Examining Individual- and Community-Level Factors Affecting Skilled Delivery Care among Women Who Received Adequate Antenatal Care in Ethiopia: Using Multilevel Analysis

Introduction. Maternal mortality continues to be a major public health and development challenge in Africa even after the permissible commitment of the international community. Although the use of skilled delivery care is the key intervention and is effective to lower maternal mortality rates, it is still at a lower proportion. The study is aimed at investigating the individual- and community level factors affecting the use of skilled delivery care among those women who had received adequate antenatal care. Materials and Methods. Data were extracted from the 2016 Ethiopian Demographic and Health Survey on women aged 15-49 years and gave birth within five years prior to the survey ( N = 957 ). Multilevel logistic regression model with two levels were fitted to assess the influence of the individual- and community-level factors on the use of skilled delivery care. Results. Women who were exposed to media were more likely to use skilled delivery care ( OR = 1.81 ; 95% CI: 1.20-2.74). Having six or more birth order ( OR = 0.33 ; 95% CI: 0.16-0.69) and residing in rural areas ( OR = 0.40 ; 95% CI: 0.21-0.79) were associated with less likelihood use of skilled delivery care. Attaining primary and secondary educational level, being older women, being from the richest household, and having a urine test during antenatal visits were significantly associated with the use of skilled delivery care. The value of intraclass correlation coefficient supported a significant community-level effect on the likelihood of using skilled delivery care. Conclusions. Factors operating both at the individual level and community level were found significantly associated with the use of skilled delivery care in Ethiopia. A considerable variation at community level accounts for the difference in the use of skilled delivery level.

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Individual and community level predictors of maternal timely postnatal care services utilization in Ethiopia: A multilevel-mixed effects analysis

10.21203/rs.2.17670/v1 ◽

2019 ◽

Author(s):

Afework Tadele ◽

Masrie Getinet

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Health Facility ◽

Postnatal Care ◽

Addis Ababa ◽

National Level ◽

Mixed Effects ◽

Community Level ◽

Community Based ◽

Individual Level

Abstract Introduction: Early identification and management of postpartum complications through timely visit for postnatal care is one of the key interventions in reducing maternal mortality. A community-based national level representative dataset was necessary to inform decision makers in achieving the sustainable development goal (SDG) target of reducing maternal mortality by 70%. This study aims to determine the individual and community level predictors of timely utilization of maternal postnatal care service in Ethiopia. Methods: A community based nationally representative survey of Ethiopian Demographic and Health Survey (EDHS) in 2016 was utilized. A total of 3,948 women aged 15-49 giving birth in the two years before the survey were included. A two-level mixed-effects logistic regression analysis was employed. Result: Among women aged 15-49 years giving birth in the 2 years before the survey, 17% had a postnatal check during the first 2 days after birth in Ethiopia. Institutional delivery AOR 2.14 [95% C.I 1.70, 2.0] and giving birth by caesarean section AOR 1.66 [95% CI 1.10, 2.50] were found to be an individual level determinants, whereas administrative regions(Oromia 69%, Somali 56%, Benishangul 55%, SNNPR 43%, Gambela 66%, Afar 50% and Dire Dawa 55% which less likely to utilize postnatal care utilization as compared to Addis Ababa city administrative area), Higher community level wealth AOR 1.44 [95% C.I 1.08, 1.2], antenatal care coverage AOR 1.52 [95% C.I 1.19, 1.96] and perceived distance of the health facility as a big problem AOR 0.78[95% C.I 0.60, 0.99] were the community level predictors of timely utilization of post-natal care in Ethiopia. Conclusion: Less than one in five women utilized postnatal care in the first 2 days after birth in Ethiopia. Individual level factors (being gave birth at health facility and caesarean delivery) and community level factors (administrative regions, community level wealth, antenatal care and perception of distance to health facility as a big problem) were found to be significant predictors. Keywords: Postnatal care; multilevel; DHS; Ethiopia

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Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4317 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Tabeta Seeiso ◽

Mamutle M. Todd-Maja

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Geographic Location ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Danger Signs ◽

In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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Feminisation of Multidimensional Poverty in Rural Odisha

Rupkatha Journal on Interdisciplinary Studies in Humanities ◽

10.21659/rupkatha.v12n5.rioc1s12n2 ◽

2020 ◽

Author(s):

Surya Narayan Biswal ◽

◽

S. K. Mishra ◽

M. K. Sarangi ◽

◽

...

Keyword(s):

Rural Areas ◽

Social Groups ◽

Multidimensional Poverty ◽

Cumulative Distribution ◽

Policy Framework ◽

Living Standard ◽

Individual Level ◽

Multidimensional Poverty Index ◽

Order Stochastic Dominance ◽

The Individual

UNDP’s 2030 agenda of Sustainable Development Goals (SDGs) emphasized gender equality in augmenting human capital and alleviating poverty. For eradication of extreme poverty and building resilience for persons who are vulnerable to poverty, SDGs calls for a pro-poor and gender-sensitive policy framework. In this context, a gender-based study on multi-dimensional aspects of poverty is highly significant. Extant literature reveals that females are more deprived in different dimensions of poverty such as education, health, living standard, empowerment, environment, autonomy and social relationship. The present study is conducted with the basic objective of examining feminization of poverty in rural areas of Jagatsinghapur district of Odisha. Seven socio-economic dimensions comprising sixteen indicators have been taken into consideration to construct the Multidimensional Poverty Index (MPI) using the Alkire-Foster (AF) Method at the individual level. The novelty of the study lies in analyzing MPI at the individual level for rural Odisha. Higher female deprivation is observed across social groups and all occupation categories except services. Dummy variable regression analysis also supports the major findings of the study. Complementary Cumulative Distribution Function satisfies strict first-order stochastic dominance condition and substantiates the feminisation of poverty at each level of poverty cut-off across all social groups and occupational categories except for services. The findings of the study have significant implications for developing suitable policies for gender equalization and poverty alleviation.

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Interactive effects between travel behaviour and COVID-19: a questionnaire study

Transportation Safety and Environment ◽

10.1093/tse/tdab003 ◽

2021 ◽

Author(s):

Jinbao Zhang ◽

Jaeyoung Lee

Keyword(s):

Early Stage ◽

Travel Behaviour ◽

Interactive Effects ◽

Factors Affecting ◽

Individual Level ◽

Passenger Volume ◽

Spatial Autoregressive ◽

Railway Passenger ◽

The Individual ◽

And Control

Abstract This study has two main objectives: (i) to analyse the effect of travel characteristics on the spreading of disease, and (ii) to determine the effect of COVID-19 on travel behaviour at the individual level. First, the study analyses the effect of passenger volume and the proportions of different modes of travel on the spread of COVID-19 in the early stage. The developed spatial autoregressive model shows that total passenger volume and proportions of air and railway passenger volumes are positively associated with the cumulative confirmed cases. Second, a questionnaire is analysed to determine changes in travel behaviour after COVID-19. The results indicate that the number of total trips considerably decreased. Public transport usage decreased by 20.5%, while private car usage increased by 6.4%. Then the factors affecting the changes in travel behaviour are analysed by logit models. The findings reveal significant factors, including gender, occupation and travel restriction. It is expected that the findings from this study would be helpful for management and control of traffic during a pandemic.

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Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

BMC Public Health ◽

10.1186/s12889-020-10071-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tsegaye Gebremedhin ◽

Demiss Mulatu Geberu ◽

Asmamaw Atnafu

Keyword(s):

Health Survey ◽

Exclusive Breastfeeding ◽

Household Wealth ◽

Community Level ◽

Wealth Status ◽

Individual Level ◽

Factors Associated ◽

Breastfeeding Practices ◽

The Individual ◽

Low Coverage

Abstract Background The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. Methods In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. Results Overall, 17.6% (95% CI: 15.6–19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21–0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16–0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21–4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16–0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44–4.82) was the community-level factors associated with the exclusive breastfeeding practices. Conclusions Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother’s employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

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Determinants of utilization of antenatal and delivery care at the community level in rural Bangladesh

PLoS ONE ◽

10.1371/journal.pone.0257782 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257782

Author(s):

Jesmin Pervin ◽

Mahima Venkateswaran ◽

U. Tin Nu ◽

Monjur Rahman ◽

Brian F. O’Donnell ◽

...

Keyword(s):

Logistic Regression ◽

Antenatal Care ◽

Pregnant Women ◽

Facility Delivery ◽

Health Facilities ◽

Community Level ◽

Delivery Care ◽

Multivariate Logistic Regression ◽

Antenatal Care Visit ◽

Care Visit

Background Timely utilization of antenatal care and delivery services supports the health of mothers and babies. Few studies exist on the utilization and determinants of timely ANC and use of different types of health facilities at the community level in Bangladesh. This study aims to assess the utilization, timeliness of, and socio-demographic determinants of antenatal and delivery care services in two sub-districts in Bangladesh. Methods This cross-sectional study used data collected through a structured questionnaire in the eRegMat cluster-randomized controlled trial, which enrolled pregnant women between October 2018-June 2020. We undertook univariate and multivariate logistic regression analysis to determine the associations of socio-demographic variables with timely first ANC, four timely ANC visits, and facility delivery. We considered the associations in the multivariate logistic regression as statistically significant if the p-value was found to be <0.05. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results Data were available on 3293 pregnant women. Attendance at a timely first antenatal care visit was 59%. Uptake of four timely antenatal care visits was 4.2%. About three-fourths of the women delivered in a health facility. Women from all socio-economic groups gradually shifted from using public health facilities to private hospitals as the pregnancy advanced. Timely first antenatal care visit was associated with: women over 30 years of age (AOR: 1.52, 95% CI: 1.05–2.19); nulliparity (AOR: 1.30, 95% CI: 1.04–1.62); husbands with >10 years of education (AOR: 1.40, 95% CI: 1.09–1.81) and being in the highest wealth quintile (AOR: 1.49, 95% CI: 1.18–1.89). Facility deliveries were associated with woman’s age; parity; education; the husband’s education, and wealth index. None of the available socio-demographic factors were associated with four timely antenatal care visits. Conclusions The study observed socio-demographic inequalities associated with increased utilization of timely first antenatal care visit and facility delivery. The pregnant women, irrespective of wealth shifted from public to private facilities for their antenatal care visits and delivery. To increase the health service utilization and promote good health, maternal health care programs should pay particular attention to young, multiparous women, of low socio-economic status, or with poorly educated husbands. Clinical trial registration ISRCTN69491836; https://www.isrctn.com/. Registered on December 06, 2018. Retrospectively registered.

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Sickness absence among privately employed white-collar workers: A total population study in Sweden

Scandinavian Journal of Public Health ◽

10.1177/1403494820934275 ◽

2020 ◽

pp. 140349482093427

Author(s):

Kristin Farrants ◽

Kristina Alexanderson

Keyword(s):

Sickness Absence ◽

Rural Areas ◽

White Collar ◽

Sociodemographic Factors ◽

Population Based ◽

Small Towns ◽

Older Individuals ◽

Individual Level ◽

White Collar Workers ◽

The Individual

Background: Knowledge about sickness absence (SA) and disability pension (DP) among privately employed white-collar workers is very limited. Aims: This study aimed to explore SA and DP among privately employed white-collar women and men using different measures of SA to investigate differences by branch of industry, and to analyse the association between sociodemographic factors and SA. Methods: This was a population-based study of all 1,283,516 (47% women) privately employed white-collar workers in Sweden in 2012, using register data linked at the individual level. Several different measures of SA and DP were used. Logistic regression was used to investigate associations of sociodemographic factors with SA. Results: More women than men had SA (10.9% women vs. 4.5% men) and DP (1.8% women vs. 0.6% men). While women had a higher risk of SA than men and had more SA days per employed person, they did not have more SA days per person with SA than men. The risk of SA was higher for women (odds ratio (OR)=2.54 (95% confidence interval (CI) 2.51–2.58)), older individuals (OR age 18–24 years=0.58 (95% CI 0.56–0.60); age 55–64 years OR=1.43 (95% CI 1.40–1.46) compared to age 45–54 years), living in medium-sized towns (OR=1.05 (95% CI 1.03–1.06)) or small towns/rural areas (OR=1.13 (95% CI 1.11–1.15)), with shorter education than college/university (OR compulsory only=1.64 (95% CI 1.59–1.69); OR high school=1.38 (95% CI 1.36–1.40)), born outside the EU25 (OR=1.23 (95% CI 1.20–1.27)) and singles with children at home (OR=1.33 (95% CI 1.30–1.36)). Conclusions: SA and DP among privately employed white-collar workers were lower than in the general population. SA prevalence, length and risk varied by branch of industry, sex and other sociodemographic factors, however, depending on the SA measure used.

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Individual-level and community-level factors associated with the family planning use among pastoralist community of Ethiopia: a community-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-036519 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036519 ◽

Cited By ~ 1

Author(s):

Mussie Alemayehu ◽

Araya Abrha Medhanyie ◽

Elizabeth Reed ◽

Afework Mulugeta

Keyword(s):

Family Planning ◽

Cross Sectional Study ◽

Married Women ◽

Community Level ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Individual Level ◽

Pastoralist Community ◽

The Individual

ObjectiveThe study aimed to identify the effects of the individual-level and community-level factors on the use of family planning (FP) among married women in the pastoralist community of Ethiopia.DesignA community-based cross-sectional study was conducted in September 2018. Data were analysed using R software. To determine the fixed effect of individual-level and community-level factors of FP use, a two-level mixed-effects logistic regression was used. The result was described using the Adjusted OR (AOR), and the variance partition coefficient.Setting and participantsAfar, Ethiopia (2018; n=891) married women of reproductive age (15–49) years.Primary outcome measuresFP use or non-use.ResultsThe current use of FP was 18.7% (16.31%–21.43%). Women who need to walk 1 hour and more to the nearest health facility (AOR 0.14, 95% CI 0.05 to 0.3), have ANC visit of 4 and above (AOR 6.02, 95% CI 1.74 to 20.8), had their last birth at a health facility (AOR 2.71 95% CI 1.27 to 5.81), have five and more children (AOR 4.71, 95% CI 1.86 to 11.9), have high knowledge on FP (AOR 2.74, 95% CI 1.11 to 6.74) and had high intentions to use FP (AOR 10.3, 95% CI 3.85 to 27.6) were more likely to report FP use. The magnitude of the effect of for FP use was smaller than that of 9 of the 13 individual factors. Apart from this 19.4% of the total variance in the odds of using FP attributed to between community difference (intraclass correlation coefficient=0.194). Regarding the community-level characteristics, clusters of having higher electronic media possession (AOR 2.84, 95% CI 1.2 to 6.72) and higher women decision making on FP (AOR 8.35, 95% CI 2.7 to 27.1) were significantly associated with increased FP use compared with clusters with lower reports of these aspects.ConclusionFP use among the pastoralist community is influenced by both individual cluster/community-level characteristics or factors. Even though the effect of clustering in FP use was large in comparison with the unexplained between-cluster variation, it was lower than the individual-level factors.Trail registrtion numberNCT03450564

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Factors Affecting the Utilization of a Minimum of Four Antenatal Care Services in Ethiopia

Obstetrics and Gynecology International ◽

10.1155/2019/5036783 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Garoma Wakjira Basha

Keyword(s):

Antenatal Care ◽

Rural Areas ◽

Wealth Index ◽

Complete Information ◽

Healthcare Services ◽

Household Wealth ◽

Routine Care ◽

Factors Affecting ◽

Poor Households ◽

Nationally Representative

Background. Antenatal care is defined as the routine care of pregnant women provided between conception and the onset of labor. This study is aimed to identify factors affecting the utilization of antenatal care (ANC) services in Ethiopia. Methods. The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 7,167 mothers who gave birth within five years preceding the 2016 EDHS whose complete information was available in the survey were included in this study. Logistic regression statistical analyses were used to identify factors associated with the utilization of a minimum of 4 ANC services in Ethiopia. Results. Among the 7,167 women included in this study, 2,598 (36.6%) had utilized a minimum of 4 ANC services in Ethiopia. This study showed that factors such as place of residence, region, mothers’ education level, household wealth index, desire for pregnancy, frequency of reading newspaper, frequency of listening to radio, and frequency of watching TV were associated with the utilization of a minimum of four ANC services at 5% level of significance in Ethiopia. Conclusion. Strategies to increase the accessibility and availability of healthcare services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with no education are vital to increase their awareness about the importance of antenatal services.

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Game of hypocrites: Beurs break silence in Faïza Guène’s Kiffe kiffe demain

French Cultural Studies ◽

10.1177/0957155819861039 ◽

2019 ◽

Vol 30 (4) ◽

pp. 335-346

Author(s):

Nour Seblini

Keyword(s):

Community Level ◽

Immigrant Community ◽

Individual Level ◽

French Culture ◽

Cultural Crisis ◽

Younger Generation ◽

The Individual

This article analyses the cultural crisis of beur youth by calling attention, in Faïza Guène’s novel, Kiffe kiffe demain (2004), to how Maghrebi immigrants as well as the French state attempt to manipulate young bodies and minds. The struggle that underlies the narrative is an exploitation of Islam within France’s Moroccan immigrant community to preserve honneur at the immigrant community level, while enjoying bonheur at the individual level. As religion is used to subjugate the younger generation, Islam loses credibility in the eyes of beurs. I also seek to explore how la laïcité of French culture marginalises individuals who do not accept assimilation into a superior racist system that is based on an exclusionary notion of citizenship. Who falls victim in the end? It is the young beur, who cannot tolerate the extremism of either French Orientalist views or their parents’ Occidentalist views.

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