scholarly journals Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Multivariate Regression Analysis ◽  
Maternal Health Services ◽  
Wealth Status ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
The Government ◽  
Trained Health Professional

Abstract Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi. Methods We use data from the 2016–2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth. Results Occupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. Conclusions In Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.

scholarly journals Empirical Analysis of Socio-Economic Determinants of Maternal Health Services Utilisation in Burundi

2021 ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Maternal Health Services ◽  
Long Distance ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
Point Of Use ◽  
Education Levels ◽  
Trained Health Professional

Abstract BackgroundTimely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.MethodsWe use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth. ResultsOccupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. ConclusionsIn Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

scholarly journals Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

2020 ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Maternal Health Services ◽  
Long Distance ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
Point Of Use ◽  
Education Levels ◽  
Trained Health Professional

Abstract Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods We use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth.Results Occupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions In Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

scholarly journals Maternal health services utilization among mothers in a rural municipality

2021 ◽  
Vol 8 (1) ◽  
pp. 121-131
Author(s):  
Nirmala Ghimire ◽  
Roshani Agrawal Khatry ◽  
Vivechana Shakya
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Rural Municipality ◽  
Good Utilization ◽  
The Government

Introduction: Maternal health is essential to ensure the good health of the mother as well as children and by extension, the whole family. Despite the various measures launched by the government to enhance maternal care services, the utilization remains at large. Method: A community-based face to face interview was conducted using a pre-tested structured survey questionnaire to find out maternal health service utilization among mothers in Mahankal Rural Municipality, Lalitpur, Nepal, during Feb-Jun 2020. A probability simple random sampling was used to select mothers having children aged between 1 to 3 y. A score of  ≥mean was considered good utilization and below it a poor utilization. The study was approved by the ethical committee. The SPSS 16 was used for descriptive (frequency, mean) and comparative analysis by chi square between demographics and health service utilization. Result: There were a total of 178 mothers surveyed, the mean age of 25.9±4.4 y, 77(43.3%) had completed elementary school, and 147(82.6%) were farmers. Good utilization of maternal health service 98(55%) and poor utilization 80(45%). The majority 153(86%) had ≥4 Antenatal checkups, 55(30.9%) had delivered at home despite the government incentive for institutional delivery, 105(59%) had postnatal visits ≥1, and 18(10%) had 3 postnatal visits.   Conclusion: The study revealed that slightly more than half (55%) of mothers surveyed had good utilization of maternal health services.

scholarly journals Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001–2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vishnu Prasad Sapkota ◽  
Umesh Prasad Bhusal ◽  
Kiran Acharya
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Concentration Index ◽  
Institutional Delivery ◽  
National Level ◽  
Wealth Index ◽  
Maternal Health Services ◽  
Demographic And Health Surveys ◽  
Cesarean Section Delivery ◽  
The Government

Abstract Background Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services. Methods The study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis. Results The study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016. Conclusion Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.

scholarly journals Conceptualizing "access" of maternal health services in lower-middle-income countries

2020 ◽  
Vol 11 (1) ◽  
pp. 108-111
Author(s):  
Bismah Jameel ◽  
Aeda Bhagaloo ◽  
Khadija Rashid ◽  
Umair Majid
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Health Services ◽  
Political Factors ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Middle Income Countries ◽  
Health System Improvement ◽  
Barriers To Access ◽  
System Improvement

A considerable number of women die each year worldwide due to preventable causes during pregnancy and childbirth. The high mortality of women who die from pregnancy-related issues can be attributed to inadequate access of high-quality maternal health services. However, access is a nebulous concept with a compendium of conceptualizations and definitions. In this paper, we discuss the various conceptualizations of access to maternal health services in lower middle-income countries, and compare how issues related to access differ between high- and lower middle-income countries. This discussion informs two priorities that we suggest for researchers conducting health system improvement work in lower middle-income countries: 1) develop a robust understanding of the barriers to access that continue to persist due to cultural, socioeconomic, and political factors, and 2) formulate frameworks and theories specific to lower middle-income countries to guide research.

scholarly journals Clients’ Perspectives on Quality of Delivery Services in a Rural Setting in Tanzania: Findings from a Qualitative Action-Oriented Research

2017 ◽  
Vol 6 (1) ◽  
pp. 60 ◽  
Author(s):  
Gerald J. Makuka, MD ◽  
Moses M. Sango, MD ◽  
Ayubu E. Mashambo, MD ◽  
Abednego E. Mashambo, MD ◽  
Sia E Msuya, MD, PhD ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Health Services ◽  
Rural Setting ◽  
Health Staff ◽  
Creative Commons ◽  
Quality Of Delivery ◽  
The Government ◽  
Oriented Research

Objective: To know and understand the perspectives of women on the quality of maternal health services provided at their health facility (HF) and to incite community self-propelled problem identification and way forward.Methods: A qualitative action- oriented research was conducted in a rural setting in Tanzania from 2011 to 2014. Twenty In-Depth Interviews (IDIs) and two Focus Group Discussions were held. The IDIs were conducted with mothers who had attended antenatal care at the HF and delivered there. The recordings transformed into English texts were used for analysis to get themes and possible explanations that were compared and reflected.Results: More than half 60% of the respondents reported to have experienced abuse by the health staff, 80% reported lack of amenities and all agreed to unavailability of health services at odd hours or weekends.Conclusion and Global Health Implications: This study reveals that the quality of maternal health services provided at the HF is not up to standard. The study demonstrates the importance of self-diagnosis in a community and to propel self-community interventions towards improving rural health services. The government, researchers and other stakeholders have key roles in the elimination of health disparities and unhealthy political mingling in health care.Key words: Quality • Maternal Health • Qualitative • Action-Oriented Research • Rural Setting • TanzaniaCopyright © 2017 Makuka 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 originalwork is properly cited.

scholarly journals Reproductive and Maternal Health Challenges of Pregnant Women in Ethiopia: An Anthropological Appraisal

2017 ◽  
Vol 4 (1) ◽  
pp. 32-37
Author(s):  
R. N. Pati
Keyword(s):  
Maternal Health ◽  
Reproductive Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Maternal Health Services ◽  
Health Seeking ◽  
African Countries ◽  
Rural Regions ◽  
The Government

A very Poor attention is given to reproductive health issues of pregnant women in rural regions of African countries. Ethiopia is one of the countries in horn of Africa representing highest maternal mortality rate in the continent. The Government of Ethiopia has reformed health policy and program to promote community involvement in maternal health, promotion of emergency obstetric health care, health seeking behavior for optimal utilization of maternal health services by women during pregnancies. The women living in pastoralist and small land holders’ communities are exposed to high risks of reproductive health hazards. Material delays comprising of delay in making the decision for referral, delay in arriving at hospital and delay in receiving appropriate maternal health services are major contributing factors for growing maternal deaths in Ethiopia. The illiteracy of woman, exposure to frequent pregnancies at adolescent age, poor decision making power of women in patriarchal society, poor employment status of women are main predicators of low utilization of maternal services and high ,maternal death in rural regions of the country. This article is based on synthesis of research projects completed by different authors on multiple dimensions of maternal mortality in Ethiopia. The promotion of referral support service and bridging up the referral gaps would address issues of maternal mortality and growing unsafe abortions among young mothers in rural regions of the country. This paper examines critically different socio – cultural barriers that prevent women living in rural area for accessing appropriate utilization of maternal and health services and infrastructure available. Int. J. Soc. Sc. Manage. Vol. 4, Issue-1: 32-37

scholarly journals Improving maternal health services through social accountability interventions in Nepal:  An analytical review of existing literature

2019 ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Grey Literature ◽  
Maternal Health Services ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background: The persistent equity and quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. The Government of Nepal has emphasized on responsive and accountable maternal health services since 2005, while social accountability interventions have been commenced as a strategical approach. This review is an attempt to critically explore the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute informed policy. Methods: A literature review and desk study were done between December 2018 to May 2019. An adapted framework of social accountability by Lodenstein et al. 2013 was used for critical analysis and synthesis of the existing literature from Nepal and other low- and middle-income countries (LMICs). The literature was searched and extracted from the search engines i.e. google and google scholar using keywords. The searched includes both published and grey literature. Results: The review found different social accountability interventions initiated by the government and external development partners in maternal health services in Nepal. The evidence from Nepal and other LMICs showed that the social accountability interventions improve the quality of maternal health services through improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. The strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions: The evidence show that social accountability interventions have the potential to improve the quality of maternal health services in Nepal. Critical factors of successful outcomes in maternal health services include quality implementation of the interventions. Similarly, continuous effort is needed from policymaker to strengthen monitoring and regulatory mechanism of the health system and decentralization, improve access to the information and establishment of proper channels to capture complaints and feedback from the community to ensure the effectiveness of the interventions for the long run. Furthermore, research is needed to evaluate the impact of the existing social accountability interventions in the reduction of maternal mortality in Nepal.

scholarly journals Psychosocial Influences on Pregnancy and Childbirth Behaviors in Northwestern Nigeria: A Cross-Sectional Analysis

2020 ◽  
Author(s):  
Emily White Johansson ◽  
Udochisom Anaba ◽  
Dele Abegunde ◽  
Mathew Okoh ◽  
Shittu Abdu-Aguye ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Behavior Change ◽  
Self Efficacy ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Cross Sectional ◽  
Pregnancy And Childbirth ◽  
Psychosocial Influences ◽  
And Behavior

Abstract BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in northwestern Nigeria. To increase service use, social and behavior change (SBC) programs target psychosocial influences across cognitive, emotional and social domains including knowledge, beliefs, self-efficacy, and social norms. Yet there remains limited research that measures and quantitatively examines the role of psychosocial influences on pregnancy and childbirth behaviors in Nigeria or elsewhere. MethodsA cross-sectional population-based survey of randomly sampled women with a child under two years was conducted in Kebbi, Sokoto and Zamfara states of northwestern Nigeria in September 2019. Women were asked about maternal health behaviors during their last pregnancy. New psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behavior Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and sociodemographic variables.ResultsAmong 3,039 women, 23.6% (95% CI: 18.0%-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8%-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancies, the most commonly cited reasons were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2- and 2.1-times more likely to attend ANC4+ times. Women who held positive views about health facilities for childbirth had 1.2- and 2.6-times higher likelihood of attending ANC4+ times and facility delivery, while women who believed ANC was only for sickness or pregnancy complications had 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes.ConclusionsTo improve pregnancy and childbirth practices in northwestern Nigeria, programs should address a range of psychosocial factors – across cognitive, emotional and social domains – that were significantly associated with pregnancy and childbirth behaviors: raising knowledge and dispelling myths, building women’s confidence to access services, engaging spousal support in decision-making, and improving perceived (and actual) maternal health services quality.

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