scholarly journals Community’s experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255404
Author(s):  
Gizachew Tadele Tiruneh ◽  
Meaza Demissie ◽  
Alemayehu Worku ◽  
Yemane Berhane
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Postnatal Care ◽  
Continuum Of Care ◽  
Maternal Health Services ◽  
Opportunity Costs ◽  
Community Perceptions ◽  
Negative Experiences ◽  
Multiple Challenges ◽  
The Continuum

Background Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. Methods This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. Results We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women’s negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. Conclusion This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

scholarly journals Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1061
Author(s):  
Sathirakorn Pongpanich ◽  
Abdul Ghaffar ◽  
Najma Ghaffar ◽  
Hafiz Abdul Majid
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Postnatal Care ◽  
Health Surveys ◽  
Newborn Care ◽  
Wealth Index ◽  
Maternal Health Services ◽  
Care Utilization ◽  
Demographic And Health Surveys ◽  
Cross Sectional

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

scholarly journals Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hanyu Wang ◽  
Eric Frasco ◽  
Rie Takesue ◽  
Kun Tang
Keyword(s):  
Maternal Health ◽  
Prenatal Care ◽  
Health Services ◽  
Primary School ◽  
Postnatal Care ◽  
Maternal Education ◽  
Maternal Health Services ◽  
Education Level ◽  
Cesarean Sections ◽  
Maternal Healthcare

Abstract Background Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization. Methods The MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods. Results Of all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations. Conclusions Mothers’ education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women’s empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.

scholarly journals Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246237
Author(s):  
Berhan Tsegaye ◽  
Elsabet Shudura ◽  
Amanuel Yoseph ◽  
Alemu Tamiso
Keyword(s):  
Regression Analysis ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Postnatal Care ◽  
Institutional Delivery ◽  
Care Service ◽  
Maternal Health Services ◽  
P Value ◽  
Services Utilization

Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.

scholarly journals Determinants of utilization of antenatal and postnatal care services in Telangana

2017 ◽  
Vol 6 (8) ◽  
pp. 3352
Author(s):  
Neelima Singh ◽  
Satyendra Nath Ponna ◽  
Venkata Prasad Upadrasta ◽  
Shankar Reddy Dudala ◽  
Renuka Sadasivuni
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Postnatal Care ◽  
Maternal Health Services ◽  
Geographical Region ◽  
System Level ◽  
Care Services ◽  
Antenatal And Postnatal Care

Background: Variation exists in utilization of antenatal and postnatal care services in public health facilities of developing countries. Provision of antenatal and postnatal care services is the major function of public health delivery system of India to improve maternal health outcomes. The objective of this study is to estimate the determinants of utilization of antenatal and postnatal care services stratified by geographical region in Telangana.Methods: It is a cross-sectional study of District Level Health and Facility Survey-4 of the state of Telangana. Multistage, stratified, probability proportional to size sample with replacement was used. 3065 women, who delivered after the year 2008, were considered for analysis. Descriptive analysis of components of antenatal and postnatal care services stratified by geographical region was carried out. Binomial logistic regression was carried out to determine association of demographic, system level variables with adequate antenatal care.Results: Study reveals variation exists across four regions of Telangana in utilization of maternal health services. Reception of adequate antenatal care is low in South region (20.6%) and high in East region (31.5%). Pregnant women with secondary education were 66% more likely to receive adequate antenatal care services compared to illiterate.Conclusions: Short term and long-term goals to be adopted and implemented by government to address the demand-supply imbalance such as public health infrastructure and quality of services in underperforming districts of Telangana to increase utilization of maternal health services by training health staff and engaging local communities to seek health care services.

scholarly journals Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

2019 ◽  
Author(s):  
Xiaojing Fan ◽  
Meghan Bruce Kumar ◽  
Zhongliang Zhou ◽  
Ching-Hung Lee ◽  
Duolao Wang ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Rural Women ◽  
Healthcare Reform ◽  
Urban Women ◽  
Continuum Of Care ◽  
Maternal Health Services ◽  
Shaanxi Province ◽  
Cross Sectional ◽  
Generalised Linear Mixed Model

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: According to China’s policy defining CMHS, post-reform CMHS utilisation was higher in both rural and urban women. The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ2=20.64, P<0.001; rural: χ2=131.38, P<0.001). This finding is consistent when the WHO’s level of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ2=10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ2=2.57, P=0.109). The GLMM showed the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007) for urban women; it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of utilisation of the CMHS among both urban and rural women in Shaanxi Province. We expect that similar impacts might be observed in other settings in China and, if so, may provide lessons in policy design to other countries looking to reduce maternal and newborn mortality.

scholarly journals Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

2020 ◽  
Author(s):  
Xiaojing Fan ◽  
Meghan Bruce Kumar ◽  
Zhongliang Zhou ◽  
Ching-Hung Lee ◽  
Duolao Wang ◽  
...  
Keyword(s):  
National Health Service ◽  
Maternal Health ◽  
Health Services ◽  
Rural Women ◽  
Healthcare Reform ◽  
Urban Women ◽  
Continuum Of Care ◽  
Maternal Health Services ◽  
Shaanxi Province ◽  
Cross Sectional

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ 2 =20.64, P<0.001; rural: χ 2 =131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ 2 =10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ 2 =2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women. Keywords: Healthcare Reform; Continuum of care for Maternal Health Services; Equity; National Health Service Surveys; China

scholarly journals Utilization, Predictors and Gaps in the Continuum of Care for Maternal and Newborn Health in Ghana

2021 ◽  
Vol 10 (1) ◽  
pp. 43-53
Author(s):  
Juliana Yartey Enos ◽  
Richard Dickson Amoako ◽  
Innocent Kwao Doku
Keyword(s):  
Maternal Health ◽  
Postnatal Care ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Continuum Of Care ◽  
Maternal And Newborn Health ◽  
Birth Attendance ◽  
Full Complement ◽  
Maternal And Newborn ◽  
The Continuum

Background: Continuum-of-care (CoC) throughout pregnancy, childbirth and the postnatal period is essential for the health and survival of mothers and their babies. This study assesses the utilization, predictors, and gaps in the continuum of maternal and newborn health (MNH) services in Eastern Ghana. Methods: A retrospective cross-sectional survey was conducted to assess utilization of MNH services and their determinants in the East Akim Municipality of Ghana. Three hundred and ten (310) mothers aged 15-49 years were sampled from 4 communities (3 rural; 1 urban) in the municipality using stratified sampling methodology. Logistic regression models were fitted to determine the likelihood of utilizing skilled birth attendance (SBA) and postnatal care (PNC) after antenatal care (ANC). Results: Sixty-six percent (66%) of mothers surveyed received the full complement of MNH services (ANC, SBA, PNC) for their most-recent birth. While 98% of mothers made at least one ANC visit with 83.5% receiving the World Health Organization-recommended 4+ visits, only 74% accessed SBA indicating a 24% attrition in the CoC from ANC to SBA, and an 8% attrition from SBA to PNC. About 86% of mothers accessed PNC within 42 days postpartum. Distance to health facility, urban residence, and exposure to media information were strong predictors of the full complement of MNH continuumof- care utilization. Conclusion and Global Health Implications: The study found a remarkable utilization of MNH services in East Akim with significant attrition along the continuum-of-care. Efforts to enhance utilization of the MNH continuum-of-care should focus on increasing access to SBA in particular, through equitable distribution of MNH services in hard-to-reach areas and innovative communication approaches for reducing attrition at each level of the continuum-of-care. Evidence from this study can inform strategies for achieving universal access and utilization of the MNH continuum-of-care towards global goals and improved health outcomes in Ghana and other countries. Key words: • Continuum-of-care • Antenatal care • Skilled birth attendance • Postnatal care • Maternal health services • Maternal health • Newborn health • Ghana Copyright © 2021 Enos et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

2020 ◽  
Author(s):  
Xiaojing Fan ◽  
Meghan Bruce Kumar ◽  
Zhongliang Zhou ◽  
Ching-Hung Lee ◽  
Duolao Wang ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Rural Women ◽  
Healthcare Reform ◽  
Urban Women ◽  
Continuum Of Care ◽  
Maternal Health Services ◽  
Shaanxi Province ◽  
Cross Sectional ◽  
Generalised Linear Mixed Model

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation.Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation.Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ2=20.64, P<0.001; rural: χ2=131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ2=10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ2=2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural).Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women.

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