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1
Nankwanga, Annet. "Factors influencing utilisation of postnatal services in Mulago and Mengo Hospitals Kampala, Uganda." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers<br>mothers&rsquo<br>knowledge about postnatal services<br>mothers&rsquo<br>socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service.
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Atuhaire, Lydia. "Barriers and facilitators to uptake of cervical cancer screening among women accessing maternal and child health services in Kampala, Uganda." University of Western Cape, 2013. http://hdl.handle.net/11394/3924.
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Magister Public Health - MPH<br>The aim of the study was to explore the challenges to uptake of cervical cancer screening among women accessing maternal and child health services at Nsambya Hospital in Kampala, Uganda.
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Kabagambe, Agaba Daphine. "Analysing human rights accountability towards ending preventable maternal morbidity and morality in Uganda." University of the Western Cape, 2017. http://hdl.handle.net/11394/6304.
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Doctor Legum - LLD<br>The persistence of preventable Maternal Morbidity and Mortality (hereafter MMM), in the
developing world, despite ground breaking technological and scientific advances, is
unacceptable. There is no cause of death and disability for men between ages 15 and 44
that comes close to the large scale of maternal mortality and morbidity. Thus, the
prevalence of high MMM ratios indicates the side-lining of women's rights. Surprisingly, the
causal factors of preventable MMM and interventions needed to reverse the pervasively high
numbers are now well known. Yet, hundreds of women continue to die daily and to suffer
lifelong illnesses while giving birth. In Uganda, despite various regulatory, policy and
programmatic strategies, the most recent survey revealed that the maternal mortality ratios
were at a staggering 438 per 100,000 live births.
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McLendon, Pamela Ann. "Opening Doors for Excellent Maternal Health Services: Perceptions Regarding Maternal Health in Rural Tanzania." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc500156/.
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The worldwide maternal mortality rate is excessive. Developing countries such as Tanzania experience the highest maternal mortality rates. The continued exploration of issues to create ease of access for women to quality maternal health care is a significant concern. A central strategy for reducing maternal mortality is that every birth be attended by a skilled birth attendant, therefore special attention was placed on motivations and factors that might lead to an increased utilization of health facilities. This qualitative study assessed the perceptions of local population concerning maternal health services and their recommendations for improved quality of care. The study was conducted in the Karatu District of Tanzania and gathered data through 66 in-depth interviews with participants from 20 villages. The following components were identified as essential for perceived quality care: medical professionals that demonstrate a caring attitude and share information about procedures; a supportive and nurturing environment during labor and delivery; meaningful and informative maternal health education for the entire community; promotion of men’s involvement as an essential part of the system of maternal health; knowledgeable, skilled medical staff with supplies and equipment needed for a safe delivery. By providing these elements, the community will gain trust in health facilities and staff. The alignment the maternal health services offered to the perceived expectation of quality care will create an environment for increased attendance at health facilities by the local population.
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Mayanja, Rehema. "Decentralized health care services delivery in selected districts in Uganda." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined.
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Mbabazi, Muniirah. "Exploring the efficacy of maternal, child health and nutrition interventions in Uganda." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/48215/.
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Introduction and background: Malnutrition, particularly undernutrition remains a major development challenge for sub-Saharan Africa. There has been mixed progress in reducing undernutrition and the numbers remain unacceptably high. However, high impact nutrition interventions have been recommended for implementation in high burden malnutrition countries to address undernutrition. Countries have responded by designing policies and programmes that reflect these recommendations. However, there is limited evidence of what works and how in local contexts. Objectives: This research explored the efficacy of nutrition interventions and modality of delivery of interventions and programmes in Uganda at national, local government and community levels. Specifically this study examined key stakeholders’ experiences of current nutrition interventions at district level in Uganda; assessed the effectiveness of previous nutrition specific and nutrition sensitive interventions on maternal and child health outcomes in Uganda; and examined the relationship between socio demographic and health factors on nutrition outcomes in Uganda. Methods and subjects: Using a combination of methods (mixed methods), this study explored nutrition interventions targeting mothers of reproductive age and children (0-5 years) in three separate studies. A systematic review was conducted to explore existing evidence on the nature of maternal and child health and nutrition interventions; and methods used to deliver them since 1986-2014. Studies were included if they were done in Uganda and reported health and nutrition related outcomes among the study group. Included studies were assessed for quality using the Newcastle Ottawa Scale. Twenty-two predominantly cross-sectional and longitudinal studies were included in the review. A qualitative study covering project implementers and project beneficiaries (n=85) in local communities was conducted using face-to-face interviews. Interviews explored methods used to deliver interventions and implementers’ and community participants’ perspectives and experiences of on-going nutrition interventions at local government (LG) and community level. Community beneficiaries were mothers or caretakers of children aged 0-59 months accessing interventions from two studied projects, while implementers were project staffs or health workers on the same projects. Interviews were transcribed verbatim and thematically analysed. Population based data of the 2011 Uganda demographic and health Survey (DHS) was quantitatively analysed. Logistic regressions analyses were done to establish factors that influence child stunting and anaemia in Uganda. Models were constructed based on 2350 stunted and 2056 child anaemia cases in the data set. Using a multilevel model design of mixed methods research, findings from each study were triangulated to obtain complementary information on the study phenomena. Results: Results suggest that planning and implementation of nutrition interventions in Uganda has transformed from random to systematic implementation since 1986. Nutrition interventions delivered diverse activities to address multiple causes of undernutrition in Uganda. However, activities were predominantly non-integrated delivered specifically at facilities or in communities. Methods of delivering interventions were broad to include community and health system compatible strategies (community mobilisation, outreaches and individual or group nutrition education and counselling) to prevent, manage and treat undernourished cases at facilities and within communities. Results further showed that maternal anaemia status, age of child and geographic factors were associated with stunting and anaemia in children. Further, the qualitative study showed, there was a conducive policy environment to implement multi-sectoral nutrition interventions in Uganda. There were linkages, collaborations and partnerships to delivery multi-sectoral integrated nutrition actions in communities and LG. Results however reveal that the dominance of external partners in implementing nutrition interventions; and absence of functional coordinating structures and mechanisms hinders intervention scale up. Further there was a need to address system and community barriers that affect implementation to improve nutrition outcomes and scale up at LG and community level. Conclusion: There have been great strides towards solving challenges of malnutrition in Uganda. Integrated approaches using community mobilisation and nutrition education and counselling at health facilities were among common delivery methods. However, bottlenecks exist in prioritisation and commitment to scale. There is a need to strengthen integrated approaches to delivering interventions across the LG and communities for multi-sectoral programming and implementation to reduce the number of undernourished Ugandans.
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Nyberg, White Maria. "Preventing maternal mortality : - Nurses’ and midwives’ experiences from Tanzanian maternal health care services." Thesis, Linköpings universitet, Avdelningen för omvårdnad, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-116479.
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Background: Half a million women died during pregnancy or childbirth in 2005. Bleeding, infections, high blood pressure, obstructed labor, unsafe abortions, malaria and HIV/Aids were the main causes. Tanzania is a highly affected country with 460 maternal deaths per 100 000 live births. Nurses and midwives play an important role in preventing maternal mortality. Purpose: The aim of this study was to explore and analyze nurses’ and midwives’ experiences of maternal mortality prevention on the Tanzanian island of Unguja. Method: Interviews with nine nurses and midwifes from four different hospitals and health care facilities were conducted with the assistance of an interpreter. A structural analysis designed by Ricoeur was undertaken. Results: The findings suggest that family planning, a more accessible health care, referral of severe cases, medical interventions, health education, community resource persons and involving fathers in maternal health care are preventive strategies that can reduce maternal mortality. Conclusion: To further improve the quality of maternal mortality prevention further knowledge aboutindividual differences in learning from health education is needed. Involvement of all fathers in maternal health care should also be considered. Training of unskilled personnel is believed to improve early identification of life-threatening complications and thereby reduce maternal mortality.<br>Bakgrund: En halv miljon kvinnor i världen dog under graviditet eller förlossning under 2005. Huvudorsaker var blödningar, infektioner, högt blodtryck, långdragna förlossningar, osäkra aborter, malaria samt HIV/Aids. Tanzania är ett drabbat land med 460 fall av mödradödlighet per 100 000 levande födda barn. Sjuksköterskor och barnmorskor spelar en viktig roll i det preventiva arbetet mot mödradödlighet. Syfte: Syftet med studien var att utforska och analysera sjuksköterskors och barnmorskors upplevelser och erfarenhet av arbetet mot mödradödlighet på ön Unguja, Tanzania. Metod: Intervjuer med nio sjuksköterskor och barnmorskor från fyra olika sjukhus/hälsocentraler genomfördes med hjälp av en tolk. En strukturanalys utformad av Ricoeur genomfördes. Resultat: Resultatet visar att familjeplanering, en mer tillgänglig hälso- och sjukvård, remitterande av patienter med allvarliga komplikationer, medicinska interventioner, hälsoutbildning, resurspersoner i samhället och att involvera pappor i mödrahälsovården var preventiva strategier som kan minska mödradödlighet. Slutsats: För att ytterligare förbättra arbetet mot mödradödlighet tycks mer kunskap om individers förmåga att ta till sig hälsoutbildning behövas. Att i ännu större utsträckning även välkomna alla blivande pappor till mödrahälsovården föreslås också kunna fungera preventivt. Utbildning för outbildade kvinnor som hjälper till vid förlossningar (Traditional Birth Attendants) tros kunna förbättra tidig identifikation av livshotande komplikationer och därmed kunna minska mödradödligheten.
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Atmarita. "Assessing the determinants of maternal mortality in Indonesia." Ann Arbor, Mich. : University of Michigan, 1999. http://books.google.com/books?id=SxUvAAAAMAAJ.
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Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.
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The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (R� = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001), as did the availability of essential medicines (β= .255, p <.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.
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Aihara, Yoko Sirikul Isaranurug. "Effect of maternal and child health handbook on maternal and child health promoting belief and action /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737949.pdf.
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Musana, Imelda Atai Madgalene. "Effect of Access to Health Services on Neonatal Mortality in Uganda." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7828.
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Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and analyzed using binary logistic regression and one-way analysis of covariance (ANCOVA). The results showed attending less than 4 antenatal care (ANC) visits during pregnancy increased the odds of neonatal deaths 1.57 times, while not taking antimalarial drugs during pregnancy increased the odds of neonatal deaths 1.67 times. However, receiving 4 or more tetanus toxoid (TT) vaccine doses before pregnancy was not statistically associated with an increased risk of neonatal death (p = .597). Also, there was no significant relationship between neonatal mortality and whether distance to health facilities was a challenge (p = .276) or receiving medical assistance during childbirth (p = .420). While there were significant differences in deaths of newborns in geographic regions while controlling for the number of ANC visits (p = .023), there were no differences while controlling for all three covariates, F(4, 117) = 2.00, p = .098. Findings may be used to inform government policies on ANC and malaria prevention during pregnancy, which may reduce neonatal mortality rates in Uganda.
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Manthalu, Gerald Herbert. "The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi." Thesis, University of Aberdeen, 2014. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=214843.
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The Government of Malawi has entered into agreements with Christian health association of Malawi (CHAM) health care facilities in order to exempt their catchment populations from paying user fees. These agreements are called service level agreements (SLAs). Government in turn reimburses the CHAM health care facilities for the health services that they provide. The agreements started in 2006 with 28 out of 166 CHAM health care facilities and increased to 68 in 2010. The aim of the exemption policy is to guarantee universal access to a basic package of health care services. Although the agreements were designed to cover every health service in the basic health care package, only maternal and neonatal health services are included due to limited resources. The main objective of this thesis was to evaluate the impact of the health care financing change on health care utilisation and health. The specific objectives were as follows: first, to examine whether health care facility visits for maternal health care changed due to user fee exemption; second, to evaluate whether user fee exemption affected the choice of the health care provider where women living in the catchment areas of CHAM health care facilities with user fee exemption sought maternal health care; third, to analyse the effect of user fee exemption on birth weight and; fourth, to explore and apply novel methods in the evaluation of user fee exemption. The gradual uptake of service level agreements by CHAM health care facilities provided a natural experiment with treated and control health care facilities. An additional control group comprised of other demographic groups apart from pregnant women and neonates at CHAM health care facilities with service level agreements. In household survey data, individuals were assigned to treatment and control groups based on their proximity to either a CHAM health care facility with SLA or a CHAM health care facility without SLA. This proffered the unique opportunity to estimate the effect of a single treatment on multiple outcomes. The difference-in-differences (DiD) approach was used to obtain causal effects of user fee exemption. It was implemented in the context of fixed effects, switching regression and multinomial logit models across different chapters. Health care facility level panel data for utmost 146 health care facilities for a maximum of 8 years, 2003-2010, were used. The data were obtained from the Malawi health management xiii information system (HMIS). Linked survey data were also used. Malawi demographic and survey data for 2004 and 2010 were linked to health care facility data and then merged. Analyses that utilised health care facility data showed that user fee exemption had led to increases in first antenatal care visits in the first trimester, first antenatal care visits in any trimester, average antenatal care visits and deliveries at CHAM health care facilities with SLAs. Results from survey data showed that the probability of using a CHAM health care facility with user fee exemption for antenatal care increased, the probability of using home antenatal care declined and the probability of not using antenatal care also declined due to user fee exemption. The probability of delivering at a CHAM health care facility with SLA also increased while the probability of delivering at home declined. User fee exemption did not affect the choice of where to go for postpartum care. Results of the effect of user fee exemption on birth weight were not reported because of potential endogeneity bias arising from lack of instrumental variables for antenatal care. The key policy messages from this thesis are that the user fee exemption policy is an important intervention for increasing the utilisation of maternal health care and needs to be extended to as many CHAM health care facilities as necessary. User fee exemption is not enough, however. Other factors such as education of the woman and her husband/partner, wealth status and cultural factors are also important. This thesis has contributed to the body of knowledge in the following ways. First, it has generated evidence on the impact of user fee exemption on maternal health care utilisation and birth weight in Malawi. Second, with respect to maternal health care utilisation, the thesis has looked at variables that capture the whole maternal health care process from early pregnancy to postpartum care and in a policy relevant way. Third, the thesis has evaluated the effect of user fee exemption on a variable that have not been looked at before, first antenatal care visits in the first trimester. Fourth, the thesis has examined the effect of a single treatment on multiple outcomes in a methodologically unique way. Treatment effects, which were the changes in the probabilities of using different alternatives summed up to zero, thus showing where any increase in the probability of using the outcome of interest came from. Fifth, this thesis is first to use disequilibrium theory of demand and supply in health economics. Application of this theory entailed using switching regression models with unknown sample separation, a seldom used estimation method in health economics. This was an important contribution to the methods xiv of analysing aggregate health care utilisation. Sixth, the STATA program that was written for the estimation of the disequilibrium models was itself a very important contribution to the methods for estimating aggregate supply and demand.
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Mabirizi, David. "Determinants of maternal delivery at rural health facilities a study undertaken in the Mpigi District of Uganda." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11285.
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Includes bibliographical references.<br>Mpigi District is a rural district in Uganda with high maternal morbidity and mortality. While most pregnant women in Uganda attend antenatal clinics, few ultimately deliver their babies in a health facility. Interventions have not achieved increased utilisation of maternal services. A review of maternal determinants and factors associated with health facility delivery is the focus of this study. To determine the reasons why women deliver in health facilities; to identify the maternal determinants or factors associated with health facility delivery; and to determine the socio-demographic characteristics of women who deliver in health facilities. This quantitative, descriptive, cross-sectional study of 257 women who delivered in the Mpigi District in 2008/2009 used face-to-face interviews at which a questionnaire was administered. Women delivered in health facilities because they expected a safe delivery. Ten factors were found to be significantly associated with a higher possibility of health facility delivery: eight or more years of education (P=0.002); previous health facility delivery (P<0.0001); first delivery in a health facility (P<0.0001); no history of a non-health facility delivery (P <0.0001); more than 50% of deliveries in a health facility (P=0.007); three or more antenatal care visits (P=0.031); above-average socio-economic status (P=0.016); living in a household of three or fewer individuals (P=0.028); living within 30 minutes? travel time of a health facility (P=0.007); and history of contraceptive use (P=0.046). These are the maternal determinants of health facility delivery in this rural setting. The mothers that delivered in health facilities were 15 and 29 years old (85.2%), either married or cohabiting (77.5%), had completed eight years or more of formal education (53.5%), lived within a radius of up to 30 minutes? journey from a health facility (67.2%) and lived in a household of four or more individuals (76.0%). This study shows that there are specific maternal characteristics (sociodemographic descriptors) that are associated with increased possibility of health facility delivery.
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Tsawe, Mluleki. "Utilization of health care services and maternal education in South Africa." University of the Western Cape, 2014. http://hdl.handle.net/11394/4358.
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Magister Philosophiae - MPhil<br>The importance of maternal health care services cannot be stressed enough. Maternal health services are important in reducing pregnancy-related complications as well as maternal and infant deaths. This study was concerned with investigating the relationship between maternal education and maternal health care utilization. Furthermore, the study aimed to investigate the rates of maternal health care use, the reasons for non-use of maternal health services, as well as the determinants of maternal health care use. Primary data was used from selected areas (Tsolo, Qumbu and Mqanduli), which fall within the O.R. Tambo district in the Eastern Cape Province. Simple random sampling was used (with a structured questionnaire) to study maternal health care use among the sampled women. To analyse this data, univariate, bivariate, and multivariate techniques were employed. The results indicated that maternal education was not statistically significant with antenatal and postnatal services, but the percentages were important in explaining the use of maternal health care services in relation to maternal education. Women with higher levels of education reported higher rates of antenatal and delivery care utilization, while those with lower levels of education reported higher rates of postnatal care use. Access factors, such as transport, payment and distance to health facilities, also played an important role in the use of maternal health care services. It was recommended that the Department of Health implement mobile clinics and centralize health care facilities as this will bring essential health services closer to the communities. Women in the study area also need to be educated about the importance of these services, more particularly pertaining to postnatal care.
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Paudel, Deepak Raj Orapin Pitakmahaket. "Women's autonomy and utilization of maternal health services in Nepal /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd392/4838764.pdf.
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Nilsen, Kristine. "Crossing the river : inequities in maternal health services in Cambodia." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/417787/.
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With the focus on universal health coverage (UHC) and the inclusion of an equity target in the newly adopted Sustainable Development Goals, equity analysis is becoming prominent in the evaluation of health policies in low-income countries. Focusing on Cambodia, the overall aim of this thesis is to examine spatial and socio-economic equity patterns in maternal health services between 2000 and 2014, a period characterised by extensive health systems reforms. Inequities of maternal health services are examined on one UHC dimensions, population coverage in terms of use and quality of services. Using household surveys and the population census, inequities are measured using econometric analysis, logistic multilevel models and small area estimation. Results show that irrespective of residency, inequities in the use of services decrease over time as population coverage increases. However, use remains pro-rich in 2014. The pro-rich bias in urban areas is particularly strong when examining inequities of the quality of services received. In rural areas, inequities in quality by socio-economic status are low as most of the health services provided fail to meet the quality criteria applied. Moving beyond the urban/ rural dichotomy, large spatial inequities in the utilisation of services are for the first time observed at small areas, suggesting that health system characteristics and other socio-economic determinants manifest themselves geographically. Findings are discussed in the context of inverse equity hypothesis, health system reform and socio-economic development. The thesis concludes that there is partial support for the inverse equity hypothesis and that the hypothesis may have a spatial dimension that has previously not been captured. It also concludes that health system reforms targeting the supply-side of service provision probably had an effect on reducing inequities, but that socio-economic development including increased household wealth cannot be excluded as a major contributor to increased service uptake.
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Umar, Abubakar Sadiq. "Use of Maternal Health Services and Pregnancy Outcomes in Nigeria." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2079.
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Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of MHS and pregnancy outcome as measured by number of antenatal visits, place of delivery, and fetal outcome. The Anderson's health behavior model was used as the theoretical framework for this study. Respondents were women aged 15 - 49 years (N= 31,985), who had given birth between January 2003 and December 2008. Bivariate and multiple logistic regressions were conducted. The results indicated that religion, education, income, and availability of skilled health workers showed consistent significant statistical association with both the number of ante natal care (ANC) visits and place of delivery even after controlling for covariates. Overall, these findings have potential for social change on the choice of public health interventions with collaboration with social services such as education, community, and labor sectors. Further, a systematic involvement of local communities is needed to drive specific culturally-sensitive interventions.
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Alyao, Ocero A. "A comparative analysis of health system governance and its impact on maternal health care in post-conflict northern Uganda and non-conflict east central Uganda." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3006579/.
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Background: Northern Uganda is recovering from a 23-year civil war that was largely confined to the region. During this period the rest of Uganda enjoyed a rapid GDP growth rate following wide-ranging macroeconomic reforms by the Ugandan government and its development partners. A post-recovery programme was implemented for Northern Uganda; however, the region still has the worst health status. This contributed to the country’s failure to attain MDG five for maternal health. Limited research has been conducted to determine which national and health system governance factors influence performance and affect access and utilisation of health care in countries like Uganda that have witnessed the dual context of conflict and non-conflict. A better understanding of the governance and policy development process in such settings is required if health policy adoption and implementation is to be more appropriate to the needs of the country’s entire population. Methods: A Political Economy Analysis framework was applied to compare governance factors at national and sub-national level in post-conflict Northern Uganda and in non-conflict East Central Uganda that had influenced the provision and utilisation of maternal health care. An analysis of constitutional, economic and health policies determined contextual factors, while data collected through in-depth interviews and focus group discussions with decision-makers, implementers and communities determined the institutional and agency features. The features were used to access power and accountability relationships and incentives that drove the actions of health system stakeholders in central government, health ministry, district local government and civil society as well as in the local communities during the post conflict period in the Northern and East Central Uganda. Findings: The post-conflict period in Northern Uganda coincided with evidence of increased national political commitment to addressing the healthcare needs of Northern Uganda. However, the President, International Funding Institutions and Finance Ministry technocrats who were the dominant governance stakeholders pursued an approach to economic development that prioritised funding for the development of energy, transportation and defence sectors over that for healthcare. Women parliamentarians emerged as maternal healthcare policy champions but played a limited role in highlighting the special health needs of Northern Uganda. The Health Ministry lacked the political and technical capacity to adapt and implement maternal health care policies to specific sub-national needs. NGOs focused on human rights advocacy in Northern Uganda that enhanced the community’s demand for appropriate healthcare while in East Central Uganda they mainly addressed supply-side issues. Political patronage at national and sub-national levels negatively influenced supply and demand for healthcare. In Northern Uganda donor funding, district-based development partner presence, and CSO health system demand-side activities moderated a more positive influence. Conclusion: Decentralisation offers greater opportunities for health system recovery in settings of confined conflict but is prone to elite capture and corruption in peaceful settings within the same national context. Women leaders are critical in the development of a national health system where there is confined conflict, but political and traditional norms limit their role in the promotion of universal healthcare coverage. Despite the presence of factors that portended better maternal healthcare in the post-conflict setting, the limited involvement of the health ministry in the recovery process diminished the impact. CSOs in collaboration with communities play an important role in enhancing the responsiveness of the health system but are prone to political intrusion. The comprehension of policies, economic processes and social institutions of a country recovering from confined conflict enables the identification of variables which, if addressed, will lead to versatile, equitable health systems for all citizens.
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Chaudhuri, Anoshua. "Intended and unintended consequences of a maternal and child health program in rural Bangladesh /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/7411.
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Biswas, Animesh. "Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-46379.
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Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.
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Witter, Sophie. "Making delivery care free : evidence from Ghana and Senegal on implementation, costs and effectiveness of national delivery exemption policies." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=25753.
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M'soka, Namakau C. S. "Beliefs of women receiving maternal and child health services at Chawama Clinic in Lusaka, Zambia regarding pregnancy and child birth." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/509.
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Thesis M. Med.(Family Medicine))University of Limpopo (Medunsa Campus), 2010.<br>The experience of child birth occurs in all cultures and is important for the continuation of a community. Beliefs related to pregnancy and child birth though usually harmless may at times be detrimental to the health and well being of women that may practice them. The adherence to such beliefs depends on the socio cultural background of individuals and the importance they place on their cultural practices.
Aim and objectives
The study aimed to explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. The main study objectives were to determine the demographic characteristics of the women and ascertain their beliefs regarding diet, behaviour and belief in the use of herbs during pregnancy, delivery and the post natal period.
Methods
A descriptive, cross-sectional survey was conducted. A 32 item questionnaire was administered to 294 women over a four week period by two research assistants, after obtaining informed consent.
Results
Results indicate that traditional beliefs were wide spread among the participants though few significant associations were demonstrated. Dietary beliefs that what is eaten could
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affect the progress of labor or the unborn child’s appearance or behaviour were popular. Negative behaviour such as quarrelling or infidelity was believed could lead to difficult labour or adverse outcomes. Herbs were generally believed to be useful for certain indications such as to assist labour or for ‘cleansing’ after miscarriage.
Conclusion
Health beliefs regarding pregnancy and child birth are an integral part of the community and to be discussed in order to have some influence on them. Continued dialogue is recommended though current clinic health education sessions and qualitative studies to explore other beliefs and myths that are arising out of new health concerns such as HIV.
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Wibbelink, Margreet. "Perceptions of private sector midwives and obstetricians regarding collaborative maternity." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020979.
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The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.
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Nguyen, Thu Ha Chanya Sethaput. "Factors influencing utilization of maternal health care services in northern Vietnam /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd381/4738660.pdf.
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Percy, Ray. "Maternal verbal communication and the treatment of children with anxiety disorders in the context of maternal anxiety disorder." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/370404/.
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Kuronen, Marjo L. A. "The social organisation of motherhood : advice giving in maternity and child health care in Scotland and Finland." Thesis, University of Stirling, 1999. http://hdl.handle.net/1893/2302.
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This study is a qualitative, cross-cultural research on advice giving for mothers in maternity and child health services in Scotland and Finland. It has been accomplished through local case studies using ethnographic methods. The main objective is to analyse how in these service systems motherhood, women's daily life, and their responsibilities for children's welfare and health are defined and organised, and how these definitions vary across social and cultural contexts. Methodologically, referring to the feminist methodology by Dorothy E. Smith, it is emphasised that beginning from the local and particular, from the everyday practices of health professionals, can provide more general understanding of the social relations that organise motherhood in the two societies. Empirical results of the study are presented under six substantial themes: The first theme discusses different professional groups as service providers and the relationships between them. Second theme concentrates on the clinic and the home as the physical settings of service provision and their professional and cultural meanings. Third section discusses the relationship and interaction between health professionals and their clients. Next two themes are related to the standards of motherhood: expectations for proper motherhood, child care, and family relations of the mothers. The last theme analyses possible conflicts between women's everyday experience and professional expertise in motherhood. The general conclusions drawn from the research suggest that motherhood is socially organised at four different but interrelated levels, named in this study as interactional level, institutional level, welfare state level, and socio-cultural leveL. Advice giving for mothers in maternity and child health care is related to family policy measures, social class and gender systems, historical and cultural tradition, customs, and ways of thinking in a certain society. This complexity underlines the relevance of qualitative approach in comparative research.
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Kachimanga, Chiyembekezo. "Improving utilisation of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29196.
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Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016. Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post-intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) 14 was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar pre-intervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs 15 visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%). Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
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Workneh, Nibretie Gobezie. "Socioeconomic Status-Related Inequities on Maternal Health Services: Trends, Associations, and Outcomes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2246.
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Maternal Mortality Rate (MMR) in Ethiopia remains one of the highest in the world due in part to very limited use of maternal health services. However, the underlying factors for limited use of the services and hence the high MMR are not well known. The purpose of this study was to identify factors associated with use of maternal health services and maternal health risks, to analyze inequity patterns between use of maternal health services and maternal health risks, and to measure the magnitude and trends in inequity. Behavioral-cultural and structural theories of health inequalities were used to frame the study. Research questions included whether there were trends of inequity in use of maternal health services, if sociodemographic characteristics were associated with use of the services, and whether inequities in use of the services were associated with maternal health risks. The study design was quantitative and used data collected through Demographic and Health Surveys (DHS) conducted in 2000, 2005, and 2011. DHS had employed stratified 2-stage cluster design; this analysis used logistic regression method, odds ratio chi-square test, and correlation measures. The findings indicated statistically significant inequities on use of antenatal care and skilled birth attendant services associated with women's residence, level of education, income, administrative region, distance to a health facility, out-of-pocket payment for health services, and involvement in decision making. Based on the findings, it is recommended to design maternal health policies and programs that improve access and use of the services, specifically for women in rural areas, with no education and with limited economic capacity. Further research is also recommended for regions where sample size was limited. Maternal health policies and programs designed to reach the most disadvantaged women could increase service use and improve maternal health, leading to positive social change.
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Sharma, Sharad Kumar Buppha Sirirassamee. "Utilization of maternal health services an evaluation of safe motherhood program in Nepal /." Abstract, 2003. http://mulinet3.li.mahidol.ac.th/thesis/2546/cd356/4538005.pdf.
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Källander, Karin. "Case management of childhood fevers in the community : exploring malaria and pneumonia care in Uganda /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-557-7/.
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Nara, Ruth. "Understanding the Reproductive Health Needs of Displaced Congolese Women in Uganda." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38394.
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Uganda currently hosts 1.4 million refugees and conflict-affected people. Known as the “best place” in Africa to be a refugee, Uganda’s policies encourage self-sufficiency and local integration. However, many refugees, particularly women and girls, face persistent challenges. Understanding the reproductive health needs of this population and exploring the accessibility of services for conflict-affected populations in this low-income host country is a priority. This multi-methods study aimed to assess the reproductive health needs of displaced Congolese women in camp- and urban-based settings in Uganda. We interviewed key informants, facilitated focus group discussions with refugee women, and conducted in-depth interviews with Congolese women of reproductive age to better understand knowledge, attitudes, practices, and services. Our results suggest that Congolese refugees have significant unmet reproductive health needs. Maternal health and delivery care is characterized by insufficient human resources, inconsistent medication availability, discrimination, bribery, and communications challenges. The availability of contraceptive products, including emergency contraception, is limited in camp-based settings due to supply-chain management challenges and theft by staff; lack of contraceptive knowledge among Congolese refugees shapes use. Finally, the legal restrictions on abortion lead to unsafe practices among refugees and pose a barrier to the provision of post-abortion care. This study provides insight for opportunities to improve the delivery of sexual and reproductive health services to refugees in Uganda to ensure that the infrastructure and processes align with national policies and international guidelines.
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Kildea, Sue. "Birthing business in the bush : it's time to listen /." Electronic version, 2005. http://adt.lib.uts.edu.au/public/adt-NTSM20051006.180714/index.html.
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Gubhaju, Bina Matsumura Masaki. "Women's status, household structure and the utilization of maternal health services in Nepal /." Abstract, 2000. http://mulinet3.li.mahidol.ac.th/thesis/2543/43E-Bina-G.pdf.
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Ngula, Asser Kondjashili. "Women's perception on the under utilization of intrapartum care services in Okakarara district, Namibia." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Maternal health care services are one of the health interventions to reduce maternal and infant morbidity and mortality. The health of mothers of childbearing age and of the unborn babies is influenced by many factors some of which include the availability and accessibility of health services for pregnant women. Low quality of health services being provided, and limited access to health facilities is correlated with increases maternal morbidity and mortality. This situation is caused by long distances between facilities as well as the people's own beliefs in traditional practices. This study was about the assessment of the women's knowledge on benefits of delivery in a hospital, the barriers to delivery services, and the perception of the delivery services rendered in the maternity ward of Okakarara hospital.
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Tophill, Church. "Quality of Nutrition Services for Children and Pregnant Women in Ntungamo District, Uganda." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5426.
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Inadequate nutrition during infancy and early childhood seriously interferes with brain development, leading to neurological and behavioral disorders. Such effects are detrimental to children under 2 years of age. The purpose of this cross-sectional study was to better understand the quality of nutrition services offered to children and pregnant women in Ntungamo District in southwestern Uganda. The cross-sectional design facilitated comparison of different variables, using a research-question-driven approach, assessing existing secondary data from SPRING Uganda database. Stepwise, backward multiple logistic regression was used to identify the independent variables that influenced the provision of quality nutrition assessment, counseling, and support (NACS) services to clients. Only the independent variables with p < 0.05 were retained in the final model. Odds ratios with 95% confidence intervals were used to estimate the strength of association between the independent variables which are: 1) training of health workers with different nutrition packages, 2) availability of nutrition assessment equipment at varied service delivery points, 3) availability of nutrition supplies for preventing and treating acute malnutrition, 4) availability of nutrition treatment protocols and IEC materials functionality of quality improvement teams, and 5) supervision and motivation of health workers. The dependent variables were indicated by percentage of children and pregnant women who were provided with appropriate NACS in outpatient departments, young child clinics, antenatal clinics, postnatal clinics and antiretroviral therapy (ART) departments in the past 3 months. Statistical analysis was performed with IBM SPSS 25.0. All associations with p < 0.05 were considered statistically significant. All surveyed facilities offer maternal health services, a positive indication that a greater percentage of the facilities in western Uganda realize the importance of nutrition assessment of pregnant mothers and children. Of the sampled health facilities supported by SPRING Uganda, 56.3% had functional nutrition assessment equipment like mid-upper arm circumferences (MUAC) tapes and weighing scales. This study showed that different nutritional services offered to pregnant and lactating mothers and children could either positively or negatively affect the quality of nutrition in Ntungamo District.
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Lima, Marilia de Carvalho. "Influence of maternal work activity on birth weight in Palmares, Northeast Brasil." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283244.
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Mwale, Ackson Tyson. "Women’s empowerment and use of Maternal Health Services in Zambia in 2010s." Thesis, Stockholms universitet, Sociologiska institutionen, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-158073.
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This study investigates the influence of women’s empowerment measured via spousal educational difference and women’s completed education level on the use of maternal health services (Antenatal care and skilled birth assistance), and whether it varies by ethnicity. A theoretical framework based on Kabeer’s three dimension of empowerment combined with Zimmerman’s approach and the rational choice theory informs the analyses. Data from the 2013/2014 Zambia Demographic and Health survey are analysed focusing on women aged 15 -49 years who are married/ live with a partner and had a birth in the past five years. Multivariate logistic regression is the tool of analysis.The results indicate significant association between women’s completed education level and use of maternal health services. Spousal educational differences show no significant association with the use of MH services. For both ANC and SBA use, a relatively weak relationship is seen with ethnicity. In addition, women’s wealth level, the province they live in and region of residence type appear to be important with respect to the utilization of MH services. The findings are explained in relation to the theoretical framework as well as previous studies, concluding the study with suggestions for further research.
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Ibrahim, Ghada. "The role of the health system in women's utilisation of maternal health services in Sudan." Thesis, City, University of London, 2015. http://openaccess.city.ac.uk/17079/.
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Background: Maternal mortality and morbidity still pose a significant challenge in Sudan, where no significant improvements in maternal health have been achieved despite the focus on the Millennium Development Goals. Under-utilisation is a major public health concern even though Sudan is among the African countries that have registered poor maternal and child health. Health services in Sudan are generally limited and with poor quality and disparate access. Therefore, there is a need for better understanding of the barriers to the provision and utilisation of maternal health services in order to improve the health and survival of Sudanese mothers. Objectives: This study sought to assess the maternal health system functions and influences on utilisation as well as the social, cultural, and women’s characteristics that may constitute barriers to utilisation. Methodology: The study used an explanatory sequential mixed-methods design. A comprehensive analysis was conducted using several quantitative and qualitative data sets, guided by a new framework, the Maternal Health System Performance framework (MHSP) developed as part of this work in order to assess both the three objectives and four functions of the health system on both macro and micro levels. Findings: The study findings provide clear evidence that the Sudan health system is not currently capable of achieving an adequate level of attainment of the health goals or equitable distribution, due to dysfunction of the four health system functions. In addition, the findings draw attention to the important role of the stewardship function in health system performance. This function can play a key role in health system reform, as it influences management of the health system and should work across all elements of the system to ensure a well-functioning health system and efficient use of resources. The findings also underline the important role of health system related factors rather than simply population factors (such as individual, household, and community factors) in the low service utilisation among women in poor settings. While it shows that certain population characteristics such as household income and education do have a significant impact on the utilisation, the health system functions, and in particular the stewardship function, are also demonstrated to be of considerable importance. Implication: These findings have implications for policy and practice, indicating that simply blaming women for not using maternal health services is unhelpful and inappropriate and indicate that decision makers should focus more fully on improving the performance of the health system. According to the comprehensive assessment of the health system performance, the study proposes several recommendations for each health system function to enhance the performance in the context of limited resources, ultimately to improve women’s and community health in Sudan.
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Ssali, Sarah Evelyn Nabwire. "The impact of health user fees on women's role in household health care decision-making in Mukono District, Uganda : a gender analysis." Thesis, Queen Margaret University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269191.
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Matizirofa, Lyness. "Perceived quality and utilisation of maternal health services in peri-urban, commercial farming, and rural areas in South Africa." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&.
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This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.
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Guo, Sufang Oratai Rauyajin. "Health service utilization of women with reproductive tract infections in rural China /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-GuoSufang.pdf.
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Heslehurst, Nicola. "Trends in maternal body mass index, health inequalities, and the impact of maternal obesity on NHS maternity services." Thesis, Teesside University, 2009. http://hdl.handle.net/10149/112673.
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The primary objective of the work presented in this thesis was to identify trends in maternal body mass index (BMI) over time, the demographic predictors of those women most at risk of being obese in pregnancy, health inequalities, and the impact of maternal obesity on maternity services. A mixed methodology utilised quantitative and qualitative research to address these objectives. Data were collated from 34 maternity units across England, including 619,323 deliveries between 1989 and 2007 inclusive. Analysis identified an increasing incidence of maternal obesity over time, regional differences in incidence, and significant inequalities with women residing in the highest levels of deprivation, and Black ethnic group. A systematic review was carried out including 49 studies investigating obesity and pregnancy outcomes with acute maternity resource implications. The meta-analysis found significantly increased odds of a number of outcomes, and concluded that maternal obesity had a considerable impact on maternity resources, and contributed towards a poorer prognosis for the mother and the baby during delivery and in the immediate post-partum period. Qualitative interviews and focus groups with 30 HCPs across eight NHS Trusts in the North East of England were carried out to identify barriers in implementing maternal obesity services, and to gain HCPs perspectives on what they felt was required in order to address maternal obesity effectively. The study identified the themes of ‘Service Development’, ‘Psychosocial Issues and Maternal Obesity Services’, ‘Information, Evidence, and Training’, and ‘Where to go From Here?’. Overall this programme of research has identified that maternal obesity is increasing over time and is significantly associated with health inequalities. The increase in maternal obesity has an impact on acute services, and HCPs feel that a holistic approach is required through partnership work in order to address maternal obesity effectively. This programme of research has primarily contributed to the knowledge of maternal obesity with the provision of the first national level statistics for trends in maternal obesity. The research has also provided a holistic view of the impact of obesity in pregnancy on maternity services, including the impact on resources and the issues relating to addressing the maternal obesity in clinical practice. The research has also identified aspects of service that need to be improved, and knowledge gaps in how to move services forward to effective address maternal obesity. The contribution of this research to the knowledge base is emphasised in the journal pre-publications, dissemination through UK and European, and international conference presentations, being an invited speaker at a number of conferences in the UK, and I received the 2007 Association for the Study of Obesity (ASO) Student Researcher Award for producing exemplary work in the study of obesity.
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Winstanley, Alice. "Maternal and infant contributions to development following premature deliveries." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/47366/.
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The focus of this thesis is on the early caregiving environment and social interactions of preterm infants. Chapter one introduces the topic of premature delivery, including infant outcomes, parent’s caregiving role, infant’s role in their own development, and dyadic interactions between parents and their premature infants. Chapter two introduces methodological difficulties in the study of preterm infants. The chapter also provides an overview of the longitudinal study of preterm infants’ development that provided the majority of the data for this thesis. Chapter three introduces a new measure of parenting principles and practices, the Baby Care Questionnaire (BCQ). The BCQ measures how parents approach caring for their infant in three contexts – sleeping, feeding and soothing. The chapter documents the development and psychometric properties of the BCQ. Chapter four studies the impact of premature birth on maternal cognitions and principles about caregiving. The chapter presents data on the consistency of maternal cognitions about child development and caregiving at an individual and group level. Chapter five studies the impact of premature birth on infant attention, in particular social attention. The chapter reports data on the style of preterm infants’ looking to a novel stimulus, how these infants followed an experimenter’s attention to a target and their regulation abilities (as reported by their mother). Chapter six studies the impact of premature birth on interactions between mothers and their infants. The chapter uses statistical techniques to represent streams of behaviour to examine different responding to person- and object-directed behaviours by mothers and their premature infants. Chapter seven brings together these findings and discusses future work.
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Gharaibeh, Muntaha Khaleel. "Maternal knowledge, beliefs, attitudes and practices relating to child immunization among Jordanian mothers." Thesis, University of Ulster, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390060.
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Kachimanga, Chiyembekezo. "Improving utilization of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29240.
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Introduction: Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016.
Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post- intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar preintervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual
Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%).
Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
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Agumeneitwe, Herbert. "A cross-sectional study examining the association between maternal education and childhood (12-23 months) immunization in Uganda." Thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-412938.
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Introduction: Complete childhood Immunization remains the most effective way for prevention of Vaccine Preventable Diseases. The 2016 Uganda Demography Health Survey (UDHS) reported that only 55% of children aged 12-23 months had been fully vaccinated. The relationship between maternal education and childhood immunization among Ugandan children remains unclear with most of the studies done being limited in scope. Objective: To investigate the association between maternal education and childhood immunization in Uganda. Methods: This study was based on analysis of data from the UDHS. The study included 2815 children aged 12 – 23 months. Permission and data to conduct the analyses was sought from the DHS Program website. Bivariate and multivariate logistic regression models were used to assess association between the maternal education and full immunization. Adjusted odds ratios (OR) with their 95% confidence intervals (CI) were reported. A p value <0.05 was considered statistically significant. Results: Association between maternal education and childhood immunization was statistically significant (Primary Education - OR = 0.50 95%CI: 0.32 - 0.77, P value = 0.002 and Secondary Education – OR = 0.62 95%CI: 0.39 – 0.97, P value = 0.038). ANC visits, possession of a Child Health Card also had a strong effect on Childhood Immunization. Conclusion: Lower maternal education is associated with reduced completion of childhood immunization. To promote childhood immunization Parents with education lower than Secondary School should be targeted and the usefulness of ANC visits should be emphasized.
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Larson, Eric Hugh. "Geographic variation in the risk of poor birth outcome in the non-metropolitan population of the United States, 1985-1987 /." Thesis, Connect to this title online; UW restricted, 1995. http://hdl.handle.net/1773/5634.
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Kazaure, Nura Ibrahim. "Impact of Free Maternal and Child Health Services on Health Care Utilization in Jigawa State, Nigeria." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10831383.
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<p> In spite of a decrease globally, the maternal mortality rate (MMR) in Nigeria and its Jigawa State has remained persistently high. Few efforts to address the MMR in Nigeria have been undertaken. The purpose of this study was to investigate the impact of Jigawa State’s Free Maternal and Child Health Program (JSFMCHP), education, employment, and parity of pregnant women on health care utilization (the outcome variable), as measured by antenatal care (ANC) visits. Anderson’s behavioral model served as the study’s theoretical framework. The sample size included 400 antenatal records of pregnant women who were randomly selected from the state’s Health Management and Information data collected between 2011 and 2015. Chi-square tests showed a significant association between those who did not participate in the JSFMCHP, education, employment, with ANC. There was no association between parity and the number of ANC visits. The odds ratio suggested that pregnant women who did not participate in the program were 5.53 times as likely to have 4 or more visits compared to those who participated. Furthermore, the recommended number (4 or more) of ANC visits was predicted by tertiary education and employment. This study’s findings indicate the need for a reevaluation of JSFMCHP policy, with a focus on ensuring a minimum recommended number of ANC visits for all program participants. These results can influence positive social change if used by policy makers to strengthen policies that have a beneficial impact on maternal morbidity and mortality in Jigawa State, in particular, and Nigeria, in general.</p><p>
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Tsawe, Mluleki. "Inequalities in the use of maternal and reproductive health services in Sierra Leone." University of the Western Cape, 2019. http://hdl.handle.net/11394/6660.
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Philosophiae Doctor - PhD<br>This thesis extends the literature on the trends and magnitude of health inequalities in the area of maternal and reproductive health services in Sierra Leone, and particular across sub-Saharan Africa. It attempted to provide a good understanding of, not only the determinants of maternal and reproductive healthcare use, but also factors that enable health inequalities to exist in Sierra Leone. This is an appropriate topic in population health studies as it aims to address important questions on the research agenda in the context of sub-Saharan Africa, particularly in a country with poor health outcomes such as Sierra Leone. A proper understanding of not only the coverage rates of population health outcomes but also the extent of health inequalities as well as the factors that contribute to these inequalities is crucial for any government. The thesis applied various techniques in the analysis of DHS data (from 2008 and 2013 rounds) in an attempt to answer the research questions.
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Urassa, David Paradiso. "Quality Aspects of Maternal Health Care in Tanzania." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distrubutör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4221.
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