Examining inequality of opportunity in the use of maternal and reproductive health interventions in Sierra Leone

2019 ◽  
Vol 42 (2) ◽  
pp. 254-261 ◽  
Author(s):  
Mluleki Tsawe ◽  
A Sathiya Susuman
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Sierra Leone ◽  
Health Indicators ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Reproductive Health Services ◽  
Dissimilarity Index ◽  
Over Time

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.

scholarly journals Perceptions of Decision-making in Accessing Reproductive Healthcare Services of Urban Women

2019 ◽  
Vol 14 (1) ◽  
pp. 15-20
Author(s):  
Md Mahbubur Rahman ◽  
Taniza Tabassum ◽  
Md Shafiqur Rahman ◽  
Abu Noman Mohammed Mosleh Uddin ◽  
Mushtaq Ahmad ◽  
...  
Keyword(s):  
Decision Making ◽  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Family Size ◽  
Urban Women ◽  
Healthcare Services ◽  
Reproductive Health Services ◽  
The Family ◽  
Reproductive Healthcare

Introduction:  Women’s healthcare during the reproductive period of life, especially decisions involving her own health is generally one of the least concerns to the common people. Women’s autonomy in decision-making within the family is fairly debatable and determines the health service seeking behaviour. Objective: To find out the perceptions about key persons involved in decision-making for accessing reproductive healthcare services as well as factors that influence those decisions among urban women of Bangladesh. Materials and Methods: The study was conducted by key informant interviewing (KII) of 72 respondents about their perceptions of decision-making in women’s reproductive health services in Dhaka South City Corporation during the period of January 2019 to April 2019. Health professionals of various levels, administrators, family heads were selected as key informants by purposive sampling method. An open-ended semi-structured questionnaire was used for data collection. Result: Among the key informants, more than half were doctors (58.3%). The majority of the respondents were female (72%) and having educational qualification up to graduate level (40.3%). Majority of the informants (73.9%) mentioned ‘both parents’ as key persons in under 18 marriage of their daughters; 57.1% of respondents opined that ‘Factors like social environment, social status, uncertainty to find better groom, dowry etc.’ influences in decision-making. All of the respondents felt antenatal care ‘essential’ and about half of them (50.0%) mentioned the importance of complication detection and treatment during pregnancy. According to the respondents, ‘mother-in-law’ is the key person in women’s decision-making regarding antenatal care (65.3%) and ‘husband’ is the key person regarding selection of the place of delivery and postnatal care (79.2%, 72.2%) respectively. Half of the respondents (50%) expressed the family size determination in an urban area is done mutually by ‘both partners’ while the role of the ‘husband’ is still perceived important (41.7%). Majority expressed that economic condition of the family (63.9%) have an influence in determining family size by the respondents. According to more than half of the respondents (52.8%), both partners take part in decision-making regarding family planning. Conclusion: Although the educated employed women enjoy some degree of autonomy in urban areas of Bangladesh, the decision-making in accessing woman’s reproductive healthcare services is directed by the husband. Involvement of both partners in decision-making is essential for better utilization of reproductive health services. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 15-20

scholarly journals Integration of HIV and reproductive health services in public sector facilities: analysis of client flow data over time in Kenya

2018 ◽  
Vol 3 (5) ◽  
pp. e000867
Author(s):  
Isolde J Birdthistle ◽  
Justin Fenty ◽  
Martine Collumbien ◽  
Charlotte Warren ◽  
James Kimani ◽  
...  
Keyword(s):  
Public Sector ◽  
Reproductive Health ◽  
Antenatal Care ◽  
Postnatal Care ◽  
Service Integration ◽  
Flow Data ◽  
Reproductive Health Services ◽  
Hiv Services ◽  
Time Points ◽  
Over Time

IntroductionIntegration of HIV/AIDS with reproductive health (RH) services can increase the uptake and efficiency of services, but gaps in knowledge remain about the practice of integration, particularly how provision can be expanded and performance enhanced. We assessed the extent and nature of service integration in public sector facilities in four districts in Kenya.MethodsBetween 2009 and 2012, client flow assessments were conducted at six time points in 24 government facilities, purposively selected as intervention or comparison sites. A total of 25 539 visits were tracked: 15 270 in districts where 6 of 12 facilities received an intervention to strengthen HIV service integration with family planning (FP); and 10 266 visits in districts where half the facilities received an HIV-postnatal care intervention in 2009–2010. We tracked the proportion of all visits in which: (1) an HIV service (testing, counselling or treatment) was received together with an RH service (FP counselling or provision, antenatal care, or postnatal care); (2) the client received HIV counselling.ResultsLevels of integrated HIV-RH services and HIV counselling were generally low across facilities and time points. An initial boost in integration was observed in most intervention sites, driven by integration of HIV services with FP counselling and provision, and declined after the first follow-up. Integration at most sites was driven by temporary rises in HIV counselling. The most consistent combination of HIV services was with antenatal care; the least common was with postnatal care.ConclusionsThese client flow data demonstrated a short-term boost in integration, after an initial intervention with FP services providing an opportunity to expand integration. Integration was not sustained over time highlighting the need for ongoing support. There are multiple opportunities for integrating service delivery, particularly within antenatal, FP and HIV counselling services, but a need for sustained systems and health worker support over time.Trial registration numberNCT01694862

scholarly journals Do home pregnancy tests bring women to community health workers for antenatal care counselling? A randomized controlled trial in Madagascar

2019 ◽  
Vol 34 (8) ◽  
pp. 566-573
Author(s):  
Alison B Comfort ◽  
Randall C Juras ◽  
Sarah E K Bradley ◽  
Justin Ranjalahy Rasolofomanana ◽  
Anja Noeliarivelo Ranjalahy ◽  
...  
Keyword(s):  
At Risk ◽  
Randomized Controlled Trial ◽  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Workers ◽  
Controlled Trial ◽  
Control Group ◽  
Reproductive Health Services ◽  
Randomized Controlled

Abstract Task-shifting the provision of pregnancy tests to community health workers (CHWs) in low-resource settings has the potential to reach significantly more underserved women at risk of pregnancy with essential reproductive health services. This study assessed whether an intervention to supply CHWs with home pregnancy tests brought more clients for antenatal care (ANC) counselling. We implemented a randomized controlled trial among CHWs providing reproductive health services to women in Eastern Madagascar. We used ordinary least squares regressions to estimate the effect of the intervention, with district- and month-fixed effects and CHW baseline characteristics as control variables. Our outcomes of interest included whether the intervention increased: (1) the number of women at risk of pregnancy who sought services from CHWs; (2) the number of these women who knew they were pregnant by the end of visit; and (3) the number of these women who received ANC counselling during visit. We found that providing pregnancy tests to CHWs to distribute to their clients for free significantly increased the number of women at risk of pregnancy who sought services from CHWs. At follow-up, treatment-group CHWs provided services to 6.3 clients compared with 4.2 clients among control-group CHWs, which represents a 50% relative increase from the control-group mean. A significantly higher number of these clients knew they were pregnant by the end of the visit, with a mean of 0.95 in treatment compared with 0.10 in control (Coeff. 0.86; 95% CI 0.59–1.13). A significantly higher number of these clients received antenatal counselling at the visit (Coeff. 0.4; 95% CI 0.14–0.64). Introducing free home pregnancy tests as part of community-based health services can improve pregnancy care by attracting more clients at risk of pregnancy to services at the community level, enabling more women to confirm they are pregnant and receive antenatal counselling.

scholarly journals Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

2020 ◽  
Author(s):  
Oluwasegun Jko Ogundele ◽  
Milena Pavlova ◽  
Wim Groot
Keyword(s):  
Cluster Analysis ◽  
Family Planning ◽  
Maternal Health ◽  
Reproductive Health ◽  
Health Services ◽  
Multinomial Logistic Regression ◽  
Maternal Health Services ◽  
Household Wealth ◽  
Reproductive Health Services ◽  
Poor Access

Abstract Background To understand differences in access to reproductive healthcare services, the use of family planning and maternal care by women in Ghana and Nigeria is examined.Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 in two-step cluster analysis followed by multinomial logistic regression analysis.Results The initial two-step cluster analyses on family planning identify three groups of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses identify five distinct groups: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. The multinomial logistic regression shows that education and occupation are associated with access to family planning and maternal health services. Women without education often have poor access to reproductive health services in both countries. In Nigeria, household wealth is strongly associated with access to maternal health services but household wealth does not explain access in Ghana. Not having insurance in Ghana is associated with low access to family planning service, while this is not the case in Nigeria.Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socioeconomic status.

scholarly journals Uterovaginal prolapse: the sociodemographic profile and reproductive health service uptake in a low resource setting, Calabar, Nigeria

2020 ◽  
Vol 9 (4) ◽  
pp. 1610
Author(s):  
Njoku Charles Obinna ◽  
Njoku A. N. ◽  
Efiok E. E. ◽  
Eyong E. M.
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Genital Prolapse ◽  
Uterovaginal Prolapse ◽  
Reproductive Health Services ◽  
Skilled Attendant ◽  
Duration Of Symptoms ◽  
Low Resource ◽  
The Mean

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. 

scholarly journals Not all inequalities are equal: differences in coverage across the continuum of reproductive health services

2019 ◽  
Vol 4 (5) ◽  
pp. e001695 ◽  
Author(s):  
Elizabeth A Sully ◽  
Ann Biddlecom ◽  
Jacqueline E Darroch
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Household Wealth ◽  
Health Interventions ◽  
Reproductive Age ◽  
Health Coverage ◽  
Reproductive Health Services ◽  
Geographical Regions ◽  
Service Coverage ◽  
Measures Of Inequality

Reducing inequalities in health service coverage is central to achieving the larger goal of universal health coverage. Reproductive health services are part of evidence-based health interventions that comprise a minimum set of essential health interventions that all countries should be able to provide. This paper shows patterns in inequalities in three essential reproductive health services that span a continuum of care—contraceptive use, antenatal care during pregnancy and delivery at a health facility. We highlight coverage gaps and their impacts across geographical regions, key population subgroups and measures of inequality. We focus on reproductive age women (15–49 years) in 10 geographical regions in Africa, Asia and Latin America and the Caribbean. We examine inequalities by age (15–19, 20–24, 25–34 and 35–49 years), household wealth quintile, residence (rural or urban) and parity. Data on service coverage and the population in need are from 84 nationally representative surveys. Our results show that dominant inequalities in contraceptive coverage are varied, and include large disparities and impact by age group, compared with maternal health services, where inequalities are largest by economic status and urban–rural residence. Using multiple measures of inequality (relative, absolute and population impact) not only helps to show if there are consistent patterns in inequalities but also whether few or many different approaches are needed to reduce these inequalities and where resources could be prioritised to reach the largest number of people in need.

scholarly journals Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

2019 ◽  
Author(s):  
Oluwasegun Jko Ogundele ◽  
Milena Pavlova ◽  
Wim Groot
Keyword(s):  
Cluster Analysis ◽  
Family Planning ◽  
Maternal Health ◽  
Reproductive Health ◽  
Health Services ◽  
Multinomial Logistic Regression ◽  
Maternal Health Services ◽  
Household Wealth ◽  
Reproductive Health Services ◽  
Poor Access

Abstract Background To understand differences in access to reproductive healthcare services, the use of family planning and maternal care by women in Ghana and Nigeria is examined.Methods We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 in two-step cluster analysis followed by multinomial logistic regression analysis.Results The initial two-step cluster analyses on family planning identify three groups of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses identify five distinct groups: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. The multinomial logistic regression shows that education and occupation are associated with access to family planning and maternal health services. Women without education often have poor access to reproductive health services in both countries. In Nigeria, household wealth is strongly associated with access to maternal health services but household wealth does not explain access in Ghana. Not having insurance in Ghana is associated with low access to family planning service, while this is not the case in Nigeria.Conclusions These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socioeconomic status.

scholarly journals Uterovaginal Prolapse: The Sociodemographic profile and reproductive health service uptake in A Low Resource Setting, Calabar, Nigeria

2020 ◽  
Vol 6 (1) ◽  
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Genital Prolapse ◽  
Uterovaginal Prolapse ◽  
Reproductive Health Services ◽  
Skilled Attendant ◽  
Duration Of Symptoms ◽  
Resource Setting ◽  
The Mean

Objective: 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. Conclusion: There is poor utilization of reproductive health services among women who develop uterovaginal prolapse in our 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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