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Tanvia L, Haque ME, Bari W. Rural-urban disparity in uptaking skilled antenatal care visits by pregnant women in Bangladesh: Zero and One Inflated Poisson regression model. PLoS One 2025; 20:e0318341. [PMID: 39879162 PMCID: PMC11778761 DOI: 10.1371/journal.pone.0318341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 01/14/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Utilization of maternal health care services, specifically, antenatal care services from skilled health providers have been given utmost priority in low- and middle-income countries over years with a view of mitigating complications during pregnancy as well as safeguarding the health and survival of both mother and newborn. However, there is a general tendency of pregnant mothers in Bangladesh of receiving skilled antenatal care (SANC) service once, or even never which refrains us to ensure World Health Organization (WHO) recommended eight plus SANC visits, additionally, to meet Sustainable Development Goal (SDG) number three. OBJECTIVES The study aims at assessing how the average number of SANC visits taken by the reproductive women in Bangladesh changes over the time in rural and urban areas together with finding out the potential demographic and socio-economic factors associated with SANC visits by addressing possible accumulation of zero and one counts in SANC visits. METHODS In this study, data have been retrieved from last four waves of Bangladesh Demographic and Health Surveys ranging from 2011 to 2022 and later combined together to form a pooled dataset. Non-parametric Kruskal-Wallis test has been performed for exploring unadjusted association of covariates with the response and Mann-Whitney U test has been conducted for multiple comparison in case of significant association for a covariate having more than two categories. For checking the existence of concurrent inflation at zero and one in the pooled dataset, partial score test has been performed. Based on the results of score test, Zero and One Inflated Poisson regression model has been fitted to the pooled dataset, where an interaction term between area of residence and survey year has been considered for trend analysis. RESULTS The study highlights that the rate of mean SANC visits is rapidly rising with time among pregnant women not only from the urban areas but also from the rural areas of Bangladesh. However, the rate of change in uptaking the SANC visits is higher in rural area compared to urban area. It was observed that for a given survey year, the rate of mean SANC visits was higher among women from urban areas compared to that among women from rural areas of Bangladesh. This study provides the evidence of 17.2% extra zero counts and 1.1% extra one counts in the pooled dataset. CONCLUSION The study results depict that inequity in SANC services based on area of residence prevails in Bangladesh. However, the gap in the rate of mean SANC visits in rural areas compared to urban areas has gradually reduced over time. Based on the results, the study comes up with some recommendations to facilitate the policy makers in improvising strategies and ensuring sustainable rise in SANC counts as well as WHO recommended positive pregnancy experience in the country to meet SDGs.
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Affiliation(s)
- Lubana Tanvia
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | | | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Yoseph A, Teklesilasie W, Guillen-Grima F, Astatkie A. Perceptions, barriers, and facilitators of maternal health service utilization in southern Ethiopia: A qualitative exploration of community members' and health care providers' views. PLoS One 2024; 19:e0312484. [PMID: 39700187 DOI: 10.1371/journal.pone.0312484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/07/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, evidence is scarce in designing efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and healthcare providers' perceptions of MHS and barriers and facilitators of MHS use in southern Ethiopia. METHODS A phenomenological qualitative study was conducted in the month of November, 2022, in the northern zone of the Sidama region. There were sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQDA 2020 software and presented in narratives. RESULTS Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD) but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of road access, and women being busy with different household chores. Distance from health facilities, costs associated with HFD use, unpredicted labor, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women's development teams, and pregnant women's forums. CONCLUSIONS Rural women still encounter challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labor continued to be fundamental barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address community and health facility barriers. The programs must emphasize the transportation arrangements during unpredictable labor and the needs of poor mothers and women with poor awareness of MHS at the community level.
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Affiliation(s)
- Amanuel Yoseph
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
- Healthcare Research Institute of Navarra (IdiSNA), Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Ayalew G, Gessesse AD, Tigabu D, Admass ZE, Girma B, Ayehu M, Sibhat MM, Demeke AD, Aragaw GM, Kelkay JM, Rade BK, Gudayu TW. Timely initiation of breastfeeding and its associated factors among immediate postpartum mother-newborn pairs in Debre Tabor comprehensive specialized hospital, South Gondar Zone, North West, Ethiopia. BMC Pregnancy Childbirth 2024; 24:735. [PMID: 39516749 PMCID: PMC11549749 DOI: 10.1186/s12884-024-06934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Initiation of breast feeding within one hour of birth is the easiest and most cost-effective intervention to reduce the risk of neonatal morbidity and mortality. Conducting studies immediately after an hour of birth for the timely initiation of breastfeeding has the significance of initiating breastfeeding and acting immediately. However, there was a paucity of information in the region as well as in the country at large. Therefore, the aim of this study was to assess the magnitude of timely initiation of breastfeeding and its associated factors among immediate postpartum mother-newborn pairs in Debre Tabor comprehensive specialized hospital, northwest Ethiopia, in 2024. METHOD An institutional-based cross-sectional study was conducted from October 25, 2023, to January 25, 2024, at Debre Tabor Comprehensive Specialized Hospital. A total of 478 immediate postpartum mothers were selected at birth using systematic random sampling techniques. Data were collected using chart reviews, interviewer-administered questionnaires, and through observation. Data entry and analysis was performed by Epi-Data version 4.6.02 and Statistical Package for Social Sciences version 25(SPSS) soft war respectively. Descriptive statistics were computed to determine the frequency of variables. After doing a binary logistic regression analysis, a p-value less than 0.25 indicated a potential candidate for multivariable analysis aimed at identifying statistically relevant factors. Both crude and adjusted odds ratios (AOR) were computed, and the levels of significance were declared based on the AOR with a 95% confidence interval (CI) at a p-value < 0.05. RESULTS In this study, the prevalence of timely initiation of breastfeeding was 73.7% with a 95% CI (69.65%, 77.67%). Being multiparous (AOR: 2.25, 95% CI: 1.32, 3.84), receiving counseling immediately after delivery (AOR: 4.19, 95% CI: 2.20, 7.98), receiving support and guidance from health care providers (AOR: 1.95, 95% CI: 1.01, 3.77), having no obstetric complications during and immediately after delivery (AOR: 4.44, 95% CI: 2.34, 8.42), and practicing rooming-in (AOR: 3.65, 95% CI: 2.05, 6.51) were significantly associated variables with timely initiation of breast feeding. CONCLUSION The overall timely initiation of breastfeeding in this study was lower than the World Health Organization's recommendations. Therefore, interventions need to focus on mothers who developed obstetric complications, primiparous mothers, improper rooming-in, a lack of advice immediately after delivery, and the support and guidance of mothers on the timely initiation of breastfeeding to improve the timely initiation of breastfeeding practice.
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Affiliation(s)
- Gizat Ayalew
- Department of Clinical Midwife, Amhara Regional Health Bureau, Northwest, Bahir Dar, Ethiopia
| | - Abraham Dessie Gessesse
- Department of Pediatric and Child Health Nursing, Woldia University College of Health Science, Woldia, Ethiopia.
| | - Dagnew Tigabu
- Department of Pediatric and Child Health Nursing, Woldia University College of Health Science, Woldia, Ethiopia
| | - Zeleke Endalew Admass
- Department of Biomedical Science, Dilla University College of Health Science and Medicine, Dilla, Ethiopia
| | - Bekahegn Girma
- Department of Pediatric and Child Health Nursing, Debre Berhan University College of Medicine and Health Science, Debre-Berhan, Ethiopia
| | - Mequanint Ayehu
- Department of Nursing, Dilla University College of Medicine and Health Science, Dilla, Ethiopia
| | - Migbar Mekonnen Sibhat
- Department of Nursing, Dilla University College of Medicine and Health Science, Dilla, Ethiopia
| | - Abel Desalegn Demeke
- Department of Nursing, Dilla University College of Medicine and Health Science, Dilla, Ethiopia
| | - Getie Mihret Aragaw
- Department of General Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jenberu Mekurianew Kelkay
- Department of Health Informatic, School of Public Health Science, Dilla University College of Health Science and Medicine, Dilla, Ethiopia
| | - Bayew Kelkay Rade
- Department of Clinical Midwifery, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Temsegen Worku Gudayu
- Department of Clinical Midwifery, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
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Alemayehu G, Birhanu S, Alemayehu A, Mulatu T. Completion and predictors of maternity continuum of care among women in the post-partum period in Gedeb district, southern Ethiopia: A community based cross-sectional study. PLoS One 2024; 19:e0303380. [PMID: 38885256 PMCID: PMC11182525 DOI: 10.1371/journal.pone.0303380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Maternal and neonatal complications related to pregnancy and childbirth pose a significant risk of morbidity and mortality to both the mother and the child. Despite its benefits in reducing maternal and neonatal mortality and morbidity associated with pregnancy and childbirth, the majority of Ethiopian mothers were dropped from the maternal continuum of care. Furthermore, there is a dearth of data regarding the status of the maternal continuum of care and its underlying factors in southern Ethiopia. OBJECTIVE This study aimed to assess the completion of the maternity continuum of care and its predictors among postpartum women who had given birth in the previous six months in the Gedeb district of Gedio Zone, southern Ethiopia. METHODS A community-based cross-sectional survey was conducted among 625 postpartum women selected by simple random sampling from June 1 to 30, 2022. The data was collected through face-to-face interviews using pretested, structured questionnaires. The association between the explanatory variables and the maternity continuum of care was examined using bivariate and multivariable logistic regression models. The adjusted odds ratio (AOR) with a 95% confidence interval was employed to measure the strength of association and the level of significance was set at p<0.05. RESULTS In this study, only 32.00% (95% CI: 28.45, 35.77) of the women completed the maternal continuum of care. Attending primary education (AOR = 2.09; 95% CI: 1.23, 3.55), secondary and above education (AOR = 1.97; 95% CI: 1.01, 3.87), receiving counseling during ANC (AOR = 1.89; 95% CI: 1.22, 2.92), being well prepared for birth and complications readiness (AOR = 4.13; 95% CI: 2.23, 7.62), and having good knowledge of pregnancy danger signs (AOR = 4.13; 95% CI: 2.60, 6.55) were all significantly associated with completing the maternity continuum of care. CONCLUSION Nearly one-third of the women completed the maternity continuum of care. Enhancing women's knowledge, offering counseling during prenatal visits, ensuring women's awareness of pregnancy danger signs, and implementing health promotion programs targeted at enhancing birth preparedness and complications readiness for all are crucial.
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Affiliation(s)
- Gemechu Alemayehu
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Simon Birhanu
- College of Health Science, Debark University, Debark, Ethiopia
| | - Afework Alemayehu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review. BMC Womens Health 2024; 24:325. [PMID: 38840156 PMCID: PMC11151574 DOI: 10.1186/s12905-024-03177-x] [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: 11/25/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs). METHODS In this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O'Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method. RESULTS The main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services. CONCLUSIONS The evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.
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Affiliation(s)
- Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyede Maryam Najibi
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Razavi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
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Yoseph A, Teklesilasie W, Guillen-Grima F, Astatkie A. Community-Based Health Education Led by Women's Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1045. [PMID: 38786455 PMCID: PMC11121210 DOI: 10.3390/healthcare12101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. METHODS From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. RESULTS The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). CONCLUSION A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. TRIAL REGISTRATION NUMBER NCT05865873.
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Affiliation(s)
- Amanuel Yoseph
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia; (W.T.); (A.A.)
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia; (W.T.); (A.A.)
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Healthcare Research Institute of Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Preventive Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 46980 Madrid, Spain
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia; (W.T.); (A.A.)
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Lateef MA, Kuupiel D, Mchunu GG, Pillay JD. Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:440. [PMID: 38673351 PMCID: PMC11050659 DOI: 10.3390/ijerph21040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.
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Affiliation(s)
- Monsurat A. Lateef
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Desmond Kuupiel
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Gugu G. Mchunu
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Julian D. Pillay
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
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Debiso AT, Tefera K, Asseffa NA, Simachew Y, Atsibeha F, Belayneh F, Olkeba BK, Feleke T, Bekele G, Asnake S, Mengesha S, Hailu M, Kassa A. Cohort Profile: The Dale-Wonsho health and demographic surveillance system, Southern Ethiopia. Int J Epidemiol 2024; 53:dyae018. [PMID: 38339865 PMCID: PMC10858346 DOI: 10.1093/ije/dyae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Alemu Tamiso Debiso
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kebede Tefera
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Yilkal Simachew
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Frehiwot Atsibeha
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Dale-Wonsho Health Demographic Surveillance Site, Yirgalem, Ethiopia
| | - Fanuel Belayneh
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Tihun Feleke
- Hawassa College of Health Sciences, Hawassa, Ethiopia
| | - Gezahegn Bekele
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Solomon Asnake
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Mesay Hailu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Andargachew Kassa
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Mare KU, Aychiluhm SB, Sabo KG, Tadesse AW, Kase BF, Ebrahim OA, Tebeje TM, Mulaw GF, Seifu BL. Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis. PLoS One 2023; 18:e0294992. [PMID: 38019840 PMCID: PMC10686498 DOI: 10.1371/journal.pone.0294992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries. METHODS We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software. RESULTS The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception. CONCLUSIONS Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.
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Affiliation(s)
- Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Epidemiology & Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Abay Woday Tadesse
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fentahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Oumer Abdulkadir Ebrahim
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Getahun Fentaw Mulaw
- School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Tesfay N, Hailu G, Woldeyohannes F. Effect of optimal antenatal care on maternal and perinatal health in Ethiopia. Front Pediatr 2023; 11:1120979. [PMID: 36824654 PMCID: PMC9941639 DOI: 10.3389/fped.2023.1120979] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Receiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care. METHODS The study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT]. RESULT The result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = -0.015, 95%CI (-0.029 to -0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563-1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = -0.012, 95%CI: (-0.018 to -0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001-0.062)] and avoiding delay to decide to seek care [ATT = -0.187, 95%CI: (-0.354 to -0.021)]. CONCLUSION Obtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Yoseph A, Teklesilasie W, Guillen-Grima F, Astatkie A. Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231218195. [PMID: 38126304 DOI: 10.1177/17455057231218195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. OBJECTIVES This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. DESIGN A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. METHODS Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. RESULTS Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). CONCLUSION Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.
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Affiliation(s)
- Amanuel Yoseph
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Hassen SS, Lelisho ME. Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district. BMC Health Serv Res 2022; 22:1318. [PMID: 36329430 PMCID: PMC9635200 DOI: 10.1186/s12913-022-08710-y] [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: 03/14/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Skilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia. Methods A community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model. Results This study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance. Conclusions This study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.
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Affiliation(s)
- Sali Suleman Hassen
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
| | - Mesfin Esayas Lelisho
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
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Amwonya D, Kigosa N, Kizza J. Female education and maternal health care utilization: evidence from Uganda. Reprod Health 2022; 19:142. [PMID: 35725605 PMCID: PMC9208099 DOI: 10.1186/s12978-022-01432-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Maternal health care is among the key indicators of population health and economic development. Therefore, the study attempted to explore female education and maternal healthcare utilization in Uganda. The study identified the causal effect of introduction of free education by exploiting the age as an instrument at the second stage model (BMC Health Serv Res. 2015. 10.1186/s12913-015-0943-8; Matern Child Health J. 2009;14:988–98). This instrument provided an exogenous source of variation in the years of schooling and allowed to implement a regression discontinuity design which accounted for heterogeneity in the cohort overtime. Methods The study used the Ordinary Least Squares (OLS) to help predict years of schooling that were used in the second stage model in the Two Stage Least Squares (2SLS). The study further used the Regression Discontinuity Design (RDD) model with a running variable of birth years to observe its effect on education. To control for heterogeneity in regions in the second stage model, a fixed effects model was used. Results Female education indeed had a positive impact on maternal health care utilization. It was further found out that age also influences maternal health care utilization. Conclusions Therefore, as an effort to improve professional maternal health care utilisation, there is need to focus on education beyond primary level. Uganda Government should also ensure that there is an improvement in community infrastructure and security across all regions and locations. Maternal health care (MHC) utilization is one of the Millennium Development Goals (SDG) of pursuit. Globally, most low-income countries like Uganda contribute greatly to pregnancy-related mortalities that are largely preventable through adequate utilization of essential maternal health care services. Though Uganda over time has registered some increase in maternal utilization, this has been attributed to a number of factors. This study intended to demonstrate whether the introduction of free primary education in Uganda led to increase in the utilization of maternal health services. To address this, we used Ordinary Least Squares (OLS), Two Stage Least Squares (2SLS), Probit and Regression Discontinuity Design (RDD) models using Demographic Health Survey (DHS) data 2006 and 2011. The study found out that indeed the introduction of free primary education increased the utilization of MHC.
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Affiliation(s)
- David Amwonya
- Department of Economics and Statistics, Kyambogo University, Kyambogo, P.O.BOX 1, Kampala, Uganda.
| | - Nathan Kigosa
- Department of Economics and Statistics, Kyambogo University, Kyambogo, P.O.BOX 1, Kampala, Uganda
| | - James Kizza
- Department of Economics and Statistics, Kyambogo University, Kyambogo, P.O.BOX 1, Kampala, Uganda
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Kebede AA, Gessesse DN, Tsega NT, Aklil MB, Abegaz MY, Anteneh TA, Tibebu NS, Alemu HN, Haile TT, Seyoum AT, Tiguh AE, Yismaw AE, Mihret MS, Nenko G, Wondie KY, Mesele TT, Taye BT, Temesgan WZ. Husband Involvement in Maternal, Neonatal, and Child Health Care among Women who Have a Child Less Than one Year in Gondar City, Northwest Ethiopia, 2021. Health Serv Res Manag Epidemiol 2022; 9:23333928221124807. [PMID: 36105368 PMCID: PMC9465560 DOI: 10.1177/23333928221124807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving maternal, neonatal and child health is one of the major components
of Sustainable Development Goal and countries implement different strategies
to achieve this goal. In spite of this, maternal, neonatal and child
mortality remains a public health burden in the developing countries,
including Ethiopia. World Health Organization recommend active involvement
of men during pregnancy, child birth and the postpartum period as an
effective strategy to improve maternal as well as newborn health. Therefore,
this study aimed to assess husband involvement in maternal, neonatal and
child health care among women who have child less than one year in Gondar
city, northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 870 married women
who have a child less than one year in Gondar city. A cluster sampling
technique was employed to select study participants. Data were entered into
Epi Data version 4.6 and exported to SPSS version 25 for analysis.
Multivariable logistic regression was done and adjusted odds ratio with a
95% confidence interval was used to report the association between
covariates and the outcome variable. Results Husband involvement in Maternal, Neonatal and Child Health (MNCH) care was
66.2% (95%CI: 63, 69.3). Maternal age (18-25years) and (26-35years), having
diploma and above education, husband occupation (government employee),
(merchant) and (self-employed), planned pregnancy and cesarean delivery were
significantly associated with husband involvement in MNCH care. Conclusion In this study, nearly two thirds (66.2%) of women had husband involvement in
MNCH care. Therefore, it is important to improve women's educational
attainment and actions should be taken to prevent unplanned pregnancy.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Nibret Gessesse
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Belayneh Aklil
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marta Yimam Abegaz
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haymanot Nigatu Alemu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsion Tadesse Haile
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmra Tesfahun Seyoum
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruye Tilahun Mesele
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia
| | - Wubedle Zelalem Temesgan
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zegeye B, Keetile M, Ahinkorah BO, Ameyaw EK, Seidu AA, Yaya S. Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis. Trop Med Health 2021; 49:53. [PMID: 34193313 PMCID: PMC8247116 DOI: 10.1186/s41182-021-00343-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. METHODS We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). RESULTS The pooled results showed that about 50.7% (95% CI 48.2-53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0-69.1%) and West Africa (24.3%, 95% CI 22.4-26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32-2.84), women with educated husbands (aOR=1.40, 95% CI 1.11-1.77), wealthier women (aOR=3.12, 95% CI 1.95-4.99), women exposed to media (aOR=1.46, 95% CI 1.18-1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24-1.83). CONCLUSIONS Enhancing women's education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Mpho Keetile
- Department of Population Studies, Faculty of Social Sciences, University of Botswana, Private Bag, UB 0022 Gaborone, Botswana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, PMB 0494 Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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