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Seong D, Espinosa C, Aghaeepour N. Computational Approaches for Predicting Preterm Birth and Newborn Outcomes. Clin Perinatol 2024; 51:461-473. [PMID: 38705652 PMCID: PMC11070639 DOI: 10.1016/j.clp.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Preterm birth (PTB) and its associated morbidities are a leading cause of infant mortality and morbidity. Accurate predictive models and a better biological understanding of PTB-associated morbidities are critical in reducing their adverse effects. Increasing availability of multimodal high-dimensional data sets with concurrent advances in artificial intelligence (AI) have created a rich opportunity to gain novel insights into PTB, a clinically complex and multifactorial disease. Here, the authors review the use of AI to analyze 3 modes of data: electronic health records, biological omics, and social determinants of health metrics.
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Affiliation(s)
- David Seong
- Immunology Program, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Medical Scientist Training Program, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Microbiology and Immunology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA
| | - Camilo Espinosa
- Immunology Program, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Biomedical Data Science, Stanford University, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA; Department of Biomedical Data Science, Stanford University, 300 Pasteur Drive, Grant S280, Stanford, CA 94305-5117, USA.
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Kuruba YP, Sinha AP, Singh A, Pradhan P, Radhika AG. Non-Medical Determinants of Access and Quality of Maternal Health Services in India-Protocol for a Scoping Review. J Obstet Gynaecol India 2024; 74:104-108. [PMID: 38707881 PMCID: PMC11065799 DOI: 10.1007/s13224-023-01892-3] [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: 05/13/2023] [Accepted: 10/21/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction The Maternal Mortality Rate (MMR) is one of the most important health indicators of a country. In India, MMR has decline from 130 to 113 per 100,000 live births between 2014 and 2018, however, there are wide disparities in utilization of maternal health services (MHS) among different states and across different socioeconomic groups within the states. Although the government is providing MHS through various health programs in India, there are several non medical factors leading to the underutilization of MHS services. Objective To map and summarise the non-medical determinants of access and quality of MHS in India. Methods We are conducting a scoping review of the published literature from 2000 till date in databases such as PubMed, Cochrane, Science Direct and CINAHL by including eligible qualitative as well as quantitative studies conducted in India. Data extraction and analysis will be conducted through a narrative integrative synthesis approach to summarize the non-medical determinants of access and quality of MHS in India and understand their mechanisms of influence.At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. Results We will summarise the non-medical determinants that influence the access and quality of MHS. Conclusion This scoping review would help to understand and summarise the existing non-medical determinants of access and quality of MHS, highlight the research gaps and suggest potential modalities for improvement of access and quality of MHS.
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Affiliation(s)
- Yamini Priyanka Kuruba
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Anju P. Sinha
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Anoop Singh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Pranita Pradhan
- ICMR Advanced Centre for Evidence Based Child Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. G. Radhika
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Wulandari RD, Laksono AD, Rohmah N, Matahari R, Antonio CA. Factors related to intrapartum/delivery care in Southeast Asia: A cross-sectional study in the Philippines and Indonesia. Heliyon 2024; 10:e27718. [PMID: 38500999 PMCID: PMC10945253 DOI: 10.1016/j.heliyon.2024.e27718] [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: 03/07/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background Policy encouraging healthcare intrapartum/delivery care is critical to accelerating the decline in maternal mortality. The study analyzes intrapartum/delivery care factors in Indonesia and the Philippines. Methods The investigation included 15,346 Indonesian and 7992 Filipino women (ages 15 to 49 who delivered during the previous five years). Aside from the location of intrapartum/delivery care as a dependent variable, additional factors investigated included domicile, marital status, age, occupation, education, parity, wealth, and ANC-the conclusion of the study utilizing binary logistic regression. Results Women in both countries predominantly do healthcare intrapartum/delivery care. Both countries' urban women are more likely to receive intrapartum/delivery care than rural women. The higher the amount of schooling, the greater the likelihood of receiving intrapartum/delivery care. The lower the parity, the higher the chance to do healthcare intrapartum/delivery care. The higher the wealth position, the greater the likelihood of receiving intrapartum/delivery care. Furthermore, women in both nations who had four or more antenatal visits were more likely to receive intrapartum/delivery care. Conclusion The study concluded five factors related to healthcare intrapartum/delivery care in the Philippines: residence, education, parity, wealth, and ANC. Meanwhile, there are six factors related to healthcare intrapartum/delivery care in Indonesia: place, age, education, parity, wealth, and ANC.
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Affiliation(s)
- Ratna Dwi Wulandari
- Universitas Airlangga, Surabaya, Indonesia
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
| | - Agung Dwi Laksono
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
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Hasan MS, Ghosal S. Gender differentials in the choice of in-patient healthcare services among the older adults in India: A cross-sectional study. Int J Health Plann Manage 2023; 38:1464-1482. [PMID: 37340537 DOI: 10.1002/hpm.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
India is presently undergoing a rapid demographic transition and experiencing a gradual increase in an ageing population. As a result, the households were continuously exposed to catastrophic economic impacts, ultimately influencing the healthcare utilisation of older people. The study examined the gender differentials in the choice of in-patient private and public hospitalisation among Indian elderly using Andersen's Health Behaviour Model. The database was acquired from the nationally representative cross-sectional survey (NSSO, 2017-18). Bivariate chi-square and binomial logistic regression techniques were used to fulfill the objective. In addition, the poor-rich ratio and concentration index was used to understand the inherent socioeconomic inequalities in healthcare preferences. The findings suggest that aged men were 27 percent more prone to avail private healthcare facilities than aged women. Further, older adults, who are married, belong to the upper caste, have higher education and gone through surgery, and primarily reside in an affluent society were more likely to prefer private in-patient hospitalisation. It represents negligence of older women in access to better healthcare who had financial strain and economically dependent. The study can be used to reframe existing public health policies and programs, particularly focusing on the older women, to avail cost-effective treatment.
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Affiliation(s)
- Md Sayed Hasan
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Somnath Ghosal
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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Exploration of spatial clustering in maternal health continuum of care across districts of India: A geospatial analysis of demographic and health survey data. PLoS One 2022; 17:e0279117. [PMID: 36520872 PMCID: PMC9754170 DOI: 10.1371/journal.pone.0279117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India. DATA AND METHODS The study is based on the fourth round of National Family Health Survey data conducted in 2015-16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC. FINDINGS Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran's I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC. CONCLUSION The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.
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Liese AD, Reboussin BA, Kahkoska AR, Frongillo EA, Malik FS, Imperatore G, Saydah S, Bellatorre A, Lawrence JM, Dabelea D, Mendoza JA. Inequalities in Glycemic Control in Youth with Type 1 Diabetes Over Time: Intersectionality Between Socioeconomic Position and Race and Ethnicity. Ann Behav Med 2022; 56:461-471. [PMID: 34570884 PMCID: PMC9116580 DOI: 10.1093/abm/kaab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Racial/ethnic health inequities have been well-documented among youth and young adults with type 1 diabetes (T1D), yet little is known about how socioeconomic position (SEP) intersects with the risk marker of race/ethnicity to predict inequities in longitudinal glycemic control. PURPOSE To identify patterns of SEP, race/ethnicity, and clinical characteristics that differentiate hemoglobin A1c (HbA1c) trajectories among youth and young adults after T1D diagnosis. METHODS The SEARCH for Diabetes in Youth cohort includes youth with diabetes diagnosed from 2002 to 2006 and 2008 who were followed through 2015. We analyzed data from 1,313 youth and young adults with T1D with ≥3 HbA1c measures. Classification tree analysis identified patterns of baseline demographic, SEP, and clinical characteristic that best predicted HbA1c trajectories over an average of 8.3 years using group-based trajectory modeling. RESULTS Two HbA1c trajectories were identified: Trajectory 1 (77%) with lower baseline HbA1c and mild increases (from mean 7.4% to 8.4%) and Trajectory 2 (23%) with higher baseline HbA1c and major increases (from 8.5% to 11.2%). Race/ethnicity intersected with different SEP characteristics among non-Hispanic white (NHW) than in non-whites. Public health insurance predicted high-risk Trajectory 2 membership in non-whites, whereas parental education, household structure, diagnosis age and glucose checking frequency predicted membership for NHW youth and young adults. Two characteristics, race/ethnicity and parental education alone identified 80% of the Trajectory 2 members. CONCLUSIONS Race/ethnicity intersects with multiple SEP and clinical characteristics among youth and young adults with T1D, which is associated with particularly high risk of poor long-term glycemic control.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna R Kahkoska
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Anna Bellatorre
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Dana Dabelea
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Mendoza
- Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children’s Research Institute, Seattle, WA, USA
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [PMID: 35694198 PMCID: PMC9171295 DOI: 10.12688/wellcomeopenres.17463.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India and compare it with the determinants of LBW based on the National Family Health Survey – 4 (NHFS-4)
Methods
Data from the NFHS-4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight: 1500-2499 g).
Results
Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW.
Conclusions
Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Affiliation(s)
- Liss Scaria
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Biju Soman
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Babu George
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Zulfikar Ahamed
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Sankar Hariharan
- Pediatrics, Government Medical College, SAT Hospital, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Wuneh AD, Bezabih AM, Okwaraji YB, Persson LÅ, Medhanyie AA. Wealth and Education Inequities in Maternal and Child Health Services Utilization in Rural Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5421. [PMID: 35564817 PMCID: PMC9099508 DOI: 10.3390/ijerph19095421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022]
Abstract
As part of the 2030 maternal and child health targets, Ethiopia strives for universal and equitable use of health services. We aimed to examine the association between household wealth, maternal education, and the interplay between these in utilization of maternal and child health services. Data emanating from the evaluation of the Optimizing of Health Extension Program intervention. Women in the reproductive age of 15 to 49 years and children aged 12-23 months were included in the study. We used logistic regression with marginal effects to examine the association between household wealth, women's educational level, four or more antenatal care visits, skilled assistance at delivery, and full immunization of children. Further, we analyzed the interactions between household wealth and education on these outcomes. Household wealth was positively associated with skilled assistance at delivery and full child immunization. Women's education had a positive association only with skilled assistance at delivery. Educated women had skilled attendance at delivery, especially in the better-off households. Our results show the importance of poverty alleviation and girls' education for universal health coverage.
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Affiliation(s)
- Alem Desta Wuneh
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Yemisrach Behailu Okwaraji
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Lars Åke Persson
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
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Rahman M, Saha P, Uddin J. Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy. BMC Pregnancy Childbirth 2022; 22:255. [PMID: 35346100 PMCID: PMC8961925 DOI: 10.1186/s12884-022-04588-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant. Methods We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04588-0.
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Affiliation(s)
- Mostafizur Rahman
- Department of Science and Humanities, Bangabandhu Sheikh Mujibur Rahman Aviation and Aerospace University, Old Airport, Tejgaon, Dhaka, 1215, Bangladesh.
| | - Priom Saha
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Jalal Uddin
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Adedini SA, Abatan SM, Ogunsakin AD, Alex-Ojei CA, Babalola BI, Shittu SB, Odusina EK, Ntoimo LFC. Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries. PLoS One 2022; 17:e0262688. [PMID: 35025949 PMCID: PMC8758032 DOI: 10.1371/journal.pone.0262688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.
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Affiliation(s)
- Sunday A. Adedini
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa
- * E-mail:
| | - Sunday Matthew Abatan
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Adesoji Dunsin Ogunsakin
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Christiana Alake Alex-Ojei
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Blessing Iretioluwa Babalola
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sarafa Babatunde Shittu
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Emmanuel Kolawole Odusina
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Lorretta Favour C. Ntoimo
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
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Srivastava A, Saxena S, Srivastava P, Mahmood SE, Pandey R, Saxena A. Newborn thermal care in western Uttar Pradesh - gap analysis between knowledge and practices. Arch Public Health 2022; 80:55. [PMID: 35172889 PMCID: PMC8848645 DOI: 10.1186/s13690-022-00809-2] [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: 02/09/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background The provision of health care services including maternal and newborn care is a dynamic system of entitlement and obligations among the community, the service providers, and the government. Thermal control remains poor in newborns owing to immaturity of the thermoregulatory center and newborn become vulnerable to hypothermia especially premature babies, intrauterine growth retardation and LBW babies, and even normal babies.This study aimed to assess the knowledge & practices regarding thermal protection their determinants. Methods Cross-sectional study was conducted in the Amroha district. The study population comprised women of reproductive age (15 to 49 years) who have delivered a live baby within the past 12 weeks before the conduct of the study. Out of 6 blocks, 2 most populous villages were selected. Total 61 villages from 6 blocks were covered under the study. Knowledge and practices regarding newborn thermal care were expressed in percentages and compared. Results The knowledge domain on thermal protection of baby, 60.9% of the respondents were well aware of how to keep baby warm after delivery, 71.4% of respondents knew that baby should be dried soon after birth, 64.9% of the respondents had an idea of time to dry the baby, 69.6% of the respondents knew that baby should be wrapped soon after birth. Conclusion The findings of the study provides an insight into the existing knowledge and necessitate a need for quantitative studies in the study area to access knowledge & practices related to thermal protection of newborns. The authors emphasize a need for improving community awareness for the promotion of newborn care and improve the health system to meet the demands of birthing mothers and the needs of newborns. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00809-2.
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Affiliation(s)
| | - Sumit Saxena
- Autonomous State Medical College & Allied Pt Ram Prasad Bismil Memorial Hospital, Shahjahanpur, India
| | | | - Syed Esam Mahmood
- College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ruchi Pandey
- Government Institute of Medical Sciences, Greater Noida, India.
| | - Anju Saxena
- Rohilkhand Medical College & Hospital, Bareilly, India
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [DOI: 10.12688/wellcomeopenres.17463.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India based on the National Family Health Survey – 4 (NHFS-4). Methods Data from the NFHS 4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight <2500 g). Results Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW. Conclusions Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Coll CVN, Santos TM, Devries K, Knaul F, Bustreo F, Gatuguta A, Houvessou GM, Barros AJD. Identifying the women most vulnerable to intimate partner violence: A decision tree analysis from 48 low and middle-income countries. EClinicalMedicine 2021; 42:101214. [PMID: 34988411 PMCID: PMC8712229 DOI: 10.1016/j.eclinm.2021.101214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary prevention strategies are needed to reduce high rates of intimate partner violence (IPV) in low- and middle-income countries (LMICs). The effectiveness of population-based approaches may be improved by adding initiatives targeted at the most vulnerable groups and tailored to context-specificities. METHODS We applied a decision-tree approach to identify subgroups of women at higher risk of IPV in 48 LMICs and in all countries combined. Data from the most recent Demographic and Health Survey carried out between 2010 and 2019 with available information on IPV and sociodemographic indicators was used. To create the trees, we selected 15 recognized risk factors for IPV in the literature which had a potential for targeting interventions. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. FINDINGS In the pooled decision tree, witnessing IPV during childhood, a low or medium empowerment level and alcohol use by the partner were the strongest markers of IPV vulnerability. IPV prevalence amongst the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group included women who witnessed IPV during childhood and had lower empowerment levels. These were 12% of the population and 1 in 4 women who experienced IPV in the selected LMICs. Across the individual national trees, subnational regions emerged as the most frequent markers of IPV occurrence. INTERPRETATION Starting with well-known predictors of IPV, the decision-tree approach provides important insights about subpopulations of women where IPV prevalence is high. This information can help designing targeted interventions. For a large proportion of women who experienced IPV, however, no particular risk factors were identified, emphasizing the need for population wide approaches conducted in parallel, including changing social norms, strengthening laws and policies supporting gender equality and women´s rights as well as guaranteeing women´s access to justice systems and comprehensive health services. FUNDING Bill and Melinda Gates Foundation (Grant INV-010051/OPP1199234), Wellcome Trust (Grant Number: 101815/Z/13/Z) and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Corresponding author at: International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Karen Devries
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Felicia Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL 33146, United States
| | | | - Anne Gatuguta
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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Matovelo D, Ndaki P, Yohani V, Laisser R, Bakalemwa R, Ndaboine E, Masatu Z, Mwaikambo M, Brenner JL, Wilson WM. Why don't illiterate women in rural, Northern Tanzania, access maternal healthcare? BMC Pregnancy Childbirth 2021; 21:452. [PMID: 34182949 PMCID: PMC8240192 DOI: 10.1186/s12884-021-03906-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03906-2.
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Affiliation(s)
- Dismas Matovelo
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Pendo Ndaki
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Victoria Yohani
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Respicious Bakalemwa
- Bugando Medical Centre, Mwanza, Tanzania.,Department of Pediatrics, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edgar Ndaboine
- Department of Obstetrics & Gynecology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Bugando Medical Centre, Mwanza, Tanzania
| | - Zabron Masatu
- District Medical Officer, Misungwi District, Mwanza, Tanzania
| | | | - Jennifer L Brenner
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Warren M Wilson
- Departments of Anthropology & Archaeology and Community Health Sciences, University of Calgary, Calgary, Canada.
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Wulandari RD, Laksono AD, Rohmah N. Urban-rural disparities of antenatal care in South East Asia: a case study in the Philippines and Indonesia. BMC Public Health 2021; 21:1221. [PMID: 34167514 PMCID: PMC8229737 DOI: 10.1186/s12889-021-11318-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. Methods The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15–49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. Results The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC’s use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. Conclusions The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.
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Affiliation(s)
- Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga Surabaya, Campus C Mulyorejo, Surabaya, 60115, Indonesia.
| | - Agung Dwi Laksono
- National Institute of Health Research and Development of The Ministry of Health of the Republic of Indonesia, Percetakan Negara 29, Jakarta, 10560, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, Gumuk Kerang, Karangrejo, Kec. Sumbersari, Jawa Timur, Kabupaten Jember, East Java, 68124, Indonesia
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Huang VS, Morris K, Jain M, Ramesh BM, Kemp H, Blanchard J, Isac S, Sarkar B, Gothalwal V, Namasivayam V, Kumar P, Sgaier SK. Closing the gap on institutional delivery in northern India: a case study of how integrated machine learning approaches can enable precision public health. BMJ Glob Health 2021; 5:bmjgh-2020-002340. [PMID: 33028696 PMCID: PMC7542627 DOI: 10.1136/bmjgh-2020-002340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 08/12/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Meeting ambitious global health goals with limited resources requires a precision public health (PxPH) approach. Here we describe how integrating data collection optimisation, traditional analytics and causal artificial intelligence/machine learning (ML) can be used in a use case for increasing hospital deliveries of newborns in Uttar Pradesh, India. METHODS Using a systematic behavioural framework we designed a large-scale survey on perceptual, interpersonal and structural drivers of women's behaviour around childbirth (n=5613). Multivariate logistic regression identified factors associated with institutional delivery (ID). Causal ML determined the cause-and-effect ordering of these factors. Variance decomposition was used to parse sources of variation in delivery location, and a supervised learning algorithm was used to distinguish population subgroups. RESULTS Among the factors found associated with ID, the causal model showed that having a delivery plan (OR=6.1, 95% CI 6.0 to 6.3), believing the hospital is safer than home (OR=5.4, 95% CI 5.1 to 5.6) and awareness of financial incentives were direct causes of ID (OR=3.4, 95% CI 3.3 to 3.5). Distance to the hospital, borrowing delivery money and the primary decision-maker were not causal. Individual-level factors contributed 69% of variance in delivery location. The segmentation analysis showed four distinct subgroups differentiated by ID risk perception, parity and planning. CONCLUSION These findings generate a holistic picture of the drivers and barriers to ID in Uttar Pradesh and suggest distinct intervention points for different women. This demonstrates data optimised to identify key behavioural drivers, coupled with traditional and ML analytics, can help design a PxPH approach that maximise the impact of limited resources.
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Affiliation(s)
| | | | | | - Banadakoppa Manjappa Ramesh
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - James Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,India Health Action Trust, New Delhi, India
| | - Bidyut Sarkar
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,India Health Action Trust, Lucknow, India
| | - Vikas Gothalwal
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,India Health Action Trust, Lucknow, India
| | - Vasanthakumar Namasivayam
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, India
| | - Sema K Sgaier
- Surgo Foundation, Washington, DC, USA .,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Khatri RB, Alemu Y, Protani MM, Karkee R, Durham J. Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey. BMC Public Health 2021; 21:1098. [PMID: 34107922 PMCID: PMC8190849 DOI: 10.1186/s12889-021-11142-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/25/2021] [Indexed: 01/15/2023] Open
Abstract
Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11142-8.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia. .,Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Yibeltal Alemu
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jo Durham
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Ward VC, Weng Y, Bentley J, Carmichael SL, Mehta KM, Mahmood W, Pepper KT, Abdalla S, Atmavilas Y, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Bhattacharya D, Nanda P, Tarigopula UK, Shah H, Darmstadt GL. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Ward VC, Weng Y, Bentley J, Carmichael SL, Mehta KM, Mahmood W, Pepper KT, Abdalla S, Atmavilas Y, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Bhattacharya D, Nanda P, Tarigopula UK, Shah H, Darmstadt GL. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. J Glob Health 2020; 10:021011. [PMID: 33425335 PMCID: PMC7759017 DOI: 10.7189/jogh.10.021011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. METHODS Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. RESULTS At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P < 0.01) and skin-to-skin care (+14.8% vs +20.4%, P < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). CONCLUSIONS Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Wajeeha Mahmood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | | | | | - Dana Rotz
- Mathematica, Princeton, New Jersey, USA
| | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | | | - Hemant Shah
- Bill and Melinda Gates Foundation, Delhi, India
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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20
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Sharma S, Mehra D, Akhtar F, Mehra S. Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India. BMC Public Health 2020; 20:1766. [PMID: 33228667 PMCID: PMC7686717 DOI: 10.1186/s12889-020-09884-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions based on building women's groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approaches in improving their access to health services. The present study evaluated a community-based intervention aimed at improving marginalized women's awareness and utilization of MCH services, and access to livelihood and savings using the peer-led approach from two districts of India. METHODS We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community levels. The intervention was implemented in two marginalized districts of Uttar Pradesh, namely Banda and Kaushambi. Two development blocks in each of the two districts were selected randomly, and 24 villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, 'post-test analysis of the project group' research design, in a mixed-method approach. Data were collected at two points in time, including qualitative interviews at the end line and tracking data of the intervention population (n = 37,324) through an online management information system. RESULTS Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for the livelihood scheme, and 94 and 80% of them had worked under the scheme in these two places, respectively. Women's awareness about MCH seemed to have increased post-intervention. The money earned after getting work under the livelihood scheme or from daily savings was deposited in the bank account by the women. These savings helped the women investing money at times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. CONCLUSION: Peer-led model of intervention can be explored to improve the combined health and economic outcomes of marginalized women.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Skåne University Hospital, S-20502, Malmö, Sweden. .,MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, Delhi, 110048, India.
| | - Devika Mehra
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, Delhi, 110048, India
| | - Faiyaz Akhtar
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, Delhi, 110048, India
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, Delhi, 110048, India
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Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Laksono AD, Rukmini R, Wulandari RD. Regional disparities in antenatal care utilization in Indonesia. PLoS One 2020; 15:e0224006. [PMID: 32053621 PMCID: PMC7018075 DOI: 10.1371/journal.pone.0224006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/11/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Affiliation(s)
- Agung Dwi Laksono
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
| | - Rukmini Rukmini
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
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Ousman SK, Mdala I, Thorsen VC, Sundby J, Magnus JH. Social Determinants of Antenatal Care Service Use in Ethiopia: Changes Over a 15-Year Span. Front Public Health 2019; 7:161. [PMID: 31294012 PMCID: PMC6603173 DOI: 10.3389/fpubh.2019.00161] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time. Methods: The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro International, USA in 2005, 2011, and 2016. A negative binomial with random effects at cluster level was used to model the number of ANC visits whereas a multilevel binary logistic regression modeled binary responses relating to whether a woman had at least 4 ANC visits or not. The model estimates were obtained with the statistical software Stata SE 15 using the restricted maximum likelihood method. Results: Although the median number of ANC visits significantly increased between 2005 and 2016, the majority of the women do not obtain the four ANC visits during pregnancy as recommended. The odds of having at least four ANC visits were significantly lower among women: below 20 years, those living in the rural areas, having higher birth order, or Muslim. In contrast, higher educational attainment, higher socio-economic status, exposure to mass media, and self-reporting decision empowerment were significantly associated with having at least four ANC visits. Conclusion: The use of ANC visits is driven mostly by the social determinants of health rather than individual health risk. The importance of the various SDHs needs to be recognized by Ministry of Health policy and program managers as a key driving force behind the country's challenges with reaching targets in the health agenda related to maternal health, particularly related to the recommended number of ANC visits.
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Affiliation(s)
- Seman Kedir Ousman
- St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Jeanette H Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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