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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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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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Baral, Y. R., K. Lyons, J. Skinner, and E. R. Van Teijlingen. "Determinants of skilled birth attendants for delivery in Nepal." Kathmandu University Medical Journal 8, no. 3 (June 4, 2012): 325–32. http://dx.doi.org/10.3126/kumj.v8i3.6223.
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This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women’s role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women’s involvement in decision making; and women’s autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women’s role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery. Qualitative research will help further exploration of the issues and contribute to improvement of maternal health services.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6223 Kathmandu Univ Med J 2010;8(3):325-32
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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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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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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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Dickson, Kwamena Sekyi, Kenneth Setorwu Adde, and Edward Kwabena Ameyaw. "Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis." PLOS ONE 16, no. 7 (July 7, 2021): e0254281. http://dx.doi.org/10.1371/journal.pone.0254281.
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Introduction In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. Materials and methods This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). Results The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance. Conclusion These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.
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Doris, Kibiwott, Mwangi Anne, and Kang’ethe Simon. "Partograph use among skilled birth attendants in selected counties, Western Kenya." International Journal of Nursing and Midwifery 13, no. 3 (August 31, 2021): 19–25. http://dx.doi.org/10.5897/ijnm2021.0467.
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Esan, Oluwaseun. "The knowledge versus self-rated confidence of facility birth attendants with respect to maternal and newborn health skills: the experience of Nigerian primary healthcare facilities." Malawi Medical Journal 31, no. 3 (September 3, 2019): 212–20. http://dx.doi.org/10.4314/mmj.v31i3.8.
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BackgroundCompetent and skilled birth attendants are critical in the reduction of maternal and infant morbidity and mortality at delivery. This study aimed to determine the association between knowledge and self-rated confidence in facility birth attendants affiliated with maternal and neonatal health (MNH) interventions.MethodsA descriptive cross-sectional study was conducted in 24 primary healthcare facilities in Osun state, Nigeria among 128 consenting facility birth attendants who were selected via a multi-stage sampling technique. Each attendant received a semi-structured interviewer-administered questionnaire. The dependent variables included the respondent’s level of knowledge in MNH interventions and their self-rated confidence in MNH skills such as the provision of antenatal care service, normal labour, use of a partograph and the management of obstetric complications and post-partum haemorrhage. Bivariate analysis of factors associated with knowledge and self-rated confidence in MNH skills was performed with statistical significance set at p<0.05.ResultsOnly 48 (37.5%) of the respondents had good knowledge of all of the assessed interventions; worse performances were reported with regards to the respondent’s knowledge of normal labour and partograph use. However, 96 (75%) of respondents were confident in performing 75% of the skills assessed. Our analysis identified two factors that were significantly associated with a good knowledge of MNH skills: the cadre of the birth attendants (p<0.001) and training in life-saving skills (p=0.001). The knowledge of our respondents relating to most of the MNH interventions assessed was not significantly associated with their self-rated confidence in the required skills.ConclusionThe confidence of facility birth attendants in MNH skills was not knowledge-based and could frustrate national efforts to reduce maternal and perinatal deaths. We recommend effective and evidence-based training of all cadres of facility birth attendants to ensure that the skills being practiced clinically are based on adequate knowledge.
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Abebe, Haftom Temesgen, Mache Tsadik Adhana, Mengistu Welday Gebremichael, Kebede Embaye Gezae, and Assefa Ayalew Gebreslassie. "Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017." PLOS ONE 16, no. 9 (September 9, 2021): e0254146. http://dx.doi.org/10.1371/journal.pone.0254146.
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Background The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Method Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009–2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009–2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. Results The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014–2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014–2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86–196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30–3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33–4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18–3.74). Conclusion Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women’s attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.
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Afulani, Patience A., and Cheryl Moyer. "Explaining Disparities in Use of Skilled Birth Attendants in Developing Countries: A Conceptual Framework." PLOS ONE 11, no. 4 (April 22, 2016): e0154110. http://dx.doi.org/10.1371/journal.pone.0154110.
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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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Afulani, Patience A., and Cheryl Moyer. "Explaining disparities in use of skilled birth attendants in developing countries: a new conceptual framework." Annals of Global Health 82, no. 3 (August 20, 2016): 375. http://dx.doi.org/10.1016/j.aogh.2016.04.602.
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Egami, Hiroyuki, and Tomoya Matsumoto. "Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda." Sustainability 12, no. 9 (May 5, 2020): 3741. http://dx.doi.org/10.3390/su12093741.
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Lack of cash on hand is a significant obstacle in accessing healthcare services in developing countries. Many expectant mothers in the least developed countries do not receive sufficient care during pregnancy due to financial constraints. If such hurdles in accessing healthcare can be overcome, it will contribute to reduction in maternal and newborn mortality, which is a key target of Sustainable Development Goal 3. This study reports the first assessment of the impact of mobile money services on maternal care utilization. We hypothesize that mobile money adoption would motivate rural Ugandan women to receive antenatal care and to deliver their children at health facilities or with skilled birth attendants. By receiving remittances utilizing mobile money, poor rural households may obtain more cash in hand, which might change women’s health-seeking behavior. We apply community- and mother-fixed effects models with heterogeneity analysis to longitudinal panel data (the RePEAT [Research on Poverty, Environment, and Agricultural Technology] survey) of three waves (2009, 2012, and 2015). The analysis uses pregnancy reports of 2007–2015 from 586 rural Ugandan households. We find suggestive evidence that mobile money adoption positively affects the take-up of antenatal care. Heterogeneity analysis indicates that mobile money brings a larger benefit to geographically challenged households by easing their liquidity constraint as they face higher cost of traveling to distant health facilities. The models failed to reject the null hypothesis of no mobile money effect on the delivery-related outcome variables. This study suggests that promoting financial inclusion by means of mobile money motivates women in rural and remote areas to make antenatal care visits while the evidence of such effect is not found for take-up of facility delivery or delivery with skilled birth attendants.
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Ettarh, Remare R., and James Kimani. "Influence of Distance to Health Facilities on the Use of Skilled Attendants at Birth in Kenya." Health Care for Women International 37, no. 2 (June 11, 2014): 237–49. http://dx.doi.org/10.1080/07399332.2014.908194.
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Mugo, Ngatho Samuel, Kingsley E. Agho, and Michael J. Dibley. "Risk Factors for Non-use of Skilled Birth Attendants: Analysis of South Sudan Household Survey, 2010." Maternal and Child Health Journal 20, no. 6 (March 9, 2016): 1266–79. http://dx.doi.org/10.1007/s10995-016-1928-x.
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K C, N. P., I. Basnett, S. K. Sharma, C. L. Bhusal, R. R. Parajuli, and K. L. Anderson. "Increasing Access to Safe Abortion Services Through Auxiliary Nurse Midwives Trained as Skilled Birth Attendants." Kathmandu University Medical Journal 9, no. 4 (June 18, 2012): 260–66. http://dx.doi.org/10.3126/kumj.v9i4.6341.
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Background The use of medical abortion methods was approved by Department of Health Services in 2009 and introduced in hospitals and a few primary health centres (PHCs). Access would increase if services were available at health post level and provided by auxiliary nurse midwives trained as skilled birth attendants. Evidence from South Africa, Bangladesh, Nepal and Vietnam show that mid-level health workers can provide medical abortion safely. Objectives To determine the best way to implement the new strategies of medical abortion into the existing health system of Nepal; and to facilitateits full-scale implementation, monitoring and evaluation. Methods An implementation research involving a baseline study, implementation phase and end line study was done in ten districts covering five development regions from July 2010 to June 2011. Both qualitative and quantitative methods were used. Results Of 1,799 medical abortion clients who received service, 46% were disadvantaged Janjati, 14% were Dalit, 42% were upper caste groups and rest were advantaged Janjati (7%), Muslim (1%) and others. 14% were referred by female community health volunteers and 56% were referred by others. Complication rate of 0.3% was well below acceptable levels. Condom use increased from 8% to 28% by the end of study. Use of Pills, Depo, intra uterine devices and Implants also increased, but use of long acting family planning methods was negligible. Conclusions This model should be replicated nationwide at health posts and sub-health posts where auxiliary nurse milwifes are available 24 hours/day. Focus should be given first to those areas where access is difficult, time consuming and costly.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6341 Kathmandu Univ Med J 2011;9(4):260-66
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Choulagai, Bishnu P., Umesh Raj Aryal, Binjwala Shrestha, Abhinav Vaidya, Sharad Onta, Max Petzold, and Alexandra Krettek. "Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants." Global Health Action 8, no. 1 (December 2015): 29396. http://dx.doi.org/10.3402/gha.v8.29396.
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Rivenes Lafontan, Sara, Johanne Sundby, Hussein Kidanto, Columba Mbekenga, and Hege Ersdal. "Acquiring Knowledge about the Use of a Newly Developed Electronic Fetal Heart Rate Monitor: A Qualitative Study Among Birth Attendants in Tanzania." International Journal of Environmental Research and Public Health 15, no. 12 (December 14, 2018): 2863. http://dx.doi.org/10.3390/ijerph15122863.
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In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor ward at two health facilities in Tanzania. The FGDs were analyzed using qualitative content analysis. The study revealed that the participants experienced the training about the device as useful but inadequate. Due to high turnover, a frequently mentioned challenge was that many of the birth attendants who were responsible for training others, were no longer working in the labor ward. Many participants expressed a need for refresher trainings, more practical exercises and more theory on labor management. The study highlights the need for frequent trainings sessions over time with focus on increasing overall knowledge in labor management to ensure correct use of the monitor over time.
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Adeyemi, Nurat Kehinde. "Determinants, Treatment and Consequences of Post-Partum Haemorrhage in Osun State, Nigeria." Nigerian Journal of Sociology and Anthropology 17, no. 1 (June 1, 2019): 133–52. http://dx.doi.org/10.36108/njsa/9102/71(0190).
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Despite concerted efforts made by United Nations and other health agencies to reduce Maternal Mortality Rate (MMR) through Skilled Birth Attendants (SBAs) and use of healthcare facilities, report reveals that Traditional Birth Attendants (TBAs) still have a place in maternal healthcare in developing countries. This paper examines causes, treatment and consequences of Post-Partum Haemorrhage (PPH) from TBAs’ perspectives in Osun State, Southwestern Nigeria. The study adopted qualitative method of data collection (In-depth Interview and Focus Group Discussion). Results show some similar (Tone, Trauma, Tissue and Thrombin) as obtained from medical literature and some divergent causes of PPH which includes: consumption of Potassium, intoxicants, dairy product, junks and iron tablets at advanced stage of pregnancy. This implies that substance/food consumption has implication on maternal health. TBAs’ treatment techniques for PPH include: use of powdery substances, concoctions, herbs and roots, and sometimes use of animal parts. Consequences of PPH include: organ failure, respiratory disorder, infection, fever, vomiting, anaemia and loss of fertility. WHO has revealed that misoprostol is effective in treating PPH in home delivery in developing countries. Reducing MMR due to PPH and achieving development in health sector in Nigeria therefore, requires training Nigeria TBAs on the proper administration of misoprostol.
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Malachi, Zillah, and Richard Seme Onkware. "Determinants of skilled care during delivery among mothers in Bomachoge Chache, Kisii county, Kenya." African Journal of Midwifery and Women's Health 14, no. 3 (July 2, 2020): 1–8. http://dx.doi.org/10.12968/ajmw.2018.0023.
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Background/Aims Utilisation of skilled care delivery remains low in developing countries, including Kenya. Literature shows that predictors of skilled birth attendance differ from region to region. This study aimed to identify predictors of skilled birth attendance for delivery among women in Bomachoge Chache, Kenya. Methods This was a case control study conducted in 2015, in Bomachoge Chache Sub County, Kisii County, Kenya. The study targeted postnatal mothers who brought their children for immunisation. A total of 322 postnatal mothers (n=161 delivered at home; n=161 delivered in a health facility) answered questions about sociodemographic characteristics on a pretested researcher-administered questionnaire. Association of characteristics with skilled birth attendance was analysed using the chi square test. Multivariate logistic regression was used to determine the strength of the associations and to control for confounders, with significance assumed at P<0.05. Results The likelihood of mothers delivering at home was higher in mothers who had two or more children (adjusted odds ratio=28.4, P=0.0005) and in mothers whose spouses were casual labourers (adjusted odds ratio=16.9, P=0.0048). However, the likelihood of delivering at home was lower in mothers who had at least secondary level education (adjusted odds ratio=0.33, P=0.03) and in mothers who were farmers (adjusted odds ratio=0.32, P=0.03). Conclusions Sociodemographic characteristics including parity, occupation, spousal occupation and education impact the use of skilled care at birth and should be evaluated to inform policy for maternal and neonatal care. Further studies at a household level are recommended to fully understand disparities in skilled attendance at birth.
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Dickson, Kwamena Sekyi, and Hubert Amu. "Determinants of Skilled Birth Attendance in the Northern Parts of Ghana." Advances in Public Health 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9102808.
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Background. An integral part of the Sustainable Development Goal three is to ensure universal access to sexual and reproductive healthcare services which include skilled delivery by the year 2030. We examined the determinants of skilled delivery among women in the Northern part of Ghana. Methods. The paper made use of data from the Demographic and Health Survey. Women from the Northern part of Ghana were included in the analysis. Bivariate descriptive analyses coupled with binary logistic regression estimation technique were used to analyse the data. Results. Region of residence, age, household wealth, education, distance to a health facility, religion, parity, partner’s education, and getting money for treatment were identified as the determinants of skilled delivery. While the probability of having a skilled delivery was higher in the Upper East Region, it was lower in the Northern and Upper West Regions compared to the Brong Ahafo Region. Conclusion. Our findings call for more attention from the Ghana Health Service and the Ministry of Health in addressing the skilled delivery gaps among women particularly in the Northern and Upper West Regions in ensuring attainment of the Sustainable Development Goal target related to reproductive health care accessibility for all by the year 2030.
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Asiedu, Christiana. "Influence of Socio-cultural and Physical Factors on Use of Skilled Birth Attendants by Pregnant Women at Central Region." Universal Journal of Public Health 7, no. 6 (November 2019): 255–61. http://dx.doi.org/10.13189/ujph.2019.070603.
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Vieira, Claudia, Anayda Portela, Tina Miller, Ernestina Coast, Tiziana Leone, and Cicely Marston. "Increasing the Use of Skilled Health Personnel Where Traditional Birth Attendants Were Providers of Childbirth Care: A Systematic Review." PLoS ONE 7, no. 10 (October 24, 2012): e47946. http://dx.doi.org/10.1371/journal.pone.0047946.
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Egharevba, MD, MPH, Johnbull, Jennifer R. Pharr, PhD, Brian Van Wyk, PhD, and Echezona E. Ezeanolue, MD, MPH. "Factors Influencing the Choice of Child Delivery Location among Women Attending Antenatal Care Services and Immunization Clinic in Southeastern Nigeria." International Journal of MCH and AIDS (IJMA) 6, no. 1 (June 25, 2017): 82. http://dx.doi.org/10.21106/ijma.213.
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Background and Objective: In Nigeria, most deliveries take place at home or with traditional birth attendants (TBAs). This study examined the factors that influenced or determined utilization of healthcare facility delivery services among women who attended antenatal care (ANC) services.Methods: A cross-sectional survey was conducted with 220 women who registered for ANC at a hospital and delivered within 18 months. Associations between independent variables and choice of healthcare facility delivery were analyzed. Multiple logistic regression was also used to identify the predictors of choice of delivery among women.Results: Of the 220 women who registered for ANC, 75% delivered at a healthcare facility while 15% delivered with a TBA or at home. In the final model, number of children, having planned to deliver at a hospital, labor occurring at night, and labor allowing time for transportation were significant predictors of child delivery location among the women.Conclusion and Global Health Implications: Utilization of the health facilities for childbirth may increase if pregnant women are encouraged to book early for ANC and if during ANC, pregnant women were counseled to detect labor signs early. In addition to focused and intensified counseling for women with more children, support should be provided that includes financial provisions for transportation to the healthcare facility.Key words: Delivery Location • Pregnant Women • Maternal Utilization • Healthcare Facility Delivery • Skilled Birth Attendants • Traditional Birth Attendants (TBA) • Antenatal Care Services (ANC) • NigeriaCopyright © 2017 Egharevba et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Obinna, Njoku Charles, Njoku A. N., Efiok E. E., and Eyong E. M. "Uterovaginal prolapse: the sociodemographic profile and reproductive health service uptake in a low resource setting, Calabar, Nigeria." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 4 (March 25, 2020): 1610. http://dx.doi.org/10.18203/2320-1770.ijrcog20201232.
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Background: Uterovaginal prolapse is a common gynaecological condition in low resource countries because of high prevalence of grand multiparity, low skilled attendant at delivery and low contraceptive usage. Objective of this study was to determine the prevalence, sociodemographic profiles, utilization of reproductive health services and delay in seeking medical care of patient with uterovaginal prolapse in Calabar, Nigeria.Methods: This was a retrospective study of women who presented with uterovaginal prolapse at University of Calabar Teaching Hospital, Calabar, Nigeria between 1st May 2009 and 1st June 2019. Patients case records were retrieved and analyzed. Statistical analysis was done using SPSS version 22.Results: The prevalence of genital prolapse was 0.3%. The mean age and parity were 60.19±8.71 years and 6.31±2.80, respectively. The mean duration of symptoms before presentation was 3.19±2.16 years. Genital prolapse was commonest among age group 60-79 years (52.8%), parity 5-9 (66.7%), post-menopausal (97.2%), primary education (55.6%) and farmers (47.2%). Grade 3 uterovaginal prolapse was the commonest grade (58.3%). Most patients (86.1%) had symptoms of genital prolapse for less than 5 years before seeking medical treatment. The majority of patients had no antenatal care during their pregnancies (80.6%), no skilled attendant at deliveries (86.1%) and no contraceptive use during their reproductive years (77.8%). Participants with lower parity (1-4) (p=0.03), higher educational level (p˂0.001) and teachers/civil servants (p=0.043) presented earlier (less than 1 year) to the hospital.Conclusions: There is poor utilization of reproductive health services among women who develop uterovaginal prolapse in study environment. Women with higher social status sought for help earlier. Increasing awareness of this condition and providing antenatal care, skilled birth attendants and contraceptive services will reduce the burden of this condition.
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Baniya, A., D. Chhetri, and B. Pokhrel. "Maternity incentive scheme on safe delivery services in rural area of Kavre district." Journal of Chitwan Medical College 5, no. 2 (August 14, 2015): 30–35. http://dx.doi.org/10.3126/jcmc.v5i2.13153.
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Maternity incentive schemes were to encourage mothers to use skilled birth attendance for the best prevention of maternal and child death whereas the pregnant women should have access to high quality prenatal care which, they can afford and where, they are treated with respect. The objective of the study was to determine the knowledge and utilization of maternal incentives scheme on delivery services at rural area of Nepal. This study was cross-sectional descriptive in nature and Study was conducted in Panchkhal VDC, Kavre district of Nepal.The numbers of married women of reproductive age group were the study population. The sample size was taken as 96. Most of the respondent had primary education (38.5%) and illiterate (15.6%). Highest mobilization of sources which provided throughout the health institute disseminates the MIS information During the study seventy nine mothers went to hospital for treatment. Utilization of incentive helps to change the delivery behavior (practice) of women (78%) within the hospital services by the skilled birth attendants. The 54.2% were not getting money (private hospital) for delivery and 13.5% respondents used money in nutrition and transport, 11.5% used in medicine and 1.0% respondent didn’t spend money. Low income and poor women (63%) have been more benefited from the incentive scheme followed by Janajati (12.5%), Dalit (12.5%) and rural women (9.4%) respectively. Importance of maternity incentive scheme (MIS) on safe delivery services (SDS) needs to be disseminated in rural community through integrated health education program. Most of the respondents reported that only incentive is not the matter of utilization of hospital services, but the issue of mother and child health.
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Koroglu, Mustafa, Bridget R. Irwin, and Karen A. Grépin. "Effect of power outages on the use of maternal health services: evidence from Maharashtra, India." BMJ Global Health 4, no. 3 (June 2019): e001372. http://dx.doi.org/10.1136/bmjgh-2018-001372.
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IntroductionElectricity outages are common in low/middle-income countries and have been shown to adversely affect the operation of health facilities; however, little is known about the effect of outages on the utilisation of health services.MethodsUsing data from the 2015–2016 India Demographic Health Survey, combined with information on electricity outages as reported by the state electricity provider, we explore the associations between outage duration and frequency and delivery in an institution, skilled birth attendance, and caesarean section delivery in Maharashtra State, India. We employ multivariable logistic regression, adjusting for individual and household-level covariates as well as month and district-level fixed effects.ResultsPower outage frequency was associated with a significantly lower odds of delivering in an institution (OR 0.98; 95% CI 0.96 to 0.99), and the average number of 8.5 electricity interruptions per month was found to yield a 2.08% lower likelihood of delivering in a facility, which translates to an almost 18% increase in home births. Both power outage frequency and duration were associated with a significantly lower odds of skilled birth attendance (OR 0.97; 95% CI 0.95 to 0.99, and OR 0.99; 95% CI 0.992 to 0.999, respectively), while neither power outage frequency nor duration was a significant predictor of caesarean section delivery.ConclusionPower outage frequency and duration are important determinants of maternal health service usage in Maharashtra State, India. Improving electricity services may lead to improved maternal and newborn health outcomes.
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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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Wicaksono, Febri. "Impact of Husband’s Participation in Antenatal Care on the Use of Skilled Birth Attendant." Kesmas: National Public Health Journal 10, no. 4 (June 21, 2016): 162. http://dx.doi.org/10.21109/kesmas.v10i4.520.
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Mukherjee, Madhumita, Rashmi Singh, Amrita Mukherjee, and Madhulekha Bhattacharya. "Non-use of Janani Avam Bal Suraksha Yojana in a district of Bihar: ensuring safe deliveries needs strategy modification." International Journal Of Community Medicine And Public Health 5, no. 8 (July 23, 2018): 3311. http://dx.doi.org/10.18203/2394-6040.ijcmph20182969.
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Background: India’s Janany Surakhsha Yojana (JSY) is the largest conditional cash transfer (CCT) program in the world in terms of the number of beneficiaries - covering about 9·5 million (36%) of 26 million women giving birth in India. Eleven States/UTs including Bihar, are still below the National estimate for institutional delivery of 78.9% (NFHS 4). In this study we attempted to find out the status of institutional and home deliveries in district Arwal of Bihar and reasons why in spite of cash incentives a proportion of mothers are opting for home delivery.Methods: A cross sectional descriptive design was used to interview 407 women, who had given birth to a child in previous one year. Focuss group discussions was held with community and health staff to corroborate the interview data.Results: Fifty nine percent of mothers were found to have preferred home delivery over institutional one. Reasons which came to light were home deliveries are cheaper (24.1%), unawareness about JSY (22%), unavailability of transport to reach hospital (22%) and better care being taken at home delivery (20.1%) variables. Older age, having a BPL card, and literacy of husband were found as favoring institutional delivery whereas dissatisfaction during a previous abortion or a livebirth in hospital were both associated with non-use.Conclusions: Better client awareness, strengthening of public health infrastructure, availability of skilled birth attendants at health subcentres (HSCs) and emergency transport in time can reduce number of home deliveries and lead to success of JBSY programme and subsequent reduction in maternal morbidity and mortality.
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Mordal, Elin, Ingrid Hanssen, Andargachew Kassa, and Solfrid Vatne. "Mothers’ Experiences and Perceptions of Facility-based Delivery Care in Rural Ethiopia." Health Services Insights 14 (January 2021): 117863292110176. http://dx.doi.org/10.1177/11786329211017684.
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In Ethiopia, delivery wards are a part of primary healthcare services. However, although the maternal mortality rate is very high, approximately 50% of mothers use skilled birth attendants. This study focused on how women in a rural southern district of Ethiopia experience maternity care offered at the local delivery wards. In this qualitative, exploratory study, 19 women who had given birth in a healthcare facility were interviewed in 2019. Individual in-depth interviews were supplemented with observations conducted at 2 different delivery wards in the same district in 2020. Two main themes emerged from the thematic content analysis: increased awareness and safety were the primary reasons for giving birth at a healthcare facility, and traditions and norms affected women’s birth experiences in public maternity wards. The main shortcomings were a shortage of medicine, ambulance not arriving in time, and lack of care at night. For some women, being assisted by a male midwife could be challenging, and the inability to afford necessary medicine made adequate treatment inaccessible. Providing continuous information gave the women a certain feeling of control. Strong family involvement indicated that collectivistic expectations were key to rural delivery wards. The healthcare system must be structured to meet women’s needs. Moreover, managers and midwives should ensure that birthing women receive high-quality, safe, timely, and respectful care.
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Shiferaw, Biruhtesfa Bekele, and Lebitsi Maud Modiba. "Women’s Perspectives on Influencers to the Utilisation of Skilled Delivery Care: An Explorative Qualitative Study in North West Ethiopia." Obstetrics and Gynecology International 2020 (February 10, 2020): 1–12. http://dx.doi.org/10.1155/2020/8207415.
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Skilled attendance at birth is widely regarded as an effective intervention to reduce maternal and early neonatal morbidity and mortality. However, many women in Ethiopia still deliver without skilled assistance. This study was carried out to identify factors that influenced or motivated women to give birth in a health facility in their previous, current, and future pregnancies. This descriptive explorative qualitative study was conducted in two districts of West Gojjam zone in North West Ethiopia. Fourteen focus group discussions were conducted with pregnant women and women who gave birth within one year. An inductive thematic analysis approach was employed to analyze the qualitative data. In this study, two major themes and a number of subthemes emerged from the focus group discussions with the study participants. The factors that influenced or motivated women to give birth in health facility in their previous, current, and future pregnancies include access to ambulance transport service, prevention of mother to child HIV transmission service, referral service, women friendly service, and emergency obstetric services, good interpersonal care from health workers, and fear and experience of obstetric danger signs and complications. In addition, reception of information and advice on importance of skilled delivery care and obstetric danger signs and complications from health workers, use of antenatal care, previous use of skilled delivery care, ensuring wellbeing of parturient women and newborns, and use of emergency obstetric care were also identified as influencers and motivators for health facility childbirth in previous, current, and future deliveries. Increased understanding of the factors that influenced or motivated women to deliver in facilities could contribute to developing strategies to improve the uptake of facility-based maternity services and corresponding declines in maternal morbidity and mortality.
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Weon, Soyoon, David W. Rothwell, Shailen Nandy, and Arijit Nandi. "Savings ownership and the use of maternal health services in Indonesia." Health Policy and Planning 34, no. 10 (October 4, 2019): 752–61. http://dx.doi.org/10.1093/heapol/czz094.
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Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.
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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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Adoyo, Joseph O., Eliphas G. Makunyi, George O. Otieno, and Alison Yoos. "Magnitude and determinants of self-referrals among women seeking skilled birth attendance services: a cross-sectional hospital-based study in Marsabit County, Kenya." International Journal Of Community Medicine And Public Health 8, no. 5 (April 27, 2021): 2124. http://dx.doi.org/10.18203/2394-6040.ijcmph20211728.
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Background: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019.Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval.Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138-0.990, p-value 0.048).Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.
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McRae, Daphne N., Nicole Bergen, Anayda G. Portela, and Nazeem Muhajarine. "A systematic review and meta-analysis of the effectiveness of maternity waiting homes in low- and middle-income countries." Health Policy and Planning 36, no. 7 (June 28, 2021): 1215–35. http://dx.doi.org/10.1093/heapol/czab010.
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Abstract Maternity waiting homes (MWHs) in low- and middle-income countries (LMICs) provide women with accommodation close to a health facility to enable timely access to skilled care at birth. We examined whether MWH use and availability compared with non-use/unavailability were associated with facility birth, birth with a skilled health professional, attendance at postnatal visit(s) and/or improved maternal and newborn health, in LMICs. We included (non-)randomized controlled, interrupted time series, controlled before–after, cohort and case–control studies published since 1990. Thirteen databases were searched with no language restrictions. Included studies (1991–2020) were assessed as either moderate (n = 9) or weak (n = 10) on individual quality using the Effective Public Health Practice Project tool. Quality was most frequently compromised by selection bias, confounding and blinding. Only moderate quality studies were analyzed; no studies examining maternal morbidity/mortality met this criterion. MWH users had less relative risk (RR) of perinatal mortality [RR 0.65, 95% confidence intervals (CIs): 0.48, 0.87] (3 studies) and low birthweight (RR 0.34, 95% CI: 0.20, 0.59) (2 studies) compared with non-users. There were no significant differences between MWH use and non-use for stillbirth (RR 0.75, 95% CI: 0.47, 1.18) (3 studies) or neonatal mortality (RR 0.51, 95% CI: 0.25, 1.02) (2 studies). Single study results demonstrated higher adjusted odds ratios (aOR) for facility birth (aOR 5.8, 95% CI: 2.6, 13.0) and attendance at all recommended postnatal visits within 6 weeks of birth (aOR 1.99, 95% CI: 1.30, 3.07) for MWH users vs. non-users. The presence vs. absence of an MWH was associated with a 19% increase in facility birth (aOR 1.19, 95% CI: 1.10, 1.29). The presence vs. absence of a hospital-affiliated MWH predicted a 47% lower perinatal mortality rate (P < 0.01), but at a healthcare centre-level a 13 higher perinatal mortality rate (P < 0.01). Currently, there remains a lack of robust evidence supporting MWH effectiveness. We outline a six-point strategy for strengthening the evidence base.
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Mathulu, Anthony Wambua, and Benard Wambua Mbithi. "Socio-Cultural Factors Influencing Uptake of Skilled Childbirth Services among Women in Kaiti Division, Makueni District (Kenya)." International Journal of Public Health Science (IJPHS) 6, no. 2 (June 1, 2017): 101. http://dx.doi.org/10.11591/ijphs.v6i2.6638.
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Each year, over 500,000 women die from the complications of pregnancy and child birth, almost all of them in the developing countries. This trend can be addressed by increasing the rates of skilled care during childbirth. This study therefore sought to establish the socio-cultural factors influencing uptake of skilled childbirth care which has remained low in Kaiti Division. The researchers applied a descriptive cross-sectional study design which involved women of childbearing age (15-49 years). The study was conducted in March 2010 and had a sample size of 246 women which was randomly selected from the estimated target population of 12,077. The researchers applied both quantitative and qualitative approaches. The tests of significance employed included Fisher’s exact test, chi-square, test and logistic regression. The study established that the proportion of women attended to by the skilled attendant within various age cohorts was higher (58.9%) amongst the youth/adolescent (15-24 years) (P-value = 0.091> 0.05, c<sup>2</sup> 10.915 df 6).). Skilled attendance declined among the grand-multiparas (para4 and above) from 7.7% in Para 4-5 to 2% in Para 6+ (P-value = .000<0.05, c<sup>2</sup> 34.888 df 3; Para 1(p =0.000, OR 28.391), Para 2-3 (p =0.000, OR 7.564), Para 4-5(p=0.030, OR 3.493) Further findings indicated that the principal decision maker (46.7%) on type of assistant in the last delivery was the woman (P-value = 0.000 <0.05, c<sup>2</sup> 56.076 df 5). However, the husband was the leading (39.5%) decision maker in use of a skilled assistant in the last delivery (p=0.000, OR 15.667). More than two thirds (70.7%) of the respondents who performed a ceremony prayed for safe delivery in their last delivery. The study concluded that women’s parity, decision making and religion were significant in use of skilled childbirth services.
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Mathulu, Anthony Wambua, and Benard Wambua Mbithi. "Socio-Cultural Factors Influencing Uptake of Skilled Childbirth Services among Women in Kaiti Division, Makueni District (Kenya)." International Journal of Public Health Science (IJPHS) 6, no. 2 (June 1, 2017): 104. http://dx.doi.org/10.11591/.v6i2.6638.
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<p>Each year, over 500,000 women die from the complications of pregnancy and child birth, almost all of them in the developing countries. This trend can be addressed by increasing the rates of skilled care during childbirth. This study therefore sought to establish the socio-cultural factors influencing uptake of skilled childbirth care which has remained low in Kaiti Division. The researchers applied a descriptive cross-sectional study design which involved women of childbearing age (15-49 years). The study was conducted in March 2010 and had a sample size of 246 women which was randomly selected from the estimated target population of 12,077. The researchers applied both quantitative and qualitative approaches. The tests of significance employed included Fisher’s exact test, chi-square, test and logistic regression. The study established that the proportion of women attended to by the skilled attendant within various age cohorts was higher (58.9%) amongst the youth/adolescent (15-24 years) (P-value = 0.091> 0.05, c<sup>2</sup> 10.915 df 6).). Skilled attendance declined among the grand-multiparas (para4 and above) from 7.7% in Para 4-5 to 2% in Para 6+ (P-value = .000<0.05, c<sup>2</sup> 34.888 df 3; Para 1(p =0.000, OR 28.391), Para 2-3 (p =0.000, OR 7.564), Para 4-5(p=0.030, OR 3.493) Further findings indicated that the principal decision maker (46.7%) on type of assistant in the last delivery was the woman (P-value = 0.000 <0.05, c<sup>2</sup> 56.076 df 5). However, the husband was the leading (39.5%) decision maker in use of a skilled assistant in the last delivery (p=0.000, OR 15.667). More than two thirds (70.7%) of the respondents who performed a ceremony prayed for safe delivery in their last delivery. The study concluded that women’s parity, decision making and religion were significant in use of skilled childbirth services.</p>
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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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Ekabua, John E., Kufre J. Ekabua, Patience Odusolu, Thomas U. Agan, Christopher U. Iklaki, and Aniekan J. Etokidem. "Awareness of Birth Preparedness and Complication Readiness in Southeastern Nigeria." ISRN Obstetrics and Gynecology 2011 (July 25, 2011): 1–6. http://dx.doi.org/10.5402/2011/560641.
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The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P=0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P=0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P=0.0009 and P=0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ2=0.3255; P=0.5683). Parity was a highly significant predictor (P=0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ2=0.8602; P=0.3536). Access to skilled birth attendance should be promoted.
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Adjiwanou, Vissého, and Thomas LeGrand. "Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis." Social Science & Medicine 86 (June 2013): 26–34. http://dx.doi.org/10.1016/j.socscimed.2013.02.047.
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Tsawe, Mluleki, and A. Sathiya Susuman. "Examining inequality of opportunity in the use of maternal and reproductive health interventions in Sierra Leone." Journal of Public Health 42, no. 2 (March 11, 2019): 254–61. http://dx.doi.org/10.1093/pubmed/fdz023.
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Abstract Background Poor countries, such as Sierra Leone, often have poor health outcomes, whereby the majority of the population cannot access lifesaving health services. Access to, and use of, maternal and reproductive health services is crucial for human development, especially in developing regions. However, inequality remains a persistent problem for many developing countries. Moreover, we have not found empirical studies, which have examined inequalities in maternal and reproductive health in Sierra Leone. Method We used data collected from the Sierra Leone Demographic and Health Surveys (DHS) conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for this study, including four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception. To measure inequalities, we adopted the Human Opportunity Index (HOI). Using this measure, we measured differentials over the two periods, and decomposed it to measure the contribution of the selected circumstance variables to inequality. Results Inequalities declined over time, as shown by the decrease in the dissimilarity index. Due to the drop in the dissimilarity index, the HOI increased for all the selected maternal and reproductive health indicators. Moreover, antenatal services were closer to equality compared to the other selected services. Overall, we found that household wealth status, maternal education and place of residence, are the most important factors contributing to the inequality in the use of maternal and reproductive health services. Conclusions Even though there are improvements in inequalities over time, there are variations in the way in which inequality within the different indicators has improved. In order to improve the use of maternal and reproductive health services, and to reduce inequalities in these services, the government will have to invest in: (i) increasing the educational levels of women, (ii) improving the standard of living, as well as (iii) bringing maternal and reproductive health services closer to rural populations.
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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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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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Fagbamigbe, Adeniyi, Elizabeth Hurricane-Ike, Oyindamola Yusuf, and Erhabor Idemudia. "Trends and drivers of skilled birth attendant use in Nigeria (1990–2013): policy implications for child and maternal health." International Journal of Women's Health Volume 9 (November 2017): 843–53. http://dx.doi.org/10.2147/ijwh.s137848.
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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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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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Nabudere, Harriet, Delius Asiimwe, and Jacinto Amandua. "IMPROVING ACCESS TO SKILLED ATTENDANCE AT DELIVERY: A POLICY BRIEF FOR UGANDA." International Journal of Technology Assessment in Health Care 29, no. 2 (March 20, 2013): 207–11. http://dx.doi.org/10.1017/s0266462313000081.
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Objective: This study describes the process of production, findings for a policy brief on Increasing Access to Skilled Birth Attendance, and subsequent use of the report by policy makers and others from the health sector in Uganda.Methods: The methods used to prepare the policy brief use the SUPPORT Tools for evidence-informed health policy making. The problem that this evidence brief addresses was identified through an explicit priority setting process involving policy makers and other stakeholders, further clarification with key informant interviews of relevant policy makers, and review of relevant documents. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options, and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved.Results: The proportion of pregnant women delivering from public and private non-profit facilities was low at 34 percent in 2008/09. The three policy options discussed in the report could be adopted independently or complementary to the other to increase access to skilled care. The Ministry of Health in deliberating to provide intrapartum care at first level health facilities from the second level of care, requested for research evidence to support these decisions. Maternal waiting shelters and working with the private-for-profit sector to facilitate deliveries in health facilities are promising complementary interventions that have been piloted in both the public and private health sector. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article.Conclusions: The policy brief report was used as a background document for two stakeholder dialogue meetings involving members of parliament, policy makers, health managers, researchers, civil society, professional organizations, and the media.
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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.