Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda

Introduction Maternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA. Materials and methods This was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA. Results The overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57–0.61) of delivering at a health facility compared with urban women. Conclusions Our findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women.

Download Full-text

Effects of antenatal care visits and health facility delivery on women's choice to circumcise their daughters in sub-Saharan Africa: evidence from demographic and health surveys

International Health ◽

10.1093/inthealth/ihab066 ◽

2021 ◽

Author(s):

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

Carolyne Njue

Keyword(s):

Antenatal Care ◽

Health Facility ◽

Healthcare Service ◽

Facility Delivery ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Service Utilisation ◽

Health Facility Delivery ◽

Maternal Healthcare ◽

Sub Saharan

Abstract Background This study examines the association between maternal healthcare service utilisation and circumcision of daughters in sub-Saharan Africa (SSA). Methods This study is based on a cross-sectional study design that draws on analysis of pooled data from current demographic and health surveys conducted between 2010 and 2019 in 12 countries in SSA. Both bivariate and multivariable binary logistic regression models were employed. Results Mothers who had four or more antenatal care visits were less likely to circumcise their daughters compared with those who had zero to three visits. Mothers who delivered at a health facility were less likely to circumcise their daughters than those who delivered at home. With the covariates, circumcision of daughters increased with increasing maternal age but decreased with increasing wealth quintile and level of education. Girls born to married women and women who had been circumcised were more likely to be circumcised. Conclusions This study established an association between maternal healthcare service utilisation and circumcision of girls from birth to age 14 y in SSA. The findings highlight the need to strengthen policies that promote maternal healthcare service utilisation (antenatal care and health facility delivery) by integrating female genital mutilation (FGM) information and education in countries studied.

Download Full-text

Timely initiation of breastfeeding and associated factors among mothers having children less than two years of age in sub-Saharan Africa: A multilevel analysis using recent Demographic and Health Surveys data

PLoS ONE ◽

10.1371/journal.pone.0248976 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248976

Author(s):

Achamyeleh Birhanu Teshale ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Health Facility ◽

Community Level ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Health Facility Delivery ◽

Timely Initiation ◽

Pooled Prevalence ◽

Sub Saharan ◽

Timely Initiation Of Breastfeeding ◽

Initiation Of Breastfeeding

Background Despite the significant advantages of timely initiation of breastfeeding (TIBF), many countries particularly low- and middle-income countries have failed to initiate breastfeeding on time for their newborns. Optimal breastfeeding is one of the key components of the SDG that may help to achieve reduction of under-five mortality to 25 deaths per 1000 live births. Objective To assess the pooled prevalence and associated factors of timely initiation of breastfeeding among mothers having children less than two years of age in sub-Saharan Africa. Methods We used pooled data from the 35 sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS). We used a total weighted sample of 101,815 women who ever breastfeed and who had living children under 2 years of age. We conducted the multilevel logistic regression and variables with p<0.05, in the multivariable analysis, were declared significantly associated with TIBF. Results The pooled prevalence of TIBF in SSA was 58.3% [95%CI; 58.0–58.6%] with huge variation between countries, ranging from 24% in Chad to 86% in Burundi. Both individual and community level variables were associated with TIBF. Among individual-level factors; being older-aged mothers, having primary education, being from wealthier households, exposure to mass media, being multiparous, intended pregnancy, delivery at a health facility, vaginal delivery, single birth, and average size of the child at birth were associated with higher odds of TIBF. Of community-level factors, rural place of residence, higher community level of ANC utilization, and health facility delivery were associated with higher odds of TIBF. Conclusion In this study, the prevalence of TIBF in SSA was low. Both individual and community-level factors were associated with TIBF. The authors recommend interventions at both individual and community levels to increase ANC utilization as well as health facility delivery that are crucial for advertising optimal breastfeeding practices such as TIBF.

Download Full-text

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

PLoS ONE ◽

10.1371/journal.pone.0259250 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259250

Author(s):

Obasanjo Afolabi Bolarinwa ◽

Effiong Fortune ◽

Richard Gyan Aboagye ◽

Abdul-Aziz Seidu ◽

Olalekan Seun Olagunju ◽

...

Keyword(s):

Health Facility ◽

Facility Delivery ◽

Health Facilities ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Age At First Birth ◽

Health Facility Delivery ◽

Odds Ratios ◽

First Birth ◽

Women Of Reproductive Age

Background High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria. Methods The study used the most recent secondary dataset from Nigeria’s Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05. Results The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74–0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above. Conclusion Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.

Download Full-text

Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1121 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Dharel ◽

A Bhattarai ◽

Y R Paudel ◽

P Acharya ◽

K Acharya

Keyword(s):

Health Facility ◽

Newborn Care ◽

Facility Delivery ◽

Early Initiation ◽

Health Facility Delivery ◽

Essential Newborn Care ◽

Place Of Delivery ◽

Early Initiation Of Breastfeeding ◽

Nationally Representative ◽

Initiation Of Breastfeeding

Abstract Background Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal. Methods We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates. Results The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods. Conclusions Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery. Key messages The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

Download Full-text

Predicting health facility delivery among women in Egypt based on antenatal care

International Journal of Contemporary Mathematical Sciences ◽

10.12988/ijcms.2021.91587 ◽

2021 ◽

Vol 16 (2) ◽

pp. 79-99

Author(s):

H. E. Semary ◽

E. M. Hassneen ◽

R. E. Ibrahim

Keyword(s):

Antenatal Care ◽

Health Facility ◽

Facility Delivery ◽

Health Facility Delivery

Download Full-text

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Pan African Medical Journal ◽

10.11604/pamj.2014.17.302.2898 ◽

2014 ◽

Vol 17 ◽

Cited By ~ 3

Author(s):

Obianuju Beatrice Ozoh ◽

Njideka Ulunma Okubadejo ◽

Ayesha Omolara Akinkugbe ◽

Oluwadamilola Omolara Ojo ◽

Chinyere Nkiru Asoegwu ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Health Facility ◽

Sub Saharan Africa ◽

Obstructive Sleep ◽

Prospective Assessment ◽

Sub Saharan

Download Full-text

Quality of antenatal care service provision in health facilities across sub–Saharan Africa: Evidence from nationally representative health facility assessments

Journal of Global Health ◽

10.7189/jogh.07.021101 ◽

2017 ◽

Vol 7 (2) ◽

Cited By ~ 29

Author(s):

Mufaro Kanyangarara ◽

Melinda K Munos ◽

Neff Walker

Keyword(s):

Antenatal Care ◽

Health Facility ◽

Service Provision ◽

Care Service ◽

Health Facilities ◽

Sub Saharan Africa ◽

Nationally Representative ◽

Sub Saharan

Download Full-text

Maternal healthcare services use in Mwanza Region, Tanzania: A cross-sectional baseline survey

10.21203/rs.2.15849/v3 ◽

2019 ◽

Author(s):

James Orwa ◽

Michaela Mantel ◽

Micheal Mugerwa ◽

Sharon Brownie ◽

Eunice Siaity Pallangyo ◽

...

Keyword(s):

Antenatal Care ◽

Health Facility ◽

Healthcare Services ◽

Facility Delivery ◽

Postpartum Care ◽

Reproductive Age ◽

Antenatal Visit ◽

Health Facility Delivery ◽

Maternal Healthcare ◽

Cross Sectional

Abstract Background: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania. Methods: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. Results: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. Conclusion: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services. Keywords: Antenatal care, health facility delivery, postpartum care, Mwanza, Tanzania

Download Full-text