1
|
Blizzard S, Dennis M, Subah M, Tehoungue BZ, Zizi R, Kraemer JD, White E, Hirschhorn LR. A repeated cross-sectional study of the association of community health worker intervention with the maternal continuum of care in rural Liberian communities. BMC Pregnancy Childbirth 2023; 23:841. [PMID: 38062415 PMCID: PMC10701987 DOI: 10.1186/s12884-023-06162-8] [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: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The maternal continuum of care (CoC) (antenatal care, facility-based delivery, postnatal care) is critical to maternal and neonatal health and reducing mortality, but completion in rural areas of low- and middle-income countries is often limited. We used repeated cross-sectional household surveys from a rural Liberian county to explore changes in rates of completion of all steps and no steps in the maternal CoC after implementation of the National Community Health Assistant Program (NCHAP), a community health worker (CHW) intervention designed to increase care uptake for families over five kilometers from a facility. METHODS We analyzed repeated cross-sectional household surveys of women aged 18-49 served by NCHAP in Rivercess County, Liberia. We measured survey-weighted, before-to-after implementation difference in completion of all steps and no steps in the maternal CoC. We used multivariable regression to explore covariates associated with completion rates before and after NCHAP implementation. RESULTS Data from surveys conducted at three timepoints (2015, n = 354; 2018, n = 312; 2021, n = 302) were analyzed. A significant increase in completing the full maternal CoC (2015:23.6%, 2018:53.4%, change:29.7% points (pp), 95% confidence interval (CI) [21.0,38.4]) and a decrease in completing no steps in the CoC (2015:17.6%, 2018:4.0%, change: -12.4pp [-17.6, -7.2]) after implementation of NCHAP were observed from 2015 to 2018, with rates maintained from 2018 to 2021. Living farther from a facility was consistently associated with less care across the continuum. Following implementation, living in a motorbike accessible community was associated with completing the CoC while living in a mining community was negatively associated with omitting the CoC. Household wealth was associated with differences in rates pre-NCHAP but not post-NCHAP. CONCLUSIONS Following NCHAP implementation, completion rate of the full maternal CoC in Rivercess County more than doubled while the rate of completing no steps in the continuum fell below 5%. These rates were sustained over time including during COVID-19 with reduced differences across wealth groups, although far distances remained a risk for less care. CHW programs providing active outreach to remote communities can be important tools for improving uptake of interventions and reducing risk of no formal care during and after pregnancy.
Collapse
Affiliation(s)
- Sam Blizzard
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | | | | | | | - John D Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington, DC, USA
| | | | - Lisa R Hirschhorn
- Department of Medical Social Sciences and Ryan Family Center for Global Primary Care, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
2
|
Mroz EJ, Willis T, Thomas C, Janes C, Singini D, Njungu M, Smith M. Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia. Int J Health Geogr 2023; 22:17. [PMID: 37525198 PMCID: PMC10391775 DOI: 10.1186/s12942-023-00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Seasonal floods pose a commonly-recognised barrier to women's access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women's walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
Collapse
Affiliation(s)
- Elizabeth Jade Mroz
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Thomas Willis
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Thomas
- Lincoln Centre for Water & Planetary Health, University of Lincoln, Lincoln, LN6 7DW, UK
| | - Craig Janes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwimanenwa Njungu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mark Smith
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
3
|
Zhang C, Lu J. Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991-2015: An Ecological Systems Theory Perspective. Healthcare (Basel) 2023; 11:healthcare11101374. [PMID: 37239658 DOI: 10.3390/healthcare11101374] [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: 03/05/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. METHODS The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991-2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. RESULTS The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009-2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. CONCLUSIONS Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals.
Collapse
Affiliation(s)
- Changli Zhang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, China
| |
Collapse
|
4
|
Hussain I, Nausheen S, Rizvi A, Ansari U, Baz M, Zehra K, Yameen S, Hackett K, Lassi Z, Canning D, Shah I, Soofi SB. Distance-quality trade-off and choice of family planning provider in urban Pakistan. Int Health 2022:6726654. [PMID: 36170976 DOI: 10.1093/inthealth/ihac063] [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: 03/09/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is limited evidence between contraceptive use, availability of commodities and distance to the facility in developing countries. Distance to the facility is an essential determinant of contraceptive use. Still, women may not seek family planning services from the nearest facility and may be prepared to travel the farthest distance to receive quality family planning services. METHODS We analyzed women's survey data linked to health facility data and applied an alternate specific conditional logit model to examine the distance a woman is prepared to travel and the quality of services offered by facilities in urban areas in Karachi, Pakistan. RESULTS This study analyzed data from 336 women and 28 facilities and identified that the mean distance to the nearest facility was 0.44 km; the chosen facility was, on average, 5 km away. Women preferred facilities that offered a range of contraceptive methods and additional services provided by female healthcare providers only. Furthermore, on average, women are willing to travel a further 1.7 km for a facility that offers more family planning methods, 1.4 km for a facility that offers additional health services and 11 km for a facility that offers services delivered by female healthcare providers. CONCLUSIONS The findings highlight the quality measures women prioritize over distance and consider essential when choosing a family planning facility.
Collapse
Affiliation(s)
- Imtiaz Hussain
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Sidrah Nausheen
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi 74800, Pakistan
| | - Arjumand Rizvi
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Uzair Ansari
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Mir Baz
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Kaneez Zehra
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Sahar Yameen
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Kristy Hackett
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Zohra Lassi
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - David Canning
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Iqbal Shah
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Sajid Bashir Soofi
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi 74800, Pakistan.,Department of Paediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| |
Collapse
|
5
|
Hailemariam T, Atnafu A, Gezie LD, Tilahun B. Why maternal continuum of care remains low in Northwest Ethiopia? A multilevel logistic regression analysis. PLoS One 2022; 17:e0274729. [PMID: 36121833 PMCID: PMC9484641 DOI: 10.1371/journal.pone.0274729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 09/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-adherence to the maternal continuum of care remains a significant challenge. Though early initiation and continuum of care are recommended for mothers' and newborns' well-being, there is a paucity of evidence that clarify this condition in resource-limited settings. This study aimed to assess the level of women's completion of the maternal continuum of care and factors affecting it in Northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from October to November, 2020. Data were collected from 811 women who had a recent history of birth within the past one year. The random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval. The p-value of 0.05 was used to declare significantly associated factors with women's completion of the maternal continuum of care. RESULTS The study revealed that 6.9% (95%CI: 5.3-8.9%) of women were retained fully on the continuum of maternal care, while 7.89% of women did not receive any care from the existing healthcare system. Attending secondary and above education (AOR = 3.15; 95%CI: 1.25,7.89), membership in the women's development army (AOR = 2.91; 95%CI: 1.56,5.44); being insured (AOR = 2.59; 95%CI: 1.33,5.01); getting health education (AOR = 2.44; 95%CI: 1.33,4.45); short distance to health facility (AOR = 4.81; 95%CI: 1.55,14.95); and mass-media exposure (AOR = 2.39; 95%CI: 1.11,5.15) were significantly associated with maternal continuum of care. CONCLUSIONS The maternal continuum of care is low in rural northwest Ethiopia compared to findings from most resource-limited settings. Therefore, the existing health system should consider multilevel intervention strategies that focus on providing maternal health education, facilitating insurance mechanisms, encouraging women's participation in health clubs, and ensuring physical accessibility to healthcare facilities to be more effective in improving maternal health services.
Collapse
Affiliation(s)
- Tesfahun Hailemariam
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Health Informatics, College of Health Sciences, Hawassa, Ethiopia
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Bora K, Barman B, Pala S, Das A, Doke G, Tripura A. Coverage of antenatal iron-folic acid and calcium distribution during pregnancy and their contextual determinants in the northeastern region of India. Front Nutr 2022; 9:894245. [PMID: 35923196 PMCID: PMC9339897 DOI: 10.3389/fnut.2022.894245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Iron-folic acid (IFA) and calcium supplementation are nutritional interventions recommended prophylactically (against maternal anemia and preeclampsia, respectively) to all antenatal mothers in India under basic antenatal care (ANC) services. Using Health Management Information System data (reporting period: 2018–19 to 2020–21), we mapped the coverage of antenatal IFA and calcium distribution across the remote northeastern region of India relative to the number of pregnant women (PW) who registered for ANC, disaggregated by states and districts. Variations in coverage were also investigated by subgroups based on contextual attributes, viz., physiography (hilly/ plateau/ plain), socioeconomic development (“aspirational”/ “non-aspirational”) and proportion of early ANC visits (low/ medium/ high). Full course of antenatal IFA and calcium supplements were received by 79.36 (95% CI: 79.31–79.40) and 61.26 (95% CI: 61.21–61.32) PW per 100 ANC registered women, respectively. There was widespread heterogeneity in outreach, with calcium coverage generally trailing behind IFA coverage. Among states, coverage of the two interventions (per 100 ANC registered women) was highest in Assam (97.06 and 78.11 PW, respectively) and lowest in Nagaland (24.87 and 16.77 PW, respectively). At the district-level, the two interventions failed to reach even 50 PW per 100 ANC registered women in 32 (out of 115) districts. The coverage tended to be inferior in districts that were hilly, “non-aspirational” and had low proportion of early ANC visits. The granular information provided by our findings will facilitate monitoring, root cause analyses, microplanning, informed resource allocation and tailoring of locally appropriate solutions to achieve targeted coverage improvements.
Collapse
Affiliation(s)
- Kaustubh Bora
- Hematology Division, ICMR-Regional Medical Research Centre North East Region, Dibrugarh, India
- *Correspondence: Kaustubh Bora
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Ananya Das
- Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Goter Doke
- Department of Obstetrics and Gynecology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, India
| | - Amar Tripura
- Department of Community Medicine, Agartala Government Medical College, Agartala, India
| |
Collapse
|
7
|
Kibret GD, Demant D, Hayen A. Bayesian spatial analysis of factors influencing neonatal mortality and its geographic variation in Ethiopia. PLoS One 2022; 17:e0270879. [PMID: 35776748 PMCID: PMC9249191 DOI: 10.1371/journal.pone.0270879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Ethiopia is a Sub-Saharan country with very high neonatal mortality rates, varying across its regions. The rate of neonatal mortality reduction in Ethiopia is slow, and Ethiopia may not meet the third United Nations sustainable development target by 2030. This study aimed to investigate the spatial variations and contributing factors for neonatal mortality rates in Ethiopia. METHODS We analysed data from the 2016 Ethiopian Demographic and Health Survey (EDHS), which used a two-stage cluster sampling technique with a census enumeration area as primary and households as secondary sampling units. A Bayesian spatial logistic regression model using the Stochastic Partial Differential Equation (SPDE) method was fitted accounting for socio-economic, health service-related and geographic factors. RESULTS Higher neonatal mortality rates were observed in eastern, northeastern and southeastern Ethiopia, and the Somali region had higher risks of neonatal mortality. Neonates from frequently drought-affected areas had a higher mortality risk than less drought-affected areas. Application of traditional substances on the cord increased the risk of neonatal mortality (Adjusted Odds Ratio (AOR) = 2.07, 95% Credible Interval (CrI): 1.12 to 4.30) and getting health facility delivery services had a lower odds of neonatal mortality (AOR = 0.60, 95% CrI: 0.37, 0.98). CONCLUSIONS Residing in drought-affected areas, applying traditional substances on the umbilical cord and not delivering at health facilities were associated with a higher risk of neonatal mortality. Policy-makers and resource administrators at different administrative levels could leverage the findings to prioritise and target areas identified with higher neonatal mortality rates.
Collapse
Affiliation(s)
- Getiye Dejenu Kibret
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| |
Collapse
|
8
|
Liyew B, Tarekegn GE, Kassew T, Tsegaye N, Asfaw MG, Tilahun AD, Tadesse AZ, Alamneh TS. Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0264707. [PMID: 35298490 PMCID: PMC8929549 DOI: 10.1371/journal.pone.0264707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia. Method The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05. Result This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers. Conclusion The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.
Collapse
Affiliation(s)
- Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Gebrekidan Ewnetu Tarekegn
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanet Tsegaye
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie Tadesse
- Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Biostatistics and Epidemiology, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
9
|
Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions. SUSTAINABILITY 2022. [DOI: 10.3390/su14042149] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The rural transport infrastructure sector is a critical force for sustainable development that is interwoven with many other sectors. Rural transportation is an underlying driver of many of the Sustainable Development Goals (SDGs) and a crucial contributor to many socioeconomic benefits for rural people around the world. This review paper expands upon, enhances, and cross-references the perspectives outlined in previous rural infrastructure-focused review papers. Firstly, this work gives a thorough look into the progress of the rural transportation sector in recent years by focusing on the thematic relationships between infrastructure and other components of sustainable development, namely, economics and agriculture, policy and governance, health, gender, education, and climate change and the environment. Secondly, several strategies, approaches, and tools employed by governments and practitioners within the rural transport sector are analyzed and discussed for their contributions to the wellbeing of rural dwellers in low- and middle-income countries (LMICs). These include rural roads, bridges, maintenance, and non-infrastructural approaches that include concepts such as advanced technological innovations, intermediate modes of transport (IMTs), and transport services. This paper concludes that enhancement, improvement, and extension of rural transportation infrastructure brings significant benefits to rural dwellers. However, this paper also calls for additional integration of the sector and increased usage of systems approaches that view rural transport as an active part of many other sectors and a key leverage point within rural development as a whole. Further, this paper notes areas for future research and investigation, including increased investigation of the relationship between rural transportation infrastructure and education, improved data collection and management in support of improved policymaking, improved prioritization of interventions and institutionalization of maintenance, and expansion of pro-poor transportation strategies and interventions.
Collapse
|
10
|
White E, Mendin S, Kolubah FR, Karlay R, Grant B, Jacobs GP, Subah M, Siedner MJ, Kraemer JD, Hirschhorn LR. Impact of the Liberian National Community Health Assistant Program on childhood illness care in Grand Bassa County, Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000668. [PMID: 36962465 PMCID: PMC10021826 DOI: 10.1371/journal.pgph.0000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys that included information on 1291 illness episodes. We measured before-to-after changes in care for childhood illness by qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented. We also assessed changes in whether children received oral rehydration therapy for diarrhea and malaria rapid diagnostic tests if they had a fever by a qualified provider (facility based or CHW). For these analyses, we used a difference-in-differences approach and adjusted for potential confounding using inverse probability of treatment weighting. We also assessed changes in the source from which care was received and examined changes by key dimensions of equity (distance from health facilities, maternal education, and household wealth). We found that care of childhood illness by a qualified provider increased by 60.3 percentage points (95%CI 44.7-76.0) more in intervention than comparison areas. Difference-in-differences for oral rehydration therapy and malaria rapid diagnostic tests were 37.6 (95%CI 19.5-55.8) and 38.5 (95%CI 19.9-57.0) percentage points, respectively. In intervention areas, care by a CHW increased from 0 to 81.6% and care from unqualified providers dropped. Increases in care by a qualified provider did not vary significantly by household wealth, remoteness, or maternal education. This evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective care in rural Grand Bassa County. Improvements were approximately equal across three measured dimensions of marginalization.
Collapse
Affiliation(s)
- Emily White
- Last Mile Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | - Mark J Siedner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John D Kraemer
- Department of Health Systems Administration, Georgetown University, Washington, D.C., United States of America
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| |
Collapse
|
11
|
Alamneh TS, Teshale AB, Worku MG, Tessema ZT, Yeshaw Y, Tesema GA, Liyew AM, Alem AZ. Preterm birth and its associated factors among reproductive aged women in sub-Saharan Africa: evidence from the recent demographic and health surveys of sub-Sharan African countries. BMC Pregnancy Childbirth 2021; 21:770. [PMID: 34781891 PMCID: PMC8591945 DOI: 10.1186/s12884-021-04233-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally, preterm birth is the leading cause of neonatal and under-five children mortality. Sub-Saharan African (SSA) accounts for the majority of preterm birth and death following its complications. Despite this, there is limited evidence about the pooled prevalence and associated factors of preterm birth at SSA level using nation-wide representative large dataset. Therefore, this study aimed to determine the pooled prevalence and associated factors of preterm birth among reproductive aged women. METHODS The recent Demographic and Health Surveys (DHSs) data of 36 SSA countries were used. We included a total weighted sample of 172,774 reproductive-aged women who were giving birth within five years preceding the most recent survey of SSA countries were included in the analysis. We used a multilevel logistic regression model to identify the associated factors of preterm birth in SSA. We considered a statistical significance at a p-value less than 0.05. RESULTS In this study, 5.33% (95% CI: 5.23, 5.44%) of respondents in SSA had delivered preterm baby. Being form eastern Africa, southern Africa, rural area, being educated, substance use, having multiple pregnancy, currently working history, having history of terminated pregnancy, and previous cesarean section delivery, primi-parity, and short birth interval were associated with higher odds of preterm birth among reproductive aged women. However, having better wealth index, being married, wanted pregnancy, and having four or more antenatal care visit were associated with lower odds for a preterm birth among reproductive aged women. CONCLUSION The prevalence of preterm birth among reproductive-aged women remains a major public health problem in SSA. Preterm birth was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during intervention to prevent the short-term and long-term consequences of preterm birth.
Collapse
Affiliation(s)
- Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
12
|
Higi AH, Debelew GT, Dadi LS. Perception and Experience of Health Extension Workers on Facilitators and Barriers to Maternal and Newborn Health Service Utilization in Ethiopia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910467. [PMID: 34639767 PMCID: PMC8508329 DOI: 10.3390/ijerph181910467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Background: Health extension workers (HEWs) have substantial inputs to reduce maternal and newborn morbidity and mortality in Ethiopia. However, their perceptions and experiences were not well understood. Therefore, this study aimed to explore their perceptions and experiences on facilitators and barriers to maternal and newborn health services in Ethiopia. Methods: A descriptive qualitative study was conducted from 8–28 April 2021 in Oromia, Amhara and Southern Nation, Nationality, and People’s Regional State of Ethiopia. Focused group discussions were made with purposively selected 60 HEWs. The data were transcribed verbatim and translated into English. An inductive thematic analysis was carried out using Atlas ti.7.1. The findings were presented in major themes, categories, and sub-categories with supporting quote(s). Results: The findings were categorized into two major themes (i.e., facilitators and barriers) and seven sub-themes. Community-related facilitators encompass awareness and behavior at the individual, family, and community. Significant others such as traditional birth attendants, religious leaders, women developmental armies, and kebele chairman substantially contributed to service utilization. Availability/access to infrastructures such as telephone, transportation services, and solar energy systems facilitated the service utilization. Furthermore, health facility-related facilitators include the availability of HEWs; free services; supervision and monitoring; maternity waiting rooms; and access to ambulance services. Maternal and newborn health services were affected by community-related barriers (i.e., distance, topography, religious and socio-cultural beliefs/practices, unpleasant rumors, etc.,), health facility-related barriers (i.e., health worker’s behaviors; lack of logistics; lack of adequate ambulance service, and placement and quality of health post), and infrastructure (i.e., lack or poor quality of road and lack of water). Conclusions: The HEWs perceived and experienced a wide range of facilitators and barriers that affected maternal and newborn health services. The study findings warrant that there was a disparity in behavioral factors (awareness, beliefs, and behaviors) among community members, including pregnant women. This underscores the need to design health education programs and conduct social and behavioral change communication interventions to address individuals, families, and the broader community to enhance maternal and newborn health service utilization. On the other hand, the health sector should put into practice the available strategies, and health workers provide services with empathy, compassion, and respect.
Collapse
Affiliation(s)
- Alemayehu Hunduma Higi
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
- Correspondence:
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Lelisa Sena Dadi
- Department of Epidemiology, Institute of Health, Jimma University, Jimma P.O. Box 937, Ethiopia;
| |
Collapse
|
13
|
Michaels-Strasser S, Thurman PW, Kasongo NM, Kapenda D, Ngulefac J, Lukeni B, Matumaini S, Parmley L, Hughes R, Malele F. Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo. HUMAN RESOURCES FOR HEALTH 2021; 19:53. [PMID: 33879170 PMCID: PMC8056204 DOI: 10.1186/s12960-021-00598-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/05/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be "master trainers". These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018-2019 school year and 285 in 2019-2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. CONCLUSIONS With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.
Collapse
Affiliation(s)
| | - Paul W Thurman
- Mailman School of Public Health, Columbia University, 722 West 168th St., 4th Floor, New York, NY, 10032, USA
| | - Narcisse Mwinkeu Kasongo
- Institut Supérieur Des Techniques Médicales (ISTM) de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Daniel Kapenda
- Institut Supérieur Des Techniques Médicales (ISTM) de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - John Ngulefac
- United States Health Resources and Services Administration, 5600 Fishers Lane, , Rockville, MD, 20852, USA
| | - Beatrice Lukeni
- ICAP At Columbia University, Lubumbashi, Democratic Republic of the Congo
| | - Serge Matumaini
- ICAP At Columbia University, Kinshasa, Democratic Republic of the Congo
| | - Lauren Parmley
- ICAP At Columbia University, 722 West 168th St., 13th Floor, New York, NY, 10032, USA
| | - Rebekah Hughes
- Mailman School of Public Health, Columbia University, 722 West 168th St., 4th Floor, New York, NY, 10032, USA
| | - Faustin Malele
- ICAP At Columbia University, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
14
|
Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project. J Pregnancy 2020; 2020:4318197. [PMID: 32908704 PMCID: PMC7471826 DOI: 10.1155/2020/4318197] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.
Collapse
|
15
|
Ihantamalala FA, Herbreteau V, Révillion C, Randriamihaja M, Commins J, Andréambeloson T, Rafenoarimalala FH, Randrianambinina A, Cordier LF, Bonds MH, Garchitorena A. Improving geographical accessibility modeling for operational use by local health actors. Int J Health Geogr 2020; 19:27. [PMID: 32631348 PMCID: PMC7339519 DOI: 10.1186/s12942-020-00220-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. METHODS We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest routes from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest routes estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. RESULTS We mapped over 100,000 buildings, 23,000 km of footpaths, and 4925 residential areas throughout Ifanadiana district; these data are freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than 1 h away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 h away, and vulnerable populations across the district with poor geographical access (> 1 h) to both PHCs and CHSs. CONCLUSION Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage (UHC) in rural areas throughout the world.
Collapse
Affiliation(s)
- Felana Angella Ihantamalala
- NGO PIVOT, Ranomafana, Madagascar. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Saint-Pierre, La Réunion, France
| | - Mauricianot Randriamihaja
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Jérémy Commins
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Tanjona Andréambeloson
- NGO PIVOT, Ranomafana, Madagascar.,School of Management and Technological Innovation, University of Fianarantsoa, Fianarantsoa, Madagascar
| | | | | | | | - Matthew H Bonds
- NGO PIVOT, Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Andres Garchitorena
- NGO PIVOT, Ranomafana, Madagascar.,MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
| |
Collapse
|
16
|
Jiang K, Liang L, Wang H, Li J, Li Y, Jiao M, Mao J, Wu Q. Sociodemographic determinants of maternal health service use in rural China: a cross-sectional study. Health Qual Life Outcomes 2020; 18:201. [PMID: 32580744 PMCID: PMC7313189 DOI: 10.1186/s12955-020-01453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/16/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang’s rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. Design, setting, and participants This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. Results The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. Conclusions Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women’s interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.
Collapse
Affiliation(s)
- Kexin Jiang
- Medical department, General Hospital of Heilongjiang Agricultural Reclamation, Harbin, 150088, China.,Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Libo Liang
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Haifeng Wang
- Department of ENT, Linkou County Maternal and Child Health Hospital, Mudanjiang, 150081, China
| | - Jingqun Li
- Department of Cardiology, Heihe First People's Hospital Heihe, Heihe, 157600, China
| | - Yuze Li
- Harbin NO.6 Senior High School, Harbin, 150000, China
| | - Mingli Jiao
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China. .,Department of Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150081, China.
| | - Jingfu Mao
- Department of Medical Human Resource, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, 150086, China.
| |
Collapse
|
17
|
Jiang K, Liang L, Wang H, Li J, Li Y, Jiao M, Mao J, Wu Q. Sociodemographic determinants of maternal health service use in rural China: a cross-sectional study. Health Qual Life Outcomes 2020. [PMID: 32580744 DOI: 10.1186/s12955-020-01453-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang's rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. RESULTS The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. CONCLUSIONS Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women's interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.
Collapse
Affiliation(s)
- Kexin Jiang
- Medical department, General Hospital of Heilongjiang Agricultural Reclamation, Harbin, 150088, China.,Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Libo Liang
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Haifeng Wang
- Department of ENT, Linkou County Maternal and Child Health Hospital, Mudanjiang, 150081, China
| | - Jingqun Li
- Department of Cardiology, Heihe First People's Hospital Heihe, Heihe, 157600, China
| | - Yuze Li
- Harbin NO.6 Senior High School, Harbin, 150000, China
| | - Mingli Jiao
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China. .,Department of Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150081, China.
| | - Jingfu Mao
- Department of Medical Human Resource, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, 150086, China.
| |
Collapse
|
18
|
Laurenzi CA, Skeen S, Coetzee BJ, Gordon S, Notholi V, Tomlinson M. How do pregnant women and new mothers navigate and respond to challenges in accessing health care? Perspectives from rural South Africa. Soc Sci Med 2020; 258:113100. [PMID: 32534304 DOI: 10.1016/j.socscimed.2020.113100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 11/30/2022]
Abstract
Women in low- and middle-income countries and in contexts characterized by inequality face various interpersonal and structural barriers when accessing formal maternal and child health (MCH) services. These barriers persist even in contexts where programs to increase access to services, such as community health worker (CHW) interventions, have been implemented. However, while barriers to accessing care have been extensively documented, less is known about the diverse ways that women respond to, and navigate, these situations. This study explores strategies pregnant women and new mothers use to navigate and respond to health care barriers in a rural district in the Eastern Cape, South Africa. Twenty-six pregnant or recently delivered clients of the Enable Mentor Mother program were interviewed about their experiences of accessing formal MCH services. Interviews were conducted between February-March 2018 by an experienced isiXhosa-speaking research assistant, translated and transcribed into English, with transcripts coded and organized by themes using ATLAS.ti software. Facing resource shortages, inconsistent communication, and long travel times to clinics, participants employed diverse, innovative strategies to navigate interpersonal and structural barriers to care. While some participants chose to respond to barriers more passively-citing endurance and acceptance as practices of health system engagement-those participants who focused more on active responses tended to leverage their education, existing relationships, and available community resources to overcome barriers. Nevertheless, most participants described feelings of frustration and dejection. While CHW interventions may alleviate some of the burdens facing fragile health care systems in these contexts, these programs still rely on an underlying infrastructure of care that primary health care clinics and hospitals should be providing. Future programming should work in tandem with formal health systems and should support staff to improve quality of care provided to pregnant women, new mothers, and their infants to prioritize their health at a time of vulnerability.
Collapse
Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, 4009 Education Building, Faculty of Medical and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa; Department of Psychology, Willcocks Building, Stellenbosch University, Stellenbosch, Western Cape, 7600, South Africa.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, 4009 Education Building, Faculty of Medical and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa
| | - Bronwyne J Coetzee
- Department of Psychology, Willcocks Building, Stellenbosch University, Stellenbosch, Western Cape, 7600, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, 4009 Education Building, Faculty of Medical and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa
| | - Vuyolwethu Notholi
- Institute for Life Course Health Research, Department of Global Health, 4009 Education Building, Faculty of Medical and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, 4009 Education Building, Faculty of Medical and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Western Cape, 7505, South Africa; School of Nursing and Midwifery, Queens University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, United Kingdom
| |
Collapse
|
19
|
Determinants of access to eHealth services in regional Australia. Int J Med Inform 2019; 131:103960. [PMID: 31518858 DOI: 10.1016/j.ijmedinf.2019.103960] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Australia has a universal public healthcare system, but access to eHealth services (i.e. use of the Internet and related technologies for healthcare services) remains a remarkable challenge, particularly in regional, rural and remote communities. Similar to many other countries, Australia faces the challenges of an ageing population and chronic disease management as well as balancing the supply of and the demand for quality healthcare and advanced medical procedures. The prima facie case for inequality in accessing eHealth services across geographical settings is widely acknowledged. However, regional residents' perceptions on access to eHealth services lack empirical evidence. Therefore, this study empirically investigates the current state and predictors of eHealth service access in regional Australia. METHODS A cross-sectional questionnaire-based household survey was conducted within a total of 390 randomly selected adults from the Western Downs Region in Southeast Queensland, Australia. Bivariate analysis was conducted to examine the relationship between eHealth access and respondents' characteristics. A multivariate logistic regression model was also performed to identify the significant predictors of eHealth service access in regional Australia. RESULTS Approximately 78% of the households have access to eHealth services. However, access to eHealth services in socioeconomically disadvantaged households was lower (19%) than that of their advantaged counterparts (25%). Factors that significantly increased the likelihood of accessing eHealth services included middle age (odds ratio [OR] = 2.75, 95% confidence interval [CI]: 1.84, 8.66), household size (three to four members) (OR = 2.29, 95% CI: 1.19, 4.73), broadband Internet access (OR = 1.67, 95% CI: 1.15, 2.90) and digital literacy (OR = 2.39, 95% CI: 1.23, 4.59). Factors that negatively influenced access to eHealth services were low educational levels (OR = 0.28, 95% CI: 0.09, 0.61), low socioeconomic status (OR = 0.65, 95% CI: 0.28, 0.83) and remote locations (OR = 0.66, 95% CI: 0.23, 0.80). CONCLUSION Emerging universal eHealth access provides immense societal benefits in regional settings. The findings of this study could assist policy makers and healthcare practitioners in identifying factors that influence eHealth access and thereby formulate effective health policies to optimise healthcare utilisation in regional Australia.
Collapse
|
20
|
Dol J, Richardson B, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Impact of mobile health (mHealth) interventions during the perinatal period for mothers in low- and middle-income countries. ACTA ACUST UNITED AC 2019; 17:1634-1667. [DOI: 10.11124/jbisrir-2017-004022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
21
|
Abraha A, Myléus A, Byass P, Kahsay A, Kinsman J. Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia. PLoS One 2019; 14:e0218101. [PMID: 31194787 PMCID: PMC6564425 DOI: 10.1371/journal.pone.0218101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers' knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.
Collapse
Affiliation(s)
- Atakelti Abraha
- Tigray Health Bureau, Tigray and Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Peter Byass
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Institutes of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - John Kinsman
- Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
22
|
Nkoka O, Chuang TW, Chen YH. Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi. Am J Trop Med Hyg 2019; 100:1454-1465. [PMID: 30994089 PMCID: PMC6553897 DOI: 10.4269/ajtmh.18-0900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015-2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01-1.58 and aOR = 1.31, 95% CI = 1.02-1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58-0.96 and aOR = 0.67, 95% CI = 0.51-0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
Collapse
Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
23
|
Karmbor-Ballah EG, Fallah MP, Silverstein JB, Gilbert HN, Desai IK, Mukherjee JS, Farmer PE, Richardson ET. Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
24
|
Blackstone SR. Evaluating antenatal care in Liberia: evidence from the demographic and health survey. Women Health 2019; 59:1141-1154. [DOI: 10.1080/03630242.2019.1590496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sarah R. Blackstone
- Department of Health Sciences, College of Health and Behavioral Sciences, James Madison University, Harrisonburg, VA, USA
| |
Collapse
|
25
|
Wu Y, Zhou H, Wang Q, Cao M, Medina A, Rozelle S. Use of maternal health services among women in the ethnic rural areas of western China. BMC Health Serv Res 2019; 19:179. [PMID: 30890133 PMCID: PMC6425603 DOI: 10.1186/s12913-019-3996-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of maternal health services can markedly promote the maternal health and safety, but there has been a low utilization rate in the ethnic rural areas of western China. Furthermore, the correlated factors have not been well studied. This study aims to assess factors related to the use of maternal health services among women in these areas. METHODS A cross-sectional study of 68 villages in China's western Sichuan province was conducted in September 2014. All qualifying women from each sample village were involved. A structured questionnaire was administrated in households through face-to-face interviews by trained enumerators to obtain information of use of maternal health services and related factors. Structural equation modeling (SEM) was used to evaluate the direct and indirect relationships between use of maternal health services and correlated factors. RESULTS A total of 760 women from 68 villages were enrolled. The proportion of antenatal care (ANC), hospital delivery and postpartum visits were 68.94, 48.29 and 28.42% respectively. The SEM analysis demonstrated that social economic status (SES) (β= - 0.75, β< 0.01), ANC (β=0.13, β< 0.01), and time from home to the nearest hospital (β= - 0.09, β< 0.05), were positively correlated to hospital delivery and postpartum care visits, while maternal care knowledge and perceived quality of hospital care did not have direct correlation. For ANC, SES (β= - 0.36, β< 0.01), time from home to the nearest hospital (β= - 0.13, β< 0.05), knowledge on maternal care (β=0.12, β< 0.01) and perceived quality of hospital care (β=0.10, β< 0.01) were all directly correlated factors. Treating ANC as an intermediate variable showed the indirect relationship that perceived quality of hospital care (β=0.01, β< 0.01) and maternal care knowledge (β=0.02, β< 0.01) had with hospital delivery and postpartum care rates. CONCLUSIONS Use of maternal health services is low among women in ethnic rural areas. ANC has important direct and intermediate effects on subsequent use of hospital delivery and postpartum care. Improving ANC behavior should be a priority of maternal health care reforms. Given the long travel times for these women, reforms must also prioritize breaking down practical barriers that prevent this population from accessing care.
Collapse
Affiliation(s)
- Yuju Wu
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, section 3, South Renmin Road, Chengdu City, Sichuan Province 610041 People’s Republic of China
| | - Huan Zhou
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, section 3, South Renmin Road, Chengdu City, Sichuan Province 610041 People’s Republic of China
| | - Qingzhi Wang
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, section 3, South Renmin Road, Chengdu City, Sichuan Province 610041 People’s Republic of China
| | - Min Cao
- Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, section 3, South Renmin Road, Chengdu City, Sichuan Province 610041 People’s Republic of China
| | - Alexis Medina
- The Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA USA
| | - Scott Rozelle
- The Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA USA
| |
Collapse
|
26
|
Yaya S, Bishwajit G, Ekholuenetale M, Shah V, Kadio B, Udenigwe O. Factors associated with maternal utilization of health facilities for delivery in Ethiopia. Int Health 2019; 10:310-317. [PMID: 29447358 DOI: 10.1093/inthealth/ihx073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background As a signatory of the Millennium Development Goals, Ethiopia has made significant achievements towards meeting the maternal mortality related goals since 1990. Despite that, the country is still experiencing unacceptably high maternal mortality rates, and challenges to improving the coverage and utilisation of health facility delivery services which represent a key strategy to combat maternal mortality. Currently, there is limited evidence on the factors associated with health facility delivery in Ethiopia. Therefore, the objective of this study was to identify the correlates of facility delivery among urban and rural women in Ethiopia. Methods This was a cross-sectional study based on data from the 2011 Ethiopian Demographic and Health Survey. Participants were 7540 women aged between 15 and 49 years with a history of at least one birth. The outcome variable was place of delivery. Data were analyzed using bivariate and multivariable regression techniques. Results The overall prevalence of health facility delivery was 17.1% (1447/7540). In the multivariable regression analysis, education, wealth status, frequency of antenatal care visits and mother's age at first birth were found to be significantly associated with women's choice of place of delivery. Among urban women, those who had primary and secondary/higher level education had increased odds of delivering at a health facility compared with those without formal education. Those who were from the richest households had higher odds of delivering at a health facility compared with those in the lowest class. In urban and rural areas, compared with those who had no ANC visits, those who had at least four visits also had increased odds of delivering at a health facility. In the urban areas, those who were over 18 years old at their first childbirth had significantly higher odds of choosing to deliver at a health facility. Conclusion Findings show that the prevalence of healthy facility delivery in Ethiopia is remarkably low. Addressing the sociodemographic and wealth inequities can help promote the utilisation of facility delivery in both urban and rural areas. Policy-makers should consider improving access to education as a strategy to meet maternal health related goals and treat education as a multipronged strategy. Providing free healthcare access could be one strategy to achieve the universal coverage of essential maternal healthcare services.
Collapse
Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Medicine and Health Management, Tongji Medical College. Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Vaibhav Shah
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Bernard Kadio
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
27
|
Manivong D, Rahman M, Nakamura K, Seino K. Assessing the link between endorsing attitudes justifying partner abuse and reproductive health care utilization among women in Lao PDR. J Rural Med 2018; 13:124-133. [PMID: 30546801 PMCID: PMC6288718 DOI: 10.2185/jrm.2968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022] Open
Abstract
Objective: Evidence from developing countries on the association between women's endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women's endorsement of attitudes justifying partner abuse and use of reproductive health services. Methods: This study used data from the 2011-2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization. Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20-34 years) or older (35-49 years), residing in urban areas, and being sexually empowered. Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women's endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.
Collapse
Affiliation(s)
- Dasavanh Manivong
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Japan
| | - Mosiur Rahman
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Japan.,Department of Environmental Health Sciences, School of Public Health, The University of Michigan, USA
| |
Collapse
|
28
|
Brault MA, Kennedy SB, Haley CA, Clarke AT, Duworko MC, Habimana P, Vermund SH, Kipp AM, Mwinga K. Factors influencing rapid progress in child health in post-conflict Liberia: a mixed methods country case study on progress in child survival, 2000-2013. BMJ Open 2018; 8:e021879. [PMID: 30327401 PMCID: PMC6196853 DOI: 10.1136/bmjopen-2018-021879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/11/2018] [Accepted: 05/11/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Only 12 countries in the WHO's African region met Millennium Development Goal 4 (MDG 4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country mixed methods study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia was selected for an in-depth case study due to its success in reducing under-five mortality by 73% and thus successfully meeting MDG 4. Liberia's success was particularly notable given the civil war that ended in 2003. We examined some factors contributing to their reductions in under-five mortality. DESIGN A case study mixed methods approach drawing on data from quantitative indicators, national documents and qualitative interviews was used to describe factors that enabled Liberia to rebuild their maternal, neonatal and child health (MNCH) programmes and reduce under-five mortality following the country's civil war. SETTING The interviews were conducted in Monrovia (Montserrado County) and the areas in and around Gbarnga, Liberia (Bong County, North Central region). PARTICIPANTS Key informant interviews were conducted with Ministry of Health officials, donor organisations, community-based organisations involved in MNCH and healthcare workers. Focus group discussions were conducted with women who have experience accessing MNCH services. RESULTS Three prominent factors contributed to the reduction in under-five mortality: national prioritisation of MNCH after the civil war; implementation of integrated packages of services that expanded access to key interventions and promoted intersectoral collaborations; and use of outreach campaigns, community health workers and trained traditional midwives to expand access to care and improve referrals. CONCLUSIONS Although Liberia experiences continued challenges related to limited resources, Liberia's effective strategies and rapid progress may provide insights for reducing under-five mortality in other post-conflict settings.
Collapse
Affiliation(s)
- Marie A Brault
- Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research and Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | - Connie A Haley
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Musu C Duworko
- Liberia Country office, World Health Organization, Monrovia, Liberia
| | - Phanuel Habimana
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kasonde Mwinga
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| |
Collapse
|
29
|
White EE, Downey J, Sathananthan V, Kanjee Z, Kenny A, Waters A, Rabinowich J, Raghavan M, Dorr L, Halder A, Nyumah J, Duokie D, Boima T, Panjabi R, Siedner MJ, Kraemer JD. A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation. Am J Public Health 2018; 108:1252-1259. [PMID: 30024811 DOI: 10.2105/ajph.2018.304555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess a community health worker (CHW) program's impact on childhood illness treatment in rural Liberia. METHODS We deployed CHWs in half of Rivercess County in August 2015 with the other half constituting a comparison group until July 2016. All CHWs were provided cash incentives, supply chain support, and monthly clinical supervision. We conducted stratified cluster-sample population-based surveys at baseline (March-April 2015) and follow-up (April-June 2016) and performed a difference-in-differences analysis, adjusted by inverse probability of treatment weighting, to assess changes in treatment of fever, diarrhea, and acute respiratory infection by a qualified provider. RESULTS We estimated a childhood treatment difference-in-differences of 56.4 percentage points (95% confidence interval [CI] = 36.4, 76.3). At follow-up, CHWs provided 57.6% (95% CI = 42.8, 71.2) of treatment in the intervention group. The difference-in-differences diarrhea oral rehydration therapy was 22.4 percentage points (95% CI = -0.7, 45.5). CONCLUSIONS Implementation of a CHW program in Rivercess County, Liberia, was associated with large, statistically significant improvements treatment by a qualified provider; however, improvements in correct diarrhea treatment were lower than improvements in coverage. Findings from this study offer support for expansion of Liberia's new National Community Health Assistant Program.
Collapse
Affiliation(s)
- Emily E White
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Jordan Downey
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Vidiya Sathananthan
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Zahir Kanjee
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Avi Kenny
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Ami Waters
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Jenny Rabinowich
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Mallika Raghavan
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Lorenzo Dorr
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Amal Halder
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Joseph Nyumah
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Derry Duokie
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Tamba Boima
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Raj Panjabi
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - Mark J Siedner
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| | - John D Kraemer
- Emily E. White is with Last Mile Health, Boston, MA. Jordan Downey, Vidiya Sathananthan, Avi Kenny, Ami Waters, Jenny Rabinowich, Mallika Raghavan, Lorenzo Dorr, Amal Halder, and Joseph Nyumah are with Last Mile Health, Monrovia, Liberia. Zahir Kanjee is with the Division of Global Health Equity, Brigham and Women's Hospital, Boston, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. Derry Duokie is with the Rivercess County Health Team, Cestos City, Liberia. Tamba Boima is with the Liberia Ministry of Health, Community Health Services Division, Monrovia. Raj Panjabi is with Last Mile Health, Boston, and the Division of Global Health Equity, Brigham and Women's Hospital. Mark J. Siedner is with Massachusetts General Hospital, Boston. John D. Kraemer is with the Department of Health Systems Administration, Georgetown University, Washington, DC
| |
Collapse
|
30
|
Laux TS, Patil S. Predictors of tuberculosis treatment outcomes among a retrospective cohort in rural, Central India. J Clin Tuberc Other Mycobact Dis 2018; 12:41-47. [PMID: 31720398 PMCID: PMC6830133 DOI: 10.1016/j.jctube.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Programmatic design affects access to healthcare and can influence tuberculosis treatment outcomes. Potential predictors of tuberculosis treatment outcomes in one rural Indian setting were examined to improve outcomes with a focus on access to care. Methods Routinely collected tuberculosis treatment data from Jan Swasthya Sahyog, a community based healthcare system in rural Chhattisgarh, India were examined from 2003–2015. Predictors were analyzed for associations with death, loss to follow-up or failure in multivariable logistic regression models. The effect of distance from treatment on outcomes was graphed and Pearson's correlation coefficients (r2) calculated. Descriptive time to event analyses were performed for all deaths and loss to follow-up from January 2010 to September 2015. Results 4979 patients with active TB were treated during the study period. Patients were mostly male, malnourished, diagnosed with pulmonary disease and many travelled lengthy distances. Positive treatment outcomes improved from 55% to 80% from 2003 to 2015 for all patients though positive treatment outcomes have been above 80% in the primary care setting since 2012. The annual case fatality rate was 4.4% with small yearly variation.Gender and site of treatment (primary versus secondary care facility) and also season of treatment initiation and travel time to care best predicted outcomes in both the complete model and model which included only patients with initial BMI data. No differences were found between primary and secondary care patients for initial BMI, percentage of sputum positivity among those with pulmonary disease and grade of sputum positivity among the sputum positive. Those who traveled the furthest to access care achieved the worst outcomes during the summer and, to a lesser degree, the monsoon. Distance from care was associated with treatment outcomes in a dose-response manner out to substantial distances. From 2010 to 2015, most patients who died or were lost to follow-up did so in the first week of treatment. Conclusions The provision of care through local facilities improves the treatment of tuberculosis in rural India. Interventions addressing death or loss to follow-up should focus on the newly diagnosed. Rural Indian physicians should be aware of how access issues affect TB treatment outcomes.
Collapse
Affiliation(s)
- Timothy S. Laux
- Jan Swasthya Sahyog (People's Health Support Group), Ganiyari, Bilaspur, Chhattisgarh 495112, India
- The HEAL Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Sushil Patil
- Jan Swasthya Sahyog (People's Health Support Group), Ganiyari, Bilaspur, Chhattisgarh 495112, India
- The HEAL Initiative, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
31
|
Thomas LM, D'Ambruoso L, Balabanova D. Use of verbal autopsy and social autopsy in humanitarian crises. BMJ Glob Health 2018; 3:e000640. [PMID: 29736275 PMCID: PMC5935165 DOI: 10.1136/bmjgh-2017-000640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Two billion people live in countries affected by conflict, violence and fragility. These are exceptional situations in which mortality shifts dramatically and in which civil registration and vital statistics systems are often weakened or cease to function. Verbal autopsy and social autopsy (VA and SA) are methods used to assign causes of death and understand the contexts in which these occur, in settings where information is otherwise unavailable. This review sought to explore the use of VA and SA in humanitarian crises, with a focus on how these approaches are used to inform policy and programme responses. METHODS A rapid scoping review was conducted on the use of VA and SA in humanitarian crises in low and middle-income countries since 1991. Drawing on a maximum variation approach, two settings of application ('application contexts') were selected and investigated via nine semi-structured expert interviews. RESULTS VA can determine causes of death in crisis-affected populations where no other registration system is in place. Combined with SA and active community involvement, these methods can deliver a holistic view of obstacles to seeking and receiving essential healthcare, yielding context-specific information to inform appropriate responses. The contexts in which VA and SA are used require adaptations to standard tools, and new mobile developments in VA raise specific ethical considerations. Furthermore, collecting and sythesising data in a timely, continuous manner, and ensuring coordination and communication between agencies, is important to realise the potential of these approaches. CONCLUSION VA and SA are valuable research methods to foster evidence-informed responses for populations affected by humanitarian crises. When coordinated and communicated effectively, data generated through these methods can help to identify levels, causes and circumstances of deaths among vulnerable groups, and can enable planning and allocating resources effectively, potentially improving health system resilience to future crises.
Collapse
Affiliation(s)
- Lisa-Marie Thomas
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Lucia D'Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| |
Collapse
|
32
|
Awantang G, Babalola S, Koenker H, Fox K, Toso M, Lewicky N, Somah D, Koko V. Correlates of social behavior change communication on care-seeking behaviors for children with fever: an analysis of malaria household survey data from Liberia. Malar J 2018. [PMID: 29514698 PMCID: PMC5842590 DOI: 10.1186/s12936-018-2249-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In 2010, malaria was responsible for an estimated 41% of deaths among children under the age of five years in Liberia. The same year, the Rebuilding Basic Health Services Project launched “Healthy Baby, Happy Mother,” a social and behavior change communication campaign. The campaign encouraged caregivers to take children under the age of five years to a health facility as soon as children developed fever. This study investigated correlates of two case management outcomes: care-seeking for children under five with fever during the past two weeks and administration of an artemisinin-based combination therapy (ACT) the same or next day as fever onset. Methods Data from a 2014 cross-sectional household survey from four counties was used to investigate correlates of two case management outcomes. Using multilevel analysis, the association between these outcomes and a caregiver’s recall of the campaign, her sociodemographic characteristics, and unmeasured characteristics of the community she lived in was investigated. Results Caregivers living in Grand Kru County were less likely (OR = 0.21, 95% CI 0.073, 0.632) to take a child to a health facility than those in Bong County. Caregiver recall of the campaign was positively associated with the odds that a child received an ACT promptly (OR 3.62, 95% CI 1.398–9.372), but not with the odds of a caregiver taking a child in their care to a health facility. While unmeasured community-level factors accounted for 19.0% of the variation in the odds that a caregiver’s child was brought to a health facility, they did not play a role in the odds of prompt ACT treatment. Conclusions Recalling the “Healthy Mother, Happy Baby” campaign was positively associated with the odds that children received ACT promptly, even in the absence of other malaria prevention and treatment messaging. While caregiver exposure was not associated with care-seeking during the two weeks before interview, prompt care-seeking likely preceded prompt receipt of ACT since most ACT came from health facilities. Unmeasured community-level factors, such as distance from the health facility, may play a role in determining the odds that a caregiver takes a child to a health facility.
Collapse
Affiliation(s)
- Grace Awantang
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Stella Babalola
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hannah Koenker
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Kathleen Fox
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Health Communication and Capacity Collaborative Project, Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Daniel Somah
- National Malaria Control Programme, Ministry of Health, Capitol By-Pass, PO Box 10-9009, 1000, Monrovia 10, Liberia
| | - Victor Koko
- National Malaria Control Programme, Ministry of Health, Capitol By-Pass, PO Box 10-9009, 1000, Monrovia 10, Liberia
| |
Collapse
|
33
|
Luckow PW, Kenny A, White E, Ballard M, Dorr L, Erlandson K, Grant B, Johnson A, Lorenzen B, Mukherjee S, Ly EJ, McDaniel A, Nowine N, Sathananthan V, Sechler GA, Kraemer JD, Siedner MJ, Panjabi R. Implementation research on community health workers' provision of maternal and child health services in rural Liberia. Bull World Health Organ 2017; 95:113-120. [PMID: 28250511 PMCID: PMC5327932 DOI: 10.2471/blt.16.175513] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.
Collapse
Affiliation(s)
- Peter W Luckow
- Geisel School of Medicine at Dartmouth College, Hanover, United States of America (USA)
| | | | | | - Madeleine Ballard
- Department of Social Policy and Intervention, University of Oxford, Oxford, England
| | | | | | | | | | | | | | | | | | - Netus Nowine
- Grand Gedeh County Health Team, Ministry of Health, Monrovia, Liberia
| | | | - Gerald A Sechler
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - John D Kraemer
- Department of Health Systems Administration, Georgetown School of Nursing and Health Studies, Washington, USA
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Rajesh Panjabi
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| |
Collapse
|
34
|
Wong KLM, Benova L, Campbell OMR. A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa. PLoS One 2017; 12:e0184432. [PMID: 28910302 PMCID: PMC5598961 DOI: 10.1371/journal.pone.0184432] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. METHOD We defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis. RESULTS 57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85-0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low. CONCLUSION Although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care.
Collapse
Affiliation(s)
- Kerry L. M. Wong
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lenka Benova
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oona M. R. Campbell
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
35
|
Adedokun ST, Adekanmbi VT, Uthman OA, Lilford RJ. Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria. PLoS One 2017; 12:e0173578. [PMID: 28296905 PMCID: PMC5351867 DOI: 10.1371/journal.pone.0173578] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. MATERIALS AND METHODS The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). RESULTS About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children. CONCLUSIONS Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres.
Collapse
Affiliation(s)
- Sulaimon T. Adedokun
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Victor T. Adekanmbi
- NIHR Collaboration for Leadership in Applied Health Research and Care, West Midlands (CLAHRC WM), University of Warwick Medical School, Coventry, United Kingdom
| | - Olalekan A. Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Richard J. Lilford
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| |
Collapse
|
36
|
Predictors of differences in health services utilization for children in Nigerian communities. Prev Med 2017; 96:67-72. [PMID: 28040520 PMCID: PMC5340469 DOI: 10.1016/j.ypmed.2016.12.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 11/22/2022]
Abstract
Health service utilization is an important component of child health promotion. Evidence shows that two-thirds of child deaths in low and middle income countries could be prevented if current interventions were adequately utilized. Aim of this study was to identify determinants of variation in health services utilization for children in communities in Nigeria. Multivariable negative binomial regression model attempting to explain observed variability in health services usage in Nigerian communities was applied to the 2013 Nigeria Demographic and Health Survey data. We included the index of maternal deprivation, gender of child, community environmental factor index, and maternal health seeking behaviour, multiple childhood deprivation index and ethnicity diversity index as the independent variables. The outcome variable was under-fives' hospital attendance rates for acute illness. Of the 7577 children from 896 communities in Nigeria that were sick 1936 (25.6%) were taken to the health care facilities for treatment. The final model revealed that both multiple childhood deprivation (incidence rate ratio [IRR]=1.23, 95% confidence interval [CI] 1.12 to 1.35) and children living in communities with a high ethnic diversity were associated with higher rate of health service use. Maternal health seeking behaviour was associated with a significantly lower rate of health care service use. There are significant variations in health services utilization for sick children across Nigeria communities which appear to be more strongly determined by childhood deprivation factors and maternal health seeking behaviour than by health system functions.
Collapse
|
37
|
Kentoffio K, Kraemer JD, Griffiths T, Kenny A, Panjabi R, Sechler GA, Selinsky S, Siedner MJ. Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization. BMC Health Serv Res 2016; 16:478. [PMID: 27604708 PMCID: PMC5015243 DOI: 10.1186/s12913-016-1709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span. Methods We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization. Results Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001). Conclusions Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Katherine Kentoffio
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA. .,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John D Kraemer
- Georgetown University Medical Center, 231 St. Mary's Hall, 3700 Reservoir Road NW, Washington, DC, 20057-1107, USA
| | | | - Avi Kenny
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA
| | - Rajesh Panjabi
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - G Andrew Sechler
- Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.,Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | | | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
38
|
Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey. PLoS Med 2016; 13:e1002096. [PMID: 27482706 PMCID: PMC4970816 DOI: 10.1371/journal.pmed.1002096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. METHODS AND FINDINGS We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. CONCLUSIONS We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
Collapse
|
39
|
Rees CP, Hawkesworth S, Moore SE, Dondeh BL, Unger SA. Factors Affecting Access to Healthcare: An Observational Study of Children under 5 Years of Age Presenting to a Rural Gambian Primary Healthcare Centre. PLoS One 2016; 11:e0157790. [PMID: 27336164 PMCID: PMC4919103 DOI: 10.1371/journal.pone.0157790] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 05/08/2016] [Indexed: 11/23/2022] Open
Abstract
Main Objective Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge. Methods Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0–5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05). Results Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI[0.310, 0.814], p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI[0.325, 0.954], p = 0.033). Conclusions Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this barrier.
Collapse
Affiliation(s)
- Claire P. Rees
- Centre for Primary Care & Public Health, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Sophie Hawkesworth
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
| | - Sophie E. Moore
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Bai L. Dondeh
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
| | - Stefan A. Unger
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
- University of Edinburgh, Department of Child Life and Health, Edinburgh, United Kingdom
- * E-mail:
| |
Collapse
|