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Bhowmik J, Apputhurai P, Williams J, Biswas RK. Investigating the role of women's education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach. Midwifery 2024; 138:104140. [PMID: 39142238 DOI: 10.1016/j.midw.2024.104140] [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: 01/25/2023] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach. METHODS A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017-18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study. RESULTS The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth (β = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use. CONCLUSION Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.
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Affiliation(s)
- Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia.
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Joanne Williams
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Raaj Kishore Biswas
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Khatir AG, Wang T, Ariyo T, Rahman N, Jiang Q. Women's healthcare autonomy and the utilization of maternal healthcare services in Afghanistan. Public Health 2024; 235:49-55. [PMID: 39047525 DOI: 10.1016/j.puhe.2024.06.021] [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: 10/26/2023] [Revised: 04/26/2024] [Accepted: 06/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES The objective of this study was to investigate the relationship between women's healthcare autonomy and the utilization of maternal healthcare services (MHS), including antenatal care services, the services of health professionals at the birth of a child, and facility-based delivery. STUDY DESIGN This was a cross-sectional study. METHODS This study utilized data from the 2015 Afghanistan Demographic and Health Survey (AFDHS 2015), which included women aged 15-49 years who had given live birth within the five years before the survey. Multilevel logistic regression was used to estimate the adjusted odd ratios (AOR) for each outcome variable. RESULTS Among respondents, 16.49% made at least four ANC visits, 52.57% of childbirth were assisted by a skilled birth attendant (SBA), and 45.60% of children were born in health facilities. Women with high healthcare autonomy, compared to medium and low, were more likely to use ANC (AOR 1.45; 95% CI = 1.26-1.67), SBA (AOR 1.15; 95% CI 1.02-1.29), and FBD (AOR 1.12; 95% CI 1.04-1.20). The association between women's healthcare autonomy and the use of maternal healthcare services (MHS) was positively and significantly moderated by household wealth and women's access to media. CONCLUSION Women's higher healthcare autonomy was significantly and positively associated with MHS in Afghanistan. Policy and programs that encourage women's empowerment and awareness of the importance of MHS utilization should be initiated.
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Affiliation(s)
- A G Khatir
- School of Public Policy and Administration, Xi'an Jiaotong University, Shaanxi Province 710049, China.
| | - T Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Shaanxi Province 710049, China.
| | - T Ariyo
- School of Health Management, Shangluo University, Shangluo, Shaanxi Province 726000, China.
| | - N Rahman
- School of Public Policy and Administration, Xi'an Jiaotong University, Shaanxi Province 710049, China.
| | - Q Jiang
- School of Public Policy and Administration, Xi'an Jiaotong University, Shaanxi Province 710049, China.
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Lefebvre CH, Starnes JR, Jakubowski A, Omondi A, Manyala J, Wamae J, Rogers A, Mudhune S, Okoth V, Were V, Mbeya J, Yap SV, Omondi P, Ochieng W, Odhong T, Siele C, Wamai R. Factors associated with facility childbirth and skilled birth attendance in Migori County, Kenya and the effect of Lwala Community Alliance intervention: a cross-sectional assessment from the 2019 and 2021 Lwala household surveys. Front Glob Womens Health 2024; 5:1426264. [PMID: 39364185 PMCID: PMC11448359 DOI: 10.3389/fgwh.2024.1426264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 09/04/2024] [Indexed: 10/05/2024] Open
Abstract
Background Despite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes. Methods A cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards. Results SBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p < 0.001, 95%CI 1.03-1.08). The 2021 survey found the highest rates of both facility childbirths (97.9%, 95%CI 96.5-98.7) and SBA (98.2%, 95%CI 97.0-99.0) in North Kamagambo, the oldest ward of Lwala intervention. Higher educational status, four or more ANC visits, marriage/cohabitation, and wealth were significantly associated with increased SBA. Conclusions We provide the first quasi-experimental evidence that Lwala interventions are significantly improving SBA which may inform related initiatives in similar settings. The household-survey data provides a baseline for continued evaluation of Lwala programs, and the breakdown by ward allows for development of specific programmatic targets.
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Affiliation(s)
| | - Joseph R Starnes
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Lwala Community Alliance, Rongo, Kenya
| | - Aleksandra Jakubowski
- Department of Health Sciences, Northeastern University, Boston, MA, United States
- Department of Economics, Northeastern University, Boston, MA, United States
| | - Alyn Omondi
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | - Janet Manyala
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | | | | | | | | | - Vincent Were
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | | | - Samantha V Yap
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, MA, United States
| | | | - Willys Ochieng
- Department of Health, County Government of Migori, Migori, Kenya
| | - Tom Odhong
- Department of Health, County Government of Migori, Migori, Kenya
| | | | - Richard Wamai
- Lwala Community Alliance, Rongo, Kenya
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, MA, United States
- Nigerian Institute of Medical Research, Lagos, Nigeria
- African Centre for Community Investment in Health, Chemolingot, Kenya
- Integrated Initiative for Global Health, Northeastern University, Boston, MA, United States
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Bamusi MT, Philip NE, Bhat LD. Women's empowerment and its influence on the uptake of breast cancer screening in Tanzania: an analysis of 2022 Tanzania demographic health survey data. BMC Womens Health 2024; 24:495. [PMID: 39243087 PMCID: PMC11378501 DOI: 10.1186/s12905-024-03345-z] [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: 07/19/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Breast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women's empowerment and its influence on the uptake of breast cancer screening among women in Tanzania. METHODS This study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening. RESULTS Findings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27-6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05-1.06), literate women (AOR = 1.13, 95% CI = 1.13-1.13), those who own a house (AOR = 3.08, 95% CI = 3.08-3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18-1.19) had significantly higher odds of going for breast cancer screening. CONCLUSION Women's empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake.
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Affiliation(s)
- Maureen Treasure Bamusi
- Department of Obstetrics and Gynecology, Kamuzu Central Hospital, P. O Box 149, Lilongwe, Malawi.
| | - Neena Elezebeth Philip
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, 610005, India
| | - Lekha D Bhat
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, 610005, India
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Shibre G. Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory. BMJ Open 2024; 14:e077532. [PMID: 39043587 PMCID: PMC11268060 DOI: 10.1136/bmjopen-2023-077532] [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: 07/11/2023] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia. DESIGN Data for the study came from a series of the Ethiopia Demographic and Health Surveys. Four major surveys were taken place between 2000 and 2016 and all were included in the study. 9867, 9075, 10 592 and 9915 live births born 5 years preceding the surveys that were attended by skilled health workers in 2000, 2005, 2011 and 2016, respectively, were included in the study. For the postnatal care, only the 2016 survey was used due to sample size issues in the other surveys, and 3843 women having live births 2 years preceding the survey had complete data, allowing for fitting of a model. Since the outcome measures are binary, the logit model was used. Intersectionality was analysed by entering interactions into models. SETTINGS Population-based representative surveys encompassing all areas of Ethiopia. PARTICIPANTS The study subjects are women of reproductive age who had live births 2 years preceding the 2016 survey (for postnatal care) and live births born 5 years preceding the respective surveys (for birth care). OUTCOME MEASURES The outcome measures are skilled birth and postnatal care services. The postnatal care was for mothers within the first 2 days of giving birth and did not include care for the newborn. Competent maternal health care services are those that are provided by competent health workers: doctors, nurses, midwives and health officers. RESULTS It was observed that women at the crossroads of multiple axes of advantage and disadvantage had better and worse utilisation, respectively. For example, maternal education and residence intersected and predicted coverage of birth care was the highest among secondary schooling women who dwelt in urban settings with the values of 0.255; 95% CI 0.113 to 0.397 in 2000 and 0.589; 95% CI 0.359 to 0.819 in 2016 but was the lowest among non-educated women who lived in rural areas with the values of 0.0236; 95% CI 0.0154 to 0.0317 in 2000 and 0.203; 95% CI 0.177 to 0.229 in 2016. CONCLUSIONS It appeared that some women who were at the intersections of multiple axes of disadvantage had the lowest predicted coverage for maternal health care services. The study suggests that targeted interventions be developed for women who are at the intersection of multiple axes of marginalisation and that multiple sectors work in their sphere of resposibility to tackle social determinants of maternity care inequality. Policymakers may consider using intersectionality to inform development of targeted policies and or strategies. Further, future studies include structural drivers in the analysis of intersectionality to gain a better insight into the causes of disparities.
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Affiliation(s)
- Gebretsadik Shibre
- Addis Ababa University, College of Health Sciences, School of Public Health, Department of Reproductive, Family and Population Health, Addis Ababa, Ethiopia
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Priebe J, Amuasi J, Dartanto T, Mombo-Ngoma G, Guigas M. Factors associated with skilled birth attendance in 37 low-income and middle-income countries: a secondary analysis of nationally representative, individual-level data. Lancet Glob Health 2024; 12:e1104-e1110. [PMID: 38876758 DOI: 10.1016/s2214-109x(24)00145-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Progress on skilled birth attendance (SBA) has been very uneven across low-income and middle-income countries (LMICs). There is scant empirical evidence on the role of fundamental development processes in explaining differences in SBA outcomes across world regions over time in these settings. We therefore aimed to estimate how these processes have contributed to observed changes in SBA across Latin America and the Caribbean, South Asia, Southeast Asia, and sub-Saharan Africa. METHODS We pooled all available Demographic and Health Survey (DHS) rounds that contained detailed birth attendance information. The compiled data covers about 1·1 million births (1·1 million female individuals) from 103 DHS rounds in 37 countries. We estimated the determinants of SBA using multivariable regression techniques and Oaxaca-Blinder decompositions for different world regions and time periods (1990s, 2000s, and 2010s). FINDINGS We show that progress in SBA is associated with improvements in terms of household-level wealth, mothers' education, urbanisation, contraceptive knowledge, and proxies of female empowerment. Furthermore, we show that changes in the underlying relationship between SBA and specific development indicators (wealth, education, and rural residence status) have further contributed to the observed rise in SBA across LMICs. Our findings further suggest that certain determinants of improvements in SBA are region-specific (eg, importance of rural residence status in sub-Saharan Africa), whereas some of the studied processes (eg, poverty, maternal education, and urbanisation) have become less predictive for the uptake of SBA over time. INTERPRETATION Although substantial progress has been made in increasing SBA rates over the past three decades across LMICs, further efforts for continued progress are still needed to achieve international targets on SBA as part of the Sustainable Development Goals, the Every Newborn Action Plan, and the Ending Preventable Maternal Mortality initiative. According to our findings, these efforts can include general policies (eg, female empowerment) and region-specific policies (eg, poverty reduction programmes in Southeast Asia). FUNDING Bernhard Nocht Institute for Tropical Medicine. TRANSLATIONS For the French and Indonesian translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jan Priebe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Hamburg Center for Health Economics, Hamburg, Germany.
| | - John Amuasi
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Teguh Dartanto
- Faculty of Economics and Business, Universitas Indonesia, Depok, Indonesia
| | - Ghyslain Mombo-Ngoma
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
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Mathur S, Kirk K, Dadi C, Dougherty L. Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger. BMC Womens Health 2024; 24:278. [PMID: 38715013 PMCID: PMC11075281 DOI: 10.1186/s12905-024-03115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).
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Affiliation(s)
- Sanyukta Mathur
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA.
| | - Karen Kirk
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
| | - Leanne Dougherty
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
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Shibre G, Mekonnen W, Haile Mariam D. Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia. Front Public Health 2024; 12:1332801. [PMID: 38680926 PMCID: PMC11045905 DOI: 10.3389/fpubh.2024.1332801] [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: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Aggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged. Methods The data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time. Results There were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same. Conclusion Substantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Das S, Deepak, Singh RR. Does Empowering Women Influence Maternal Healthcare Service Utilization?: Evidence from National Family Health Survey-5, India. Matern Child Health J 2024; 28:679-690. [PMID: 37934327 DOI: 10.1007/s10995-023-03823-0] [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] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. DATA AND METHODS: The study uses data from the fifth round of the National Family Health Survey conducted in 2019-2021 and analyzed 26,552 (15-49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. RESULTS Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. CONCLUSION There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality.
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Affiliation(s)
- Sunandita Das
- Department of Family and Generation, International Institute for Population Sciences, Mumbai, India
| | - Deepak
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Rajeev Ranjan Singh
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.
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Show KL, Maung TM, Disney G, Bohren MA, Lumbiganon P, Ngamjarus C. Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study. BMJ Open 2024; 14:e076646. [PMID: 38503412 PMCID: PMC10952930 DOI: 10.1136/bmjopen-2023-076646] [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: 06/13/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES This study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar. STUDY DESIGN Cross-sectional study design. SETTING AND POPULATION We used secondary data from the Myanmar Demographic and Health Survey (2015-2016). Our outcome measures of skilled birth attendance and utilisation of CS were taken from the most recent birth of interviewed women. Absolute and relative inequalities across several sociodemographic characteristics were assessed and evaluated by calculating rate differences, rate ratio and concentration indexes. RESULTS More than one-third (36%, 95% CI 32.5% to 39.4%) of women gave birth without a skilled birth attendant present at their most recent birth. 40.7% (95% CI 37.8% to 43.7%) gave birth in healthcare facilities, and the CS rate was 19.7% (95% CI 17.9% to 21.8%) for their most recent birth. The highest proportion of birth without a skilled provider was found in the hilly regions and rural residents, poorest and less educated women, and those with less than four antenatal care visits. Inequalities in birth without a skilled provider were observed across regions, place of residence, wealth quintile, education level and number of antenatal care taken. The highest rate of CS was found among plain regions and urban residents, richest women, more than secondary education, those with more than four antenatal care visits and in private health facilities. Inequalities in CS utilisation were observed across place of residence, wealth quintiles, education level, number of antenatal care taken and type of health facilities. CONCLUSION This study provides evidence regarding inequalities in maternal health service utilisation in Myanmar. Increasing maternal health service availability and accessibility, promoting quality of care and health education campaigns to increase maternal health services utilisation are recommended.
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Affiliation(s)
- Kyaw Lwin Show
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - George Disney
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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Habte A, Bizuayehu HM, Lemma L, Sisay Y. Road to maternal death: the pooled estimate of maternal near-miss, its primary causes and determinants in Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:144. [PMID: 38368373 PMCID: PMC10874058 DOI: 10.1186/s12884-024-06325-1] [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: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. METHODS A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. RESULTS Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. CONCLUSION The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | | | - Lire Lemma
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Yordanos Sisay
- Department of Epidemiology, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Shen H, Zhao H, Wang B, Jiang Y. Women's status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling. Front Public Health 2024; 11:1192966. [PMID: 38269389 PMCID: PMC10807043 DOI: 10.3389/fpubh.2023.1192966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Skilled birth attendants (SBA) facilitate identifying and overcoming labor problems and saving lives. With one of the highest maternal death rates in the Asia-Pacific area, SBA utilization during childbirth among Papua New Guinea (PNG) women remains low. Women's status and empowerment are important factors in maternal and child health services and critical to maternal and child health development. This study is intended to apply structural equation modeling based on data from the Demographic and Health Survey (DHS) to evaluate the causal relationship between women's status, empowerment, and SBA utilization in PNG and the mechanisms of their influence. Methods This study employed data from the 2016-2018 Papua New Guinea Demographic Health Survey (PNG DHS), which recruited 18,175 women aged 15-49 years. A multi-stage sample and a structured questionnaire were used to collect information on maternal health, women's empowerment, and related topics. STATA 17.0 was used to describe the data, while MPLUS 8.2 was employed for structural equation modeling and pathway analysis. Results The two empowerment dimensions of household decision-making (standardized path coefficient, β = 0.049, p < 0.05) and access to health services (β = 0.069, p < 0.01) were positively associated with SBA utilization, while the association between attitudes toward partner violence and SBA utilization was not statistically significant. In addition, mediation analysis revealed that education indirectly influenced SBA utilization through access to health services (β = 0.011, 95% CI: 0.002, 0.022). Conclusion The findings confirmed the direct and indirect effects of women's status and empowerment on SBA utilization in PNG. Therefore, a call for further evidence-based interventions in PNG and possibly Pacific Small Island Developing States (PSIDS) is needed to improve women's educational attainment, household decision-making, and access to health services to enhance maternal and newborn health and well-being.
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Affiliation(s)
- Hao Shen
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hang Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Baoqin Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
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Kea AZ, Lindtjørn B, Tekle AG, Hinderaker SG. Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002466. [PMID: 38150438 PMCID: PMC10752526 DOI: 10.1371/journal.pgph.0002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.
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Affiliation(s)
- Aschenaki Zerihun Kea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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Armah-Ansah EK, Bawa B, Dindas J, Budu E, Ahinkorah BO, Ameyaw EK. A multilevel analysis of social determinants of skilled birth attendant utilisation among married and cohabiting women of Madagascar. Int Health 2023:ihad108. [PMID: 38011796 DOI: 10.1093/inthealth/ihad108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/30/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Maternal mortality ratio (MMR) in Madagascar is 392 deaths per 100 000 live births, and this is a major public health concern. One of the strategies for reducing MMR and achieving target 3.1 of the Sustainable Development Goals (i.e. reducing the global MMR below 70 per 100 000 live births) is the utilisation of skilled birth attendants (SBAs). This analysis examined the prevalence and social determinants of SBA utilisation among married and cohabiting women of Madagascar. METHODS Data from the 2021 Madagascar Demographic and Health Surveys was analysed on a weighted sample of 6997 married and cohabiting women. A multilevel regression was carried out to determine the social determinants of utilising SBAs. The results are presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and a p-value <0.05 to determine the significant associations. RESULTS The prevalence of SBAs among married and cohabiting women of Madagascar was 64.4% (95% CI 0.62 to 0.68). In model 3 of the multilevel regression, women 35-39 y of age (adjusted OR [aOR] 1.86 [95% CI 1.30 to 2.60]), women with secondary/higher education (aOR 1.67 [95% CI 1.32 to 2.10]), women whose partners had secondary/higher education (aOR 1.58 [95% CI 1.25 to 1.99]), cohabiting women (aOR 1.33 [95% CI 1.07 to 1.65]), women who had four or more antenatal care visits (aOR 2.05 [95% CI 1.79 to 2.35]), female household head (aOR 1.44 [95% CI 1.06 to 1.95]), Muslims (aOR 1.58 [95% CI 0.71 to 3.53]), those of the richest wealth index (aOR 4.32 [95% CI 2.93 to 6.36]) and women who lived in communities with high literacy levels (aOR 2.17 [95% CI 1.57 to 3.00]) had higher odds of utilisation of SBA. CONCLUSION This current analysis revealed low SBA utilisation among married and cohabiting women in Madagascar. The analysis points to the fact that understaffing and inaccessibility of health facilities remain major contributors to the low utilisation of SBAs. The findings call on the government and stakeholders in Madagascar to consider implementing programs that will empower women and focus on disadvantaged groups. These programs could include providing free maternal healthcare services to all pregnant women and intensifying health education programs that target women and their partners with no formal education.
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Affiliation(s)
- Ebenezer Kwesi Armah-Ansah
- Population Dynamics Sexual and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Population and Development, National Research University, Higher School of Economics, Moscow, Russia
| | | | - John Dindas
- Department of Public Health and Healthcare, I.M. Scehenov First Moscow State Medical University, Moscow, Russia
| | - Eugene Budu
- Korle Bu Teaching Hospital, P.O. Box, 77, Accra, Ghana
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- REMS Consult Limited, Sekondi-Takoradi, Western Region, Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Limited, Wa, Upper West Region, Ghana
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James PB, Yendewa GA, Bah AJ, Osborne A, Kpagoi SS, Margao EK, Kangbai J, Wardle J. Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey. BMC Pregnancy Childbirth 2023; 23:810. [PMID: 37993807 PMCID: PMC10664373 DOI: 10.1186/s12884-023-06126-y] [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: 09/02/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND A nationwide assessment of the link between women's empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women's empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. METHOD We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15-49 years who gave birth in the five years preceding the survey were included. Outcome variable was "home birth of their last child among women in the five years preceding the 2019 SLDHS. Women's empowerment parameters include women's knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. RESULTS Three in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43-2.92] and medium [aOR 1.44; 95%CI 1.05-1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51-2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women's decision-making power and home birth [aOR 1.11; 95% CI 0.86-1.41]. CONCLUSION Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Satta Sylvia Kpagoi
- Bo Government Hospital, Ministry of Health and Sanitation, Bo, Sierra Leone
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jia Kangbai
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
- Faculty of Health Sciences and Disaster Management, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
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Altijani N, Khogali M, Hinton L, Opondo C, Eljack E, Knight M, Nair M. Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014). Front Glob Womens Health 2023; 4:1012676. [PMID: 37711966 PMCID: PMC10498120 DOI: 10.3389/fgwh.2023.1012676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR). Methods Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level. Results Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82-2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37-0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12-0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31-0.65). In the ecological analysis 2014-2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho -0.55; p: 0.02). Conclusion This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality.
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Affiliation(s)
- Noon Altijani
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mustafa Khogali
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Eman Eljack
- Health Systems Strengthening and Malaria Program Management Unit, Federal Ministry of Health, Khartoum, Sudan
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Hetherington E, Harper S, Davidson R, Festo C, Lampkin N, Mtenga S, Teixeira C, Vincent I, Nandi A. Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania. J Epidemiol Community Health 2023; 77:410-416. [PMID: 37116960 DOI: 10.1136/jech-2022-219995] [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: 10/29/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient-provider communication. METHODS Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects. RESULTS Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient-provider communication. CONCLUSION Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes.
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Affiliation(s)
- Erin Hetherington
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | | | - Charles Festo
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | | | - Sally Mtenga
- Ifakara Health Institute, Ifakara, Tanzania, United Republic of
| | | | - Ilona Vincent
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
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Addo IY, Acquah E, Nyarko SH, Boateng ENK, Dickson KS. Factors associated with unskilled birth attendance among women in sub-Saharan Africa: A multivariate-geospatial analysis of demographic and health surveys. PLoS One 2023; 18:e0280992. [PMID: 36730358 PMCID: PMC9894461 DOI: 10.1371/journal.pone.0280992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA. METHODS The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data. RESULTS There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance. CONCLUSION Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities.
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Affiliation(s)
- Isaac Yeboah Addo
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- * E-mail: (KSD); (IYA)
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Volta Region, Ghana
| | - Samuel H. Nyarko
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Ebenezer N. K. Boateng
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail: (KSD); (IYA)
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Adde KS, Ameyaw EK, Dickson KS, Paintsil JA, Oladimeji O, Yaya S. Women's empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries. Reprod Health 2022; 19:222. [PMID: 36474291 PMCID: PMC9727987 DOI: 10.1186/s12978-022-01532-5] [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: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries. METHODS We utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25. RESULTS The study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28-1.62) and short-acting (aOR = 2.00, CI 1.79-2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09-1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09-2.17) of using long-acting methods than their counterparts with low knowledge level. CONCLUSION Our findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women.
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Affiliation(s)
- Kenneth Setorwu Adde
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- grid.411382.d0000 0004 1770 0716Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong ,L & E Research Consult Ltd, Upper West Region, Ghana
| | - Kwamena Sekyi Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Jones Arkoh Paintsil
- grid.413081.f0000 0001 2322 8567Department of Economic Studies, School of Economics, University of Cape Coast, Cape Coast, Ghana
| | - Olanrewaju Oladimeji
- grid.412870.80000 0001 0447 7939Department of Public Health, Walter Sisulu University, Mthatha, Eastern Cape 5099 South Africa
| | - Sanni Yaya
- grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK ,grid.28046.380000 0001 2182 2255School of International Development and Global Studies, University of Ottawa, Ottawa, ON Canada
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Seidu AA, Ahinkorah BO, Aboagye RG, Okyere J, Budu E, Yaya S. Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries. BMC Health Serv Res 2022; 22:1394. [PMID: 36419060 PMCID: PMC9682703 DOI: 10.1186/s12913-022-08693-w] [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: 06/08/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Given the intricate relationship between mothers and their children with the continuum of care, it is quintessential for their healthcare and interventions to be enhanced through a continuum of care approach. We examined the factors associated with the continuum of care for maternal, newborn, and child health in sub-Saharan Africa. METHODS Data for the study were pooled from the Demographic and Health Surveys of 17 countries in sub-Saharan Africa. We extracted the data from the women's files in all 17 countries. We included 15,359 married and cohabiting women with the most recent children aged 12-23 months at the time of the survey in the study. Multivariable multilevel logistic regression analysis was performed to examine the factors associated with continuum of care. Results were presented as adjusted odds ratios (aORs) with their 95% confidence interval. RESULTS Women whose partners had secondary or higher level of education [aOR = 1.52; 95%CI = 1.07, 2.16], those with health insurance [aOR = 1.64; 95%CI = 1.18, 2.30], those who decide alone on their healthcare [aOR = 1.38; 95%CI = 1.01, 1.89], those with joint healthcare decision [aOR = 1.33; 95%CI = 1.02, 1.74], those exposed to radio [aOR = 1.38; 95%CI = 1.06, 1.79], those who started antenatal care early [aOR = 1.88; 95%CI = 1.50, 2.36] and those in southern Africa [aOR = 7.02; 95%CI = 3.23, 15.27] had higher odds of completing the continuum of care. CONCLUSION We found that only 3.4% of women across the 17 sub-Saharan African countries included in this study completed all of the 11 maternal, newborn, and child health care interventions along the continuum of care. The factors that are associated with the maternal, newborn, and child health continuum of care include women's autonomy in decision-making, partners' level of education, health insurance coverage, early initiation of antenatal care, exposure to radio, and residing in Southern Africa. Problem with the distance to the facility lowered women's odds of completing the continuum of care. Governments and departments of health services across sub-Saharan African countries must leverage the radio to disseminate critical messages about the need to complete the continuum of care. Much commitment must be made toward advancing the autonomy of women. Health insurance coverage would have to be extended to reach all women to facilitate the completion of the continuum of care.
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Affiliation(s)
- Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, K1N 6N5 Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Tarekegn W, Tsegaye S, Berhane Y. Skilled birth attendant utilization trends, determinant and inequality gaps in Ethiopia. BMC Womens Health 2022; 22:466. [PMID: 36419061 PMCID: PMC9682649 DOI: 10.1186/s12905-022-01995-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globally over half a million women die every year from potentially preventable and treatable pregnancy and childbirth complications; of which 99% occur in low-and middle-income countries (LMICs). The utilization of skilled birth attendants can timely identify treatable birth complications and save lives. However, utilization of services remained low in LMICs. This study aimed to examine the trends in the utilization of skilled birth attendants and the inequality gaps in Ethiopia using data from the Demographic and Health Surveys. METHODS We used data from five rounds of Ethiopian Demographic and Health Surveys conducted in the period 2000-2019. Respondents were women in the reproductive age group who had a live birth within five years preceding the surveys. We used the concentration curve and concentration index to identify the inequalities using the World Health Organization recommended Health Equity Analysis Toolkit software. We did a logistic regression analysis to examine factors associated with skilled birth attendant utilization using STATA version 14.0. RESULT The skilled birth attendant coverage trend showed an increment from 5.7% in 2005 to 49.8% in 2019. The inequality gaps within the wealth, residence and education categories also showed a reduction over time. The odds of utilizing SBA were higher among those having primary, secondary, and above education status [AOR = 1.61 95%CI (1.33, 1.95)], being in the upper wealth quintile [AOR = 3.46 95%CI (1.8, 4.31)] and living in urban areas [AOR = 3.53 95%CI (1.88, 6.64)]. CONCLUSION The skilled birth attendant coverage trend showed a steady increase from 2005 to 2019 but if we continue with the current pace, it will be difficult to achieve the national target. The inequality gaps in household wealth status and residency area remain high. Efforts like strengthening the health system and engaging multisectoral agents need to be given priority to further reach the poorest and those living in rural areas to achieve national and international targets.
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Affiliation(s)
- Workagegnhu Tarekegn
- grid.458355.a0000 0004 9341 7904Department of Nutrition and Behavioral Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sitota Tsegaye
- grid.458355.a0000 0004 9341 7904Department of Nutrition and Behavioral Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- grid.458355.a0000 0004 9341 7904Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Sserwanja Q, Mufumba I, Kamara K, Musaba MW. Rural-urban correlates of skilled birth attendance utilisation in Sierra Leone: evidence from the 2019 Sierra Leone Demographic Health Survey. BMJ Open 2022; 12:e056825. [PMID: 35351721 PMCID: PMC8961150 DOI: 10.1136/bmjopen-2021-056825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Understanding the rural-urban context-specific correlates of skilled birth attendance (SBA) is important to designing relevant strategies and programmes. This analysis aimed to assess for the rural-urban correlates of SBA in Sierra Leone. SETTING The latest nationally representative Sierra Leone Demographic and Health Survey of 2019. PARTICIPANTS The study included a weighted sample of 7326 women aged 15-49 years. Each of them had a live birth within 5 years prior to the survey (4531 in rural areas and 2795 women in urban areas). PRIMARY AND SECONDARY OUTCOME MEASURE SBA (primary) and predictors of SBA (secondary). RESULTS SBA was higher in urban areas at 94.9% (95% CI 94.1% to 95.7%) compared with 84.2% (95% CI 83.8% to 85.9%) in rural areas. Rural women resident in the Southern, Northern and Eastern regions, with postprimary education (adjusted OR (aOR) 1.8; 95% CI 1.3 to 2.5), exposure to mass media (aOR 1.5; 95% CI 1.1 to 1.9), not having difficulties with distance to the nearest health facility (aOR 2.3; 95% CI 1.7 to 3.0) were associated with higher odds of SBA. Urban women resident in the Southern, Eastern region, with households having less than seven members (aOR 1.5; 95% CI 1.1 to 2.3), exposure to mass media (aOR 1.8; 95% CI 1.1 to 2.9) and not having difficulties with distance to the nearest health facility (aOR 1.6; 95% CI 1.1 to 2.5) were associated with higher odds of SBA. CONCLUSION Given the observed differences, improving SBA requires programmes and strategies that are context-specific.
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Affiliation(s)
| | - Ivan Mufumba
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- CHILD Research Laboratory, Global Health Uganda, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Milton W Musaba
- Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana. BIOMED RESEARCH INTERNATIONAL 2022; 2021:9914027. [PMID: 34977252 PMCID: PMC8720006 DOI: 10.1155/2021/9914027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022]
Abstract
Background A critical public health issue is maternal mortality. Around 810 women die per day from pregnancy and childbirth, with approximately 99 percent of these deaths recorded in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA), more than half of these mortalities are registered. The situation is remarkably similar in Ghana, with maternal mortality standing at 319 deaths per 100,000 live births in 2015. Methods Using data from 2014 Demographic and Health Surveys, the study examined the association between women empowerment and skilled birth attendance among women in rural Ghana. Results Women with medium decision-making (OR = 0.75, CI = 0.61, 0.93), low knowledge level (OR = 0.55, CI = 0.40, 0.76), high acceptance of wife beating (OR = 0.68, CI = 0.51, 0.90), with less than 4 ANC visits (OR = 0.25, CI = 0.19, 0.32), whose partner had higher education (OR = 1.96, CI = 1.05, 3.64), and who had a big problem with the distance getting to the health facility (OR = 0.63, CI = 0.50, 0.78) had a significant association with skilled birth attendants. Decision-making power, women's knowledge level, acceptance of wife beating, antenatal care visit, partner's education, getting medical help for self, and distance to health facility were seen to have a significant association with skilled birth attendants among women in Ghana. Conclusion Efforts to increase the current SBA should concentrate on the empowerment of women, male involvement in maternal health problems, women's education, and participation in the ANC. There is a need to review current policies, strategies, and services to improve maternal health conditions.
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