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Aydin E, Glasgow KA, Weiss SM, Austin T, Johnson MH, Barlow J, Lloyd-Fox S. Expectant parents' perceptions of healthcare and support during COVID-19 in the UK: a thematic analysis. J Reprod Infant Psychol 2024; 42:209-221. [PMID: 35579070 DOI: 10.1080/02646838.2022.2075542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/03/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, expectant parents experienced changes in the availability and uptake of both National Health Service (NHS) community and hospital-based healthcare. OBJECTIVE To examine how COVID-19 and its societal related restrictions have impacted the provision of healthcare support for pregnant women during the COVID-19 pandemic. METHOD A thematic analysis using an inductive approach was undertaken using data from open-ended responses to the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 507 families). FINDINGS The overarching theme identified was the way in which the changes to healthcare provision increased parents' anxiety levels, and feelings of not being supported. Five sub-themes, associated with the first wave of the pandemic, were identified: (1) rushed and/or fewer antenatal appointments, (2) lack of sympathy from healthcare workers, (3) lack of face-to-face appointments, (4) requirement to attend appointments without a partner, and (5) requirement to use PPE. A sentiment analysis, that used quantitative techniques, revealed participant responses to be predominantly negative (50.1%), with a smaller proportion of positive (21.8%) and neutral (28.1%) responses found. CONCLUSION This study provides evidence indicating that the changes to healthcare services for pregnant women during the pandemic increased feelings of anxiety and have left women feeling inadequately supported. Our findings highlight the need for compensatory social and emotional support for new and expectant parents while COVID-19 related restrictions continue to impact on family life and society.
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Affiliation(s)
- Ezra Aydin
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kevin A Glasgow
- Department of Education, University of Cambridge, Cambridge, UK
| | - Staci M Weiss
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Topun Austin
- The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Jane Barlow
- Intervention, Department of Social Policy and Intervention, University of OxfordCentre for Evidence-Based, Oxford, UK
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, UK
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Tiwari M. Financial incentives and delivery care: Evidence from the Safe Delivery Incentive Program in Nepal. Health Econ 2023; 32:2372-2389. [PMID: 37421645 DOI: 10.1002/hec.4732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/18/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
This paper examines the effects of the Safe Delivery Incentive Program in Nepal, a cash transfer program that reduced the costs of childbirth in healthcare facilities. Women giving birth for the first, second, or third time (below-cutoff) became eligible in 2005, and women giving birth for the fourth time or more (above-cutoff) became eligible two years later. Using a difference-in-differences design, I find that below-cutoff women in high Human Development Index (HDI) districts increased facility delivery by 8.8 percentage points. Despite larger cost reductions, below-cutoff women in low HDI districts did not increase facility delivery but increased home delivery with skilled personnel by 4.8 percentage points. The program had no impact on above-cutoff women, who become eligible 2 years into the program. I suggest that pre-existing barriers such as poor infrastructure of roads and facilities, customs, liquidity constraints, and lack of program awareness limited the program's effectiveness.
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Affiliation(s)
- Manda Tiwari
- Western Illinois University, Macomb, Illinois, USA
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Montanari Vergallo G, Ricci P, Gulino M. The choice of Caesarean section between clinical indication and patient autonomy: The physician between rock and hard place. J Eval Clin Pract 2023; 29:1068-1072. [PMID: 36793133 DOI: 10.1111/jep.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Caesarean delivery carries a higher risk of short- and long-term complications for both mother and baby than vaginal delivery. However, over the past two decades, data show a considerable increase in requests for Caesarean sections. This manuscript analyses the case of Caesarean Section on maternal request without a clinical indication from a medico-legal and ethical perspective. METHOD Medical associations and bodies databases were searched for published guidelines and recommendations on the use of caesarean sections on maternal requests. As derived from the literature, medical risks, attitudes, and reasons for this choice have also been summarized. RESULTS International guidelines and medical associations recommend strengthening the doctor-patient relationship by setting up an information process to make the pregnant woman understand the danger of Caesarean delivery without clinical indications and to make her consider whether she can survive natural childbirth. CONCLUSION Caesarean section on maternal request and without clinical indications is an emblematic case of how the physician could be between two opposing interests. Our analysis shows that if the woman's rejection of natural birth persists and clinical indications for Caesarean delivery are lacking, the physician must respect the patient's choice.
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Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Ricci
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Gulino
- Department of Clinical Sciences and Translational Medicine, TorVergata University of Rome, Rome, Italy
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Akerstrom M, Sengpiel V, Hadžibajramović E, Carlsson Y, Graner S, Andersson O, Jonsson M, Naurin E, Veje M, Wessberg A, Linden K. The COPE Staff study: Study description and initial report regarding job satisfaction, work-life conflicts, stress, and burnout among Swedish maternal and neonatal healthcare workers during the COVID-19 pandemic. Int J Gynaecol Obstet 2023; 162:989-997. [PMID: 36998146 DOI: 10.1002/ijgo.14772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To describe the study design of the COPE Staff cohort study on working conditions for maternal and neonatal healthcare workers (MNHCWs), and present baseline data regarding job satisfaction, work-life conflicts, stress, and burnout. METHODS Between January and April 2021, 957 MNHCWs (administrative and medical staff) completed a baseline survey. Average levels of job satisfaction, work-life conflicts, stress, and burnout, and associations to perceived workload were assessed. RESULTS The average levels of job satisfaction, work-life conflicts, stress, and burnout were 68.6 (95% confidence interval [CI] 64.3-72.8), 42.6 (95% CI 37.3-48.0), 42.0 (95% CI 37.7-46.3), and 1.9 (95% CI 1.6-2.2), respectively. The respondents scoring above critical values indicating clinical burnout ranged between 3% and 18%, respectively, for the four burnout sub-dimensions. Women reported significantly higher levels of stress and burnout. Younger participants had lower job satisfaction and higher levels of work-life conflicts, stress, and burnout. Higher perceived workload was significantly associated with lower job satisfaction levels and higher levels of work-life conflicts, stress, and burnout. CONCLUSIONS Our results indicate associations between MNHCWs perceived workload and job satisfaction, work-life conflicts, stress, and burnout during the COVID-19 pandemic. Eighteen percent scored above critical values for exhaustion.
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Affiliation(s)
- Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emina Hadžibajramović
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Carlsson
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Graner
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
- BB Stockholm, Danderyd Hospital, Stockholm, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
- Department of Neonatology, Skåne University Hospital, Malmö, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Malin Veje
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Wessberg
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Szlyk HS, Constantino-Pettit A, Li X, Kasson E, Maranets E, Worku Y, Montayne M, Banks DE, Kelly JC, Cavazos-Rehg PA. Self-Identified Stage in Recovery and Substance-Use Behaviors among Pregnant and Postpartum Women and People with Opioid Use Disorder. Healthcare (Basel) 2023; 11:2392. [PMID: 37685426 PMCID: PMC10486579 DOI: 10.3390/healthcare11172392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Opioid use among pregnant and postpartum women and people (PPWP) has significant health repercussions. This study explores how substance-use behaviors may vary by stage in recovery among PPWP with opioid use disorder (OUD). We recruited 29 PPWP with OUD. "High-risk" participants self-identified as "not being engaged in treatment" or "new or early in their recovery" (n = 11); "low-risk" participants self-identified as being "well-established" or "in long-term recovery" (n = 18). Participants were queried regarding sociodemographic, mental health, and drug-misuse factors; urine drug screens were collected at baseline. Univariate group comparisons between high-risk and low-risk PPWP were conducted. High-risk PPWP were more likely to self-identify as non-Hispanic African American and more likely to report current opioid use, other illicit drugs, and tobacco. High-risk PPWP had higher opioid cravings versus low-risk PPWP. High-risk PPWP were more likely to screen positive on urine tests for non-opioid drugs and on concurrent use of both non-opioid drugs and opioids versus low-risk participants. PPWP earlier in recovery are at higher-risk for opioid and other illicit drug misuse but are willing to disclose aspects of their recent use. PPWP early in recovery are an ideal population for interventions that can help facilitate recovery during the perinatal period and beyond.
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Affiliation(s)
- Hannah S. Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Emily Maranets
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Yoseph Worku
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Mandy Montayne
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Devin E. Banks
- Department of Psychological Sciences, University of Missouri–St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO 63121, USA;
| | - Jeannie C. Kelly
- Department of Obstetrics & Gynecology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA;
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
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Hussen AM, Ibrahim IM, Tilahun B, Tunçalp Ö, Grobbee DE, Browne JL. Completion of the Continuum of Maternity Care in the Emerging Regions of Ethiopia: Analysis of the 2019 Demographic and Health Survey. Int J Environ Res Public Health 2023; 20:6320. [PMID: 37444167 PMCID: PMC10342030 DOI: 10.3390/ijerph20136320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Maternal mortality in Ethiopia was estimated to be 267 per 100,000 live births in 2020. A significant number of maternal deaths occur in the emerging regions of the country: Afar, Somali, Gambela, and Benishangul-Gumuz. Achieving the Sustainable Development Goal (SDG) target requires a dramatic increase in maternal healthcare utilisation during pregnancy, childbirth, and the postpartum period. Yet, there is a paucity of evidence on the continuum of maternity care utilisation in Ethiopia, particularly in the emerging regions. Therefore, this study aimed to assess completion and factors associated with the continuum of maternity care in the emerging regions of Ethiopia. This study used the 2019 Ethiopian Demographic and Health Survey data (n = 1431). Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with the completion of the continuum of maternity care. An adjustment was made to the survey design (weight, stratification, and clustering). 9.5% (95% Confidence Interval (CI): 7.0-13.0) of women completed the continuum of maternity care (four or more antenatal care, institutional delivery, and postnatal care within 24 h). Living in Somali (adjusted Odds Ratio (aOR): 0.23, 95%CI: 0.07-0.78) and Benishangul-Gumuz (aOR 3.41, 95%CI: 1.65-7.04) regions, having a secondary and higher educational level (aOR 2.12, 95%CI: 1.13-4.00), and being in the richest wealth quintile (aOR 4.55, 95%CI: 2.04-10.15) were factors associated with completion of the continuum of maternity care. Although nearly half of the women had one antenatal care, fewer than 10% completed the continuum of maternity care. This indicates that women in these regions are not getting the maximum health benefits from maternal healthcare services, and this might contribute to the high maternal death in the regions. Moreover, the completion of the continuum of maternity care was skewed toward women who are more educated (secondary or higher education) and in the richest quintile.
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Affiliation(s)
- Abdulaziz Mohammed Hussen
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
- Department of Midwifery, College of Medicine and Health Science, Samara University, Samara P.O. Box 132, Ethiopia;
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, Samara P.O. Box 132, Ethiopia;
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
- eHealth Lab Ethiopia, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Özge Tunçalp
- UNDP—UNFPA—UNICEF—WHO—World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland;
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
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Gayatri RV, Hsu YY, Damato EG. Utilization of Maternal Healthcare Services among Adolescent Mothers in Indonesia. Healthcare (Basel) 2023; 11. [PMID: 36900683 DOI: 10.3390/healthcare11050678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Providing maternal healthcare services is one of the strategies to decrease maternal mortality. Despite the availability of healthcare services, research investigating the utilization of healthcare services for adolescent mothers in Indonesia is still limited. This study aimed to examine the utilization of maternal healthcare services and its determinants among adolescent mothers in Indonesia. Secondary data analysis was performed using the Indonesia Demographic and Health Survey 2017. Four hundred and sixteen adolescent mothers aged 15-19 years were included in the data analysis of frequency of antenatal care (ANC) visits and place of delivery (home/traditional birth vs. hospital/birth center) represented the utilization of maternal healthcare services. Approximately 7% of the participants were 16 years of age or younger, and over half lived in rural areas. The majority (93%) were having their first baby, one-fourth of the adolescent mothers had fewer than four ANC visits and 33.5% chose a traditional place for childbirth. Pregnancy fatigue was a significant determinant of both antenatal care and the place of delivery. Older age (OR 2.43; 95% CI 1.12-5.29), low income (OR 2.01; 95% CI 1.00-3.74), pregnancy complications of fever (OR 2.10; 95% CI 1.31-3.36), fetal malposition (OR 2.01; 95% CI1.19-3.38), and fatigue (OR 3.63; 95% CI 1.27-10.38) were significantly related to four or more ANC visits. Maternal education (OR 2.14; 95% CI 1.35-3.38), paternal education (OR 1.62; 95% CI 1.02-2.57), income level (OR 2.06; 95% CI 1.12-3.79), insurance coverage (OR 1.68; 95% CI 1.11-2.53), and presence of pregnancy complications such as fever (OR 2.03; 95% CI 1.33-3.10), convulsion (OR 7.74; 95% CI 1.81-32.98), swollen limbs (OR 11.37; 95% CI 1.51-85.45), and fatigue (OR 3.65; 95% CI 1.50-8.85) were significantly related to the place of delivery. Utilization of maternal healthcare services among adolescent mothers was determined by not only socioeconomic factors but also pregnancy complications. These factors should be considered to improve the accessibility, availability, and affordability of healthcare utilization among pregnant adolescents.
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Jamee AR, Kumar Sen K, Bari W. Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study. Health Sci Rep 2022; 5:e791. [PMID: 35989946 PMCID: PMC9382035 DOI: 10.1002/hsr2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Aims Essential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices. Methods The study used a cross-sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast-feeding), χ 2 test and t-test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design. Results Only about 24% (95% confidence interval [CI]: 22.95%-25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice. Conclusion The study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.
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Affiliation(s)
| | | | - Wasimul Bari
- Department of StatisticsUniversity of DhakaDhakaBangladesh
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Franke MA, Ranaivoson RM, Rebaliha M, Rasoarimanana S, Bärnighausen T, Knauss S, Emmrich JV. Direct patient costs of maternal care and birth-related complications at faith-based hospitals in Madagascar: a secondary analysis of programme data using patient invoices. BMJ Open 2022; 12:e053823. [PMID: 35459664 PMCID: PMC9036443 DOI: 10.1136/bmjopen-2021-053823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We aimed to determine the rate of catastrophic health expenditure incurred by women using maternal healthcare services at faith-based hospitals in Madagascar. DESIGN This was a secondary analysis of programmatic data obtained from a non-governmental organisation. SETTING Two faith-based, secondary-level hospitals located in rural communities in southern Madagascar. PARTICIPANTS All women using maternal healthcare services at the study hospitals between 1 March 2019 and 7 September 2020 were included (n=957 women). MEASURES We collected patient invoices and medical records of all participants. We then calculated the rate of catastrophic health expenditure relative to 10% and 25% of average annual household consumption in the study region. RESULTS Overall, we found a high rate of catastrophic health expenditure (10% threshold: 486/890, 54.6%; 25% threshold: 366/890, 41.1%). Almost all women who required surgical care, most commonly a caesarean section, incurred catastrophic health expenditure (10% threshold: 279/280, 99.6%; 25% threshold: 279/280, 99.6%). The rate of catastrophic health expenditure among women delivering spontaneously was 5.7% (14/247; 10% threshold). CONCLUSIONS Our findings suggest that direct patient costs of managing pregnancy and birth-related complications at faith-based hospitals are likely to cause catastrophic health expenditure. Financial risk protection strategies for reducing out-of-pocket payments for maternal healthcare should include faith-based hospitals to improve health-seeking behaviour and ultimately achieve universal health coverage in Madagascar.
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Affiliation(s)
- Mara Anna Franke
- Charité Global Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Till Bärnighausen
- Medical Faculty, University of Heidelberg, Institute of Global Health, Heidelberg, Germany
- University of Heidelberg, University Hospital, Heidelberg, Germany
- Department of Global Health and Population, Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Samuel Knauss
- Charité Global Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- University of Heidelberg, University Hospital, Heidelberg, Germany
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Julius Valentin Emmrich
- Charité Global Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- University of Heidelberg, University Hospital, Heidelberg, Germany
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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Gyan EK, Dugle G, Abiiro GA. Promoting male participation in maternal healthcare in the Jaman North District in Ghana: Strategies and implementation challenges. Int J Health Plann Manage 2022; 37:1754-1768. [PMID: 35178753 DOI: 10.1002/hpm.3441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/03/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022] Open
Abstract
Promoting male participation in maternal healthcare is essential for improved maternal health outcomes. This study explored existing strategies to promote male participation in maternal healthcare and assessed their implementation challenges within healthcare facilities in the Jaman North District in Ghana. A qualitative approach was implemented in April 2020. Interviews were administered to a stratified purposive sample of 18 respondents comprising six midwives and 12 male partners of postnatal mothers. All interviews were audio-recorded, transcribed, and manually analysed using thematic analysis. The findings revealed early service, male partner invitation, male partner incentivisation, public sensitization, and male informed education, as strategies to promote male participation in the district. The implementation of these strategies has been constrained by socio-cultural and health system factors, namely, perception of pregnancy as non-illness, perceived experiences gained by women during previous births, cultural stereotypes, unconducive environment of healthcare facilities, inappropriate timing of facility attendance and unexpected costs associated with male participation. Promoting male participation, therefore, requires dedicated policy attention to the existing socio-cultural and health system constraints. The Ghana Health Service and other stakeholders should consider both community-level and targeted sensitization on the benefits of male participation in maternal healthcare and a general improvement in maternal healthcare infrastructure.
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Affiliation(s)
- Emmanuel Kofi Gyan
- Graduate School (MPhil Candidate), University for Development Studies, Tamale, Ghana
| | - Gordon Dugle
- Department of Management Studies, School of Business, SD-Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.,Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
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Mutabazi UP, Brysiewicz P. Descriptive survey of women's childbirth experiences in two state hospitals in KwaZulu-Natal. Curationis 2021; 44:e1-e7. [PMID: 33970005 PMCID: PMC8111629 DOI: 10.4102/curationis.v44i1.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Giving birth is one of the most important events in a woman’s life and is a highly individualistic and unique experience. Objectives The study aimed to describe women’s childbirth experiences in two state hospitals in KwaZulu-Natal. Method A non-experimental, quantitative, descriptive survey of low-risk mothers was conducted in two state hospitals by using the Childbirth Experience Questionnaire (CEQ). Results With a response rate of 96%, 201 questionnaires were completed and returned. The highest mean score of the four dimensions of the CEQ was for the dimension of Professional Support (3.1). The results of the individual dimension items scoring the highest positive response were: I felt that I handled the situation well (147; 74%) (Own Capacity); I felt very well cared for by my midwife (165; 82%) (Professional Support); 151 respondents (76%) scored the item My impression of the team’s medical skill made me feel secure as the highest positive experience (Perceived Safety); and I felt I could have a say in the choice of pain relief (105; 52%) (Participation). The relationship between demographic variables (age, level of education, parity, antenatal clinic attendance, induction of labour, augmentation and duration of labour) and respondents’ scores of the CEQ dimensions was calculated, and only the dimension of Perceived Safety and duration of labour (≥ 12 hours) were found to be significant (p = 0.026). Conclusion From the women perspectives, the study results described childbirth experience as multi-dimensional experience and subjective. Both positive and negative experiences coexisted in all dimensions of the CEQ, with the dimension of Professional Support scoring the highest positive response. To maintain a positive birth experience, the study suggests that women should be involved and equipped with knowledge on the process of childbirth.
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Madlala ST, Ngxongo TS, Sibiya MN. Perceptions of student accoucheurs regarding gender inequality in midwifery training at Free State maternal healthcare institutions. Curationis 2021; 44:e1-e8. [PMID: 33764131 PMCID: PMC8008052 DOI: 10.4102/curationis.v44i1.1988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/02/2020] [Accepted: 10/10/2020] [Indexed: 11/03/2022] Open
Abstract
Background Worldwide, gender inequality has been a dominating factor in the training of student accoucheurs in most maternal healthcare institutions. This poses challenges for the maternal healthcare institutions where student accoucheurs are placed for clinical practice as most women become reluctant or refuse to accept their services. Gender inequality has a negative impact on the training of student accoucheurs as most of them become demotivated which could lead to a high attrition rate. Objectives This study explored and described the perceptions of student accoucheurs regarding gender inequality in midwifery training at the Free State maternal healthcare institutions. Method An explorative and descriptive qualitative research design was undertaken. There were 40 student accoucheurs that formed 10 focus group discussions. Each focus group discussion had four participants. Tesch’s eight-steps of data analysis was used to analyse data. Results Three major themes emerged during data analysis: meeting the training requirements in midwifery, women’s autonomy in a choice of healthcare provider versus student accoucheurs’ autonomy to be trained in midwifery and staff establishment to render maternal healthcare. Conclusion The participants perceived prejudice, rejection and resistance by women in maternity units as a contributing factor to gender inequality, which has a negative impact on their training in midwifery. The study recommends that health directorates, nurse managers and training institutions should consider revising maternal healthcare policies regarding the recruitment and placement of willing accoucheurs in maternity units in order to address gender inequality.
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Affiliation(s)
- Siphiwe T Madlala
- Department of Nursing Science, Faculty of Science and Agriculture, University of Zululand, Kwadlangezwa.
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Atuhaire R, Atuhaire LK, Wamala R, Nansubuga E. Interrelationships between early antenatal care, health facility delivery and early postnatal care among women in Uganda: a structural equation analysis. Glob Health Action 2020; 13:1830463. [PMID: 33124520 PMCID: PMC7599015 DOI: 10.1080/16549716.2020.1830463] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early medical checkups during and after delivery are key strategies to detect, prevent and treat maternal health concerns. Knowledge of interrelationships between early Antenatal Care (ANC), skilled delivery and early postnatal care (EPNC) is essential for focused and well-targeted interventions. This paper investigated the interconnectedness between maternal health services in Uganda. OBJECTIVE This study examines the predictors of interrelationships between early antenatal care, health facility delivery and early postnatal care. METHODS We used a sample of 10,152 women of reproductive ages (15-49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. A generalized Structural Equation Model and STATA 13.0 software were used. RESULTS Early ANC was a mediating factor for health facility delivery (aOR=1.04; 95% CI=1.01-1.14) and EPNC (aOR=1.1; 95% CI=1.05-1.26). Increased odds of early ANC utilization was directly associated with: Adult women aged 35-49 (aOR=1.18; 95% CI=1.10-1.35), having completed primary seven (aOR=1.68; 95% CI=1.56-1.84); distance to a health facility (aOR=1.35; 95% CI=1.23-1.73) and costs (aOR=1.85; 95% CI=1.31-2.12) not being a problem, available community workers (aOR=1.06; 95% CI=1.04-1.17), pregnancy complications (aOR=2.04; 95% CI=1.85-2.26) and desire for pregnancy (aOR=1.15; 95% CI=1.07-1.36). Through early ANC utilization, being married (aOR=1.16; (=1.04*1.10)), no distance issues ((aOR=1.40; (=1.04*1.35)) and complications (aOR=2.12; (=1.04*2.04)) indirectly influenced utilization of health facility delivery. Women aged 20-34 (aOR=1.01; (=0.92*1.1)), completing primary seven (aOR=1.85; (=1.69*1.1)) and no cost problems (aOR=2.04; (=1.85*1.1)) indirectly influenced EPNC. CONCLUSION Early antenatal care was a mediating factor for health facility delivery and EPNC; and hence, there is need for more focus on factors for increased early antenatal care utilization. Women with higher education and those with no cost problems were more likely to have early ANC utilization, skilled delivery and EPNC; therefore there is need to design and implement policies targeting social and economically disadvantaged women.
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Affiliation(s)
- Ruth Atuhaire
- Department of Management Science, Makerere University Business School, Kampala, Uganda
| | - Leonard K Atuhaire
- Department of Planning and Applied Statistics, Makerere University School of Statistics and Planning, Kampala, Uganda
| | - Robert Wamala
- Department of Planning and Applied Statistics, Makerere University School of Statistics and Planning, Kampala, Uganda
| | - Elizabeth Nansubuga
- Department of Planning and Applied Statistics, Makerere University School of Statistics and Planning, Kampala, Uganda
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Kuupiel D, Adu KM, Bawontuo V, Adogboba DA, Mashamba-Thompson TP. Estimating the Spatial Accessibility to Blood Group and Rhesus Type Point-of-Care Testing for Maternal Healthcare in Ghana. Diagnostics (Basel) 2019; 9:diagnostics9040175. [PMID: 31694228 PMCID: PMC6963207 DOI: 10.3390/diagnostics9040175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background: In Ghana, a blood group and rhesus type test is one of the essential recommended screening tests for women during antenatal care since blood transfusion is a key intervention for haemorrhage. We estimated the spatial accessibility to health facilities for blood group and type point-of-care (POC) testing in the Upper East Region (UER), Ghana. Methods: We assembled the attributes and spatial data of hospitals, clinics, and medical laboratories providing blood group and rhesus type POC testing in the UER. We also obtained the spatial data of all the 131 towns, and 94 health centres and community-based health planning and services (CHPS) compounds providing maternal healthcare in the region. We further obtained the topographical data of the region, and travel time estimated using an assumed tricycle speed of 20 km/h. We employed ArcGIS 10.5 to estimate the distance and travel time and locations with poor spatial access identified for priority improvement. Findings: In all, blood group and rhesus type POC testing was available in 18 health facilities comprising eight public hospitals and six health centres, one private hospital, and three medical laboratories used as referral points by neighbouring health centres and CHPS compounds without the service. Of the 94 health centres and CHPS compounds, 51.1% (48/94) and 66.4% (87/131) of the towns were within a 10 km range to a facility providing blood group and rhesus type testing service. The estimated mean distance to a health facility for blood group and rhesus POC testing was 8.9 ± 4.1 km, whilst the mean travel time was 17.8 ± 8.3 min. Builsa South district recorded the longest mean distance (25.6 ± 7.4 km), whilst Bongo district recorded the shortest (3.1 ± 1.9 km). The spatial autocorrelation results showed the health facilities providing blood group and rhesus type POC testing were randomly distributed in the region (Moran Index = 0.29; z-score = 1.37; p = 0.17). Conclusion: This study enabled the identification of district variations in spatial accessibility to blood group and rhesus type POC testing in the region for policy decisions. We urge the health authorities in Ghana to evaluate and implement recommended POC tests such as slide agglutination tests for blood group and rhesus type testing in resource-limited settings.
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Affiliation(s)
- Desmond Kuupiel
- Discipline of Public Health Medicine, School 0.0of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa;
- Research for Sustainable Development Consult, Sunyani, Ghana;
- Correspondence: or ; Tel.: +27-735568200 or +233-550972968
| | | | - Vitalis Bawontuo
- Research for Sustainable Development Consult, Sunyani, Ghana;
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Duncan A. Adogboba
- Regional Health Directorate, Ghana Health Service, Upper East Region, Bolgatanga, Ghana;
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School 0.0of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa;
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Yaya S, Bishwajit G, Gunawardena N. Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau. BMJ Glob Health 2019. [PMID: 31139452 DOI: 10.1136/bmjgh-2018-001341.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women's access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women's choice of health facility delivery with their SES. Methods Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15-49 years). Respondents' characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants. Results Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively. Conclusion Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women's SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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Yaya S, Bishwajit G, Gunawardena N. Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau. BMJ Glob Health 2019; 4:e001341. [PMID: 31139452 PMCID: PMC6509696 DOI: 10.1136/bmjgh-2018-001341] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women's access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women's choice of health facility delivery with their SES. Methods Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15-49 years). Respondents' characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants. Results Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively. Conclusion Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women's SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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Mahumud RA, Alamgir NI, Hossain MT, Baruwa E, Sultana M, Gow J, Alam K, Ahmed SM, Khan JAM. Women's Preferences for Maternal Healthcare Services in Bangladesh: Evidence from a Discrete Choice Experiment. J Clin Med 2019; 8:E132. [PMID: 30678044 PMCID: PMC6406443 DOI: 10.3390/jcm8020132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 11/17/2022] Open
Abstract
Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women's decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women's preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland 4350, Australia.
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh..
| | - Nadia Ishrat Alamgir
- BRAC James P Grant School of Public Health, BRAC University and Centre of Excellence for Universal Health Coverage, Dhaka 1212, Bangladesh.
| | - Md Tarek Hossain
- Maternal and Child Health Division, icddr,b, Dhaka 1212, Bangladesh.
| | - Elaine Baruwa
- Abt Associates Inc., International Health Division, 6130 Executive Boulevard, Rockville, MD 20852, USA.
| | - Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh.
- Deakin Health Economics, School of Health and Social Development, Deakin University, Burwood, Melbourne, VIC 3125, Australia.
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland 4350, Australia.
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban 4000, South Africa..
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland 4350, Australia.
| | - Syed Masud Ahmed
- BRAC James P Grant School of Public Health, BRAC University and Centre of Excellence for Universal Health Coverage, Dhaka 1212, Bangladesh.
| | - Jahangir A M Khan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.
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Patel P, Das M, Das U. The perceptions, health-seeking behaviours and access of Scheduled Caste women to maternal health services in Bihar, India. Reprod Health Matters 2018; 26:114-125. [PMID: 30403933 DOI: 10.1080/09688080.2018.1533361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India. Eighteen in-depth, semi-structured interviews were conducted with SC women in Bihar. Data were analysed using Framework Analysis and presented using the AAAQ Toolbox. Main facilitating factors included the introduction of accredited social health activists (ASHAs), free maternal health services, the Janani Shishu Suraksha Karyakram (JSSK), and changes in the cultural acceptability of institutional delivery. Main barriers included inadequate ASHA coverage, poor information access, transport costs and unauthorised charges to SC women from healthcare staff. SC women in Bihar may be inequitably served by maternal health services, and in some cases may face specific discrimination. Recommendations to improve SC service utilisation include research into the improvement of postnatal care, reducing unauthorised payments to healthcare staff and improvements to the ASHA programme.
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Affiliation(s)
- Parisa Patel
- a Medical Student & BSc International Health , University of Leeds , Leeds , UK
| | - Mahua Das
- b Teaching Fellow, Nuffield Centre for International Health and Development , University of Leeds , Leeds , UK
| | - Utpal Das
- c Family Planning Lead at Bihar Technical Support Unit , Care India, Bihar , India
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Montalban M. A critical analysis of the Australian Defence Force policy on maternal health care. Aust N Z J Public Health 2017; 41:399-404. [PMID: 28370902 DOI: 10.1111/1753-6405.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/01/2016] [Accepted: 10/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To critically analyse the Australian Defence Force (ADF) policy on maternal health care: Health Directive No 235 - Management of pregnant members in the Australian Defence Force. METHOD Bacchi's 'What's the problem represented to be' framework was used to analyse Health Directive No 235. This paper critically examines the representation of pregnancy and birth, the resulting effects and considers alternate representations. RESULTS The ADF's policy on maternal healthcare considers pregnancy as a health issue that requires specialist intervention and care, also known as the medicalisation of birth. Current research emphasises women-centred care; a model of care not contained in the ADF policy. CONCLUSION The problematisation of pregnancy in the ADF restricts women's choices regarding their maternal healthcare provider. This is contrary to the healthcare rights of Australians and likely contributes to health inequalities of ADF women. Implications for public health: A research gap regarding ADF women's knowledge and wishes regarding their maternal health care has been identified. Future research can inform any alterations to the ADF policy on maternal healthcare.
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Vellakkal S, Gupta A, Khan Z, Stuckler D, Reeves A, Ebrahim S, Bowling A, Doyle P. Has India's national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study. Health Policy Plan 2017; 32:79-90. [PMID: 27515405 PMCID: PMC5886191 DOI: 10.1093/heapol/czw100] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states. METHODS Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995-99) and 2 (2000-04) from the pre-NRHM period, and Round 3 (2007-08), Round 4 and Annual Health Survey (2011-12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated. RESULTS Inequities in institutional delivery declined between pre-NRHM Period 1 (1995-99) and pre-NRHM Period 2 (2000-04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011-12 than in the early post-NRHM period 2007-08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007-08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011-12. CONCLUSION In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child healthcare components are critical for universal access to healthcare.
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Affiliation(s)
- Sukumar Vellakkal
- Center for Chronic Diseases and Injuries, Public Health Foundation of India, Gurgaon, Haryana, Postal code 122002, India
| | - Adyya Gupta
- Center for Chronic Diseases and Injuries, Public Health Foundation of India, Gurgaon, Haryana, Postal code 122002, India
| | - Zaky Khan
- Center for Chronic Diseases and Injuries, Public Health Foundation of India, Gurgaon, Haryana, Postal code 122002, India
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, OX1 3UQ, United Kingdom
| | - Aaron Reeves
- Department of Sociology, University of Oxford, Oxford, OX1 3UQ, United Kingdom
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine 15-17 Tavistock place, London, WC1H 9SH, United Kingdom
| | - Ann Bowling
- Department of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Pat Doyle
- Department of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
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Shahram MS, Hamajima N, Reyer JA. Factors affecting maternal healthcare utilization in Afghanistan: secondary analysis of Afghanistan Health Survey 2012. Nagoya J Med Sci 2015; 77:595-607. [PMID: 26663938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study, a secondary analysis of data from Afghanistan Health Survey 2012, aimed to identify factors affecting maternal healthcare utilization in Afghanistan. Subjects were 5,662 women aged 15-49 years who had had one delivery in the two years preceding the survey. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression analysis. The study found that 54.0% of mothers used antenatal care (ANC) at least one time, and 47.4% of births were assisted by skilled birth attendants (SBA). Adjusted OR of ANC use was 2.74 (95% CI, 2.08-3.60) for urban residency, 1.69 (95% CI, 1.26-2.27) for primary education relative to no education, 3.94 (95% CI, 3.51-4.42) for knowledge on danger signs of pregnancy, and 1.78 (95% CI, 1.47-2.15) for television and radio relative to no exposure. Adjusted OR of SBA utilization was 3.71 (95% CI, 2.65-5.18) for urban residency, 0.67 (95% CI, 0.48-0.91) for age <20 years relative to age 34-49 years, 1.43 (95% CI, 1.03-1.97) for secondary and higher education relative to no education, 1.83 (95% CI, 1.47-2.27) for para 1 relative to para ≥5, 6.66 (95% CI, 5.43-8.15) for ≥4 ANC visits relative to no visit, 1.37 (95% CI, 1.21-1.57) for knowledge of danger signs of pregnancy, 1.62 (95% CI, 1.38-1.90) for radio relative to no exposure, and 2.71 (95% CI, 2.25-3.27) for rich households relative to poor ones. Since women's education and knowledge about danger signs of pregnancy were significant factors of both ANC and SBA, educating women may be an effective step in promoting safe maternal health.
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van Bastelaer T, Woodman B, Chatterji M, Long D. Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya. Int J Health Plann Manage 2015; 31:e254-e272. [PMID: 25920603 DOI: 10.1002/hpm.2292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Many women in low-income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored-value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed-methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended-to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non-card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - David Long
- Princeton Policy Associates, Princeton, New Jersey, USA
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Kalu-Umeh NN, Sambo MN, Idris SH, Kurfi AM. Costs and Patterns of Financing Maternal Health Care Services in Rural Communities in Northern Nigeria: Evidence for Designing National Fee Exemption Policy. Int J MCH AIDS 2013; 2:163-72. [PMID: 27621969 PMCID: PMC4948141 DOI: 10.21106/ijma.21] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As population and access to information increases, so does the demand for health services. Unfortunately, many people who genuinely require these services do not usually have access to them. To increase access, various financing options have been used. Despite this, maternal morbidity and mortality rates remain high and spending is still largely out of pocket. This study assesses maternal health problems, preferred sources of care and the pattern of financing in a semi-rural community in North Western part of Nigeria. METHODOLOGY A cross-sectional descriptive study design was used. The study population consisted of women within the reproductive age group who had experienced childbirth 12 months or less prior to the study. A sample size of 240 was drawn using cluster and random sampling techniques. Interviewer administered questionnaires were used and the results were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS The mean age of the respondents was 29 years and 49% had no personal income. Fever was the commonest problem. Although majority received antenatal care, those who lacked antenatal care mostly cited financial difficulties. Nearly half of the women delivered at home as opposed to a health facility. On average, women spent between Nigerian Naira (N) N1, 350-N14, 850 (USD$9-99) for a total package of maternal health services. Out of pocket spending by the husbands or household heads and the women themselves accounted for 73.3% of expenses. CONCLUSION AND PUBLIC HEALTH IMPLICATIONS In Nigeria, women are still vulnerable to common and preventable causes of maternal morbidity and mortality due to lack of access to antenatal health care. Out of pocket spending is still a popular method of financing. Harmonization of fee exemption policies can improve access to maternal healthcare.
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Affiliation(s)
- Nnennaya N Kalu-Umeh
- National Health Insurance Scheme, Corporate Headquarters, Plot 297, P.O.W. Mafemi Crescent, Off Solomon Lar Way, Utako District, Abuja, Nigeria
| | - Mohammed N Sambo
- Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Suleiman H Idris
- Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Abubakar M Kurfi
- National Health Insurance Scheme, Kaduna Zonal Office, No. 2, Waziri Drive, Off Alkali Road, Kaduna, Nigeria
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Attah AF, O'Brien M, Koehbach J, Sonibare MA, Moody JO, Smith TJ, Gruber CW. Uterine contractility of plants used to facilitate childbirth in Nigerian ethnomedicine. J Ethnopharmacol 2012; 143:377-82. [PMID: 22766472 PMCID: PMC3430860 DOI: 10.1016/j.jep.2012.06.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/14/2012] [Accepted: 06/24/2012] [Indexed: 05/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pregnant women in Nigeria use plant preparations to facilitate childbirth and to reduce associated pain. The rationale for this is not known and requires pharmacological validation. AIM OF STUDY Obtain primary information regarding the traditional use of plants and analyze their uterine contractility at cellular level. MATERIALS AND METHODS Semi-structured, open interviews using questionnaires of traditional healthcare professionals and other informants triggered the collection and identification of medicinal plant species. The relative traditional importance of each medicinal plant was determined by its use-mention index. Extracts of these plants were analyzed for their uterotonic properties on an in vitro human uterine cell collagen model. RESULT The plants Calotropis procera, Commelina africana, Duranta repens, Hyptis suaveolens, Ocimum gratissimum, Saba comorensis, Sclerocarya birrea, Sida corymbosa and Vernonia amygdalina were documented and characterized. Aqueous extracts from these nine plants induced significant sustained increases in human myometrial smooth muscle cell contractility, with varying efficiencies, depending upon time and dose of exposure. CONCLUSION The folkloric use of several plant species during childbirth in Nigeria has been validated. Seven plants were for the first time characterized to have contractile properties on uterine myometrial cells. The results serve as ideal starting points in the search for safe, longer lasting, effective and tolerable uterotonic drug leads.
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Affiliation(s)
- Alfred F. Attah
- Medical University of Vienna, Center for Physiology and Pharmacology, Schwarzspanierstr. 17, A-1090 Vienna, Austria
- Department of Pharmacognosy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Margaret O'Brien
- National Centre for Biomedical and Engineering Science, National University of Ireland, Galway, Ireland
| | - Johannes Koehbach
- Medical University of Vienna, Center for Physiology and Pharmacology, Schwarzspanierstr. 17, A-1090 Vienna, Austria
| | - Mubo A. Sonibare
- Department of Pharmacognosy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Jones O. Moody
- Department of Pharmacognosy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Terry J. Smith
- National Centre for Biomedical and Engineering Science, National University of Ireland, Galway, Ireland
| | - Christian W. Gruber
- Medical University of Vienna, Center for Physiology and Pharmacology, Schwarzspanierstr. 17, A-1090 Vienna, Austria
- Corresponding author. Tel.: +43 1427762511; fax: +43 142779623.
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