scholarly journals A comparative study of adult and adolescent maternal care continuum following community-oriented interventions in Cambodia, Guatemala, Kenya, and Zambia

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261161
Author(s):  
Anbrasi Edward ◽  
Younghee Jung ◽  
Grace Ettyang ◽  
Chhea Chhorvann ◽  
Casey Risko ◽  
...  
Keyword(s):  
Low Income ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Adult Women ◽  
Care Seeking ◽  
Care Continuum ◽  
Birth Attendance ◽  
Maternal Morbidity And Mortality ◽  
Adolescents And Adults ◽  
Quasi Experimental

Background The coverage for reproductive care continuum is a growing concern for communities in low- income economies. Adolescents (15–19 years) are often at higher odds of maternal morbidity and mortality due to other underlying factors including biological immaturity, social, and economic differences. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20–49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive care-seeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design. Methods In each country, communities in two districts/sub-districts received timed community health worker (CHW) household health promotion and social accountability interventions with community scorecards. Two matched districts/sub-districts were selected for comparison and received routine healthcare services. Results Results from the final evaluation showed that there were no significant differences in the care continuum for adolescents and adults except for Kenya (26.1% vs 18.8%, p<0.05). SBA was significantly higher for adolescents compared to adult women for Guatemala (64% vs 55.5%, p<0.05). Adolescents in the intervention sites showed significantly higher ANC utilization for Kenya (95.3% vs 84.8%, p<0.01) and Zambia (87% vs 72.7%, p<0.05), ANC4 for Cambodia (83.7% vs 43.2%, p<0.001) and Kenya (65.9% vs 48.1%, p<0.05), SBA for Cambodia (100% vs 88.9%, p<0.05), early PNC for Cambodia (91.8% vs 72.8%, p<0.01) and Zambia (56.5% vs 16.9%, p<0.001) compared to the comparison sites. However, the findings from Guatemala illustrated significantly lower care continuum for intervention sites (aOR:0.34, 95% CI 0.28–0.42, p<0.001). The study provides some evidence on the potential of multilevel community-oriented interventions to improve adolescent healthcare seeking in rural contexts. The predictors of care continuum varied across countries, indicating the importance of contextual factors in designing interventions.

scholarly journals Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Petula Fernandes ◽  
Emmanuel Kolawole Odusina ◽  
Bright Opoku Ahinkorah ◽  
Komlan Kota ◽  
Sanni Yaya
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Reproductive Age ◽  
Maternal Healthcare ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan. Methods This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression. Results Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001). Conclusions Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

scholarly journals Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chijioke Okoli ◽  
Mohammad Hajizadeh ◽  
Mohammad Mafizur Rahman ◽  
Rasheda Khanam
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Healthcare Services ◽  
Socioeconomic Inequalities ◽  
Low Income Countries ◽  
Theil Index ◽  
Maternal Healthcare ◽  
North East ◽  
Birth Attendance ◽  
Urban And Rural Areas

Abstract Background Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. Methods The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. Results The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Conclusion We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

Normative Beliefs and Values Shape Mother’s Care Seeking Behaviours for Skilled Birth Attendance (Sba) During Birthing in Africa: A Scoping Review Protocol

2020 ◽  
Author(s):  
Choolwe Jacobs ◽  
Adnan Hyder
Keyword(s):  
Scoping Review ◽  
Grey Literature ◽  
Skilled Birth Attendance ◽  
Health Facilities ◽  
Barriers And Facilitators ◽  
Care Seeking ◽  
Normative Beliefs ◽  
Birth Attendance ◽  
Beliefs And Values ◽  
Scoping Reviews

Abstract Background: Skilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. An understanding of the beliefs and values and how mothers are influenced by relational normative motivations is critical in understanding some “hidden” barriers and facilitators to utilisation of SBA in health facilities.Methods: A scoping review of normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa will be conducted. Google scholar, PubMed, EBSCOhost, SCOPUS, Embase and WEB of Science will be searched for articles that meet the eligibility criteria. The primary search will include peer-reviewed articles. Further searches will be made on Research gate, including grey literature from university websites for dissertations and theses. We will also search reference lists for relevant articles and studies. Keyword searches will be used to identify articles. Two independent reviewers will begin screening for eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. During title and abstract screening, duplicates will be removed. Study selection will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and the Mixed Method Appraisal Tool will determine the quality of included studies. Content analysis will be used to present the narrative Discussion: Understanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible “hidden” barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa.

scholarly journals Normative beliefs and values that shape care-seeking behaviours for skilled birth attendance (SBA) during birthing by mothers in Africa: a scoping review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Choolwe Jacobs ◽  
Adnan A. Hyder
Keyword(s):  
Health Care Providers ◽  
Scoping Review ◽  
Grey Literature ◽  
Skilled Birth Attendance ◽  
Health Facilities ◽  
Care Seeking ◽  
Care Providers ◽  
Normative Beliefs ◽  
Birth Attendance ◽  
Beliefs And Values

Abstract Background Skilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. The proposed scoping review aims to map literature on beliefs and values and how mothers are influenced by relational normative motivations in utilisation of SBAs in health facilities. Methods We designed and registered a study protocol for a scoping review. Literature searches will be conducted in multiple electronic databases (from January 2000 onwards), including PubMed, EMBASE, Scopus and Web of Science. Grey literature will be identified through searching dissertation databases, Google Scholar, EBSCOhost and ResearchGate. Keyword searches will be used to identify articles. Only articles published in English, related on beliefs and values surrounding childbirth, and on perceptions towards facility delivery or skilled health care providers will be considered eligible for inclusion. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. The study methodological quality (or bias) will be appraised using the Mixed Method Appraisal Tool. A narrative summary of findings will be conducted. We will employ NVIVO version 10 software package to extract the relevant outcomes from the included articles using content thematic analysis. This protocol is registered with the Open Science Framework (osf.io/9gn76). Discussion Understanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible ‘hidden’ barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care-seeking behaviours for skilled birth attendance by mothers in Africa.

scholarly journals Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Edward Kwabena Ameyaw ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Maternal Education ◽  
Economic Status ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Married Women ◽  
Maternal Healthcare ◽  
Maternal Deaths ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background In Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon. Methods Data from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15–49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI). Results The coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11–1.91), higher decision making (aOR = 1.88, 95% CI: 1.36–2.59), maternal education (aOR = 2.38, 95% CI; 1.65–3.42), place of residence (aOR = 0.50, 95% CI; 0.33–0.74), religion (aOR = 0.55, 95% CI; 0.35–0.87), economic status (aOR = 5.16, 95% CI; 2.58–10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05–1.65), parity (aOR = 0.62, 95% CI; 0.41–0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01–20.89) were found to be significant predictors of skilled birth attendance. Conclusions This study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals. Plain English Summary Globally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance. This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.

scholarly journals Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

2020 ◽  
Author(s):  
Anbrasi Edward ◽  
Aparna Krishnan ◽  
Grace Ettyang ◽  
Younghee Jung ◽  
Henry B Perry ◽  
...  
Keyword(s):  
Experimental Study ◽  
Health Promotion ◽  
Secondary Education ◽  
Rural Communities ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Social Accountability ◽  
Birth Attendance ◽  
Quasi Experimental ◽  
Matched Comparison

Abstract Background Skilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce. Methods A quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on skilled birth attendance (SBA). In each country, communities in two districts/sub-districts received a package of community-oriented interventions comprised of timed CHW household health promotion for maternal, newborn and child health complemented by social accountability mechanisms using community scorecards. Two matched comparison districts/sub-districts received ongoing routine interventions. Data from the final evaluation were examined to determine the effect of timed CHW services and community-oriented interventions on SBA. Results Over 80% of the 3,037 women in Cambodia, 2,805 women in Kenya and 1,171 women in Zambia reported SBA. Women in intervention sites who received timely CHW health promotion and social accountability mechanisms in Cambodia showed significantly higher odds of SBA (aOR=7.48; 95% CI: 3.87, 14.5). The findings also indicated that women over the age of 24 in Cambodia, women with primary or secondary education in Cambodia and secondary education in Kenya, women from higher wealth quintiles in Cambodia, and women with four or more antenatal care (ANC) visits in all countries reported significantly higher odds of SBA. Inclusion of family members in pregnancy-related discussions in Kenya (aOR=2.12; 95% CI: 1.06, 4.26) and Zambia (aOR=6.78; 95% CI: 1.15, 13.9) and follow up CHW visits after a referral or health facility visit (aOR=2.44; 95% CI: 1.30, 4.60 in Cambodia; aOR=2.17; 95% CI 1.25, 3.75 in Kenya; aOR=1.89; 95% CI: 1.05, 2.02 in Zambia) also showed significantly greater odds of SBA.Conclusions Enhancing people-centered care through culturally appropriate community-oriented strategies integrating timely CHW health promotion and social accountability mechanisms shows some evidence for improving SBA during delivery. These strategies can accelerate the achievement of the sustainable development goals for maternal child and newborn health.

scholarly journals The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia

2019 ◽  
Vol 4 (4) ◽  
pp. e001388 ◽  
Author(s):  
Abimbola Olaniran ◽  
Barbara Madaj ◽  
Sarah Bar-Zev ◽  
Nynke van den Broek
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Health Workers ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Scope Of Practice ◽  
Maternal And Newborn Health ◽  
Birth Attendance ◽  
Maternal And Newborn

IntroductionA variety of community health workers (CHWs) provide maternal and newborn health (MNH) services in low-income and middle-income settings. However, there is a need for a better understanding of the diversity in type of CHW in each setting and responsibility, role, training duration and type of remuneration.MethodsWe identified CHWs providing MNH services in Bangladesh, India, Kenya, Malawi and Nigeria by reviewing 23 policy documents and conducting 36 focus group discussions and 131 key informant interviews. We analysed the data using thematic analysis.ResultsIrrespective of training duration (8 days to 3 years), all CHWs identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. Therapeutic care, antenatal care and skilled birth attendance, and provision of long-acting reversible contraceptives are within the exclusive remit of CHWs with training greater than 3 months. In contrast, community mobilisation and patient tracking are often done by CHWs with training shorter than 3 months. Challenges CHWs face include pressure to provide MNH services beyond their scope of practice during emergencies, and a tendency in some settings to focus CHWs on facility-based roles at the expense of their traditional community-based roles.ConclusionCHWs are well positioned geographically and socially to deliver some aspects of MNH care. However, there is a need to review and revise their scope of practice to reflect the varied duration of training and in-country legislation.

Under 5 Children Mortality in Sudan: Situation Analysis

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Selwa Y Abdeldafie
Keyword(s):  
Postnatal Care ◽  
Skilled Birth Attendance ◽  
Community Treatment ◽  
Care Seeking ◽  
Antenatal Corticosteroids ◽  
Birth Attendance ◽  
Essential Interventions ◽  
The Government ◽  
Minimal Reduction ◽  
Initiation Of Breastfeeding

Sudan like other developing countries suffers a high mortality rate among under 5 children. Although there is an steady minimal reduction of this rate among Sudanese children but it is still high even after implementing many policies and interventions by the federal government. The aim of this work is to analyze the situation of under 5children mortality in Sudan in term of trend, causes of death, policies and interventions under taken to reduce this risk. Methods :the Sudan annual statistical report of 2015 was reviewed, it revealed that : the trend of under 5children mortality in Sudan is 70.10 as of 2015 and this is the lowest value while the highest one is 178.40 in the year 1960.There are a lot of policies under taken by the government to reduce this risk like : diarrhea community treatment , antenatal corticosteroids , postnatal care and IMCI implementation and the essential interventions which are implemented include :exclusive breastfeeding, skilled birth attendance, postnatal care, early initiation of breastfeeding , access to improved drinking- water sources, pneumonia care-seeking and pneumonia antibiotics.

scholarly journals Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

2019 ◽  
Author(s):  
Anbrasi Edward ◽  
Aparna Krishnan ◽  
Grace Ettyang ◽  
Younghee Jung ◽  
Henry B Perry ◽  
...  
Keyword(s):  
Experimental Study ◽  
Health Promotion ◽  
Rural Communities ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Maternal Health Services ◽  
Social Accountability ◽  
Engagement Strategies ◽  
Birth Attendance ◽  
Quasi Experimental

Abstract Background Skilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce. Methods A quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on SBA. In each country, communities in two districts/sub-districts received a package of community-oriented interventions comprised of timed CHW household health promotion for maternal, newborn and child health complemented by social accountability mechanisms using community scorecards. Two comparison districts/sub-districts received ongoing routine interventions. Data from the final evaluation were examined to determine the effect of community-oriented interventions including timed CHW services and SBA. Results Over 90% of the 3,037 women in Cambodia, 2,805 women in Kenya and 1,171 women in Zambia reported SBA. Women in intervention sites who received timely CHW health promotion and social accountability mechanisms in Cambodia and Kenya showed significantly higher odds of SBA (Cambodia, aOR=7.48; 95% CI: 3.87, 14.5, Kenya, aOR=0.60; 95% CI: 0.41, 0.85). The findings also indicated that older women (>24 years), in Cambodia, women with primary or secondary education in Cambodia and Kenya, women from higher wealth quintiles in Cambodia, and women with four or more ANC visits in all countries reported significantly higher odds of SBA. Inclusion of family members in pregnancy-related discussions (aOR=1.69; 95% CI: 0.92, 3.13 in Cambodia; aOR=2.12; 95% CI: 1.06, 4.26 in Kenya; aOR=6.78; 95% CI: 1.15, 13.9 in Zambia), follow up visits from the CHW following a referral or health facility visit (aOR=2.44; 95% CI: 1.30, 4.60 in Cambodia; aOR=2.17; 95% CI 1.25, 3.75 in Kenya; aOR=1.89; 95% CI: 1.05, 2.02 in Zambia) also showed significantly greater odds of SBA. Conclusions Enhancing people-centered care through culturally appropriate community-oriented strategies integrating timely CHW health promotion and social accountability mechanisms shows some evidence for improving SBA during delivery and accelerating the sustainable development goals for maternal child and newborn health.

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