalities in access to and utilization of maternal, newborn and child health (MNCH) services in the sub-Saharan African region. The focus of the review was on urban settings where growing needs and challenges have been registered over the past few years due to rapid increase in urban populations and urban slums. METHODS The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies published in English between 2000 and 2019 were included. A narrative synthesis of both qualitative and quantitative data was undertaken. The record for registration in PROSPERO was CRD42019122066. RESULTS The review highlights a great variation in MNCH services utilization across urban sub-Saharan Africa (SSA). The main aspects of vulnerability to unequal and poor MNCH services utilization in urban settings of the region include poverty, low level of education, unemployment, lower socioeconomic status and poor livelihoods, younger maternal age, low social integration and social support, socio-cultural taboos, residing in slums, and being displaced, refugee, or migrant. At the health system level, persistent inequalities are associated with distance to health facility, availability of quality services and discriminating attitudes from health care personnel. CONCLUSION Context-specific intervention programs that aim at resolving the identified barriers to access and use MNCH services, particularly for the most vulnerable segments of urban populations, are essential to improve the overall health of the region and universal health coverage (UHC) targets.
Collapse
Affiliation(s)
- E M Sidze
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
| | - F M Wekesah
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - L Kisia
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - A Abajobir
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| |
Collapse
|
8
|
Okedo-Alex IN, Akamike IC, Nwafor JI, Abateneh DD, Uneke CJ. Multi-stakeholder Perspectives on the Maternal, Provider, Institutional, Community, and Policy Drivers of Disrespectful Maternity Care in South-East Nigeria. Int J Womens Health 2020; 12:1145-1159. [PMID: 33324116 PMCID: PMC7733334 DOI: 10.2147/ijwh.s277827] [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: 08/19/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Understanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities. Materials and Methods This was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semi-structured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively. Results Maternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers. Conclusion A variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.
Collapse
Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Johnbosco Ifunanya Nwafor
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Dejene Derseh Abateneh
- Department of Medical Laboratory Sciences, Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| |
Collapse
|
9
|
Gurung MS, Wangdi S, Lethro P, Tshomo T, Dema T, Pelzom D. Barriers to Institutional Delivery Services in Districts With the Lowest Institutional Delivery Coverage in Bhutan. Asia Pac J Public Health 2020; 33:84-92. [PMID: 33164566 DOI: 10.1177/1010539520969236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bhutan aims to achieve 100% institutional delivery coverage. While evidence indicates improved institutional delivery coverage over the years, coverage in some of the districts is only 49%. This study was aimed at exploring barriers to institutional delivery in three low-coverage districts. In-depth qualitative interviews and six focus group discussions were conducted in December 2015. The analysis was done as per the Braun and Clarke's 6-phase guide to doing thematic analysis. This study sheds light on 15 barriers for institutional deliveries, which include hesitancy to seek health care when the pregnancy is out of wedlock, the restriction of alcohol consumption at health centers, fear of hypothermia in cold places, pastoralism, health care providers shortage, lack of maternity waiting home and food, distance, difficult terrain, lack of transportation services, and financial constraints. Some of these barriers could be unique to Bhutan. The coverage could be improved considerably if the recommendations in this article are implemented.
Collapse
|
10
|
Dahab R, Sakellariou D. Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124292. [PMID: 32560132 PMCID: PMC7344902 DOI: 10.3390/ijerph17124292] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022]
Abstract
The new Sustainable Development Goals (SDGs) to 2030 aim to reduce maternal mortality and provide equitable access to maternal healthcare. Compromised access to maternal health facilities in low-income countries, and specifically in Africa, contribute to the increased prevalence of maternal mortality. We conducted a systematic review to investigate access barriers to maternal health in low-income countries in Africa since 2015, from the perspective of both community members and health providers. The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care. Further research is required to guide policymakers towards firm multi-sectoral action to ensure appropriate and equitable access to maternal health in line with the SDGs to 2030.
Collapse
Affiliation(s)
- Rana Dahab
- Formerly London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK;
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK
- Correspondence:
| |
Collapse
|
11
|
Bayo P, Belaid L, Tahir EO, Ochola E, Dimiti A, Greco D, Zarowsky C. "Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing": institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study. BMC Pregnancy Childbirth 2020; 20:250. [PMID: 32345240 PMCID: PMC7189725 DOI: 10.1186/s12884-020-02910-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Methods A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data. Results Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery. Conclusion Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.
Collapse
Affiliation(s)
- Pontius Bayo
- Department of Obstetrics and Gynecology, Torit State Hospital, Torit, South Sudan.
| | - Loubna Belaid
- Department of family medicine, McGill University, Montreal, Canada
| | | | - Emmanuel Ochola
- Department of public health, St, Mary's Hospital Lacor, Gulu, Uganda
| | | | - Donato Greco
- School of public health, University of Rome, Rome, Italy
| | | |
Collapse
|
12
|
Belaid L, Bayo P, Kamau L, Nakimuli E, Omoro E, Lobor R, Samson B, Dimiti A. Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan: a scoping review. Confl Health 2020; 14:20. [PMID: 32313550 PMCID: PMC7155266 DOI: 10.1186/s13031-020-00258-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. Strengthening the healthcare system is a key strategy for the implementation of effective policies and ultimately the improvement of health outcomes. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. In this paper, we map the key RMNCAH policies and describe the current status of the WHO health system building blocks that impede the implementation of RMNCAH policies in South Sudan. METHODS We conducted a scoping review (39 documents) and individual interviews (n = 8) with staff from the national Ministry of Health (MoH) and implementing partners. We organized a workshop to discuss and validate the findings with the MoH and implementing partner staff. We synthesized and analyzed the data according to the WHO health system building blocks. RESULTS The significant number of policies and healthcare strategic plans focused on pregnant women, neonates, children, and adolescents evidence the political will of the MoH to improve the health of members of these categories of the population. The gap in the implementation of policies is mainly due to the weaknesses identified in different health system building blocks. A critical shortage of human resources across the blocks and levels of the health system, a lack of medicines and supplies, and low national funding are the main identified bottlenecks. The upstream factors explaining these bottlenecks are the 2012 suspension of oil production, ongoing conflict, weak governance, a lack of accountability, and a low human resource capacity. The combined effects of all these factors have led to poor-quality provision and thus a low use of RMNCAH services. CONCLUSION The implementation of RMNCAH policies should be accomplished through innovative and challenging approaches to building the capacities of the MoH, establishing governance and accountability mechanisms, and increasing the health budget of the national government.
Collapse
Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montréal, Québec Canada
| | | | - Lynette Kamau
- African population and health research center, Nairobi, Kenya
| | - Eva Nakimuli
- Partners in Population and Development Africa Regional Office, Kampala, Uganda
| | - Elijo Omoro
- Torit State Ministry of Health, Juba, South Sudan
| | - Robert Lobor
- WHO, South Sudan Country Office, Juba, South Sudan
| | | | - Alexander Dimiti
- Department of Reproductive of Health, Ministry of Health, Juba, South Sudan
| |
Collapse
|
13
|
Massavon W, Wilunda C, Nannini M, Agaro C, Amandi S, Orech JB, De Vivo E, Lochoro P, Putoto G. Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study. BMJ Open 2019; 9:e026851. [PMID: 31501099 PMCID: PMC6738676 DOI: 10.1136/bmjopen-2018-026851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the perceptions of community members and other stakeholders on the use of baby kits and transport vouchers to improve the utilisation of childbirth services. DESIGN A qualitative study. SETTING Oyam district, Uganda. PARTICIPANTS We conducted 10 focus group discussions with 59 women and 55 men, and 18 key informant interviews with local leaders, village health team members, health facility staff and district health management team members. We analysed the data using qualitative content analysis. RESULTS Five broad themes emerged: (1) context, (2) community support for the interventions, (3) health-seeking behaviours postintervention, (4) undesirable effects of the interventions and (5) implementation issues and lessons learnt. Context regarded perceived long distances to health facilities and high transport costs. Regarding community support for the interventions, the schemes were perceived to be acceptable and helpful particularly to the most vulnerable. Transport vouchers were preferred over baby kits, although both interventions were perceived to be necessary. Health-seeking behaviours entailed perceived increased utilisation of maternal health services and 'bypassing', promotion of collaboration between traditional birth attendants and formal health workers, stimulation of men's involvement in maternal health, and increased community awareness of maternal health. Undesirable effects of the interventions included increased workload for health workers, sustainability concerns and perceived encouragement to reproduce and dependency. Implementation issues included information gaps leading to confusion, mistrust and discontent, transport voucher scheme design; implementation; and payment problems, poor attitude of some health workers and poor quality of care, insecurity, and a shortage of baby kits. Community involvement was key to solving the challenges. CONCLUSIONS The study provides further insights into the implementation of incentive schemes to improve maternal health services utilisation. The findings are relevant for planning and implementing similar schemes in low-income countries.
Collapse
Affiliation(s)
| | - Calistus Wilunda
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
- Division of Epidemiology and Prevention, National Cancer Center Japan, Chuo-ku, Japan
| | - Maria Nannini
- School of Economics and Development, University of Florence, Florence, Italy
| | - Caroline Agaro
- District Health Office, Oyam District Local Government, Loro, Uganda
| | - Simon Amandi
- District Health Office, Oyam District Local Government, Loro, Uganda
| | - John Bosco Orech
- District Health Office, Oyam District Local Government, Loro, Uganda
| | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| |
Collapse
|
14
|
Tongun JB, Mukunya D, Tylleskar T, Sebit MB, Tumwine JK, Ndeezi G. Determinants of Health Facility Utilization at Birth in South Sudan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2445. [PMID: 31324060 PMCID: PMC6651414 DOI: 10.3390/ijerph16132445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/02/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022]
Abstract
South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2-35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.
Collapse
Affiliation(s)
- Justin Bruno Tongun
- Centre for International Health, University of Bergen, 7804 Bergen, Norway.
- Department of Paediatrics, University of Juba, Juba P.O. Box 82, South Sudan.
| | - David Mukunya
- Centre for International Health, University of Bergen, 7804 Bergen, Norway
| | - Thorkild Tylleskar
- Centre for International Health, University of Bergen, 7804 Bergen, Norway
| | - Mohamedi Boy Sebit
- Department of Internal Medicine, University of Juba, Juba P.O. Box 82, South Sudan
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda
| |
Collapse
|
15
|
Theuring S, Koroma AP, Harms G. "In the hospital, there will be nobody to pamper me": a qualitative assessment on barriers to facility-based delivery in post-Ebola Sierra Leone. Reprod Health 2018; 15:155. [PMID: 30219070 PMCID: PMC6139160 DOI: 10.1186/s12978-018-0601-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sierra Leone has one of the highest maternal mortality rates in the world. Encouraging the use of skilled birth attendance in health facilities is an important step in the endeavor to increase the number of safe deliveries. However, public trust in health facilities has been greatly damaged during the Ebola epidemic outbreak in Sierra Leone in 2014/2015, and little is known about external and intrinsic barriers to facility-based delivery (FBD) in the country since the end of the Ebola epidemic. METHODS We conducted a qualitative study on FBD in Princess Christian Maternity Hospital, Freetown, which is the national referral maternity hospital in Sierra Leone. We performed six focus group discussions with providers, pregnant women and recent mothers surrounding experiences, attitudes and behaviors regarding FBD and potential barriers. Discussions were tape recorded, transcribed and evaluated through content analysis. RESULTS Women in our study were overall technically aware of the higher safety linked with FBD, but this often diverged from their individual desire to deliver in a supportive and trusted social and traditional environment. Close relatives and community members seemed to be highly influencial regarding birth practices. Many women associated FBD with negative staff attitudes and an undefined fear. Logistic issues regarding transportation problems or late referral from smaller health centers were identified as frequent barriers to FBD. CONCLUSIONS More supportive staff attitudes and acceptance of an accompanying person throughout delivery could be promising approaches to increase women's confidence in FBDs. However, these approaches also imply revising health systems structures, like staff working conditions that are conducive for a friendly atmosphere, sufficient space in delivery wards allowing the women to bring a birth companion, or like the establishment of a reliable peripheral ambulance system to ensure transportation and fast referral.
Collapse
Affiliation(s)
- Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Alimamy Philip Koroma
- Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
16
|
Kane S, Rial M, Kok M, Matere A, Dieleman M, Broerse JEW. Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan. Reprod Health 2018; 15:51. [PMID: 29559000 PMCID: PMC5859446 DOI: 10.1186/s12978-018-0487-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to developing and implementing locally appropriate public health interventions. METHODS A qualitative study was conducted to gain insight into what hinders women from using maternal health services. Focus group discussions (5) and interviews (44) were conducted with purposefully selected community members and health personnel. A thematic analysis was done to identify key themes. RESULTS While accessibility, affordability, and perceptions (need and quality of care) related barriers to the use of maternal health services exist and are important, women's decisions to use services are also shaped by a variety of social fears. Societal interactions entailed in the process of going to a health facility, interactions with other people, particularly other women on the facility premises, and the care encounters with health workers, are moments where women are afraid of experiencing dignity violations. Women's decisions to step out of their homes to seek maternal health care are the results of a complex trade-off they make or are willing to make between potential threats to their dignity in the various social spaces they need to traverse in the process of seeking care, their views on ownership of and responsibility for the unborn, and the benefits they ascribe to the care available to them. CONCLUSIONS Geographical accessibility, affordability, and perceptions related barriers to the use of maternal health services in South Sudan remain; they need to be addressed. Explicit attention also needs to be paid to address social accessibility related barriers; among others, to identify, address and allay the various social fears and fears of dignity violations that may hold women back from using services. Health services should work towards transforming health facilities into social spaces where all women's and citizen's dignity is protected and upheld.
Collapse
Affiliation(s)
- Sumit Kane
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands. .,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, VIC, 3010, Australia.
| | - Matilda Rial
- Independent Consultant, Wau, Western Bahr el Ghazal, South Sudan
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands
| | - Anthony Matere
- School of Public and Environmental Health, University of Bahr el Ghazal, Wau, Western Bahr el Ghazal, South Sudan
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Mauritskade 63, Amsterdam, 1092 AD, The Netherlands.,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline E W Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Bayo P, Itua I, Francis SP, Boateng K, Tahir EO, Usman A. Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study. BMJ Open 2018; 8:e018739. [PMID: 29444779 PMCID: PMC5829877 DOI: 10.1136/bmjopen-2017-018739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication. DESIGN This was a retrospective cross-sectional study. SETTING Four primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan. PARTICIPANTS All admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes. RESULTS Two hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions. CONCLUSION The met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.
Collapse
Affiliation(s)
- Pontius Bayo
- Department of Obstetrics and Gynecology, St Mary’s Hospital Lacor, Gulu, Uganda
- Department of Maternal and Child Health, WHO, Juba, South Sudan
| | - Imose Itua
- School of Public Health, University of Liverpool, Liverpool, UK
| | | | | | - Elijo Omoro Tahir
- Department of Pharmaceuticals, Torit State Hospital, Torit, South Sudan
| | | |
Collapse
|
18
|
Mugo NS, Dibley MJ, Damundu EY, Alam A. "The system here isn't on patients' side"- perspectives of women and men on the barriers to accessing and utilizing maternal healthcare services in South Sudan. BMC Health Serv Res 2018; 18:10. [PMID: 29316933 PMCID: PMC5759875 DOI: 10.1186/s12913-017-2788-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022] Open
Abstract
Background In fragile and war-affected setting such as South Sudan, a combination of physical environmental, socioeconomic factors and healthcare’s characteristic contributes to higher rates of home delivery attended by unskilled attendants. This study aims to understand the community members’ experience, perceptions and the barriers in relation to accessing and utilizing maternal healthcare services in South Sudan. Methods We conducted in-depth one-on-one interview with 30 women and 15 men to investigate their perspectives on the barriers to access maternal and child health related services. We purposively selected women and their partners in this study. Results Our study revealed that inadequate quality of antenatal care services such as lack of essential medicine, supplies and tools was linked to individual’s mothers dissatisfaction with the services they received. In addition, sudden onset of labor and lack of safety and security were important reasons for home delivery in this study. Furthermore, lack of transport as a result of a combination of long distance to a facility and associated costs either restricted or delayed women reaching the health facilities. Conclusions Our study highlighted an urgent need for the government of South Sudan to implement security and safety measures in order to improved access to delivery service at night. Incorporating private transports to provide access to affordable and reliable transport services for pregnant and post-partum women is also important. Increasing the budget allocation for medicine and health supplies and improving management of medicine and supply chain logistics are essential.
Collapse
Affiliation(s)
- Ngatho S Mugo
- Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Michael J Dibley
- Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Ashraful Alam
- Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
19
|
Barriers to utilisation of antenatal care services in South Sudan: a qualitative study in Rumbek North County. Reprod Health 2017; 14:65. [PMID: 28532513 PMCID: PMC5440928 DOI: 10.1186/s12978-017-0327-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world's poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. This study was conducted to identify barriers to utilisation of ANC services in Rumbek North County. METHODS Using a qualitative design, data were collected through 14 focus group discussions with 169 women and 45 men and 12 key informant interviews with community leaders, staff working in health facilities, and the staff of the County Health Department. Data were analysed using inductive content analysis. RESULTS The perceived barriers to ANC utilisation were categorised as follows: 1) Issues related to access to health facilities and lack of resources. These included long distance to health facilities, lack of means of transportation to the health facilities, floods and poor roads, and demand for payment for health care at some health facilities; 2) The influence of the socio-cultural context and conflict including heavy burden of domestic chores, the negative influence of husbands who were reluctant to allow their wives to attend ANC, and insecurity; 3) Perceptions about pregnancy including misperceptions about the benefits of ANC and low perceived risk of pregnancy-related complications; and 4) Perceptions about the quality of care and the efficacy of medical treatment. CONCLUSIONS This study identified a myriad of factors deeply entrenched in the society, which prevent women from utilising ANC services. It also elicits broad aspects of interconnectedness among the barriers. To ensure effectiveness, strategies to improve utilisation of ANC in the study area and in similar contexts need to take into account the barriers identified by this study.
Collapse
|