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Gube AA, Murányi E, Vitrai J, Lohner S. Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis. Front Public Health 2024; 12:1415092. [PMID: 38989116 PMCID: PMC11233804 DOI: 10.3389/fpubh.2024.1415092] [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: 04/09/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
Background Maternal health service uptake remains an important predictor of maternal outcomes including maternal mortality. This systematic review and meta-analysis aimed to summarize the available evidence on the uptake of maternal health care services in developing countries and to assess the impact of place of residence, education status, and wealth index on the uptake of these services. Methods We examined the databases MEDLINE, Web of Science, Global Index Medicus, and Scopus until June 14, 2022. Cross-sectional studies done between 2015 and 2022 were considered. Mothers of reproductive age and all states of health were included in the study. Independently, two authors determined the eligibility of studies, extracted data, evaluated the risk of bias, and ranked the evidence's degree of certainty. To combine the data, we performed a random-effects meta-analysis. The PROSPERO registration ID is CRD42022304094. Results We included 51 studies. Mothers living in urban areas were three times more likely to receive antenatal care (OR 2.95; 95% CI 2.23 to 3.89; 15 studies; 340,390 participants) than rural mothers. Compared with no education, those with primary education were twice as likely to utilize antenatal care (OR 2.36; 95% CI 1.80 to 3.09; 9 studies; 154,398 participants) and those with secondary and higher education were six and fourteen times more likely to utilize antenatal care, respectively. Mothers in the second wealth index were twice as likely as mothers in the lowest wealth index to utilize antenatal care (OR 1.62; 95% CI 1.36 to 1.91; 10 studies; 224,530 participants) and antenatal care utilization increased further among mothers in the higher wealth index. We observed similar relative inequalities in skilled delivery care and postnatal care utilization based on the pace of residence, education, and wealth index. Conclusion In developing countries, the problem of inequity in utilizing maternal health care services persists and needs considerable attention.
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Affiliation(s)
- Addisu Alemayehu Gube
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Edit Murányi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Jozsef Vitrai
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Szimonetta Lohner
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
- Cochrane Hungary, Medical School, University of Pécs, Pécs, Hungary
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Lori JR, Kukula VA, Liu L, Apetorgbor VEA, Ghosh B, Awini E, Lockhart N, Amankwah G, Zielinski R, Moyer CA, Williams J. Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana. BMC Pregnancy Childbirth 2024; 24:37. [PMID: 38182969 PMCID: PMC10768124 DOI: 10.1186/s12884-023-06224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. METHODS A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. RESULTS Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. CONCLUSION While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. TRIAL REGISTRY Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).
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Affiliation(s)
- Jody R Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America.
| | - Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Liya Liu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | | | - Bidisha Ghosh
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Elizabeth Awini
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Nancy Lockhart
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Georgina Amankwah
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Ruth Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - John Williams
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
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Akum LA, Offei EA, Kpordoxah MR, Yeboah D, Issah AN, Boah M. Compliance with the World Health Organization's 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth outcomes among pregnant women in northern Ghana. PLoS One 2023; 18:e0285621. [PMID: 37289811 PMCID: PMC10249792 DOI: 10.1371/journal.pone.0285621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Children born with adverse birth outcomes (ABOs) have a greater risk of mortality, stunting, and poor cognitive development. In 2016, the World Health Organization (WHO) recommended at least eight antenatal care (ANC) contacts before delivery for a healthy mother and baby. We examined the association between compliance with this recommendation and the risk of ABOs, such as low birthweight (LBW) and preterm birth (PTB), in the Tamale Metropolitan Area of the northern region of Ghana. METHODS We conducted a cross-sectional study in the Tamale Metropolis of the northern region of Ghana. We analysed a systematic random sample of 402 postnatal women aged 15-49 drawn from five public health facilities. We gathered information electronically on their birth outcomes, specifically their birthweight and gestation at delivery, using a structured questionnaire. Information on women's background characteristics, including the number of ANC contacts made before delivery, was also collected. The association between the number of ANC contacts and ABOs was investigated using regression models. RESULTS We found that 37.6% (95% CI: 32.9, 42.4) of our sample had at least eight ANC contacts before delivery. We estimated that 18.9% of babies were born prematurely and 9.0% were born LBW. ABOs were found in 22.9% (95% CI: 19.0, 27.3) of babies. A minimum of eight ANC contacts before delivery reduced the risk of ABOs (adjusted IRR = 0.43; 95% CI: 0.25, 0.73), PTB (AOR = 0.28; 95% CI: 0.14, 0.58), and LBW (AOR = 0.36; 95% CI: 0.14, 0.91). CONCLUSION In the current study's setting, about a quarter of newborns have ABOs, jeopardising their survival, health, and development. Compliance with at least eight ANC contacts prior to birth was associated with a reduced incidence rate ratio of ABOs. However, less than four out of every ten pregnant women make at least eight ANC contacts before delivery. Efforts are needed to increase coverage of eight contacts among pregnant women before delivery to reduce the risk of ABOs in the study setting.
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Affiliation(s)
- Leticia Achangebe Akum
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Eunice Amina Offei
- Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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Gezae KE, Berhie KA, Gebresilassie AA, Tsadik M. Contextual Disparity on Trend and Determinants of Optimal Antenatal Care (ANC4+) Use for Women in Eastern Tigray, Ethiopia: Evidence from KA-HDSS Database. Int J Womens Health 2023; 15:511-521. [PMID: 37038463 PMCID: PMC10082613 DOI: 10.2147/ijwh.s399956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
Background Though optimal antenatal care (ANC4+) use is absolutely critical, only 43% of women had ANC4+ in Ethiopia and nearly 64% in Tigray in 2019. Furthermore, only 20% of women had their first ANC visit during their first trimester in 2016. However, there is no literature on area based disparity of ANC4+ use in Tigray. Therefore, this study is aimed to generate evidence for ANC4+ use using the Kilite-Awlaelo Health and Demographic Surveillance System (KA-HDSS) database. Methods A population-based longitudinal study was employed on 5,414 women from 12 kebelles included in the KA-HDSS site of Tigray. A pregnancy database was used as a source of data. A Line graph was used to depict the trend of ANC4+ use. A stratified robust Poisson model was fitted to estimate the incidence rate ratio (IRR) for women from rural and urban areas separately. Results The ANC4+ coverage was 36.3% (95% CI=35.0-37.6%) - 34.2% in rural versus 52.8% urban areas, with an increasing linear trend. Single marital status (IRR=1.29; 95% CI=1.17-1.42); able to read and write (IRR=1.15; 95% CI=1.01-1.32); primary education (IRR=1.22; 95% CI=1.11-1.34); ANC follow-up (2015-2018) (IRR=1.42; 95% CI=1.23-1.64); previous pregnancy exposure (IRR=2.20; 95% CI=1.98-2.45); and having 6+ children (IRR=1.11; 95% CI=1.01-1.21) determined ANC4+ use for rural women. Marital status (Divorced/widowed/separated) (IRR=0.79; 95% CI=0.66-0.95); primary education (IRR=1.44; 95% CI=1.16-1.79); ANC follow-up (2015-2018) (IRR=2.00; 95% CI=1.59-2.50); previous pregnancy exposure (IRR=1.54; 95% CI=1.31-1.80); and having 6+ children (IRR=1.18; 95% CI=1.07-1.31) determined the ANC4+ use for urban women. Conclusion The optimal ANC coverage is significantly low, with significant disparity by geographical area and increasing trend. However, further efforts have to be made to maximize the optimal use of ANC, particularly for women from rural areas.
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Affiliation(s)
- Kebede Embaye Gezae
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- Correspondence: Kebede Embaye Gezae, Email
| | - Kidanemariam Alem Berhie
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Assefa Ayalew Gebresilassie
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mache Tsadik
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Dickson KS, Boateng ENK, Adde KS, Ameyaw EK, Munro-Kramer ML. Non-adherence to WHO's recommended 8-contact model: geospatial analysis of the 2017 Maternal Health Survey. BMC Pregnancy Childbirth 2023; 23:192. [PMID: 36934240 PMCID: PMC10024456 DOI: 10.1186/s12884-023-05504-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: 06/29/2022] [Accepted: 03/07/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Evidence shows that most women in Ghana do not meet the minimum 8-contact model for antenatal care as recommended by WHO with only 31.2%-41.9% of them meeting the recommendation. To the best of our knowledge, no study in Ghana has examined women's noncompliance with the WHO's recommended 8-contact model for antenatal care using geospatial analysis, as this study sets out to do. METHODS We sourced data from the recent version of the Ghana Maternal Health Survey which was executed in 2017. A sample of 10,077 women with complete data participated in this study. The link between the explanatory variables and the outcome variable was investigated using binary and multivariate logistic regression models and Spatial analyses such as spatial autocorrelation (Moran's I), hotspot, cluster and outlier analysis, and geographically weighted regression were conducted using ArcMap version 10.7. RESULTS Districts found in the north-eastern and south-western parts of the country were more likely to experience noncompliance with ANC. Women staying within the middle belt without health insurance were more likely (17-29%) to be noncompliant with ANC. Women with low community socioeconomic status were found to be more likely (17-34%) to be noncompliant with ANC in the eastern parts of Ghana. CONCLUSION The study has shown that in order to achieve targets one and three of Sustainable Development Goal 3, the government of Ghana, the Ministry of Health, together with the Ghana Health Service may have to intensify health education in the identified areas to highlight the importance of adherence to the WHO recommendations on ANC 8-contact model.
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Affiliation(s)
- Kwamena Sekyi Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N. K. Boateng
- grid.413081.f0000 0001 2322 8567Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - 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, Hong Kong, Hong Kong
- L and E Research Consult Ltd, Upper West Region Wa, Ghana
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Ambaye E, Regasa ZW, Hailiye G. Early initiation of antenatal care and its associated factors among pregnant women attending antenatal care at public health centres in Bahir Dar Zuria zone, Northwest Ethiopia, 2021: a cross-sectional study. BMJ Open 2023; 13:e065169. [PMID: 36635035 PMCID: PMC9843213 DOI: 10.1136/bmjopen-2022-065169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This study aimed to assess the prevalence of, and factors associated with, early initiation of antenatal care (ANC) follow-up among pregnant women attending ANC services at Bahir Dar Zuria zone public health centres (HCs), Bahir Dar, Northwest Ethiopia. DESIGN An institution-based, cross-sectional study was conducted from 15 December 2020 to 1 March 2021. A systematic random sampling technique was applied to select the study participants. SETTING Five public HCs (Han HC, Shimbit HC, Dagmawi Minilik HC, Shumabo HC and Meshentie HC) in Bahir Dar Zuria zone. PARTICIPANTS Pregnant mothers who were attending their ANC service during the data collection period were enrolled in this study. A total of 592 mothers were interviewed for the study. OUTCOME MEASURE Early initiation of ANC services (within 16 weeks of gestation). RESULTS 48.6% (95% CI 41.6% to 53.5%) of participants began their first ANC service before 16 weeks of gestation. Family size less than five (adjusted OR 2.0, 95% CI 1.25 to 3.25), urban residence (3.0, 1.48 to 6.17), secondary education (2.1, 1.3 to 3.6), college-level education and above (3.5, 1.8 to 6.8), primigravida (2.6, 1.65 to 4.14), planned pregnancy (3.5, 1.5 to 8.1) and knowledge about early initiation of ANC (1.7, 1.14 to 2.55) were significantly associated with early initiation of ANC. CONCLUSION A substantial number of participants had not received ANC services in a timely manner. Sociodemographic and obstetric characteristics of the respondents were associated with timely booking of ANC services. Dissemination of information about recommended time to initiate ANC services and efforts to improve women's educational status to increase knowledge about early initiation of ANC are needed in the region.
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Affiliation(s)
- Eskahun Ambaye
- Health Informatics, Bahir Dar Health Science College, Bahir Dar, Ethiopia
| | | | - Gizaw Hailiye
- College Of Health science, Debre Markos University, Debre Markos, Ethiopia
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Woldeamanuel BT. Factors associated with inadequate prenatal care service utilization in Ethiopia according to the WHO recommended standard guidelines. Front Public Health 2022; 10:998055. [PMID: 36408015 PMCID: PMC9670123 DOI: 10.3389/fpubh.2022.998055] [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: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Adequate maternal health care could prevent 54% of maternal deaths in low- and middle-income countries. In Ethiopia, the maternal mortality rate was reduced from 817 to 412 deaths per 100,000 live births between 2000 and 2016. Thus, the current study focuses on the adequacy of prenatal care (PNC) services rather than the mere prenatal contacts available to assess compliance with the WHO recommended standard guidelines. Methods A nationally representative cross-sectional dataset from the Ethiopian Mini Demographic and Health Survey 2019 was analyzed. Risk factors for prenatal care adequacy were assessed using a multilevel ordinal logistic regression model. Results About 43% of women met the old WHO recommendation of at least four prenatal contacts, while only 3.5% of women met the new WHO recommended minimum of eight prenatal contacts. The overall adequacy of prenatal care based on the four prenatal care utilization indicators was 52.1% no PNC, 37.4% received inadequate PNC and 10.5% received adequate PNC. Being a rural resident [AOR = 0.694 (95% CI: 0.557, 0.865)] and wanting no more children [AOR = 0.687 (95% CI: 0.544, 0.868)] are associated with inadequate prenatal care. Higher educational attainment of women and spouses, exposure to the media, upper wealth quintile, and a perceived shorter distance to a health facility were significantly associated with adequate prenatal care. Conclusion The prevalence of adequate prenatal care was lower. Multi-sectoral efforts are needed to improve maternal health targets by reducing maternal mortality through improved health care services.
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Anaba EA, Afaya A. Correlates of late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age: insights from the 2019 Ghana Malaria Indicator Survey. BMJ Open 2022; 12:e058693. [PMID: 35793917 PMCID: PMC9260762 DOI: 10.1136/bmjopen-2021-058693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study assessed the correlates of late initiation and underutilisation of the WHO's recommended eight or more antenatal care visits among women in Ghana. DESIGN We analysed secondary data from 2163 women in the 2019 Ghana Malaria Indicator Survey, which collected data on malaria and antenatal care indicators among women of reproductive age across the previous 10 regions of Ghana. SETTING AND PARTICIPANTS Women of reproductive age across the 10 regions of Ghana. MAIN OUTCOME MEASURES Late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age. RESULTS About half (49%) of the participants were between the ages of 25 and 34 years; mean (±SD)=30 (±7.10). The majority (57%) of the participants obtained less than eight antenatal care visits, while 32% initiated antenatal care visits after the first trimester. The significant factors associated with the late initiation of antenatal care visits were age, region and parity (p<0.05). Factors associated with underutilisation of the recommended eight or more antenatal care visits were marital status, wealth index, parity, region and place of residence (p<0.05). CONCLUSION A majority of the women underused antenatal care services. A significant minority of the women started antenatal care visits late. Socio-demographic factors, parity and socioeconomic factors were identified as the significant factors associated with the late initiation and underutilisation of antenatal care services. Maternal health interventions should prioritise young, multiparous and poor women.
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Affiliation(s)
- Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Agani Afaya
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Anaba EA, Alor SK, Badzi CD. Utilization of antenatal care among adolescent and young mothers in Ghana; analysis of the 2017/2018 multiple indicator cluster survey. BMC Pregnancy Childbirth 2022; 22:544. [PMID: 35790931 PMCID: PMC9254585 DOI: 10.1186/s12884-022-04872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Complications during pregnancy and childbirth are the leading cause of death among adolescent girls. In Ghana, the prevalence of adolescent pregnancy remains high. Yet, little is known about ANC utilization among adolescent and young mothers. This study aimed to assess the prevalence of obtaining 4 or more ANC visits and associated factors among adolescent and young mothers. Methods We analysed secondary data from the sixth round of the Ghana Multiple Indicator Cluster Survey. A total of 947 adolescent and young mothers were included in this study. Data were analysed using STATA/SE, version 16, employing descriptive statistics and Binary Logistic Regression. Results It was found that majority of the participants were aged 20-24 years (70%), married/in union (61%) and non-insured (64%). The prevalence of obtaining 4 or more ANC visits was 84%. Adolescent and young mothers with junior high school education, in the second wealth quintile, exposed to the internet, and resided in the Upper East region had a higher likelihood of obtaining 4 or more ANC visits (p < 0.05). Conclusions This study demonstrated that optimal ANC utilization among adolescent and young mothers were determined by socio-economic factors. Going forward, maternal healthcare interventions must prioritize adolescent and young mothers from poor socio-economic backgrounds.
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Ekholuenetale M, Nzoputam CI, Okonji OC. Association between socio-economic factors and HIV self-testing knowledge amongst South African women. South Afr J HIV Med 2022; 23:1347. [PMID: 35399747 PMCID: PMC8991179 DOI: 10.4102/sajhivmed.v23i1.1347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes. Objectives This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women. Method We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05. Results The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9–26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37–11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51–0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection. Conclusion Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chimezie I. Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, Nigeria
- Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
| | - Osaretin C. Okonji
- School of Pharmacy, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
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Yehualashet DE, Seboka BT, Tesfa GA, Mamo TT, Seid E. Determinants of optimal antenatal care visit among pregnant women in Ethiopia: a multilevel analysis of Ethiopian mini demographic health survey 2019 data. Reprod Health 2022; 19:61. [PMID: 35248079 PMCID: PMC8898451 DOI: 10.1186/s12978-022-01365-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Optimal antenatal care (ANC4+) needs to be used throughout pregnancy to reduce pregnancy complications and maternal mortality. The World Health Organization (WHO) recommends eight ANC contacts, while Ethiopia has the lowest coverage of at least four ANC visits. Therefore, this study aimed to identify factors associated with optimal ANC visits among pregnant women in Ethiopia. Methods This study is a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). A multilevel logistic regression model is set up to identify factors associated with optimal ANC visits. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to estimate the strength of the association between the outcome and the predictor variables. Results Overall, 43% of women had optimal ANC visits during their last pregnancy. Higher educated women are 3.99 times more likely (AOR = 3.99; 95% CI: 2.62–6.02) to have optimal ANC visits than women with no formal education. The wealthiest women are 2.09 times more likely (AOR = 2.09; 95% CI: 1.56–2.82) to have optimal ANC visits than women in the poorest quintile. The odds of optimal ANC visit is 42 percent lower in rural women (AOR = 0.58, 95% CI: 0.41–0.83) compared to women living in urban areas. Conclusion Women's educational status, wealth status, mass media exposure, place of residence and region are factors that are significantly associated with optimal ANC visit. These findings help health care programmers and policymakers to introduce appropriate policies and programs to ensure optimal ANC coverage. Priority should be given to addressing economic and educational interventions. Optimal antenatal care means attending at least four antenatal care visits during pregnancy. In Ethiopia, evidence on factors affecting the use of at least four antenatal care services has not been adequately documented. Using the 2019 Ethiopian Mini Demographic and Health Survey data, this study attempted to uncover factors associated with optimal antenatal care visits among pregnant women in Ethiopia. Data for women aged 15–49 who gave birth five years before the survey and attended antenatal care visits for their last pregnancy were taken from the 2019 Ethiopian Mini Demographic and Health Survey. Accordingly, 3927 women were included in the analysis. Coverage of optimal antenatal care visits is low among pregnant women in Ethiopia. In this study, only 43% of pregnant women received optimal antenatal care. Women’s educational status, household wealth status, household size, mass media exposure, place of residence, and administrative region were associated with optimal antenatal care visits. Strategies to increase access and availability of antenatal care services are important, especially for communities in rural areas and disadvantageous regions. Financial assistance that allows mothers from poor families to access antenatal care services can be beneficial. Health promotion programs targeting uneducated mothers are important to raise awareness of the importance of receiving a minimum of four antenatal care services.
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Barrow A, Barrow S, Jobe A. Differentials in prevalence and correlates on uptake of tetanus toxoid and intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy: A community-based cross-sectional study in The Gambia. SAGE Open Med 2022; 10:20503121211065908. [PMID: 35024140 PMCID: PMC8744190 DOI: 10.1177/20503121211065908] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: The study examined the differentials in prevalence and correlates on the
uptake of tetanus toxoid and intermittent preventive treatment of malaria
among pregnant women in The Gambia. Methods: The 2018 data from The Gambia Multiple Indicators Cluster Survey were
analyzed. Data from 6143 women of reproductive age who have given birth were
extracted for the analysis. Percentages and Chi-square tests were used. In
addition, a multivariable logistic regression model was used to calculate
the adjusted odds ratios (with a corresponding 95% confidence interval). The
level of significance was set at p < 0.05. Results: The prevalence of tetanus toxoid uptake among women in The Gambia was 88.2%,
while that of the adequate tetanus toxoid doses was 34.8%. The prevalence of
intermittent preventive treatment with sulfadoxine-pyrimethamine uptake
among maternal women in The Gambia was 98.6%, while that of the adequate
intermittent preventive treatment with sulfadoxine-pyrimethamine doses taken
was 34.3%. The identified statistically significant covariates of tetanus
toxoid immunization and intermittent preventive treatment with
sulfadoxine-pyrimethamine uptake includes women’s age, local government
areas, parity, use of radio, use of newspaper, and antenatal care
visits. Conclusion: The current utilization rate for adequate intermittent preventive treatment
with sulfadoxine-pyrimethamine and tetanus toxoid immunization during
pregnancy in The Gambia is very low and even below universal levels. The
country needs to strengthen more and effective mass media advocacy programs
that would target both rural and urban populace, and motivate maternal women
to ensure adequate vaccination against malaria and tetanus.
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Affiliation(s)
- Amadou Barrow
- Department of Public and Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
| | - Sulayman Barrow
- Department of Public and Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia.,Public Health Unit, Brikama District Hospital, Ministry of Health, Brikama, The Gambia
| | - Amienatta Jobe
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
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Mohammed A, Dwomoh D, Nonvignon J. The impact of maternal and child health and nutrition improvement project on maternal health service utilization in Ghana: An Interrupted time series analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000372. [PMID: 36962325 PMCID: PMC10021576 DOI: 10.1371/journal.pgph.0000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
Abstract
Maternal and Child Health and Nutrition Improvement Project (MCHNP) is an intervention that, adopts financial strategies to provide incentives as a means of motivating community health workers and ensuring accountability. This study highlights on the service delivery component of the intervention; thus, utilization of essential community nutrition and health action. This paper aims to determine the differential impact of MCHNP on maternal health service utilization in Ghana. A retrospective longitudinal pre-test post-test study design was employed. Six administrative regions were used for analyzing the impact of the intervention in uptake of maternal health services. Administrative data were extracted from the DHIMS2 database for the periods of January 2014 to December 2018. Analysis was conducted using interrupted time series analysis (ITSA) due to the absence of a control group. The difference in the pre-intervention and post-intervention means were statistically significant in the Central, Western, Eastern and Upper West region for the proportion of ANC 4 visits. With the exception of Northern region that recorded negative impact (-0.005; p-value >0.05), all the remaining regions recorded positive impacts on the percentage of women that had 4 ANC visits. All six regions had positive impacts in the proportion of women that received supervised delivery. However, none of these impacts were statistically significant; thus, the MCHNP intervention had no significant impact on maternal health outcomes which are, ANC four visits and skilled deliveries.
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Affiliation(s)
- Arif Mohammed
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
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Ekholuenetale M, Nzoputam CI, Barrow A. Effects of socioeconomic factors and booking time on the WHO recommended eight antenatal care contacts in Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000136. [PMID: 36962339 PMCID: PMC10022028 DOI: 10.1371/journal.pgph.0000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022]
Abstract
Antenatal care (ANC) is an important intervention that has been linked to reduce maternal and newborn adverse outcomes. However, the long years of war in Liberia may have contributed to the poor health indices including the uptake of maternal health care services. The objective of this study was to determine the marginal interaction effects between booking time and socioeconomic factors in eight or more ANC contacts. A total sample of 4,185 women who had given birth were included in this study. The 2020 Liberia Demographic and Health Survey (LDHS) dataset was analyzed. The outcome variable was eight or more ANC contacts. Percentage and Chi-square test were used in univariate and bivariate analyses respectively. The marginal interaction effects between booking time and socioeconomic factors of eight or more ANC contacts were estimated. The statistical significance was determined at 5%. The weighted prevalence of eight or more ANC contacts was 26.6% (95% CI: 23.8%, 29.6%). The uptake of eight or more ANC contacts increased steadily by increasing women's level of education and household wealth index. Women with higher educational attainment had a prevalence of 49.0% (95%CI: 36.5%, 61.6%) and those in the richest households had an estimated prevalence of 31.4% (95%CI: 24.9%, 38.8%) respectively. Furthermore, the urban dwellers had a weighted eight or more ANC contacts prevalence of 29.0% (95%CI: 24.6%, 34.0%). The key finding is increased marginal interaction effects for higher education and early booking (48.4%), richest households and early booking (35.4%), and urban residential status and early booking (36.2%) respectively. Overall, the prevalence of eight or more ANC contacts was low. However, we found higher coverage of eight or more ANC contacts among women who initiated ANC within the first trimester and among those with higher socioeconomic status. We recommend the Liberian government to design and/or support programmes targeted at promoting early ANC initiation and supporting the disadvantaged women such as the uneducated, poor and those living in rural or remote settings.
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Affiliation(s)
- Michael Ekholuenetale
- Faculty of Public Health, Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chimezie Igwegbe Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, Nigeria
- Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
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Apanga PA, Kumbeni MT. Association between early antenatal care and antenatal care contacts across low-and middle-income countries: effect modification by place of residence. Epidemiol Health 2021; 43:e2021092. [PMID: 34735758 PMCID: PMC8920740 DOI: 10.4178/epih.e2021092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The relationship between early antenatal care (ANC) and having eight or more antenatal contacts (ANC8+) have not been well characterised across low-and middle-income countries (LMICs). It is also unclear whether the association between early ANC and ANC8+ is modified by a woman's place of residence. Our primary aim was to assess the relationship between early ANC and ANC8+ and assessed whether this relationship was modified by place of residence. We also estimated the coverage of ANC8+ across LMICs. Methods We analysed data on 207388 mothers with a live birth using multiple indicator cluster surveys (MICSs) from 30 LMICS conducted between 2017 and 2020. Modified Poisson regression with a robust variance was used to assess the relationship between early ANC and ANC8+, whilst adjusting for country, clustering, stratification and sampling weights. Effect modification by place of residence was assessed on the additive and multiplicative scales. Meta-analysis was used to pool prevalent estimates of ANC8+ across all countries. Results The overall prevalence of ANC8+ was 35.6% and ranged from 1.7% in Madagascar to 99.4% in Belarus. Early ANC was positively associated with ANC8+ [adjusted prevalence ratio (aPR): 2.61, 95% CI: 1.82,3.74]. There was evidence of positive effect modification on the additive [relative excess risk due to interaction (RERI): 0.39, 95% CI: 0.35, 0.44] and multiplicative (aPR: 1.78, 95% CI: 1.08, 2.95) scales. Conclusion Many LMICs may not have adopted the WHO 2016 guidelines on ANC8+. Women who had early ANC were more likely to have ANC8+, particularly those in rural areas.
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Ekholuenetale M, Onuoha H, Ekholuenetale CE, Barrow A, Nzoputam CI. Socioeconomic Inequalities in Human Immunodeficiency Virus (HIV) Sero-Prevalence among Women in Namibia: Further Analysis of Population-Based Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179397. [PMID: 34501987 PMCID: PMC8431544 DOI: 10.3390/ijerph18179397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022]
Abstract
Socioeconomic inequality is a major factor to consider in the prevention of human immunodeficiency virus (HIV) transmission. The aim of this study was to investigate socioeconomic inequalities in HIV prevalence among Namibian women. Data from a population-based household survey with multistage-stratified sample of 6501 women were used to examine the link between socioeconomic inequalities and HIV prevalence. The weighted HIV prevalence was 13.2% (95% CI: 12.1–14.3%). The HIV prevalence among the poorest, poorer, middle, richer, and richest households was 21.4%, 19.7%, 16.3%, 11.0%, and 3.7%, respectively. Similarly, 21.2%, 21.7%, 11.8%, and 2.1% HIV prevalence was estimated among women with no formal education and primary, secondary, and higher education, respectively. Women from poor households (Conc. Index = −0.258; SE = 0.017) and those with no formal education (Conc. Index = −0.199; SE = 0.015) had high concentration of HIV infection, respectively. In light of these findings, HIV prevention strategies must be tailored to the specific drivers of transmission in low socioeconomic groups, with special attention paid to the vulnerabilities faced by women and the dynamic and contextual nature of the relationship between socioeconomic status and HIV infection.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200284, Nigeria
- Correspondence:
| | - Herbert Onuoha
- Department of Tropical Hygiene and Public Health, Medical Faculty, Heidelberg University, 69117 Heidelberg, Germany;
| | | | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing 3530, The Gambia;
| | - Chimezie Igwegbe Nzoputam
- Department of Community Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City 300001, Nigeria;
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Kumbeni MT, Apanga PA, Yeboah EO, Kolog JT, Awuni B. The relationship between time spent during the first ANC contact, home visits and adherence to ANC contacts in Ghana. Glob Health Action 2021; 14:1956754. [PMID: 34402419 PMCID: PMC8381959 DOI: 10.1080/16549716.2021.1956754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The World Health Organization in 2016 recommended eight or more antenatal care (ANC) contacts for a positive pregnancy experience, however, it is unclear what impact the time spent during the first ANC contact and home visits can have on eight or more ANC contacts. Objectives Our study investigated the relationship between time spent during the first ANC contact and eight or more ANC contacts, and between home visits and eight or more ANC contacts. We also assessed the prevalence of eight or more ANC contacts. Methods A cross-sectional study was conducted among 519 mothers with children 12 months old and below attending child welfare clinics in the Nabdam district in the Upper East Region, Ghana. Multivariable logistic regression analysis was used to assess the relationship between time spent during the first ANC contact, home visits, and eight or more ANC contacts, while controlling for potential confounders. Results The proportion of mothers who attained eight or more ANC contacts during pregnancy was 31.2%. Spending 20 minutes or more during the first ANC contact was associated with 2.07 times the odds of having eight or more ANC contacts compared to spending less than 20 minutes [adjusted odds ratio (aOR): 2.07, 95% CI: 1.18,3.63]. Mothers who received at least a home visit from skilled health professionals during pregnancy were 2.44 times more likely to have eight or more ANC contacts compared to mothers who were not visited (aOR: 2.44, 95% CI: 1.51,3.94). Conclusion Spending at least 20 minutes during the first ANC contact and home visits were positively associated with eight or more ANC contacts. We recommend that skilled health professionals should spend at least 20 minutes during the first ANC contact as well as encourage home visits in order to increase the coverage of eight or more ANC contacts.
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Affiliation(s)
| | | | - Eugene Osei Yeboah
- Ghana Health Service, Bolgatanga East District Health Directorate, Zuarungu, Ghana
| | | | - Baba Awuni
- Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana
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