scholarly journals Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255094
Author(s):  
Reta Dewau ◽  
Dessie Abebaw Angaw ◽  
Getahun Molla Kassa ◽  
Baye Dagnew ◽  
Yigizie Yeshaw ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Rural Women ◽  
Access To Health Care ◽  
Institutional Delivery ◽  
Child Death ◽  
Decomposition Analysis ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Oaxaca Decomposition ◽  
Urban Rural

Background Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. Methods The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). Results The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. Conclusions The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.

scholarly journals Maternity Care Services Utilization and Factors Associated with Institutional Delivery Among Postpartum Women in Dabat Demographic and Health Survey Site, Northwest Ethiopia: A Community Based Baseline Survey for MNCH Surveillance

2021 ◽  
Author(s):  
Abebaw Addis Gelagay ◽  
Abebaw Gebeyehu Worku ◽  
Debrework Tesgera Bashah ◽  
Nigusie Birhan Tebeje ◽  
Mignote Hailu Gebrie ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Postnatal Care ◽  
Institutional Delivery ◽  
Care Utilization ◽  
Postpartum Women ◽  
Community Based ◽  
Services Utilization ◽  
Care Services ◽  
Care Visit ◽  
Antenatal Care Utilization

Abstract Background Maternal continuum of care is identified to have a greatest impact on maternal and child survival. However, there is a wide variation in maternal health services utilization from place to place in Ethiopia. Therefore, knowing antenatal care, labor and delivery, and postnatal care uptake has paramount importance to take interventions. Methods A community-based cross-sectional survey was conducted among 1626 postpartum women. Descriptive statistics were done to characterize the study population and utilization of antenatal care, institutional delivery, and postnatal care services. Logistic regression analysis was employed to identify factors associated with institutional delivery. Results Nearly eighty percent, (79.7%, 95% CI: 77.7, 81.6), of women attended at least one antenatal care visit at any health facility. However, only less than one third (31.4%) used all the recommended antenatal care (ANC). About half, 820 (49.2%: 95% CI: 46.7, 51.8) women delivered their child in health institution. About half, 822 (50.6%, 95% CI: 48.2, 52.9) of postpartum women who participated in this study had at least one postnatal care (PNC) visit at health facilities. Being urban resident (AOR=8.18, 95%CI: 4.69, 14.26)), respondents of higher educational status (AOR= 4.99, 95%CI: 2.51, 9.90), being Orthodox Christian (AOR= 2.35, 95%CI: 1.15, 4.79), getting TT vaccination during pregnancy (AOR=1.54, 95%CI: 1.06, 2.23), and antenatal care utilization (AOR=2.97, 95%CI: 2.06, 4.27) were predictors for health facility/institutional delivery. Conclusions Though a significant proportion of the study participants initiated antenatal care, utilization of all the recommended antenatal care visits, facility delivery, and postnatal care services were low. Health professionals need to use the first antenatal care visit as a golden opportunity to attract and maintain pregnant women for the subsequent maternal health care services.

scholarly journals Utilization of Postnatal Care Services among the Rural Women in Bangladesh

2017 ◽  
Vol 8 (2) ◽  
pp. 208-212
Author(s):  
Shafia Khatun Nayan ◽  
Nasreen Begum ◽  
Mumtaz Rahman Abid ◽  
Sanjida Rahman ◽  
Ahsanul Kabir Rajib ◽  
...  
Keyword(s):  
Health Care ◽  
Antenatal Care ◽  
Rural Women ◽  
Postnatal Care ◽  
Postpartum Care ◽  
Care Utilization ◽  
Care Providers ◽  
Care Services ◽  
Post Natal Care ◽  
Natal Care

Background : Low utilization of routine postnatal care (PNC) is an important determinant of high maternal and neonatal mortality in Bangladesh.Objective : To determine the utilization of post-natal care services among the rural women in a selected area in Bangladesh.Methodology : During October 2015 to March 2016 a descriptive, cross-sectional study was carried out among 200 married women of reproductive age who had a live baby below 5years of age. Sample was selected purposively from village Islampur in Dhamrai Upzilla under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire.Results : The study revealed that 73.50% of the respondents utilized PNC services among them 55.10% took PNC for less than 3 times and 28.57% took PNC for more than 3 times during postnatal period. Most of them 86% were house wife; age between 25-30 years. About 35% respondents were educated up to secondary level and 31.5% were from middle economic group. In this study 79.50% respondents received Antenatal care and advice for Post-Natal Care (PNC) Source of information for PNC was 32.5% from health workers. Fifty nine percent respondents took PNC on combined decision of husband and wife. A significant number of respondents 61.91% received postnatal care at Upazilla Health Complex. Most of the respondents 73.47% found health care provider available on duty and good behavior were found by 72.11% respondents. Among respondents 62.59% attended Health Centre by walking. Only 59.86% respondents got free PNC service. Regarding importance of PNC 67.5% believed for healthy mother and 12.5% for healthy baby.Conclusions : Post Natal Care service utilization was satisfactory (73.50%) in the study area which is higher than the national figure (36%). The findings of the study clearly showed that female education, monthly household income, antenatal care utilization, distance of health center turned out important factors in determining the postpartum care utilization among the mothers. Availability and interaction with health care providers also affected the postpartum care utilization in the study population.Northern International Medical College Journal Vol.8(2) January 2017: 208-212

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-2000

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Facility ◽  
Rural Areas ◽  
Access To Health Care ◽  
Cox Proportional Hazards ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Probability Models ◽  
Linear Probability

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods: We combined retrospective reports on 22,088 births between 1980 and 2000 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. Using a difference-in-differences approach with Cox proportional hazards models, we estimated the effect of a reduction in distance to nearest facility, conditional on initial distance, on under-5 mortality. Using a difference-in-difference approach with linear probability models, we estimated the effect of a reduction in distance to nearest facility on number of antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery.Findings: We found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years. We also found no effect of reduced distance to nearest facility on utilization of maternal health services. The effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure.

Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria

2020 ◽  
pp. 1-21
Author(s):  
Tunde A. Alabi ◽  
Sonnen Atinge ◽  
Chibuike Ejim ◽  
Samuel O. Adejoh
Keyword(s):  
Health Care ◽  
Rural Women ◽  
Access To Health Care ◽  
Care Facility ◽  
First Trimester ◽  
Health Care Facilities ◽  
The South ◽  
The North ◽  
Study Results ◽  
Care Facilities

Abstract Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country – two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15–49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-2000

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Facility ◽  
Rural Areas ◽  
Access To Health Care ◽  
Cox Proportional Hazards ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Probability Models ◽  
Linear Probability

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods: We combined retrospective reports on 22,088 births between 1980 and 2000 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. Using a difference-in-differences approach with Cox proportional hazards models, we estimated the effect of a reduction in distance to nearest facility, conditional on initial distance, on under-5 mortality. Using a difference-in-difference approach with linear probability models, we estimated the effect of a reduction in distance to nearest facility on number of antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery. Findings: We found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years. We also found no effect of reduced distance to nearest facility on utilization of maternal health services. The effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors. Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure.

scholarly journals THE IMPACT OF HEALTH SUBSIDY ON HEALTH CARE UTILIZATION IN INDONESIA

2021 ◽  
Vol 3 (2) ◽  
pp. 16-37
Author(s):  
Renosa Tosca Zamaro
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Insurance Premium ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Care Utilization ◽  
Poor People ◽  
Outpatient Visits ◽  
Care Facilities ◽  
The Impact

Equal opportunity and access to health care services regardless of one’s socio-economic background is important for health equity. To achieve this, the Indonesian government introduced a national health insurance program named Jaminan Kesehatan Nasional in 2014 and provided insurance premium subsidies for poor people. The current study evaluates the health subsidy policy’s impact on the utilization of different kinds of health care facilities, both public and private. Two waves of Indonesian socio-economic surveys, namely 2013 and 2018, and two analysis methods, namely logistic regression, and difference-in-differences, were applied in this study. The results show that in first-level health care facilities, the health subsidy improves the probability of outpatient visits in public health centers and polyclinics but decreases the probability of outpatient visits in medical practices. Then, in secondary-level health care facilities, the health subsidy was found to increase the likelihood of outpatient visits in public hospitals; however, it lowers the probability of outpatient visits in private hospitals.

scholarly journals Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Atkure Defar ◽  
Yemisrach B. Okwaraji ◽  
Zemene Tigabu ◽  
Lars Åke Persson ◽  
Kassahun Alemu
Keyword(s):  
Antenatal Care ◽  
Health Facility ◽  
Institutional Delivery ◽  
District Level ◽  
Care Utilization ◽  
Cross Sectional ◽  
Childhood Illnesses ◽  
Full Immunization ◽  
And Child Health ◽  
Antenatal Visits

Abstract Background Maternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions. Methods A cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13–49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*. Results Of the 6321women included in the study, 714 had a live birth in the 12 months before the survey. One-third of the women (30, 95% CI 26–34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43–51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40–57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37–45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron’s I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron’s I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women’s age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone. Conclusions This study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage.

scholarly journals Trends and determinants of an acceptable antenatal care coverage in Ethiopia, evidence from 2005-2016 Ethiopian demographic and health survey; Multivariate decomposition analysis

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Tilahun Yemanu Birhan ◽  
Wullo Sisay Seretew
Keyword(s):  
Health Care ◽  
Educational Attainment ◽  
Antenatal Care ◽  
Health Survey ◽  
Decomposition Analysis ◽  
Health Care Facilities ◽  
Demographic And Health Survey ◽  
Reproductive Age ◽  
Antenatal Care Visit ◽  
Care Visit

Abstract Background an acceptable antenatal care (ANC4+) is defined as attending at least four antenatal care visit, received at least one dose of tetanus toxoid (TT) injections and consumed 100 iron-folic acids (IFA) tablets/syrup during the last pregnancy. Since maternal health care service utilization continues to be an essential indicator for monitoring the improvements of maternal and child health outcomes. This study aimed to analyze the trends and determinants that contributed to the change in an acceptable antenatal care visit over the last 10 years in Ethiopia. Methods Nationally representative repeated cross-sectional survey was conducted using 2005, 2011, and 2016 Ethiopian Demographic and Health Survey datasets. The data were weighted and analyzed by STATA 14.1 software. Multivariate decomposition regression analysis was used to identify factors that contribute for the change in an acceptable antenatal care visit. A p-value < 0.05 was taken to declare statistically significant predictors to acceptable antenatal care visit. Results among the reproductive age women the rate of an acceptable antenatal care visits was increased from 16% in 2005 to 35% in 2016 in Ethiopia. In the multivariate decomposition analysis, about 29% of the increase in acceptable antenatal care visit was due to a difference in composition of women (endowments) across the surveys. Residence, religion, husband educational attainment, and wealth status was the main source of compositional change factors for the improvements of an acceptable antenatal care visit. Almost two-thirds of an overall change in acceptable antenatal care visit was due to the difference in coefficients/ change in behavior of the population. Religion, educational attainment (both women and husband), and residence are significantly contributed to the change in full antenatal care visit in Ethiopia over the last decades. Conclusion Besides the relevance of receiving an acceptable antenatal care visit for pregnant women and their babies, an acceptable antenatal care visit was slightly increased over time in Ethiopia. Women’s characteristics and behavior change were significantly associated with the change in acceptable antenatal care visits. Public interventions needed to improve acceptable antenatal care coverage, women’s education, and further advancing of health care facilities in rural communities should be done to maintain the further improvements acceptable antenatal care visits.

Sign in / Sign up

Export Citation Format

Share Document