Utilisation of maternal health services by adolescent mothers in Kenya: analysis of the demographic health survey 2008-2009

A comparative study of adult and adolescent maternal care continuum following community-oriented interventions in Cambodia, Guatemala, Kenya, and Zambia

Background

The coverage for reproductive care continuum is a growing concern for communities in low- income economies. Adolescents (15–19 years) are often at higher odds of maternal morbidity and mortality due to other underlying factors including biological immaturity, social, and economic differences. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20–49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive care-seeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design.

Methods

In each country, communities in two districts/sub-districts received timed community health worker (CHW) household health promotion and social accountability interventions with community scorecards. Two matched districts/sub-districts were selected for comparison and received routine healthcare services.

Results

Results from the final evaluation showed that there were no significant differences in the care continuum for adolescents and adults except for Kenya (26.1% vs 18.8%, p<0.05). SBA was significantly higher for adolescents compared to adult women for Guatemala (64% vs 55.5%, p<0.05). Adolescents in the intervention sites showed significantly higher ANC utilization for Kenya (95.3% vs 84.8%, p<0.01) and Zambia (87% vs 72.7%, p<0.05), ANC4 for Cambodia (83.7% vs 43.2%, p<0.001) and Kenya (65.9% vs 48.1%, p<0.05), SBA for Cambodia (100% vs 88.9%, p<0.05), early PNC for Cambodia (91.8% vs 72.8%, p<0.01) and Zambia (56.5% vs 16.9%, p<0.001) compared to the comparison sites. However, the findings from Guatemala illustrated significantly lower care continuum for intervention sites (aOR:0.34, 95% CI 0.28–0.42, p<0.001). The study provides some evidence on the potential of multilevel community-oriented interventions to improve adolescent healthcare seeking in rural contexts. The predictors of care continuum varied across countries, indicating the importance of contextual factors in designing interventions.

Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria

Introduction

Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services.

Methods

The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate.

Results

Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead.

Conclusion

The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.

Roles of Midwives and Indonesian Midwives Association in Reducing Risk Factors for Stunting in Indonesia

Background: Stunting is caused by multi-dimensional factors and the most decisive intervention should be carried out in the first 1,000 days of life. Poor parenting practices, lack of knowledge about health and nutrition before and during pregnancy are some of the contributing factors and 60% of children aged 0-6 months do not receive exclusive breastfeeding. Aim: To assess the role of midwives and the Indonesian Midwives Association Professional Organization in reducing the risk of stunting in Indonesia.   Method: This type of descriptive research uses an exploratory study approach by assessing the role of midwives and the professional organization of the Indonesian Midwives Association (IBI) in reducing the risk of stunting in Central Sulawesi. The data of 288 midwives were collected using google form from 22 July 2020 to 22 August 2020. Data were analyzed by SPSS. Result: In general, midwives have provided maternal and child health books to pregnant women, recorded complete maternal and child health records, conducted antenatal care for pregnant women, provided nutritional food counseling for pregnant women, gave Fe 90 tablets to pregnant women, provided calcium tablets to pregnant women, conducting classes for pregnant women, delaying umbilical cord cutting (>30 minutes), providing vitamin A to postpartum mothers, conducting exclusive breastfeeding counseling, providing family planning services, providing IYCF counseling. However, for the activities of Implementing a special stunting prevention program, implementing postnatal care and initiating early breastfeeding still need improvement. Conclusion: The role of midwives in efforts to prevent stunting in Indonesia with midwives have provided maternal and child health books to pregnant women. Delaying umbilical cord cutting to 30 minutes, giving vitamin A to postpartum mothers, breastfeeding counseling, providing family planning services, providing IYCF counseling

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Prevalence and predictors of birth preparedness and complication readiness in the Kassena-Nankana district of Ghana: an analytical cross-sectional study

OBJECTIVES

To assess birth preparedness and complication readiness (BPACR) and associated factors among mothers who had given birth in the past 12 months prior to the study.

DESIGN

An analytical cross-sectional study.

SETTING

The study was carried out in the rural areas of Kassena-Nankana district located in the Upper East Region of Ghana.

PARTICIPANTS

The study population comprised 600 postpartum women who had delivered within the last 12 months prior to the study.

PRIMARY OUTCOME MEASURE

The primary outcome measure was BPACR.

RESULTS

The prevalence of BPACR among recently delivered women was very low as less than 15% were able to mention at least three of the five basic components of birth preparedness/complication readiness that were fulfilled. After adjustment for confounding effect using multivariable logistic regression analysis, high educational level (adjusted OR (AOR)=3.40 (95% CI: 1.88 to 6.15)), better knowledge about obstetric danger signs during pregnancy (AOR=4.88 (95% CI: 2.68 to 8.90)), older women (≥35 years) (AOR=2.59 (95% CI: 1.11 to 6.02)), women of low household wealth index (AOR=4.64 (95% CI: 1.97 to 10.91)) and women who received lower content of antenatal care services (AOR=3.34 (95% CI: 1.69 to 6.60)) were significant predictors of BPACR.

CONCLUSION

This study concludes that BPACR practices were low. High educational attainment of the woman, having adequate knowledge about obstetric danger signs during pregnancy, older women (≥35 years) and women of low household wealth index were significant predictors of BPACR. The predictors identified should be given high priority by health authorities in addressing low prevalence of BPACR.

Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review

Introduction

Sub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care.

Method

A systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included.

Results

From 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa.

Conclusions

The review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.

Maternal health services utilisation by Kenyan adolescent mothers: Analysis of the Demographic Health Survey 2014

BACKGROUND

Kenya has one of the highest adolescent fertility rates in East-Africa, estimated at 106 births per 1000 females aged 15-19years. In addition to promoting safe sexual behaviour, utilisation of maternal health services (MHS) is essential to prevent poor outcomes of pregnancy and childbirth. To ensure optimum planning, particularly in the context of the Sustainable Development Goals, this study assesses the current service utilisation patterns of Kenyan adolescent mothers and the factors that affect this utilisation.

METHODS

Using data from the recently published 2014 Kenya Demographic Health Survey, we collected demographic and utilisation data of all three MHSs (antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC)) of adolescent mothers aged 15-19years. We then conducted bivariate and multivariate analyses to test associations between selected demographic and service utilisation variables.

RESULTS

Our findings showed that half of Kenyan adolescent mothers have had their first birth by the age of 16. MHS utilisation rates amongst Kenyan adolescent mothers were 93%, 65%, 92% for ANC, SBA and PNC respectively. Mother's education, religion, ethnicity, place of residence, wealth quintile, mass media exposure, and geographical region were significant predictors for both ANC and SBA utilisation. Education level of partner was significant for ANC utilisation while parity was significant for both SBA and PNC.

CONCLUSIONS

Adolescent MHS utilisation is not optimum in Kenya. More work that includes affordable care provision, cultural re-orientation, targeted mass-media campaigns and male involvement in care need to be done with emphasis on the most disadvantaged areas.