scholarly journals The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Mariam Tanou ◽  
Takaaki Kishida ◽  
Yusuke Kamiya
Keyword(s):  
Antenatal Care ◽  
Health Center ◽  
Travel Time ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Services Utilization ◽  
The World ◽  
Delivery Services ◽  
Geographical Accessibility

Abstract Background The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones. Methods We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15–49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness. Results Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women’s residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin. Conclusions Geographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin.

Geographical Access to Health Facilities and Maternal Healthcare Utilization in Benin: A Cross-sectional Study

2021 ◽  
Author(s):  
Mariam Tanou ◽  
Takaaki Kishida ◽  
Yusuke Kamiya
Keyword(s):  
Health Center ◽  
Healthcare Utilization ◽  
Multivariate Logistic Regression Analysis ◽  
Health Facilities ◽  
Transport Infrastructure ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Maternal Healthcare ◽  
The World ◽  
Geographical Accessibility

Abstract Background: The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is suspected to be a major obstacle hampering the use of appropriate MCH services. Benin, a country with unique geographical characteristics whereby the southern and northern parts belong to different climatic zones, sees the highest maternal mortality rate among the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of distance to health facilities on maternal healthcare utilization in Benin, with an emphasis on geographical zones.Methods: We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 32,727 women aged 15–49 years (16,599 from BDHS-2011/2012 and 15,928 from BDHS-2017/2018). We measured the distance from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of distance on maternal healthcare utilization. We conducted a propensity score-matching analysis to check for robustness.Results: Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in distance to the nearest health center reduces the odds of the woman receiving at least one antenatal care by 0.034, delivering in facility by 0.020, and delivering her baby with assistance of skilled birth attendants by 0.028. Nonetheless, these effects were mainly seen in the northern part of Benin.Conclusions: Geographical accessibility to health facilities is critically important for the improvement of appropriate maternal healthcare, particularly in the northern part of Benin. Investment in transport infrastructure should be prioritized for further improvements in the MCH.

scholarly journals Population cluster data to assess the urban-rural split and electrification in Sub-Saharan Africa

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Babak Khavari ◽  
Alexandros Korkovelos ◽  
Andreas Sahlberg ◽  
Mark Howells ◽  
Francesco Fuso Nerini
Keyword(s):  
World Bank ◽  
Population Distribution ◽  
Population Data ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Disease Response ◽  
The World Bank ◽  
The World ◽  
Urban Rural

AbstractHuman settlements are usually nucleated around manmade central points or distinctive natural features, forming clusters that vary in shape and size. However, population distribution in geo-sciences is often represented in the form of pixelated rasters. Rasters indicate population density at predefined spatial resolutions, but are unable to capture the actual shape or size of settlements. Here we suggest a methodology that translates high-resolution raster population data into vector-based population clusters. We use open-source data and develop an open-access algorithm tailored for low and middle-income countries with data scarcity issues. Each cluster includes unique characteristics indicating population, electrification rate and urban-rural categorization. Results are validated against national electrification rates provided by the World Bank and data from selected Demographic and Health Surveys (DHS). We find that our modeled national electrification rates are consistent with the rates reported by the World Bank, while the modeled urban/rural classification has 88% accuracy. By delineating settlements, this dataset can complement existing raster population data in studies such as energy planning, urban planning and disease response.

scholarly journals Exploring country-wide equitable government health care facility access in Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Dowhaniuk
Keyword(s):  
Health Care ◽  
Random Forest ◽  
Health Center ◽  
Travel Time ◽  
Health Centers ◽  
Sub Saharan Africa ◽  
Walking Distance ◽  
Laboratory System ◽  
Government Health ◽  
Sub Saharan

Abstract Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity.

scholarly journals Equity of geographical access to public health facilities in Nepal

2021 ◽  
Vol 6 (10) ◽  
pp. e006786
Author(s):  
Wen-Rui Cao ◽  
Prabin Shakya ◽  
Biraj Karmacharya ◽  
Dong Roman Xu ◽  
Yuan-Tao Hao ◽  
...  
Keyword(s):  
Public Health ◽  
Travel Time ◽  
Weighted Average ◽  
Developed Countries ◽  
Public Health Facility ◽  
Health Facilities ◽  
Public Health Facilities ◽  
Geographical Access ◽  
Geographical Accessibility ◽  
New Facilities

IntroductionGeographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available.MethodsBased on the up-to-date dataset of Nepal formal public health facilities in 2021, we measured the geographical accessibility by calculating the travel time to the nearest public health facility of three levels (ie, primary, secondary and tertiary) across Nepal at 1×1 km2 resolution under two travel modes: walking and motorised. Gini and Theil L index were used to assess the inequality. Potential locations of new facilities were identified for best improvement of geographical efficiency or equality.ResultsBoth geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation is available to everyone, the population coverage within 5 min to any public health facilities would be improved by 62.13%. The population-weighted average travel time was 17.91 min, 39.88 min and 69.23 min and the Gini coefficients 0.03, 0.18 and 0.42 to the nearest primary, secondary and tertiary facilities, respectively, under motorised mode. For primary facilities, low accessibility was found in the northern mountain belt; for secondary facilities, the accessibility decreased with increased distance from the district centres; and for tertiary facilities, low accessibility was found in most areas except the developed areas like zonal centres. The potential locations of new facilities differed for the three levels of facilities. Besides, the majority of inequalities of geographical accessibility were from within-province.ConclusionThe high-resolution geographical accessibility maps and the assessment of inequality provide valuable information for health resource allocation and health-related planning in Nepal.

scholarly journals Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261316
Author(s):  
Kennedy A. Alatinga ◽  
Jennifer Affah ◽  
Gilbert Abotisem Abiiro
Keyword(s):  
Antenatal Care ◽  
Health Workers ◽  
Belief Systems ◽  
Home Delivery ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
At Home

Background The Sustainable Development Goal Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives. The place, where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care. Methods A qualitative, exploratory, cross-sectional design was deployed. Data were collected from a purposive sample of 23 women, who attended antenatal care during pregnancy but delivered their babies at home, 10 health workers and 17 other community-level stakeholders. The data were collected through semi-structured interviews, which were audio-recorded, transcribed and thematically analysed. Results In line with the Andersen and Newman Model, the study discovered that traditional and religious belief systems about marital fidelity and the role of the gods in childbirth, myths about consequences of facility-based delivery, illiteracy, and weak women’s autonomy in healthcare decision-making, predisposed women to home delivery. Home delivery was also enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities. The fear of caesarean section, also created the need for women who attended antenatal care to deliver at home. Conclusion The study has established that socio-cultural and institutional level factors influenced women’s decisions to deliver at home. We recommend a general improvement in the service delivery capacity of health facilities, and the implementation of collaborative educational and women empowerment programmes by stakeholders, to strengthen women’s autonomy and reshape existing traditional and religious beliefs facilitating home delivery.

scholarly journals Choice of Delivery Places and Factors which Influence it in the Aceh Besar Regency

2019 ◽  
pp. 251-254
Author(s):  
Moh. Andalas ◽  
Ilham Kosman
Keyword(s):  
Multivariate Analysis ◽  
Antenatal Care ◽  
Travel Time ◽  
Health Facilities ◽  
Influential Factor ◽  
Chi Square ◽  
Design Data ◽  
Cross Sectional ◽  
Safe Delivery ◽  
Aceh Province

Objective: To determine the relationship of maternal delivery and the factors that influence in Aceh Besar regency of Aceh Province. Method: We used a cross-sectional study design. Data were collected in all Community Health Centres in each sub-district in Aceh Besar regency of Aceh province. The total sample size of this study was 80 patient data, with details of 40 maternity patients in health facilities and 40 patients who were delivered to non-health facilities. Data were taken on factors that influence the choice of place of delivery, i.e. travel time from home to health facilities, age, parity, antenatal care, education, and income. Results: The result of chi-square test showed significant relation time (p = 0,000), Education (p = 0,011), parity (p = 0,000), antenatal care (p = 0,025), age (p = 0,003), revenue (p = 0.022) with maternity delivery in Aceh Besar regency. From the result of multivariate analysis found that travel time is the most influential factor in choosing the birth place with (OR = 51,976). Conclusion: The result of multivariate analysis showed that travel time was the most influential factor in choosing the delivery place with 51,976 times. Keywords: health facilities, maternal mortality rate, safe delivery   Abstrak Tujuan: Untuk mengetahui hubungan tempat persalinan ibu dan faktor-faktor yang mempengaruhi di Kabupaten Aceh Besar Provinsi Aceh. Metode: Penelitian ini menggunakan desain potong lintang. Data diambil di seluruh Puskesmas di setiap kecamatan di Kabupaten Aceh Besar Provinsi Aceh. Jumlah total sampel penelitian ini adalah 80 data pasien, dengan rincian 40 pasien yang bersalin di fasilitas kesehatan dan 40 pasien yang bersalin di non fasilitas kesehatan. Data yang diambil mengenai informasi faktor yang mempengaruhi pilihan tempat persalinan, yaitu waktu tempuh dari rumah ke fasilitas kesehatan, usia, paritas, ANC, pendidikan, dan pendapatan. Hasil: Hasil uji chi-square menunjukkan terdapat hubungan secara signifikan waktu tempuh (p=0,000), pendidikan (p=0,011), paritas (p=0,000), ANC (p=0,025), usia (p=0,003), pendapatan (p=0,022) dengan pemilihan tempat persalinan ibu di Kabupaten Aceh Besar. Dari hasil analisis multivariate didapatkan waktu tempuh adalah faktor yang paling berpengaruh dalam memilih tempat persalinan dengan (OR=51,976). Kesimpulan: Berdasarkan hasil analisis regresi logistik, kelompok yang waktu tempuh nya dari rumah ke fasilitas kesehatan < 30 menit 51,976 kali lebih besar kemungkinan memilih tempat persalinan di fasilitas kesehatan. Kata kunci: angka kematian ibu, fasilitas kesehatan, persalinan aman

scholarly journals Latrine Utilization and Associated Factors in Mehal Meda Town in North Shewa Zone, Amhara Region, Ethiopia, 2019

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ayele Mamo Abebe ◽  
Mesfin Wudu Kassaw ◽  
Abinet Dagnew Mekuria ◽  
Sisay Shewasinad Yehualshet ◽  
Endegena Abebe Fenta
Keyword(s):  
Associated Factors ◽  
Occupational Status ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Amhara Region ◽  
Toilet Facility ◽  
Water Well ◽  
The World ◽  
Sub Saharan ◽  
Latrine Use

Background. Worldwide lack of sanitation is a serious health risk, affecting billions of people around the world, particularly the poor and disadvantaged of people around the world. In Sub-Saharan Africa, the number of people who defecate remains the open field 215 million. According to the 2016 Ethiopian Demographic and Health Surveys report, 56% of the rural households use unimproved toilet facilities. One in every three households in the country has no toilet facility. However, achieving real gains in increasing latrine use and quality remained as a challenge. This study was used to assess the latrine utilization and associated factors in Mehal Meda town in North Shewa zone, Amhara region, Ethiopia, 2019. Result. In this study, a total of 558 participants were included. Out of households, 509 (91.2%) utilized their latrine facility. On the other way, 503 (98.8%) households utilized latrine regularly. Significant variables that were associated to latrine utilization were the occupational status of head of households, observing feces around the compound/latrine, duration of latrine utilization, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine. According to this study, the magnitude of latrine utilization in Mehal Meda district was 91.2%. It was lower than Ethiopia national expected target of MDGs (100%). Significant variables that were associated to latrine utilization were occupational status of head of households, observing feces around the compound/latrine, shape and structure of latrine facility, latrine status during observation, and distance between water well and latrine facility. Therefore, health education about latrine utilization and its advantage should be given for community in the study area.

scholarly journals Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Ebenezer Agbaglo ◽  
Collins Adu ◽  
Eugene Budu ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Health Survey ◽  
Wealth Quintile ◽  
Skilled Birth Attendance ◽  
Demographic And Health Survey ◽  
Sub Saharan Africa ◽  
Level Of Education ◽  
Services Utilization ◽  
Birth Attendance ◽  
Childbearing Women

Abstract Background Globally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea. Methods Data for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression. Results The results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and those whose partners had secondary/higher level of education (AOR=1.46, CI=1.22-1.75), women in the richest wealth quintile (AOR=5.09, CI=3.70-7.00), those with planned pregnancies (AOR=1.50, CI=1.23-1.81), Muslim women (AOR=1.65, CI=1.38-2.12), those who take healthcare decisions alone (AOR=1.53, CI=1.24-1.89), and those who listened to radio less than once a week (AOR= 1.30, CI=1.10-1.53) had higher odds of antenatal care uptake. Also, women with secondary/higher level of education (AOR=1.83, CI=1.25-2.68), those whose partners had secondary/higher level of education (AOR=1.40, CI=1.11-1.76), those in the richest wealth quintile (AOR=10.79, CI=6.64-17.51), those with planned pregnancies (AOR=1.25, CI=1.03-1.52), Christian women (AOR=4.13, CI=3.17-5.39), those living in urban areas (AOR=3.00, CI=2.29-3.94), women with one birth (AOR= 1.58, CI=1.20-2.06), those who take healthcare decisions alone (AOR=1.87, CI=1.46-2.39), those who read newspaper at least once a week (AOR= 1.19, CI=1.01-1.40), those who watched television at least once week (AOR=1.69, CI=1.30-2.19), and those in female-headed households (AOR=1.52, CI=1.20-1.92) were more likely to utilize the services of skilled birth attendants. Conclusion The study proved that various socio-economic and contextual factors influence antenatal care and skilled birth attendance in Guinea. These findings suggest the need to design community-based interventions (e.g., miniature local ANC clinics, early screening services) that prioritize women’s education and vocational training, media accessibility, especially among the poor, and those residing in rural settings. Such interventions should not ignore the influence of other socio-cultural norms that hinder the utilization of antenatal care and skilled birth attendance services in Guinea.

scholarly journals Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Betregiorgis Zegeye ◽  
Mpho Keetile ◽  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Abdul-Aziz Seidu ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Married Women ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Related Factors ◽  
Factors Associated ◽  
Software Analysis ◽  
Sub Saharan

Abstract Background Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. Methods We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). Results The pooled results showed that about 50.7% (95% CI 48.2–53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0–69.1%) and West Africa (24.3%, 95% CI 22.4–26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32–2.84), women with educated husbands (aOR=1.40, 95% CI 1.11–1.77), wealthier women (aOR=3.12, 95% CI 1.95–4.99), women exposed to media (aOR=1.46, 95% CI 1.18–1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24–1.83). Conclusions Enhancing women’s education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.

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