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Karim, Abu Naser MD Rezaul. "Skilled Birth Attendant and Its Determinants among the Tribal Women of Bangladesh." Current Women s Health Reviews 16, no. 2 (April 29, 2020): 127–36. http://dx.doi.org/10.2174/1573404816666200106125222.
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Background: The indigenous people are socially, linguistically, and scientifically diverse. A global trend leads us to the notion that primitive women are somewhat less privileged than non-tribal mothers around the world. This problem also sounds true in the context of Bangladesh. A competent birth attendant at birth is the most important intervention for pregnant women. However, the use of skilled birth attendants has been widely discriminated among tribal and non-tribal women. Objective: This study assesses SBA acceptance and utilization barriers during childbirth among Bangladesh tribal women. Method: A quantitative approach was employed, and the data were collected via questionnaires. Descriptive statistics, Chi-square ( ) χ 2 tests and Binary Logistic Regression were used to analyze the frequency, relationship, and to determine tribal women seeking the services of SBA during childbirth. Results: The results showed that the highest prevalence of delivery (66%) among tribal women occurred at home. 46% of the mothers gave birth to their children with the assistance of a skilled birth attendant, of which 12% of them were at home, and 34% were in the hospital. The remaining 54% of mothers gave birth to their babies with the assistance of a traditional midwife. Results also show that socio-economic conditions, education of women, distance from health care facilities, family planning, husbands’ occupation, and media exposure are the key determinants in pursuing SBA. Conclusion: The study revealed a low prevalence of utilizing skilled birth attendance among tribal women of Bangladesh. Hence, upgrading socio-economic conditions and boosting the education levels of tribal women, ensuring easy access to the media, and launching short-term training to train typical birth attendants are the key recommendations for seeking expert birth attendants.
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Singh, Mayank Kumar, and Krishan Chand Ramotra. "Skilled Birth Attendant (SBA) and Home Delivery in India: A Geographical Study." IOSR Journal of Humanities and Social Science 19, no. 12 (2014): 81–88. http://dx.doi.org/10.9790/0837-191248188.
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Radovich, Emma, Lenka Benova, Loveday Penn-Kekana, Kerry Wong, and Oona Maeve Renee Campbell. "‘Who assisted with the delivery of (NAME)?’ Issues in estimating skilled birth attendant coverage through population-based surveys and implications for improving global tracking." BMJ Global Health 4, no. 2 (April 2019): e001367. http://dx.doi.org/10.1136/bmjgh-2018-001367.
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The percentage of live births attended by a skilled birth attendant (SBA) is a key global indicator and proxy for monitoring progress in maternal and newborn health. Yet, the discrepancy between rising SBA coverage and non-commensurate declines in maternal and neonatal mortality in many low-income and middle-income countries has brought increasing attention to the challenge of what the indicator of SBA coverage actually measures, and whether the indicator can be improved. In response to the 2018 revised definition of SBA and the push for improved measurement of progress in maternal and newborn health, this paper examines the evidence on what women can tell us about who assisted them during childbirth and methodological issues in estimating SBA coverage via population-based surveys. We present analyses based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted since 2015 for 23 countries. Our findings show SBA coverage can be reasonably estimated from population-based surveys in settings of high coverage, though women have difficulty reporting specific cadres. We propose improvements in how skilled cadres are classified and documented, how linkages can be made to facility-based data to examine the enabling environment and further ways data can be disaggregated to understand the complexity of delivery care. We also reflect on the limitations of what SBA coverage reveals about the quality and circumstances of childbirth care. While improvements to the indicator are possible, we call for the use of multiple indicators to inform local efforts to improve the health of women and newborns.
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Hermawan, Asep, Yayi Suryo Prabandari, and Siswanto Agus Wilopo. "Determinan Persalinan oleh Tenaga Kesehatan di Indonesia." Berita Kedokteran Masyarakat 32, no. 7 (March 30, 2018): 231. http://dx.doi.org/10.22146/bkm.12320.
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Determinants of skilled birth attendance in IndonesiaPurposeThis study aimed to find the relationship between health worker ratio with skilled birth attendants (SBA). MethodsThis research was a cross-sectional study using data from Rifaskes 2011 (a nationwide survey of healthcare facilities), SP 2010 (population census), and Riskesdas 2013 (a nationwide survey based on community for basic health). The sample was total population of the district/city as many as 497 districts/cities. The unit of analysis of this study was the district/city in Indonesia. Statistical analysis used univariate analysis, bivariate analysis and generalized linear model (GLM).ResultsThere was no correlation between the ratio of health workers with SBA coverage. But, the GLM analyses showed positive correlation of midwives ratio in the population and SBA when regressed with physicians, nurses, accessibility to community health center (puskesmas) with OR 1.07 (95% CI: 1-1.14), status of region (remote, borderland or islands area) 1.07 (95% CI: 1.01-1.15), and administrative status (district/city) with OR 1.11 (95% CI: 1.03-1.19).ConclusionThe midwives ratio has a strong correlation with SBA after improving accessibility to primary health centers.
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Bhandari, Tulsi Ram, Shreejana Wagle, and Ganesh Dangal. "Practices and Women’s Perceptions of Childbirth in Western Nepal: A Qualitative Study." Journal of Nepal Health Research Council 18, no. 1 (April 20, 2020): 64–69. http://dx.doi.org/10.33314/jnhrc.v18i1.2413.
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Background: Despite continuous efforts to increase the utilization of institutional delivery care services nearly two-fifths women deliver their babies at home without the assistance of skilled birth attendants (SBA) in Nepal. The skilled care at birth can reduce the high maternal and neonatal mortality. This study explored childbirth practices and women’s perceptions of childbirth and its associated factors.Methods: An exploratory study was conducted in three purposively selected remote villages of Kapilvastu district, from March to May 2017. Face-to-face in-depth interviews were conducted with women who had an under-one year child. We performed a thematic analysis to draw the findings of the study. Results: Women sought institutional delivery care either for long labor-pain or obstructed-delivery. Despite various incentives, people still preferred home for normal deliveries. There was also practiced skilled birth attendant (SBA) assisted home delivery care. Some of the local health workers also advised pregnant-women for assisted home delivery care. People considered childbirth as a normal process. Due to cultural beliefs and norms, people were also reluctant to pursue institutional delivery care services. Financial constraints, poor access to services and expensive transportation services were other underlining causes of home delivery practices. Conclusions: Despite various incentives for institutional delivery care; the study did not spectacle an encouraging reaction. It pointed to the very basic and strong relationship between women’s position in the household and the society and education with childbirth practices. There were limits to how far financial incentives can overcome these obstacles. So, the improvement of the socio-economic conditions of the women would be the viable way-out of the problem.Keywords: Childbirth practices; home delivery; institutional delivery; women’s perception
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McKellar, Lois V., and Kevin Taylor. "Safe Arrivals: Responding to the Local Context in a Training Program for Birth Attendants in Cambodia." International Journal of Childbirth 4, no. 2 (2014): 77–85. http://dx.doi.org/10.1891/2156-5287.4.2.77.
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The World Health Organization (WHO) recommends that every woman should have a skilled birth attendant (SBA) attend her birth; however, until this ideal is met, traditional birth attendants (TBA) continue to provide care to women, particularly in rural areas of countries such as Cambodia. The lack of congruence between an ideal and reality has caused difficulty for policy makers and governments. In 2007, The 2h Project, an Australian-based, nongovernment organization in partnership with a local Cambodian organization, “Smile of World,” commenced the “Safe Arrivals” project, providing annual training for SBAs and TBAs in the rural provinces of Cambodia. Following implementation of this project, feedback was collected through a questionnaire undertaken by interviews with participants. This was part of a quality assurance process to further develop training in line with WHO recommendations and to consider the cultural context and respond to local knowledge. Over a 2-year period, 240 birth attendants were interviewed regarding their role and practice. Specifically, through the responses to the questionnaires, several cultural practices were identified that have informed training focus and resource development. More broadly, it was evident that TBAs remain a valuable resource for women, acknowledging their social and cultural role in childbirth.
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Karim, A. N. M. Rezaul. "Factors Affecting the Selection of Institutional Delivery among Tribal Women in Bangladesh." Journal of Cognitive Sciences and Human Development 5, no. 2 (September 30, 2019): 104–15. http://dx.doi.org/10.33736/jcshd.1923.2019.
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Background: Safe maternity is a global issue with the ongoing discussion of ways to reduce mortality. This problem is prevalent among women from low-income countries such as Bangladesh. Hence, this study evaluated the factors affecting delivery practices among tribal women in Bangladesh Chittagong Hill Tracts (CHT). Method: This is an analysis of cross-sectional research. To achieve the sample size of 556 married women, a convenient sampling technique was used. In a semi-structured questionnaire, data were collected. Associations were tested using Chi-square ( ) tests, and multivariate regression analysis was applied to elicit results from the data. Result: Result from the present study shows that most deliveries (66%) occur at home. Of this quantity, 50% of births were facilitated by untrained traditional midwives, 12% by trained conventional birth caregivers, and 4% by relatives and neighbors. Wealth index, place of dwelling, women’s educational level, age at first childbirth, range to health care, and profession of the husband have all significantly contributed to the approach to delivery. Conclusion: This study concludes that institutional delivery (34%) is poor among tribal women of Bangladesh. Factors limiting the adoption of institutional delivery by these tribal women should be managed adequately via awareness campaigns and improving the socio-economic status of the tribal people of CHT.
Keywords: Delivery care; Institutional delivery; Choice of the birthplace; Skilled birth attendant (SBA); Traditional birth attendants (TBA); Trained birth attendants (TTBA); Home delivery
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Anik, Asibul Islam, Bishwajit Ghose, and Md Mosfequr Rahman. "Relationship between maternal healthcare utilisation and empowerment among women in Bangladesh: evidence from a nationally representative cross-sectional study." BMJ Open 11, no. 8 (August 2021): e049167. http://dx.doi.org/10.1136/bmjopen-2021-049167.
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ObjectiveTo examine the relationship between women’s empowerment and maternal healthcare utilisation in Bangladesh.DesignThis cross-sectional study uses data from the most recent nationally representative Bangladesh Demographic and Health Survey, 2017–2018.SettingBangladesh.ParticipantsMarried women aged 15–49 years who had a live birth within the 3 years preceding the survey (n=4767).Primary and secondary outcome measuresWomen’s empowerment was measured using the recently developed and validated survey-based Women’s emPowERment (SWPER) index. The index includes three domains: social independence, decision-making and attitude to violence. Outcomes included utilisation of at least one antenatal care from skilled providers (ANC1), at least four antenatal care visits (≥4 ANC), delivery assisted by a skilled birth attendant (SBA) and a postnatal visit within 2 days of delivery (PNC). Logistic regression analyses were used to assess the identified relationships.ResultsAmong participants, 83% received ANC1, 46.3% received ≥4 ANC, 51.9% reported SBA and 50.9% sought PNC. Women with high levels of social empowerment relative to those with low levels were more likely to use ANC1 (adjusted OR (AOR) 1.85; 95% CI 1.40 to 2.45), ≥4 ANC (AOR 1.55; 95% CI 1.27 to 1.90), SBA (AOR 2.12; 95% CI 1.71 to 2.62) and PNC (AOR 1.95; 95% CI 1.56 to 2.44). Compared with women with low levels of decision-making empowerment, women with high levels were more likely to use SBA (AOR 1.49; 95% CI 1.21 to 1.83) and PNC (AOR 1.47; 95% CI 1.19 to 1.81). Additionally, significant inequality was observed among women moving from low to high empowerment in all domains of the empowerment index.ConclusionsHigher empowerment levels were positively associated with maternal healthcare utilisation in Bangladesh. Our findings suggest the need to address women’s empowerment in policies aiming to expand health service utilisation.
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Saaka, Mahama, and Jones Akuamoah-Boateng. "Prevalence and Determinants of Rural-Urban Utilization of Skilled Delivery Services in Northern Ghana." Scientifica 2020 (May 11, 2020): 1–13. http://dx.doi.org/10.1155/2020/9373476.
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Background. There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods. The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results. The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR = 1.59; CI: 1. 07–2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions. This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.
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Shahi, Prakash. "Female Community Health Volunteers’ (FCHVs) Involvement in Improving Maternal Health, Nepal." Journal of Karnali Academy of Health Sciences 2, no. 3 (December 10, 2019): 250–52. http://dx.doi.org/10.3126/jkahs.v2i3.26664.
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Improving maternal health was one of the eight millennium development goals (MDGs) in 2000 and later included in SDG as a major agenda in 2015 which was adopted by the international community. In Nepal, the first elected democratic government developed Health Policy in 1991 and revised in 2014 which has identified safe motherhood as a priority program and institutionalized safe motherhood as a primary health care. In order to effectively address maternal and neonatal morbidity and mortality, the Family Health Division, Department of Health Services (DoHS) developed National Safe Motherhood Long Term Plan 2002- 2017 (revised in 2006) which aimed to establish basic and comprehensive emergency obstetric care services in all districts. To complement this plan, the National Policy on SBA (2006) was developed with the aim of increasing the percentage of births assisted by a skilled birth attendant (as internationally defined) to 60 percent by 2015. Table 1 explains some historical shifts in maternal health policies and programs in Nepal.
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Nam, Eun Woo, Afisah Zakaria, Festus Adams, Young Suk Jun, and Richard Adanu. "Comparison of maternal health services and indicators in three districts of the Volta Region, Ghana." Ghana Medical Journal 50, no. 3 (September 29, 2016): 122–28. http://dx.doi.org/10.4314/gmj.v50i3.2.
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Background: Ghana’s maternal mortality ratio continues to decline, but is not expected to meet the Millennium Development Goal (MDG) 5 target. The Ghana Health Service and Ministry of Health have displayed a high commitment to the improvement of maternal health in the country. One of the most recent partnerships directed at this is with the Korea International Cooperation Agency.Methods: This study was conducted among women between ages 15 and 49 resident in Keta Municipal, Ketu North and Ketu South districts in the Volta Region of Ghana who were pregnant or who had children aged less than five. Ethical approval was obtained from the Ghana Health Service Ethical Review Committee. Data were collected using questionnaires, entered into Stata version 12 and analyzed using frequency distribution and assessment of means. Comparisons among districts were conducted using chi square test and one way analysis of variance (ANOVA).Results: The study covered 630 women whose mean age was 28.4 years. Almost all participants (99.1%) from Ketu North knew where to obtain family planning services. Use of modern contraception was highest in Ketu North with 31% of respondents using a modern method. Delivery in a health facility was highest in Keta Municipal (62.3%) with overall institutional delivery being 57.6%. Delivery by a skilled birth attendant (SBA) was also highest in Keta Municipal.Conclusion: Indicators used to assess maternal health services show a coverage of over 50% but we need to improve institutional delivery, use of modern contraception and education about danger signs in pregnancy. Funding: This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2013S1A5B8A01055336) and the Korea International Cooperation Agency(2013).Keywords: Maternal Health, Ghana, Volta Region, Family Planning, Skilled Birth Attendant
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Enos, Juliana Yartey, Richard Dickson Amoako, and Innocent Kwao Doku. "Utilization, Predictors and Gaps in the Continuum of Care for Maternal and Newborn Health in Ghana." International Journal of Maternal and Child Health and AIDS (IJMA) 10, no. 1 (February 9, 2021): 43–53. http://dx.doi.org/10.21106/ijma.425.
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Background: Continuum-of-care (CoC) throughout pregnancy, childbirth and the postnatal period is essential for the health and survival of mothers and their babies. This study assesses the utilization, predictors, and gaps in the continuum of maternal and newborn health (MNH) services in Eastern Ghana. Methods: A retrospective cross-sectional survey was conducted to assess utilization of MNH services and their determinants in the East Akim Municipality of Ghana. Three hundred and ten (310) mothers aged 15-49 years were sampled from 4 communities (3 rural; 1 urban) in the municipality using stratified sampling methodology. Logistic regression models were fitted to determine the likelihood of utilizing skilled birth attendance (SBA) and postnatal care (PNC) after antenatal care (ANC). Results: Sixty-six percent (66%) of mothers surveyed received the full complement of MNH services (ANC, SBA, PNC) for their most-recent birth. While 98% of mothers made at least one ANC visit with 83.5% receiving the World Health Organization-recommended 4+ visits, only 74% accessed SBA indicating a 24% attrition in the CoC from ANC to SBA, and an 8% attrition from SBA to PNC. About 86% of mothers accessed PNC within 42 days postpartum. Distance to health facility, urban residence, and exposure to media information were strong predictors of the full complement of MNH continuumof- care utilization. Conclusion and Global Health Implications: The study found a remarkable utilization of MNH services in East Akim with significant attrition along the continuum-of-care. Efforts to enhance utilization of the MNH continuum-of-care should focus on increasing access to SBA in particular, through equitable distribution of MNH services in hard-to-reach areas and innovative communication approaches for reducing attrition at each level of the continuum-of-care. Evidence from this study can inform strategies for achieving universal access and utilization of the MNH continuum-of-care towards global goals and improved health outcomes in Ghana and other countries. Key words: • Continuum-of-care • Antenatal care • Skilled birth attendance • Postnatal care • Maternal health services • Maternal health • Newborn health • Ghana Copyright © 2021 Enos et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Manyiwa, Johnson S. "Preference for Utilization of Skilled Birth Attendants (SBA) Services by Expectant Mothers in Mombasa County." TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH 6, no. 3 (September 28, 2018): 1–15. http://dx.doi.org/10.21522/tijph.2013.06.03.art001.
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Al-Jawaldeh, Ayoub, and Azza Abul-Fadl. "The Effect of Cesarean Delivery on Child Survival and Early Breastfeeding Practices: Global Data from 103 Provinces in the Eastern Mediterranean Region." International Journal of Scientific Research and Management 8, no. 02 (February 13, 2020): 293–304. http://dx.doi.org/10.18535/ijsrm/v8i02.mp02.
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Background: Early initiation of breastfeeding (EIBF) plays an important role in the reduction of infant mortality. Although Cesarean section (CS) can save lives it delays EIBF and thereby increases risk of mortality.
Aim: To examine the relationship between CS and EIBF with child mortality.
Methods: Data was recruited from recent demographic health surveys for 129 provinces of seven Eastern Mediterranean countries. The data was analyzed for breastfeeding initiation (EBFI) rates in the first hour and the first day, feeding prelacteals, delivery by skilled birth attendant (SBA), and delivery by CS, also neonatal mortality (NMR), infant mortality rates (IMR) and under-five mortality rates (U5MR). Statistical analysis was done using Pearson correlation and descriptive statistics. The economic cost of unnecessary CS correlated to mortality rates and EBFI.
Results: Overall CS was inversely associated with EBFI in the first hour after birth (r-0.2, P=0.1), intake of prelacteals (r-0.3, P=0.008) and NMR (r-0.3, P=0.1), IMR (r-0.4, P=0.0001), and U5MR (r-0.4, P=0.0001) at P<0.05 and positively associated with EBFI in first day (r0.2, P=0.06). CS below the recommended level by WHO (<15%) was inversely associated with IMR. Moderately high CS >18% was inversely correlated with EBFI and positively correlated with intake of prelacteals, NMR and IMR. Very high CS >40 was inversely correlated with mortality at P<0.01. Unnecessary CS was significantly inversely correlated with U5MR.
Conclusions: CS when unnecessary or by unskilled birth attendant, is a threat to child survival. Breastfeeding initiation, as early as possible skin-to-skin, is recommended to alleviate the outcome of CS.
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SINGH, PRASHANT KUMAR, and LUCKY SINGH. "EXAMINING INTER-GENERATIONAL DIFFERENTIALS IN MATERNAL HEALTH CARE SERVICE UTILIZATION: INSIGHTS FROM THE INDIAN DEMOGRAPHIC AND HEALTH SURVEY." Journal of Biosocial Science 46, no. 3 (July 19, 2013): 366–85. http://dx.doi.org/10.1017/s0021932013000370.
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SummaryThis study examines the association between age cohort and utilization of maternal health care services in India, before and after adjusting for individual, household and contextual factors. Using data from the Demographic and Health Survey 2005–06, women were classified into three distinct age cohorts based on their age at childbirth: 15–24, 25–34 and 35–49 years. Binary logistic regression models were applied to assess the influence of women's age cohort on receiving full antenatal care (ANC) and skilled birth attendance (SBA). The analytical sample included the women who delivered their most recent birth at any time in the 5 years preceding the survey. Women belonging to the younger age cohort were found to be disadvantaged in receiving full ANC, whereas increasing age of women was negatively associated with receiving SBA. Low level of education, low mass media exposure, low autonomy, belonging to deprived social groups, poor economic status and residence in the central region were found to be major constraining factors in receiving full ANC and SBA for women in India. The findings support the need for ‘age-sensitive’ interventions that tailor programmes and incentives to women's health care needs through the reproductive life-stage. Urgent efforts are needed to ensure that women who are illiterate and those belonging to low autonomy and low socioeconomic groups receive the recommended maternal health care benefits.
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Joseph, Gary, Inácio Crochemore Mohnsam da Silva, Aluísio J. D. Barros, and Cesar G. Victora. "Socioeconomic inequalities in access to skilled birth attendance among urban and rural women in low-income and middle-income countries." BMJ Global Health 3, no. 6 (December 2018): e000898. http://dx.doi.org/10.1136/bmjgh-2018-000898.
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IntroductionRapid urbanisation is one of the greatest challenges for Sustainable Development Goals. We compared socioeconomic inequalities in urban and rural women’s access to skilled birth attendance (SBA) and to assess whether the poorest urban women have an advantage over the poorest rural women.MethodsThe latest available surveys (DemographicHealth Survey, Multiple Indicators Cluster Surveys) of 88 countries since 2010 were analysed. SBA coverage was calculated for 10 subgroups of women according to wealth quintile and urban-rural residence. Poisson regression was used to test interactions between wealth quintile index and urban-rural residence on coverage. The slope index of inequality (SII) and concentration index were calculated for urban and rural women.Results37 countries had surveys with at least 25 women in each of the 10 cells. Average rural average coverage was 72.8 % (ranging from 17.2% % in South Sudan to 99.9 % in Jordan) and average urban coverage was 80.0% (from 23.6% in South Sudan to 99.7% in Guyana. In 33 countries, rural coverage was lower than urban coverage; the difference was significant (p<0.05) in 15 countries. The widest urban/rural coverage gap was in the Central African Republic (32.8% points; p<0.001). Most countries showed narrower socioeconomic inequalities in urban than in rural areas. The largest difference was observed in Panama, where the rural SII was 77.1% points larger than the urban SII (p<0.001). In 31 countries, the poorest rural women had lower coverage than the poorest urban women; in 20 countries, these differences were statistically significant (p<0.05).ConclusionIn most countries studied, urban areas present a double advantage of higher SBA coverage and narrower wealth-related inequalities when compared with rural areas. Studies of the intersectionality of wealth and residence can support policy decisions about which subgroups require special efforts to reach universal coverage.
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Natai, Clara C., Neema Gervas, Frybert M. Sikira, Beatrice J. Leyaro, Juma Mfanga, Mashavu H. Yussuf, and Sia E. Msuya. "Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study." BMJ Open 10, no. 9 (September 2020): e036211. http://dx.doi.org/10.1136/bmjopen-2019-036211.
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BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services.ObjectivesTo determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania.DesignA cross-sectional study conducted from June to July 2019.SettingThis study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City.ParticipantsIncluded 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care).Outcome measures4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery.MethodsInterviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS.ResultsThe mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with SBA use or PNC utilisation.ConclusionMale involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.
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Wariri, Oghenebrume, Egwu Onuwabuchi, Jacob Albin Korem Alhassan, Eseoghene Dase, Iliya Jalo, Christopher Hassan Laima, Halima Usman Farouk, Aliyu U. El-Nafaty, Uduak Okomo, and Winfred Dotse-Gborgbortsi. "The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria." PLOS ONE 16, no. 1 (January 7, 2021): e0245297. http://dx.doi.org/10.1371/journal.pone.0245297.
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Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.
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Anichukwu, Onyekachi Ibenelo, and Benedict Oppong Asamoah. "The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study." BMJ Open 9, no. 6 (June 2019): e026324. http://dx.doi.org/10.1136/bmjopen-2018-026324.
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ObjectiveTo examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria.DesignIndividual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children.SettingNigeria Demographic and Health Survey 2013.Participants5506 women aged 15–49 years with children aged 12–23 months born in the 5 years preceding the survey.Primary outcome measuresFully immunised children and not fully immunised children.ResultsThe percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR)1–3 visits2.4, 95% CI 1.79 to 3.27; AOR4–7 visits3.2, 95% CI 2.52 to 4.13; AOR≥ 8 visits3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant.ConclusionsThe percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.
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Agarwal, Smisha, Sian Curtis, Gusavo Angeles, Ilene Speizer, Kavita Singh, and James Thomas. "Are community health workers effective in retaining women in the maternity care continuum? Evidence from India." BMJ Global Health 4, no. 4 (July 2019): e001557. http://dx.doi.org/10.1136/bmjgh-2019-001557.
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ObjectivesDespite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum.MethodsUsing the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care—at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights.ResultsOur study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12% (95% CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8% (95% CI: −10.2 to −7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum.ConclusionsWhile ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.
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Ali, Balhasan, Preeti Dhillon, and Sanjay K. Mohanty. "Inequalities in the utilization of maternal health care in the pre- and post-National Health Mission periods in India." Journal of Biosocial Science 52, no. 2 (June 24, 2019): 198–212. http://dx.doi.org/10.1017/s0021932019000385.
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AbstractSince the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005–06 and 2015–16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005–06 to 0.08 by 2015–16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.
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Nasution, Siti Khadijah, Yodi Mahendradhata, and Laksono Trisnantoro. "Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia." Asia Pacific Journal of Public Health 32, no. 1 (December 6, 2019): 19–26. http://dx.doi.org/10.1177/1010539519892394.
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The Indonesian government has been implementing the National Health Insurance ( Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation ( P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.
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Ahmed, Firoz, Fahmida Akter Oni, and Sk Sharafat Hossen. "Does gender inequality matter for access to and utilization of maternal healthcare services in Bangladesh?" PLOS ONE 16, no. 9 (September 16, 2021): e0257388. http://dx.doi.org/10.1371/journal.pone.0257388.
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There is a high prevalence of gender gap in Bangladesh which might affect women’s likelihood to receive maternal healthcare services. In this backdrop, we aim to investigate how gender inequality measured by intrahousehold bargaining power (or autonomy) of women and their attitudes towards intimate partner violence (IPV) affects accessing and utilizing maternal health care services. We used Bangladesh Demographic and Health Survey (BDHS) data of 2014 covering 5460 women who gave birth at least one child in the last three years preceding the survey. We performed logistic regression to estimate the effect of women’s autonomy and their attitude towards IPV on access to and utilization of maternal healthcare services. Besides, we employed different channels to understand the heterogeneous effect of gender inequality on access to maternal healthcare services. We observed that women having autonomy positively influenced attaining five required antenatal care (ANC) services (AOR: 1.17; 95% CI: 0.98–1.41) and women’s negative attitudes towards IPV were positively associated with five ANC services (AOR: 1.42; 95% CI: 1.02–1.97), sufficient ANC visits (COR: 1.55; CI: 1.19–2.01), skilled birth attendant (SBA) (AOR: 1.43; 95% CI: 1.05–1.94) and postnatal care (PNC) services (AOR: 1.44; 95% CI: 1.12–1.84). Besides, rural residency, religion, household wealth, education of both women and husband were found to have some of the important channels which were making stronger effect of gender inequality on access to maternal healthcare services. The findings of our study indicate a significant association between access to maternal healthcare services and women’s autonomy as well as attitude towards IPV in Bangladesh. We, therefore, recommend to protect women from violence at home and mprove their intrahousehold bargaining power to increase their access to and utilization of required maternal healthcare services.
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Moedjiono, Apik Indarty, Kuntoro Kuntoro, and Hari Basuki Notobroto. "Indicators of Husband's Role in Pregnancy and Maternity Care." International Journal of Public Health Science (IJPHS) 6, no. 2 (September 1, 2017): 192. http://dx.doi.org/10.11591/ijphs.v6i2.6181.
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The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. Antenatal Care (ANC), delivery with skilled birth attendance (SBA) at the time of delivery and delivery in institutional are universally considered important for reducing maternal mortality. Husbands can play a crucial role in pregnancy and childbirth. Therefore, the aim of this study was analyze the indicators of husband's role in pregnancy and maternity care which were suspected as one of the determinants of ANC and SBA use in Polewali Mandar Regency. The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire data processing by using SMART-PLS. The result of data analysis suggested that the coefficient value that has been standardized from each indicator were as follows: accessibility = 0.944 and engagement = 0.954, dan responsibility = 0.968. Indicators of organizational support in implementing Maternal and Child Health Information System at Polewali Mandar Regency, respectively from the most important are: responsibility, engagement, and accessibility.
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Chaudhary, Shrawan K. "Scaling up safe motherhood program at Dang district: Impact of programmatic intervention." Nepal Journal of Obstetrics and Gynaecology 3, no. 2 (July 29, 2014): 21–25. http://dx.doi.org/10.3126/njog.v3i2.10827.
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Introduction: Safe motherhood has been a national priority programme and this article highlights the impact of a good programmatic approach to improve safe motherhood services in a district of mid west region of Nepal. Method: Interventions included strengthening of program- Emergency Obstetric Care Services (EmOC) at district hospital and Primary Health Care Center level (basic and comprehensive), Skilled Birth Attendance (SBA) at Health Post level and Community Based Safe Motherhood interventions at community level. In addition, improved family/community practices for birth preparedness and referral of mothers through building the capacity of individuals and families to demand and utilize health services were also implemented. Results: Met need of Emergency Obstetric Care increased from 2% in 2000 to 27.58 % in 2005/06. Number of births increased in hospital from 1078 (2003/2004) to 1753 (2005/2006). Number of caesarean sections was 10 in 2003/04 whereas it has risen to 174 in 2005/06. Similar trends were noticed in other obstetric procedures such as instrumental deliveries and manual removal of placenta. There has also been a significant increase in utilization of EmOC services among the poorest castes- Dalits and Janjatis (from 6.3% in 2000/01 to 12.7% in 2003/04). Twenty four hours blood transfusion services are made available at district hospital. EmOC fund has saved the life of 676 women who utilized EmOC fund and watch group has referred total 559 women to health facilities. Conclusion: Data from Dang district suggests that if interventions are delivered simultaneously and effectively at community level and health facility level, there is definite impact on various indicators of safe motherhood program. However, frequent turnover of staff, vacant post, lack of provision of 24 hours SBA services, limited budget for construction, training and equipment supports, lack of transportation and communication in remote Village Development Committees are barriers of effective safe motherhood program. DOI: http://dx.doi.org/10.3126/njog.v3i2.10827 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 21-25
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Mai, Vanthy, and Win Ei Phyu. "Intimate partner violence and utilization of reproductive and maternal health services in Cambodia." Journal of Health Research 34, no. 2 (November 26, 2019): 100–111. http://dx.doi.org/10.1108/jhr-03-2019-0046.
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Purpose The purpose of this paper is to explore an association between women experience lifetime intimate partner violence (IPV) and women decision making with utilization of reproductive and maternal health services in Cambodia. Design/methodology/approach An analysis of secondary data of Cambodia Demographic and Health Survey (CDHS) 2014. The total number of sample size was 1,539 married women who had birth in the last five years prior to the time of interview and completed the domestic violence module in the CDHS 2014 questionnaire. χ² test and binary logistic regression were performed in this study. Findings Results give an evidence that emotional violence had significant impact on receiving sufficient antenatal care (ANC) (OR: 0.7, 95%CI: 0.43–0.86) while physical violence had significant association with deliver with skilled birth attendance (SBA) (OR: 0.5, 95%CI: 0.27–0.79). Further, women’s participation in household decision making played as important factor in enabling women revive sufficient ANC (OR: 1.7, 95%CI: 1.19–2.29), and utilization of modern contraceptive method (OR: 1.5, 95%CI: 1.09–1.97). Originality/value This study provides significant finding on the impact of IPV and women’s decision making on reproductive and maternal health in Cambodia. Result has drawn an attention to policy makers, related ministries and stakeholder to promulgate and effectiveness of policies and program implementation within the country.
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Aryastami, Ni Ketut, and Rofingatul Mubasyiroh. "Traditional practices influencing the use of maternal health care services in Indonesia." PLOS ONE 16, no. 9 (September 10, 2021): e0257032. http://dx.doi.org/10.1371/journal.pone.0257032.
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Background Maternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia. Methods We used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates. Results Traditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services. Discussion Not all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.
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Akseer, Nadia, James Wright, Hana Tasic, Karl Everett, Elaine Scudder, Ribka Amsalu, Ties Boerma, et al. "Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival." BMJ Global Health 5, no. 1 (January 2020): e002214. http://dx.doi.org/10.1136/bmjgh-2019-002214.
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IntroductionConflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs).MethodsWe carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea.ResultsConflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries.ConclusionsInequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.
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Salehi, Ahmad S., Josephine Borghi, Karl Blanchet, and Anna Vassall. "The cost-effectiveness of using performance-based financing to deliver the basic package of health services in Afghanistan." BMJ Global Health 5, no. 9 (September 2020): e002381. http://dx.doi.org/10.1136/bmjgh-2020-002381.
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Performance-based financing (PBF) is a mechanism to improve the quality and the utilisation of health benefit packages. There is a dearth of economic evaluations of PBF in the ‘real world’. Afghanistan implemented PBF between 2010 and 2015 and evaluated the programme using a pragmatic cluster-randomised control trial. We conducted a cost-effectiveness analysis of the PBF programme in Afghanistan, compared with the standard of care, from the provider payer’s perspective. The incremental cost-effectiveness ratio of PBF compared with the standard of care was US$1242 per disability-adjusted life year averted; not cost-effective when compared with an opportunity cost threshold of US$349. Incentive payments were the main contributor to PBF financial cost (70%) followed by data verification (23%), staff time (5%) and administration (2%). The unit cost per case of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) services in the standard of care was US$0.96 (95% CI 0.92–1.0), US$4.8 (95% CI 4.1–6.3) and US$1.3 (95% CI 1.2–1.4), respectively, whereas the cost of ANC, SBA and PNC services per case in PBF areas were US$4.72 (95% CI 4.68–5.7), US$48.5 (95% CI 48.0–52.5) and US$5.4 (95% CI 5.1–5.9), respectively. To conclude, our study found that PBF, as implemented in the Afghan context, was not the best use of funds to strengthen the delivery of maternal and child health services. The cost-effectiveness of alternative PBF designs needs to be appraised before using PBF at scale to support health benefit packages. PBF needs to be considered in the context of funding the range of constraints that inhibit health service performance improvement.
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Khan, Md Nuruzzaman, Melissa L. Harris, and Deborah Loxton. "Assessing the effect of pregnancy intention at conception on the continuum of care in maternal healthcare services use in Bangladesh: Evidence from a nationally representative cross-sectional survey." PLOS ONE 15, no. 11 (November 20, 2020): e0242729. http://dx.doi.org/10.1371/journal.pone.0242729.
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Background The Continuum of Care (CoC; defined as accessing the recommended healthcare services during pregnancy and the early postpartum period) is low in lower-middle-income countries (LMICs). This may be a major contributor to the high rates of pregnancy-related complications and deaths in LMICs, particularly among women who had an unintended pregnancy. With a lack of research on the subject in Bangladesh, we aimed to examine the effect of unintended pregnancy on CoC. Methods Data from 4,493 mother-newborn dyads who participated in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Women’s level of CoC was generated from responses to questions on the use and non-use of three recommended services during the course of pregnancy: four or more antenatal care (ANC) visits, skilled birth attendance (SBA) during delivery, and at least one postnatal care (PNC) visit within 24 hours of giving birth. Global recommendations of service use were used to classify CoC as high (used each of the recommended services), moderate (used at least two of the three recommended services), and low/none (no PNC, no SBA, and ≤3 ANC visits). Women’s pregnancy intention at the time of conception of their last pregnancy (ending with a live birth) was the major exposure variable, classified as wanted, mistimed, and unwanted. Unadjusted and adjusted (with individual-, household-, and community-level factors) multilevel multinomial logistic regression models were used to assess the association between unintended pregnancy and level of CoC. Results In Bangladesh, the highest level of CoC occurred in only 12% of pregnancies that ended with live births. This figure was reduced to 5.6% if the pregnancy was unwanted at conception. The antenatal period saw the greatest drop in CoC, with 65.13% of women receiving at least one ANC visit and 26.32% having four or more ANC visits. Following the adjustment of confounders, an unwanted pregnancy was found to be associated with 39% and 62% reduced odds of women receiving moderate and high levels of CoC, respectively, than those with a wanted pregnancy. Having a mistimed pregnancy was found to be associated with a 31% reduction in odds of women achieving a high CoC than women with a wanted pregnancy. Conclusion Almost nine in ten women did not achieve CoC in their last pregnancy, which was even higher when the pregnancy was unintended. Given that the ANC period has been identified as a critical time for intervention for these women, it is necessary for policies to scale up current maternal healthcare services that provide in-home maternal healthcare services and to monitor the continuity of ANC, with a particular focus on women who have an unintended pregnancy. Integration of maternal healthcare services with family planning services is also required to ensure CoC.
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Chol, Chol, Joel Negin, Kingsley Emwinyore Agho, and Robert Graham Cumming. "Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016." BMJ Open 9, no. 3 (March 2019): e023128. http://dx.doi.org/10.1136/bmjopen-2018-023128.
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ObjectivesTo examine the association between women’s autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.Design, setting and participantsWe analysed the Demographic and Health Survey (DHS) (2010–2016) data collected from married women aged 15–49 years. We used four DHS measures related to women’s autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women’s autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots.Outcome measuresThe primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA).ResultsPooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women’s autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94).ConclusionOur results revealed a weak relationship between women’s autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.
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Shibanuma, Akira, Evelyn Korkor Ansah, Kimiyo Kikuchi, Francis Yeji, Sumiyo Okawa, Charlotte Tawiah, Keiko Nanishi, et al. "Evaluation of a package of continuum of care interventions for improved maternal, newborn, and child health outcomes and service coverage in Ghana: A cluster-randomized trial." PLOS Medicine 18, no. 6 (June 25, 2021): e1003663. http://dx.doi.org/10.1371/journal.pmed.1003663.
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Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman–child pairs in Ghana. Methods and findings This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman–child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health workers, and offering women with 24-hour stay at a health facility or a home visit within 48 hours after delivery. In the control arm, women received routine services only. Eligibility criteria were as follows: women who gave birth or had a stillbirth from September 1, 2012 to September 30, 2014 (before the trial period), from October 1, 2014 to December 31, 2015 (during the trial period), or from January 1, 2016 to December 31, 2016 (after the trial period). Health service and morbidity outcomes were assessed before and during the trial periods through face-to-face interviews. Mortality was assessed using demographic surveillance data for the 3 periods above. Mixed-effects logistic regression models were used to evaluate the effectiveness as difference in differences (DiD). For health service and morbidity outcomes, 2,970 woman–child pairs were assessed: 1,480 from the baseline survey and 1,490 from the follow-up survey. Additionally, 33,819 cases were assessed for perinatal mortality, 33,322 for neonatal mortality, and 39,205 for maternal mortality. The intervention arm had higher proportions of completed CoC (410/870 [47.1%]) than the control arm (246/620 [39.7%]; adjusted odds ratio [AOR] for DiD = 1.77; 95% confidence interval [CI]: 1.08 to 2.92; p = 0.024). Maternal complications that required hospitalization during pregnancy were lower in the intervention (95/870 [10.9%]) than in the control arm (83/620 [13.4%]) (AOR for DiD = 0.49; 95% CI: 0.29 to 0.83; p = 0.008). Maternal mortality was 8/6,163 live births (intervention arm) and 4/4,068 live births during the trial period (AOR for DiD = 1.60; 95% CI: 0.40 to 6.34; p = 0.507) and 1/4,626 (intervention arm) and 9/3,937 (control arm) after the trial period (AOR for DiD = 0.11; 95% CI: 0.11 to 1.00; p = 0.050). Perinatal and neonatal mortality was not significantly reduced. As this study was conducted in a real-world setting, possible limitations included differences in the type and scale of health facilities and the size of subdistricts, contamination for intervention effectiveness due to the geographic proximity of the arms, and insufficient number of cases for the mortality assessment. Conclusions This study found that an integrated package of CoC interventions increased CoC completion and decreased maternal complications requiring hospitalization during pregnancy and maternal mortality after the trial period. It did not find evidence of reduced perinatal and neonatal mortality. Trial registration The study protocol was registered in the International Standard Randomised Controlled Trial Number Registry (90618993).
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Olakunde, Babayemi O., Daniel A. Adeyinka, Bertille O. Mavegam, Olubunmi A. Olakunde, Hidayat B. Yahaya, Oluwatosin A. Ajiboye, Temitayo Ogundipe, and Echezona E. Ezeanolue. "Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017." International Health 11, no. 6 (April 16, 2019): 545–50. http://dx.doi.org/10.1093/inthealth/ihz017.
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AbstractBackgroundThis study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria.MethodsThe study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15–19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables.ResultsOf the 789 married adolescent girls, 387 (27% [95% CI=22.8–30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery.ConclusionsInterventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.
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Hobbs, Amy J., Ann-Beth Moller, Liliana Carvajal-Aguirre, Agbessi Amouzou, Doris Chou, and Lale Say. "Protocol for a scoping review to identify and map the global health personnel considered skilled attendants at birth in low and middle-income countries between 2000 and 2015." BMJ Open 7, no. 10 (October 2017): e017229. http://dx.doi.org/10.1136/bmjopen-2017-017229.
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IntroductionDespite progress towards the Millennium Development Goals (MDG), maternal mortality remains high in countries where there are shortages of skilled personnel able to manage and provide quality care during pregnancy and childbirth. The ‘percentage of births attended by skilled health personnel’ (SAB, skilled attendants at birth) was a key indicator for tracking progress since the MDGs and is part of the Sustainable Development Goal agenda. However, due to contextual differences between and within countries on the definition of SAB, a lack of clarity exists around the training, competencies, and skills they are qualified to perform. In this paper, we outline a scoping review protocol that poses to identify and map the health personnel considered SAB in low and middle-income countries (LMIC).Methods and analysisA search will be conducted for the years 2000–2015 in PubMed/MEDLINE, EMBASE, CINAHL Complete, Cochrane Database of Systematic Reviews, POPLINE and the WHO Global Health Library. A manual search of reference lists from identified studies or systematic reviews and a hand search of the literature from international partner organisations will be done. Original studies conducted in LMIC that assessed health personnel (paid or voluntary) providing interventions during the intrapartum period will be considered for inclusion.Ethics and disseminationA scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review proposes to synthesise data on the training, competency and skills of identified SAB and expands on other efforts to describe this global health workforce. The results will inform recommendations around improved coverage measurement and reporting of SAB moving forward, allowing for more accurate, consistent and timely data able to guide decisions and action around planning and implementation of maternal and newborn health programme globally. Data will be disseminated through a peer-reviewed manuscript, conferences and to key stakeholders within international organisations.
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Alemayehu, Mulunesh, and Wubegzier Mekonnen. "The Prevalence of Skilled Birth Attendant Utilization and Its Correlates in North West Ethiopia." BioMed Research International 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/436938.
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The low utilization of skilled birth attendants sustained high maternal mortality. The aim of this study was to assess its magnitude and correlates in Northwest Ethiopia. A study was conducted on 373 randomly selected women who gave birth in the 12 months preceding the survey. Correlates were identified using binary logistic regression. Skilled birth attendance was 18.8%. Inability to perform cultural practices in health facilities (65.5%), expecting smooth delivery (63.4%), and far distance (62%) were the main barriers. Women with urban residence (AOR = 5.46: 95% CI[2.21–13.49]), primary (AOR = 2.10: 95% CI[0.71–6.16]) and secondary-plus (AOR = 6.12:[1.39–26.92]) educational level, four-plus ANC visits (AOR = 17.33: 95% CI[4.22–71.29]), and proximity to health centers (AOR = 5.67: 95% CI[1.47–25.67]) had higher odds of using skilled birth attendants though women with no labor complications had lower odds (AOR = 0.02: 95% CI[0.01–0.05]). Skilled birth attendance use was low. Urban residence, primary-plus level of education, frequent ANC visits, living nearby the health centers, and a problem during labor were positively correlated with skilled birth attendance utilization. Stakeholders should enhance girls’ education beyond primary level and ANC services and shorten distances to health facilities.
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STANTON, CYNTHIA, ANN K. BLANC, TREVOR CROFT, and YOONJOUNG CHOI. "SKILLED CARE AT BIRTH IN THE DEVELOPING WORLD: PROGRESS TO DATE AND STRATEGIES FOR EXPANDING COVERAGE." Journal of Biosocial Science 39, no. 1 (March 8, 2006): 109–20. http://dx.doi.org/10.1017/s0021932006001271.
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Skilled attendance at delivery is one of the key indicators to reflect progress toward the Millennium Development Goal of improving maternal health. This paper assesses global progress in the use of skilled attendants at delivery and identifies factors that could assist in achieving Millennium Development Goals for maternal health. National data covering a substantial proportion of all developing country births were used for the estimation of trends and key differentials in skilled assistance at delivery. Between 1990 and 2000, the percentage of births with a skilled attendant increased from 45% to 54% in developing countries, primarily as a result of an increasing use of doctors. A substantial proportion of antenatal care users do not deliver with a skilled attendant. Delivery care use among antenatal care users is highly correlated with wealth. Women aged 35 and above, who are at greatest risk of maternal death, are the least likely to receive professional delivery care. Births in mid-level facilities appear to be a strategy that has been overlooked. More effective strategies are needed to promote skilled attendance at birth during antenatal care, particularly among poor women. Specific interventions are also needed to encourage older and high parity mothers to seek professional care at delivery.
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Gitonga, Eliphas. "Skilled Birth Attendance among Women in Tharaka-Nithi County, Kenya." Advances in Public Health 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/9740196.
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Background. The burden of maternal mortality is concentrated in sub-Saharan Africa with an estimation of 500 000 deaths annually. In 2012, about forty million births occurred without a skilled attendant in developing countries. Skilled birth attendance improves maternal and newborn survival. The aim of this study therefore was to establish the level of skilled birth attendance and the associated factors. Methods. A cross-sectional survey was carried out using structured questionnaires as tools of data collection. Systematic sampling was used to select the respondents from the facilities that were stratified. The dependent variable was skilled birth attendance. Descriptive statistics were used to generate proportions and percentages while chi-square and Fisher’s exact tests were used to draw inferences. Association was significant if P<0.05. Results. The level of utilisation of skilled birth attendance was 77%. Skilled birth attendance was noted to be associated with age, level of education, average family income, parity, distance to the health facility, timing of initiation of antenatal care, level of facility attended during pregnancy, and birth preparedness status. Conclusion. The level of skilled birth attendance among women in Tharaka-Nithi County, Kenya, despite being higher than in some counties, requires improvement.
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Dufera, Adugna, Elias Teferi Bala, Habtamu Oljira Desta, and Kefyalew Taye. "Determinants of Skilled Birth Attendant Utilization at Chelia District, West Ethiopia." International Journal of Reproductive Medicine 2020 (April 29, 2020): 1–8. http://dx.doi.org/10.1155/2020/9861096.
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Background. An estimated 303,000 maternal deaths occurred globally in 2015 from which sub-Saharan Africa alone accounted for 201,000 (66%) of the maternal deaths, and most of these are attributed to complications of pregnancy and childbirth due to the absence of institutional delivery by skilled attendants. Objective. The aim of this study was to assess institutional delivery utilization and associated factors among mothers who gave birth in the last one year in Chelia District. Methodology. A community-based cross-sectional study design supplemented by a qualitative method was employed from March 15 to 30, 2018. A multistage sampling technique was used to select 475 study participants. Quantitative data were collected using structured questionnaires, and focus group discussions were employed to get qualitative data. The data were entered to EpiData version 3.1 and exported to the statistical package version 21 for analysis. Descriptive statistics and bivariate and multivariate logistic regression analysis were computed to measure the strength of association between dependent and independent variables at a p value of <0.05. Results. Among the respondents, 216 (46.2%) utilized institutional delivery service. Monthly income (AOR=4.465, 95%CI=1.729,11.527), antenatal care attendance (AOR=0.077, 95%CI=0.008,0.73), knowledge of mothers about their expected date of delivery (AOR=0.297, 95%CI=0.179,4.93), intended pregnancy (AOR=0.326, 95%CI=0.162,0.654), discussion with health extension workers about the place of delivery at home visit (AOR=0.11, 95%CI=0.023,0.523), knowledge of mothers about the existence of the waiting area in health facilities (AOR=0.14, 95%CI=0.023,0.84), and number of children (AOR=0.119, 95%CI=0.029,0.485) had a significant association with institutional delivery utilization. Conclusion. Utilization of institutional delivery was low and far away from the expected country target in the district. The health sector should strive to increase proportion of institutional delivery by reaching pregnant mothers with timely antenatal care service provision and enhancing family planning provision.
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Bhuiyan, A. B., S. Mukherjee, S. Acharya, S. J. Haider, and F. Begum. "Evaluation of a Skilled Birth Attendant pilot training program in Bangladesh." International Journal of Gynecology & Obstetrics 90, no. 1 (June 3, 2005): 56–60. http://dx.doi.org/10.1016/j.ijgo.2005.03.031.
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Fullerton, Judith T., Atf Ghérissi, Peter G. Johnson, and Joyce B. Thompson. "Competence and Competency: Core Concepts for International Midwifery Practice." International Journal of Childbirth 1, no. 1 (2011): 4–12. http://dx.doi.org/10.1891/2156-5287.1.1.4.
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The global health community has implemented several initiatives over the past in the interest of accelerating country-by-country progress toward the Millennium Development Goal of improving maternal health. Skilled attendance at every birth has been recognized as an essential component of approaches for reducing maternal and perinatal morbidity and mortality.Midwives have been acknowledged as a preferred cadre of skilled birth attendant. The International Confederation of Midwives (ICM) speaks for the global community of fully qualified (professional) midwives. The ICM document entitledEssential Competencies for Basic Midwifery Practiceis a core policy statement that defines the domains and scope of practice for those individuals who meet the international definition of midwife. This article explores the meaning of competence and competency as core concepts for the midwifery profession. An understanding of the meaning of these terms can help midwives speaking individually at the clinical practice level and midwifery associations speaking at the policy level to articulate more clearly the distinction of fully qualified midwives within the skilled birth attendant and sexual and reproductive health workforce. Competence and competency are fundamental to the domains of midwifery education, legislation, and regulation, and to the deployment and retention of professional midwives.
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Roberts, Lisa R., and Barbara A. Anderson. "Enhancing Traditional Birth Attendant Training in Guatemala." International Journal of Childbirth 11, no. 1 (February 18, 2021): 27–36. http://dx.doi.org/10.1891/ijcbirth-d-20-00028.
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BACKGROUNDThis article describes the follow-up study to Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants, published in the International Journal of Childbirth in 2017. This current study had two purposes: (a) to implement and evaluate the use of enhanced training modalities (active-learning strategies and use of technology in a remote area), and (b) to pilot training-of-trainer (ToT) methods. The current study builds upon the previous study in which we conducted and evaluated a simulation-based training among low-literacy Guatemala traditional birth attendants (TBAs).MATERIALS AND METHODSIn the current study, we conducted a focus group with experienced TBAs (n = 8) to elicit concepts and issues important to address in the training. The 60-hour training designed for low-resource settings, was enhanced with active-learning strategies, technology, and ToT modules. We assessed pre–posttest knowledge and attitudes by paper-pencil format, and pre–post skills by demonstration using simulation.RESULTSTraining participants (N = 31) included the eight experienced TBAs from the focus group. Knowledge, skills, and attitudes all improved, with statistical significance achieved in many parameters. Evaluation of the training was positive and enhancement strategies were noted as particularly helpful. Two participants participated in the additional ToT modules and are now collaborating to provide short educational programs to other TBAs in their regions.CONCLUSIONTraining enhancement strategies have the potential to increase safe practice among TBAs where skilled birth attendants are lacking. Adding ToT modules enhances sustainability and exemplifies the importance of locally prepared trainers in a time when global interaction is severely limited.
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Mayhew, Maureen, Peter M. Hansen, David H. Peters, Anbrasi Edward, Lakhwinder P. Singh, Vikas Dwivedi, Ashraf Mashkoor, and Gilbert Burnham. "Determinants of Skilled Birth Attendant Utilization in Afghanistan: A Cross-Sectional Study." American Journal of Public Health 98, no. 10 (October 2008): 1849–56. http://dx.doi.org/10.2105/ajph.2007.123471.
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Chowdhury, M. "W333 COMMUNITY SKILLED BIRTH ATTENDANT (CSBA): HOW TO DEVELOP A FUNCTIONAL PROGRAM." International Journal of Gynecology & Obstetrics 119 (October 2012): S812—S813. http://dx.doi.org/10.1016/s0020-7292(12)62056-6.
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DO, MAI. "UTILIZATION OF SKILLED BIRTH ATTENDANTS IN PUBLIC AND PRIVATE SECTORS IN VIETNAM." Journal of Biosocial Science 41, no. 3 (May 2009): 289–308. http://dx.doi.org/10.1017/s0021932009003320.
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SummaryThe private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women’s decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women’s household wealth, education, antenatal care and community’s wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.
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Omidakhsh, Negar, and Ondine S. von Ehrenstein. "Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys." International Journal of Environmental Research and Public Health 18, no. 14 (July 19, 2021): 7667. http://dx.doi.org/10.3390/ijerph18147667.
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Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined associations between household availability of improved drinking water and sanitation, respectively, and use of maternal and child health (MCH) services in South Asian countries. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0–36 months (n = 145,262). Types of households’ water source and sanitation facilities were categorized based on the World Health Organization and UNICEF’s definitions of “improved” and “unimproved”. We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, and reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water source was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. Approaches addressing water/sanitation and MCH services across sectors could be a suggested public health strategy.
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Affipunguh, Pius Kaba, and Alexander Suuk Laar. "Assessment of knowledge and practice towards birth preparedness and complication readiness among women in Northern Ghana: a cross-sectional study." International Journal of Scientific Reports 2, no. 6 (June 14, 2016): 121. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20161878.
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<p class="abstract"><strong>Background:</strong> The principle and practice of birth preparedness and complication readiness (BP&CR) in resource-poor settings have the potential of reducing maternal and neonatal morbidity and mortality rates. The purpose of this study was to assess BP and CR among pregnant women and women who gave birth in the12 months preceding the study and the socio-demographic factors affecting BP and CR.</p><p class="abstract"><strong>Methods:</strong> The study was a health facility-based cross-sectional survey using pre-tested and structured questionnaires to gather data among 422 currently pregnant women and women who gave birth in the 12 months preceding the study and attending antenatal or postnatal care in health facilities in the Kassena-Nankana Districts in Northern Ghana. Data were analysed using State version 10.</p><p class="abstract"><strong>Results:</strong> For the 422 respondents, 50% were rural and 50% urban residents. Having at least a primary education and living in a rural area were significantly associated with birth preparedness plan (BPP) (P = 0.044) and (P = 0.007). There was no association between age group, occupation, marital status and religion to BPP (P=0.907), (P=0.397), (P=0.573) and (P=0.564) respectively. The study also revealed that identification of a potential blood donor and a skilled birth attendant were not considered crucial by the respondents.</p><strong>Conclusions:</strong> The study identified poor knowledge and practices of identification of a potential blood donor and skilled birth attendant preparation for birth preparedness and its complication in the study area. Antenatal care education should place emphasis on birth preparedness and complication readiness to improve access to skilled and emergency obstetric care.
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Tabong, Philip Teg-Nefaah, Joseph Maaminu Kyilleh, and William Wilberforce Amoah. "Reasons for the utilization of the services of traditional birth attendants during childbirth: A qualitative study in Northern Ghana." Women's Health 17 (January 2021): 174550652110024. http://dx.doi.org/10.1177/17455065211002483.
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Background: Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities. Method: Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses. Results: The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also an essential consideration for the use of their services. Conclusion: The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.
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Kruk, Margaret E., Marta R. Prescott, and Sandro Galea. "Equity of Skilled Birth Attendant Utilization in Developing Countries: Financing and Policy Determinants." American Journal of Public Health 98, no. 1 (January 2008): 142–47. http://dx.doi.org/10.2105/ajph.2006.104265.
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van den Boogaard, Jossy, Bart Arntzen, Junist Chilwana, Martin Liyungu, Albert Mantingh, and Jelle Stekelenburg. "Skilled or Traditional Birth Attendant? Choices of Communities in Lukulu District, Rural Zambia." World Health & Population 10, no. 1 (March 15, 2008): 34–43. http://dx.doi.org/10.12927/whp.2008.19736.
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Deshmukh, Namita, Avinash Borkar, and Mrityunjay Rathore. "Assessment of birth preparedness and complication readiness among pregnant women in rural area of Chhattisgarh: a community based cross-sectional study." International Journal Of Community Medicine And Public Health 6, no. 4 (March 27, 2019): 1634. http://dx.doi.org/10.18203/2394-6040.ijcmph20191397.
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Background: Neonatal and maternal mortality are the major concerns in the country mainly due to the “three delays” in seeking, reaching, and obtaining appropriate care. Birth preparedness and complication readiness (BPACR) is one of the most important tools to assess these delays. BPACR is the process of planning for normal birth and anticipating the actions needed in case of an emergency. The current study was undertaken to assess the status of BPACR among pregnant women in rural area of Kharsiya block in Raigarh district.Methods: A community-based, cross-sectional study was conducted among 110 pregnant women in rural area of Kharsiya during January-June 2017. All the pregnant females were interviewed using a pretested and structured questionnaire. Knowledge about danger signs, planning for transport, place and delivery by skilled birth attendant, financial management were assessed. BPACR index was also calculated.Results: The BPACR index was found to be very low (27.79%). About 73.65% women identified a skilled birth attendant for delivery but, only 10% women saved money and only 2.7% women had identified a blood donor for emergency. Nearly 74.54% women had no knowledge about danger or warning signs during pregnancy while 89.09% were unaware of complications during labour and 97.27% women did not know about puerperal complications.Conclusions: BPACR index in this rural area was very low. Vast majority of women were not knowledgeable about birth preparedness and complication readiness.