Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

Abstract Background Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery. Method The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery. Result Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery. Conclusion The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account. Trial registration ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019.

Download Full-text

Relationship between women’s characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling

Women & Health ◽

10.1080/03630242.2016.1222327 ◽

2016 ◽

Vol 57 (8) ◽

pp. 942-961 ◽

Cited By ~ 6

Author(s):

Patrick Opiyo Owili ◽

Miriam Adoyo Muga ◽

Yiing-Jenq Chou ◽

Yi-Hsin Elsa Hsu ◽

Nicole Huang ◽

...

Keyword(s):

Structural Equation Modeling ◽

Maternal Health ◽

Structural Equation ◽

Continuum Of Care ◽

Equation Modeling ◽

Survey Analysis ◽

Complex Survey

Download Full-text

WOMEN’S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS

Journal of Biosocial Science ◽

10.1017/s0021932017000505 ◽

2017 ◽

Vol 50 (6) ◽

pp. 725-748 ◽

Cited By ~ 13

Author(s):

Zacharie Tsala Dimbuene ◽

Joshua Amo-Adjei ◽

Dickson Amugsi ◽

Joyce Mumah ◽

Chimaraoke O. Izugbara ◽

...

Keyword(s):

Maternal Health ◽

Health Service ◽

Antenatal Care ◽

Service Utilization ◽

Women's Education ◽

Health Service Utilization ◽

Maternal Health Services ◽

Maternal Health Service ◽

Care Visit ◽

Socioeconomic Strata

SummaryThere is an abundant literature on the relationship between women’s education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the ‘equity’ lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women’s education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women’s education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner’s education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women’s education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner’s education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women’s education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an ‘equity’ approach, taking into account the specific needs of sub-populations.

Download Full-text

Does intimate partner violence influence the utilization of maternal health services?

10.21203/rs.2.10538/v2 ◽

2019 ◽

Author(s):

Devaraj Acharya ◽

Ramesh Adhikari ◽

Chhabilal Ranabhat ◽

Radha Paudel ◽

Purna Bahadur Thapa ◽

...

Keyword(s):

Intimate Partner Violence ◽

Maternal Health ◽

Service Utilization ◽

Partner Violence ◽

Educational Level ◽

Institutional Delivery ◽

Intimate Partner ◽

Maternal Health Service ◽

Negative Consequences ◽

Wealth Status

Abstract Background: Intimate partner violence [IPV] is a public health problem globally and most common in developing countries that affects more than one fourth of women of reproductive age [WRA]. It is more critical during pregnancy. IPV not only affects physical and mental well-being but also leads to negative consequences in with birth outcomes. Methods: We conducted a secondary data analysis of the Nepal Demographic and Health Survey 2016 to assess the association between IPV and maternal service utilization: ANC visits and institutional delivery. Altogether 1374 WRA were randomly selected. Background characteristics of WRA and IPV were the independent variables and ANC visits and institutional delivery were the dependent variables. Results: Data showed that 26 percent of WRA had faced at least one form of IPV, 68 percent had visited health facilities at least four times for ANC check-ups during pregnancy, and the rate of institutional delivery was 61 percent. There were associations among IPV with ANC visits and institutional delivery (p<0.001). Age group, educational level, ethnicity, number of children, residence setting, and wealth status of WRA were significantly associated with ANC visits and institutional delivery (p<0.001). Conclusion: IPV, educational level, and wealth status of WRA were significant predictors for maternal health service utilization. Policy makers should incorporate these significant predictors during planning and interventions as well.

Download Full-text

Women’s retention on the Continuum of Maternal Care Pathway in West Gojjam Zone, Ethiopia: Multilevel Analysis

10.21203/rs.2.13859/v3 ◽

2020 ◽

Author(s):

Amanu Aragaw Emiru ◽

Getu Degu Alene ◽

Gurmesa Tura Debelew

Keyword(s):

Maternal Health ◽

Health Service ◽

Antenatal Care ◽

Service Utilization ◽

Maternal Care ◽

Health Service Utilization ◽

Continuum Of Care ◽

Maternal Health Service ◽

West Gojjam ◽

The Continuum

Abstract Background: The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. Methods: A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95 % confidence interval. Results: The study revealed that only 12.1% of women completed the continuum of care (ANC4+, SBA, PNC within 48 hours after birth); while 25.1% reported not having care at any stage for their most recent birth. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR=7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR=3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. Conclusions: The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality

Download Full-text

Women’s autonomy and maternal health service utilization among the women’s having less than two years age children in Rautahat district, Nepal

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20213256 ◽

2021 ◽

Vol 7 (9) ◽

pp. 427

Author(s):

Sanjaya Kumar Shah ◽

Neelima Yadav ◽

Richa Shah ◽

Ramesh Bhatta ◽

Rajesh Karki ◽

...

Keyword(s):

Maternal Health ◽

Health Service ◽

Antenatal Care ◽

Service Utilization ◽

Health Service Utilization ◽

Simple Random Sampling ◽

Cross Sectional Study ◽

Maternal Health Service ◽

Cross Sectional ◽

Care Visit

Background: Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Despite various attempts and schemes made by government. maternal mortality remains as one of the biggest public health challenges in Nepal. The aim of the study was to assess the association of women autonomy with maternal health service utilization among the women having 2 years children in Paroha municipality ward no. 3 and 4, Rautahat, Nepal.Methods: Cross sectional study was conducted. Simple random sampling was used to select respondents. Data were collected through face to face interview. Data were entered in Epi data and analyzed using SPSS. Chi square test was applied to test the significance of association at 95% confidence interval. Results: Majority (76.8%) of the respondents had antenatal care visit and more than half of them had four or more antenatal care visits. similarly, overwhelming majority (88.4%) of the birth were institutional delivery. Almost (91%) of the women had postnatal care visit for their last child. The study indicates that almost (95.5%) of the decisions were made without the involvement of the women. Most of women had medium level autonomy in all aspect (score= 17-32). Autonomy was positively associated with use of maternal health services i.e.; ANC visit (p=0.000), place of delivery (p=0.036), PNC visit (p=0.045).Conclusions: Findings of the study show that if women autonomy will be higher, there will be increase in maternal service utilization. Whereas autonomy has link with better education and employment opportunity of the women.

Download Full-text

A cross-sectional study on utilization of maternal health services and its determinants among rural population of district Sitapur, Uttar Pradesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20213035 ◽

2021 ◽

Vol 8 (8) ◽

pp. 3999

Author(s):

Arslan Neyaz ◽

Jaideep K. Chaubey ◽

Malik S. Ahmed ◽

Virendra Kumar ◽

Kripashankar Nayak

Keyword(s):

Maternal Health ◽

Health Service ◽

Service Utilization ◽

Health Service Utilization ◽

Institutional Delivery ◽

Maternal Health Services ◽

Cross Sectional Study ◽

Maternal Health Service ◽

Sectional Study ◽

Cross Sectional

Background: In India, despite substantial improvements in maternal health over the last decade or so, still condition is even poor in rural areas. As per National health policy 2017, target is to reduce MMR to 100 by 2020 and sustaining antenatal coverage at 100%, institutional delivery 80% and skilled attendance of birth 100% by 2025.The study is conducted with the objective to assess the pattern of maternal health service utilization and to identify the factors affecting it.Methods: A community based cross-sectional study was conducted at field practice area of Rural Health Training Centre, Hind Institute Of Medical Sciences, Sitapur with a sample of 208 women selected using systematic random sampling. SPSS Statistics 20.0 was used for data entry and calculation of statistical tests.Results: ANC utilization was found to be 70.7% whereas minimum recommended ANC visits were 50%. Only 54.8% deliveries were found to be institutional whereas 59.1% women received at least one postnatal check-up in our study. Most common reason for not utilizing ANC, Institutional delivery and PNC services was found to be tradition, availability of trained person and no need respectively. A highly significant association was found between maternal health service utilization and woman’s education, partner’s education, partner’s occupation, birth order and standard of living index (p<0.05).Conclusions: This study established that educating the population, empowering women, promoting maternal health service utilization in multipara’s and improving the socio-economic status of the family would yield greater results in increasing the use of maternal health services.

Download Full-text

Does intimate partner violence influence the utilization of maternal health services?

10.21203/rs.2.10538/v1 ◽

2019 ◽

Author(s):

Devaraj Acharya ◽

Ramesh Adhikari ◽

Chhabilal Ranabhat ◽

Radha Paudel ◽

Purna Bahdur Thapa

Keyword(s):

Intimate Partner Violence ◽

Maternal Health ◽

Service Utilization ◽

Partner Violence ◽

Educational Level ◽

Institutional Delivery ◽

Intimate Partner ◽

Maternal Health Service ◽

Negative Consequences ◽

Wealth Status

Abstract Background Intimate partner violence [IPV] is public health problem globally and most common in developing countries that affects more than one fourth of women of reproductive age [WRA]. It is more critical during pregnancy. IPV not only affects physical and mental well-being but also leads in birth outcomes with negative consequences. Methods We use secondary data from Nepal Demographic and Health Survey 2016 to assess the association between IPV, and maternal service utilization: ANC visits and institutional delivery. Altogether 1374 WRA were randomly selected. Background characteristics of WRA and IPV were the independent variables, and ANC visits and institutional delivery were the dependent variables. Results Data show that 26 percent of WRA had faced at least one form of IPV, 68 percent had visited health facilities at least four times for ANC check-up during pregnancy, and the rate of institutional delivery was 61 percent. There were association among IPV with ANC visits and institutional delivery (p<0.001). Age group, educational level, ethnicity, number of child, residence setting, and wealth status of WRA were significantly associated with ANC visits and institutional delivery (p<0.001). Conclusion IPV, educational level, and wealth status of WRA were significant predictors for maternal health service utilization. Policy maker should incorporate these significant predictors during planning and intervention as well.

Download Full-text

Effectiveness of Checklist based Box system Interventions (CBBSI) versus routine care on improving utilization of Maternal Health Service in North West, Ethiopia: Study protocol for a Cluster Randomized Controlled Trial

10.21203/rs.2.12208/v4 ◽

2019 ◽

Author(s):

Netsanet Belete ◽

Mulusew Gerbaba ◽

Gurmesa Tura

Keyword(s):

Randomized Controlled Trial ◽

Maternal Health ◽

Antenatal Care ◽

Service Utilization ◽

Postnatal Care ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Maternal Health Service ◽

Randomized Controlled ◽

Cluster Randomized

Abstract Background-Maternal mortality is still high in Ethiopia. Antenatal care, use of skilled delivery and postnatal care are key maternal health care services that can significantly reduce maternal mortality. However, in low and middle-income countries including Ethiopia, utilization of these key services is limited, so that preventive, promotive and curative services are not provided as per the recommendation. The aim of this study is to examine the effectiveness of checklist based box system interventions on improving maternal health service utilization. Methods - A community level cluster-randomized controlled trial will be conducted to compare the effectiveness of checklist based box system interventions over the routine standard of care, as a control arm. The intervention will use health extension program and provided by health extension workers and midwives, using a special type of health education scheduling and service utilization monitoring boxes, placed at health posts and health centers respectively. For this, 1,200 pregnant mothers, below 16 weeks of gestation, will be recruited from 30 clusters. Suspected pregnant mothers will be identified through a community survey and linked to the nearby health center. With effective communication between health centers and health posts, dropout-tracing mechanisms are implemented to make mothers resume service utilization. Data will be collected using ODK-Collect and analyzed using STATA version 13.0. Data will be analyzed by intention to treat analysis. Risk ratio will be computed at cluster level and the summary will be compared using t-test. Outcomes between intervention and control groups will be compared with random effects logistic regression models. Achieving four antenatal care, health facility delivery and postnatal care visits at 6 weeks of delivery were treated as primary out comes for this study. Discussion - The authors of this study expect that, the study will generate evidence on the effectiveness of checklist based box system interventions on improving utilization of maternal health care service, that produce inputs for related policies in the country. Trial Registration – ClinicalTrials.gov NCT03891030, 26 March 2019, Retrospectively Registered Keywords - Box system, maternal health, Antenatal care, skilled delivery, postnatal care, cluster randomized controlled trial, Ethiopia

Download Full-text

Factors Associated with Use of Maternal Health Services in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i3.1525 ◽

2019 ◽

Vol 17 (3) ◽

pp. 301-307

Author(s):

Prithutam Bhattarai

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Survey ◽

Institutional Delivery ◽

Maternal Health Services ◽

Demographic And Health Survey ◽

Maternal Health Service ◽

Health Institution ◽

Delivery Services

Background: Timely access and use of health services are critical for improving maternal health services. The objective of present study is to identify key factors related to antenatal care and institutional delivery services in Nepal.Methods: Data from the Nepal Demographic Health Survey 2016 was analyzed. Women who have taken four or more antenatal checkup (ANC4+), and who delivered at a health Institution were considered outcome variables. Logistic regression analysis was used to compute odds ratio. Women (15-49) having most recent birth in 5 years preceding the survey were included in the study.Results: 69.4% women had taken four or more ANC and 60.6 % had given delivery at a health institution. Age of mother at birth of child, birth order, residence, and ethnicity were significantly associated with use of maternal health service. Educated were 3.79(CI2.83-5.08) times likely to take ANC4+ and 2.71 (CI 2.05-3.57) times likely to give birth at health institution. Richest women were 2.25(CI2.83-5.08) times likely to utilize the ANC4+ service and 9.48(CI6.46-13.91) times likely to give birth at health institution. Women in Province 7 were 3.16(CI2.14-4.67) times likely to utilize ANC4+ service and 2.71(CI 1.83-4.05) times likely to give delivery in health institution compared to women in Province 6.Conclusions: Higher educated and richest women were using antenatal care and institutional delivery compared to less educated. The finding reinforces importance of empowering women with education and improving economic situation.Keywords: Antenatal care; demographic and health survey; institutional delivery; maternal health; Nepal.

Download Full-text

Factors Affecting Antenatal Care Utilization Among the Disadvantaged Dalit Population of Nepal: A Cross- sectional Study

The Open Public Health Journal ◽

10.2174/1874944501912010155 ◽

2019 ◽

Vol 12 (1) ◽

pp. 155-163

Author(s):

Surendra Prasad Chaurasiya ◽

Nilesh Kumar Pravana ◽

Vishnu Khanal ◽

Dhiraj Giri

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Service Utilization ◽

Health Workers ◽

Statistical Significance ◽

Cross Sectional Study ◽

Maternal Health Service ◽

Care Utilization ◽

Sectional Study ◽

Cross Sectional

Background: Antenatal Care (ANC) visits are intended to prevent, identify and treat conditions that may threaten the health of the mother and newborn, and to increase the chance she has a smooth pregnancy and and safe childbirth. The most disadvantaged and underprivileged caste (Dalit) of Nepal has benefitted the least from maternal health service improvements in the recent years. Objective: This study was conducted to determine the rate and factors associated with the antenatal care service utilization among the most disadvantaged ethnic group (Dalit women) and recommend interventions to improve ANC utilisaiton, in the Mahottari district of Nepal. Methods: A cross-sectional study was conducted during July-December 2014 using a structured questionnaire. A total of 328 recently delivered mothers were interviewed covering the entire district. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios with 95% confidence intervals. Results: ANC utilization rate (≥ 4 ANC visit) was found to be 42%. Mother's education, husband's education, mother's occupation, perceived “good quality” ANC, hearing about incentive program, maternal health message, non-perception of health workers behaviours as discriminatory, and exposure to Female Community Health Volunteer were found to be significantly associated with ANC utilization. Conclusion: ANC service utilization is low. So, there is an urgent need to address the issue of ANC quality and discriminatory behaviour of health workers toward Dalit. A targeted & comprehensive maternal health program should be developed to raise awareness and motivate pregnant women for maximum utilisation of ANC services.

Download Full-text