Using multi‐country household surveys to understand who provides reproductive and maternal health services in low‐ and middle‐income countries: a critical appraisal of the Demographic and Health Surveys

Background: Cost is a major barrier to maternal health service utilisation for many women in low- and middle-income countries (LMICs). However, comparable evidence of the available cost data in these countries is limited. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings. Methods: We searched peer-reviewed and grey literature databases for articles reporting cost of utilising maternal health services in LMICs published post-2000. All retrieved records were screened and articles meeting the inclusion criteria selected. Quality assessment was performed using the relevant cost-specific criteria of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. To guarantee comparability, disaggregated costs data were inflated to 2019 US dollar equivalents. Total adjusted costs and cost drivers associated with utilising each service were systematically compared. Where heterogeneity in methods or non-disaggregated costs was observed, narrative synthesis was used to summarise findings. Results: Thirty-six studies met our inclusion criteria. Many of the studies costed multiple services. However, the most frequently costed services were utilisation of normal vaginal delivery (22 studies), caesarean delivery (13), and antenatal care (ANC) (10). The least costed services were post-natal care (PNC) and post-abortion care (PAC) (5 each). Studies used varied methods for data collection and analysis and their quality ranged from low to high with most assessed as average or high. Generally, across all included studies, cost of utilisation progressively increased from ANC and PNC to delivery and PAC, and from public to private providers. Medicines and diagnostics were main cost drivers for ANC and PNC while cost drivers were variable for delivery. Women experienced financial burden of utilising maternal health services and also had to pay some unofficial costs to access care, even where formal exemptions existed. Conclusion: Consensus regarding approach for costing maternal health services will help to improve their relevance for supporting policy-making towards achieving universal health coverage. If indeed the post-2015 mission of the global community is to "leave no one behind," then we need to ensure that women and their families are not facing unnecessary and unaffordable costs that could potentially tip them into poverty.

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A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries

Health Systems & Reform ◽

10.1080/23288604.2018.1440344 ◽

2018 ◽

Vol 4 (2) ◽

pp. 77-92

Author(s):

Jenna Wright ◽

Rena Eichler

Keyword(s):

Maternal Health ◽

Health Services ◽

Quality Measurement ◽

Maternal Health Services ◽

Middle Income ◽

Middle Income Countries ◽

Provider Payment ◽

Low And Middle Income

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Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2018-027822 ◽

2019 ◽

Vol 9 (8) ◽

pp. e027822 ◽

Cited By ~ 1

Author(s):

Aduragbemi Banke-Thomas ◽

Ibukun-Oluwa Omolade Abejirinde ◽

Oluwasola Banke-Thomas ◽

Adamu Maikano ◽

Charles Anawo Ameh

Keyword(s):

Systematic Review ◽

Maternal Health ◽

Health Service ◽

Health Services ◽

Maternal Health Services ◽

Maternal Health Service ◽

Economic Evaluations ◽

Middle Income ◽

Health Service Provision ◽

Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

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A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: Evidence from Demographic and Health Surveys (DHS)

Social Science & Medicine ◽

10.1016/j.socscimed.2006.11.004 ◽

2007 ◽

Vol 64 (6) ◽

pp. 1311-1325 ◽

Cited By ~ 99

Author(s):

Monica Akinyi Magadi ◽

Alfred O. Agwanda ◽

Francis O. Obare

Keyword(s):

Comparative Analysis ◽

Maternal Health ◽

Health Services ◽

Health Surveys ◽

Maternal Health Services ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Older Mothers ◽

Sub Saharan

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Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

F1000Research ◽

10.12688/f1000research.25700.2 ◽

2020 ◽

Vol 9 ◽

pp. 1061

Author(s):

Sathirakorn Pongpanich ◽

Abdul Ghaffar ◽

Najma Ghaffar ◽

Hafiz Abdul Majid

Keyword(s):

Maternal Health ◽

Health Services ◽

Postnatal Care ◽

Health Surveys ◽

Newborn Care ◽

Wealth Index ◽

Maternal Health Services ◽

Care Utilization ◽

Demographic And Health Surveys ◽

Cross Sectional

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

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Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010–2017)

International Health ◽

10.1093/inthealth/ihz113 ◽

2019 ◽

Vol 12 (5) ◽

pp. 388-394

Author(s):

Emmanuel O Adewuyi ◽

Asa Auta

Keyword(s):

Health Surveys ◽

Meta Analysis ◽

Healthcare Services ◽

Demographic And Health Surveys ◽

Injection Equipment ◽

Middle Income ◽

Middle Income Countries ◽

Unsafe Injection ◽

Injection Practices ◽

Low And Middle Income

Abstract Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. Results The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3–35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. Conclusions Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.

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