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Oyugi B, Audi-Poquillon Z, Kendall S, Peckham S. Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study. BMJ Open 2024; 14:e082011. [PMID: 38697765 PMCID: PMC11086406 DOI: 10.1136/bmjopen-2023-082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.
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Affiliation(s)
- Boniface Oyugi
- Western Heights, The Mint Nairobi, M and E Advisory Group, Nairobi, Kenya
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Zilper Audi-Poquillon
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e073669. [PMID: 38081664 PMCID: PMC10729209 DOI: 10.1136/bmjopen-2023-073669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. METHODS We conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed. RESULTS The findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation. CONCLUSIONS We identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.
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Affiliation(s)
- Joby George
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Susan Jack
- Te Whatu Ora - Southern, National Public Health Service, Dunedin, New Zealand
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | | | - Tim Stokes
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
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Awotunde TA, Ani-Amponsah M, Ajala DE, Ojo SA, Adeleke TO, Awotunde OT, Olaolorun AD. Unveiling contextual influences of maternal satisfaction with labour care services in Nigeria: A qualitative inquiry. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 38044891 PMCID: PMC10696893 DOI: 10.4102/phcfm.v15i1.4173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND In light of the rising global effort to lower maternal mortality rates, it is crucial for low- and middle-income countries with poor maternal indices to investigate the problem of maternal satisfaction and the key elements that affect it. To this effect, this study explored the experiences of postnatal women in relation to labour services and investigated the factors that contribute to their overall satisfaction. AIM The study set out to explore factors influencing maternal satisfaction with labour care services in Ogbomoso, Oyo State, Nigeria. This study ultimately seeks to advance our understanding of this phenomenon to impact labour care and policy. SETTING The study was conducted among multiparous women who had their antenatal care and delivery in Ogbomoso, Oyo State, Nigeria. METHODS A qualitative study was performed using in-depth interviews among postnatal women. RESULTS The results revealed a number of variables that could affect the women's satisfaction with labour care, including the choice of health facility, healthcare providers, environment of the facility, assurance of privacy, treating patients with dignity, provision of needed amenities and having a well-planned postnatal care assessment. CONCLUSION The study revealed that the costs of care, the skill of the caregiver, the provision of confidential and dignified care, and the availability of supplies all have an impact on maternal satisfaction. Hospital administration should address these issues to enhance the experience of women and labour care services.Contribution: The study's findings provide insights that will inform strategies to improve the quality of care being provided to parturients in Nigeria.
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Ajayi AI, Ahinkorah BO, Seidu AA. "I don't like to be seen by a male provider": health workers' strike, economic, and sociocultural reasons for home birth in settings with free maternal healthcare in Nigeria. Int Health 2023; 15:435-444. [PMID: 36167330 PMCID: PMC10318974 DOI: 10.1093/inthealth/ihac064] [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] [Received: 05/29/2022] [Revised: 08/10/2022] [Accepted: 09/18/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ending maternal mortality has been a significant global health priority for decades. Many sub-Saharan African countries introduced user fee removal policies to attain this goal and ensure universal access to health facility delivery. However, many women in Nigeria continue to deliver at home. We examined the reasons for home birth in settings with free maternal healthcare in Southwestern and North Central Nigeria. METHODS We adopted a fully mixed, sequential, equal-status design. For the quantitative study, we drew data from 211 women who reported giving birth at home from a survey of 1227 women of reproductive age who gave birth in the 5 y before the survey. The qualitative study involved six focus group discussions and 68 in-depth interviews. Data generated through the interviews were coded and subjected to inductive thematic analysis, while descriptive statistics were used to analyse the quantitative data. RESULTS Women faced several barriers that limited their use of skilled birth attendants. These barriers operate at multiple levels and could be grouped as economic, sociocultural and health facility-related factors. Despite the user fee removal policy, lack of transportation, birth unpreparedness and lack of money pushed women to give birth at home. Also, sociocultural reasons such as hospital delivery not being deemed necessary in the community, women not wanting to be seen by male health workers, husbands not motivated and husbands' disapproval hindered the use of health facilities for childbirth. CONCLUSIONS This study has demonstrated that free healthcare does not guarantee universal access to healthcare. Interventions, especially in the Nasarawa state of Nigeria, should focus on the education of mothers on the importance of health facility-based delivery and birth preparedness.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
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Ilesanmi BB, Solanke BL, Oni TO, Yinusa RA, Oluwatope OB, Oyeleye OJ. To what extent is antenatal care in public health facilities associated with delivery in public health facilities? Findings from a cross-section of women who had facility deliveries in Nigeria. BMC Public Health 2023; 23:820. [PMID: 37143016 PMCID: PMC10161441 DOI: 10.1186/s12889-023-15688-7] [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: 10/15/2022] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Facility delivery remains an important public health issue in Nigeria. Studies have confirmed that antenatal care may improve the uptake of facility delivery. However, information is rarely available in Nigeria on the extent to which antenatal care in public health facilities is associated with delivery in public health facilities. The objective of the study was thus to examine the extent of the association between antenatal care in public health facilities and delivery in public health facilities in Nigeria. The study was guided by the Andersen behavioral model of health services use. METHODS The cross-sectional design was adopted. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). A sample of 9,015 women was analyzed. The outcome variable was the facility for delivery. The main explanatory variable was the antenatal care facility. The predisposing factors were maternal age, age at first birth, parity, exposure to mass media, and, religion. The enabling factors were household wealth, work status, partners' education, women's autonomy, health insurance, and, perception of distance to the health facility. The need factors were pregnancy wantedness, the number of antenatal care visits, and the timing of the first antenatal care. Statistical analyses were performed with the aid of Stata version 14. Two binary logistic regression models were fitted. RESULTS Findings showed that 69.6% of the women received antenatal care in public health facilities, while 91.6% of them subsequently utilized public health facilities for deliveries. The significant predisposing factors were age at first birth, parity, maternal education, and religion, while household wealth, work status, women's autonomy, and partners' education were the significant enabling factors. The timing of the first antenatal contact, pregnancy wantedness, and the number of antenatal care visits were the important need factors. CONCLUSION To a significant extent, antenatal care in public health facilities is associated with deliveries in public health facilities in Nigeria. It is imperative for governments in the country to take more steps to ensure the expanded availability of public health facilities in all parts of the country since their use for antenatal care is well-associated with their use for delivery care.
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Affiliation(s)
- Benjamin Bukky Ilesanmi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Tosin Olajide Oni
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rasheed Adebayo Yinusa
- Department of Demography and Social Statistics, Federal University, Birnin-Kebbi, Nigeria
| | - Omolayo Bukola Oluwatope
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
- National Centre for Technology Management, Obafemi Awolowo University, Ile-Ife, Nigeria
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Esan DT, Sokan-Adeaga AA, Rasaq NO. Assessment of satisfaction with delivery care among mothers in selected health care facilities in Ekiti state. J Public Health Res 2022; 11:22799036221127572. [PMID: 36226307 PMCID: PMC9549099 DOI: 10.1177/22799036221127572] [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: 05/26/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
The study assessed the maternal satisfaction with delivery care in selected health care facilities in Ekiti state. The study employed a descriptive cross-sectional study design and a simple random sampling technique was utilized to select respondents based on calculated sample size and a total of 267 respondents participated in the study. A semi-structured pretested questionnaire was used for the data collection. Data was analyzed and summarized using descriptive statistics and inferential statistics (Chi-square) with significance set at p < 0.05. The mean respondents' age was 28.2 ± 1.4 years with majority falling within the age group of 21-30 years. Majority of the respondents revealed to be satisfied with the following: proximity of the health facilities 194 (72.7%); cost of service 174 (65.2%); drug availability 184 (69.7%); cleanliness of the hospital ambience 219 (82.0%); and professional conduct of the care givers 186 (70.2%). However, the respondents expressed dissatisfaction in terms of the following: referral link 107 (40.1%); waiting time 122 (45.7%); communication gap 56 (21.0%); and maintenance of privacy 51 (19.1%). Overall, majority (94.8%) of the respondents were satisfied with the delivery services rendered at the facilities while 14 (5.2%) expressed dissatisfaction. Furthermore, a significant association exists between respondents' level of education and maternal satisfaction on delivery care (p < 0.05). Although the general maternal gratification/satisfaction on intrapartum and postpartum care in this study was overwhelmingly high, the few domains of discontentment identified need to be addressed by all the stakeholders in the health sector to enhance the usage of health care services amongst women, thus promoting the attainment of Sustainable Development Goal (SDG) 3.
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Affiliation(s)
- Deborah Tolulope Esan
- Department of Nursing Science, Afe
Babalola University, Ado-Ekiti, Ekiti, Nigeria,Deborah Tolulope Esan, Department of
Nursing Science, College of Medicine and Health Sciences, Afe Babalola
University, P.M.B. 5454, Ado-Ekiti, Ekiti 360102, Nigeria.
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Udenigwe O, Okonofua FE, Ntoimo LFC, Yaya S. Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study. PLoS One 2022; 17:e0272523. [PMID: 35921313 PMCID: PMC9348693 DOI: 10.1371/journal.pone.0272523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Existing studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers. Methods In this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches. Results Policymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare. Conclusion The emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Friday E. Okonofua
- Women’s Health and Action Research Centre, Benin City, Edo State Nigeria, Nigeria
- Centre for Excellence in Reproductive Health Innovation, Benin City, Nigeria
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- * E-mail:
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Mweemba C, Mapulanga M, Jacobs C, Katowa-Mukwato P, Maimbolwa M. Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design. Pan Afr Med J 2021; 40:4. [PMID: 34650654 PMCID: PMC8490167 DOI: 10.11604/pamj.2021.40.4.28423] [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: 02/16/2021] [Accepted: 08/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts. Methods a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component. Results the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards. Conclusion based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.
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Affiliation(s)
- Chris Mweemba
- Department of Health Policy, Systems and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Miriam Mapulanga
- Department of Public Health, University of Lusaka, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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Maung TM, Mon NO, Mehrtash H, Bonsaffoh KA, Vogel JP, Aderoba AK, Irinyenikan TA, Balde MD, Pattanittum P, Tuncalp Ö, Bohren MA. Women's experiences of mistreatment during childbirth and their satisfaction with care: findings from a multicountry community-based study in four countries. BMJ Glob Health 2021; 5:bmjgh-2020-003688. [PMID: 33436494 PMCID: PMC7816916 DOI: 10.1136/bmjgh-2020-003688] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/29/2020] [Accepted: 11/22/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Experiences of care and satisfaction are intrinsically linked, as user’s experiences of care may directly impact satisfaction, or indirectly impact user’s expectations and values. Both experiences of care and satisfaction are important to measure so that quality can be monitored and improved. Globally, women experience mistreatment during childbirth at facilities; however, there is limited evidence exploring the mistreatment and women’s satisfaction with care during childbirth. Methods This is a secondary analysis of a cross-sectional survey within the WHO study ‘How women are treated during facility-based childbirth’ exploring the mistreatment of women during childbirth in Ghana, Guinea, Myanmar and Nigeria. Women’s experiences of mistreatment and satisfaction with care during childbirth was explored. Multivariable logistic regression modelling was conducted to evaluate the association between mistreatment, women’s overall satisfaction with the care they received, and whether they would recommend the facility to others. Results 2672 women were included in this analysis. Despite over one-third of women reporting experience of mistreatment (35.4%), overall satisfaction for services received and recommendation of the facility to others was high, 88.4% and 90%, respectively. Women who reported experiences of mistreatment were more likely to report lower satisfaction with care: women were more likely to be satisfied if they did not experience verbal abuse (adjusted OR (AOR) 4.52, 95% CI 3.50 to 5.85), or had short waiting times (AOR 5.12, 95% CI 3.94 to 6.65). Women who did not experience any physical or verbal abuse or discrimination were more likely to recommend the facility to others (AOR 3.89, 95% CI 2.98 to 5.06). Conclusion Measuring both women’s experiences and their satisfaction with care are critical to assess quality and provide actionable evidence for quality improvement. These measures can enable health systems to identify and respond to root causes contributing to measures of satisfaction.
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Affiliation(s)
- Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar .,Doctor of Epidemiology and Biostatics Program, Epidemiology and Biostatistics Department, Khon Kaen University, Khon Kaen, Thailand
| | - Nwe Oo Mon
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kwame Adu Bonsaffoh
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Joshua P Vogel
- Maternal and Child Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Adeniyi Kolade Aderoba
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK.,Obstetrics and Gynaecology, Mother and Child Hospital Akure, Akure, Ondo, Nigeria
| | - Theresa Azonima Irinyenikan
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Ondo State, Nigeria.,University of Medical Sciences Teaching Hospital, Akure, Nigeria
| | - Mamadou Dioulde Balde
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), University National Hospital-Donka, Conakry, Guinea
| | - Porjai Pattanittum
- Epidemiology and Biostatistics Department, Khon Kaen University, Khon Kaen, Thailand
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Ajayi AI, Akpan W. Maternal health care services utilisation in the context of 'Abiye' (safe motherhood) programme in Ondo State, Nigeria. BMC Public Health 2020; 20:362. [PMID: 32192429 PMCID: PMC7082975 DOI: 10.1186/s12889-020-08512-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nigeria Demographic and Health Survey (NDHS) of 2008 show that Ondo State had the worst maternal outcomes in the South Western region of Nigeria. To address this problem, the "Abiye" (safe motherhood) programme-which included community engagement, health system strengthening and user fee removal- was implemented by the state government. We assessed the use of maternal health care services and its determinants at 5 years after the implementation of this programme using a population-based survey. We also compared the results of our survey to the NDHS 2013 to assess improvement in maternal health care services utilisation. METHODS We conducted a population-based survey in 2016 among representative sample of 409 women who had given birth between 2011 and 2015, which were selected using cluster random sampling. We compared the findings of this 2016 survey to the 2013 NDHS, which contains maternal health care services utilisation information of a total of 434 women who gave birth between 2009 and 2013 to assess progress in the use of maternal health care services. We used descriptive and inferential statistics for our data analysis. RESULTS In the 2013 NDHS survey, about 80% of women received antenatal care compared to 98% in the 2016 survey. Our survey shows that the majority of births (85.6%) took place in health facilities compared to only 56.5% in NDHS 2013 survey, which represents a 29.1 percentage points increase. In both surveys, women with primary level of education or less had lower odds of delivering their babies in health facilities. However, while the 2013 NDHS survey shows that women who resided in urban areas were twice more likely to deliver their babies in health facilities compared to those living in rural areas, the 2016 survey shows that urban residence was no longer significantly associated with a higher odds of facility-based child delivery. CONCLUSION Maternal health services utilisation has improved considerably following the implementation of the "Abiye" initiative. The findings of this study suggest that with community engagement, health system strengthening and user fee removal for the most vulnerable, universal access to and utilisation of maternal health services is possible.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100, Kenya.
| | - Wilson Akpan
- Research and Innovation, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
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