Predictors of Utilisation of Skilled Maternal Healthcare in Lilongwe District, Malawi

Background: Despite numerous efforts to improve maternal and child health in Malawi, maternal and newborn mortality rates remain very high, with the country having one of the highest maternal mortality ratios globally. The aim of this study was to identify which individual factors best predict utilisation of skilled maternal healthcare in a sample of women residing in Lilongwe district of Malawi. Identifying which of these factors play a significant role in determining utilisation of skilled maternal healthcare is required to inform policies and programming in the interest of achieving increased utilisation of skilled maternal healthcare in Malawi. Methods: This study used secondary data from the Woman’s Questionnaire of the 2010 Malawi Demographic and Health Survey (MDHS). Data was analysed from 1126 women aged between 15 and 49 living in Lilongwe. Multivariate logistic regression was conducted to determine significant predictors of maternal healthcare utilisation. Results: Women’s residence (P=.006), education (P=.004), and wealth (P=.018) were significant predictors of utilisation of maternal healthcare provided by a skilled attendant. Urban women were less likely (odds ratio [OR] = 0.47, P=.006, 95% CI = 0.28–0.81) to utilise a continuum of maternal healthcare from a skilled health attendant compared to rural women. Similarly, women with less education (OR = 0.32, P=.001, 95% CI = 0.16–0.64), and poor women (OR = 0.50, P=.04, 95% CI = 0.26–0.97) were less likely to use a continuum of maternal healthcare from a skilled health attendant. Conclusion: Policies and programmes should aim to increase utilisation of skilled maternal healthcare for women with less education and low-income status. Specifically, emphasis should be placed on promoting education and economic empowerment initiatives, and creating awareness about use of maternal healthcare services among girls, women and their respective communities.

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

BMC Health Services Research ◽

10.1186/s12913-020-05700-w ◽

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.

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Socioeconomic inequalities in maternal healthcare utilization in Zambia: 1997-2014

10.21203/rs.3.rs-26381/v1 ◽

2020 ◽

Author(s):

Zhifei He ◽

Ghose Bishwajit ◽

Sanni Yaya ◽

Zhaohui Cheng ◽

Guo Shuyan ◽

...

Keyword(s):

Postnatal Care ◽

Multivariate Regression ◽

Healthcare Utilisation ◽

Healthcare Services ◽

Socioeconomic Inequalities ◽

Facility Delivery ◽

Health Facility Delivery ◽

Maternal Healthcare ◽

Regression Methods ◽

Care Services

Abstract Background Exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilisation between 1997 and 2014. Methods Data were analyzed using descriptive and multivariate regression methods. Results Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate ANC visit was comparatively higher among those in the lower wealth quintiles. Conclusion Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilisation of these services.

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Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/4691477 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Navid Feroze ◽

Muhammad Ajmal Ziad ◽

Rabia Fayyaz ◽

Yaé Ulrich Gaba

Keyword(s):

Logistic Regression ◽

Regression Models ◽

Goodness Of Fit ◽

Healthcare Services ◽

Maternal Healthcare ◽

Logistic Regression Models ◽

Socioeconomic Groups ◽

Bayesian Logistic Regression ◽

Skilled Health ◽

Better Than

Objectives. This study is aimed at investigating the time trends and disparities in access to maternal healthcare in Pakistan using Bayesian models. Study Design. A longitudinal study from 2006 to 2018. Methods. The detailed analysis is based on the data from Pakistan Demographic and Health Survey (PDHS) conducted during 2006-2018. We have proposed Bayesian logistic regression models (BLRM) to investigate the trends of maternal healthcare in the country. Based on different goodness-of-fit criteria, the performance of proposed models has also been compared with repeatedly used classical logistic regression models (CLRM). Results. The results from the analysis suggested that BLRM perform better than CLRM. The access to antenatal healthcare increased from 61% to 86% during years 2006-18. The utilization of medication also improved from 44% in 2006 to 60% in 2018. Despite the improvements from 2006 to 2018, every three out of ten women were not protected against neonatal tetanus, neither delivered in the health facility place nor availed with the skilled health provider at the time of delivery during 2018. Similarly, two-fifth mothers did not received any skilled postnatal checkup within two days after delivery. Additionally, the likelihood of MHS provided to mothers is in favor of mothers with lower ages, lower birth orders, urban residences, higher education, higher wealth quintiles, and residents of Sindh and Punjab. Conclusions. The gaps in utilization of MHS in different socioeconomic groups of the society have not decreased significantly during 2006-2018. Any future maternal health initiative in the country should focus to reduce the observed disparities among different socioeconomic sectors of the society.

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Continuum of maternal healthcare services utilisation and associated factors among women who gave birth in Siyadebirena Wayu district, Ethiopia: community-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-051148 ◽

2021 ◽

Vol 11 (11) ◽

pp. e051148

Author(s):

Seblewongel Gebretsadik Sertsewold ◽

Ayal Debie ◽

Demiss Mulatu Geberu

Keyword(s):

Healthcare Utilisation ◽

Healthcare Services ◽

Cross Sectional Study ◽

Healthcare Sector ◽

Sectional Study ◽

Maternal Healthcare ◽

Community Based ◽

Cross Sectional ◽

Central Ethiopia ◽

Factors Associated

ObjectiveThis study aimed to analyse the prevalence and factors associated with continuum of maternal healthcare services among women who gave birth in Siyadebirena Wayu district, Central Ethiopia.DesignCommunity-based cross-sectional study.SettingAt eight Kebeles in Central Ethiopia.ParticipantsThe study was done on 614 women aged 15–49 years using interviewer-administered structured questionnaire. Following proportional allocation of the sample, we used simple random sampling technique to select study participants.MethodsBinary logistic regression model was fitted to identify the factors associated with the outcome. Variables with p<0.2 in the bivariable analysis were the candidates for multivariable analysis. A p<0.05 and adjusted OR (AOR) with 95% CI were taken to declare the factors and the strengths of association with continuum of maternal healthcare utilisation.OutcomeContinuum of maternal healthcare utilisation.ResultsOnly 16.1% (95% CI 13.3% to 19.0%) of the women had used a complete continuum of maternal health services. Variables, such as contraceptive use (AOR 4.95; 95% CI 1.61 to 15.20), autonomy (AOR 4.45; 95% CI 1.69 to 11.60), urban residence (AOR 3.91; 95% CI 1.06 to 14.39), educated women (AOR 5.36; 95% CI 1.15 to 25.06), took less than 30 min to reach a health facility (AOR 3.17; 95% CI 1.38 to 7.25), use public transportation (AOR 2.48; 95% CI 1.12 to 5.52) and good knowledge (AOR 9.88; 95% CI 3.89 to 25.0) were positively associated with continuum of maternal healthcare. In the contrary, women who had third child birth order (AOR 0.22; 95% CI 0.06 to 0.8) was negatively associated.ConclusionsOverall, the level of the continuum of maternal healthcare services utilisation was low compared with the national and global targets. Therefore, programme planners and implementer had better conduct health education to enhance the awareness of women about continuum of maternal healthcare services. Healthcare sector policy-makers and managers shall also scale up healthcare facilities to improve access to maternal healthcare services.

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Socioeconomic Determinants of Maternal HealthCare Utilisation in Zambia: 1997-2014

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211067480 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110674

Author(s):

Zhifei He ◽

Caihua Zhang ◽

Shiming Wang ◽

Ghose Bishwajit ◽

Xinglong Yang

Keyword(s):

Postnatal Care ◽

Multivariate Regression ◽

Healthcare Utilisation ◽

Healthcare Services ◽

Facility Delivery ◽

Health Facility Delivery ◽

Maternal Healthcare ◽

Regression Methods ◽

Care Services ◽

Care Visit

This study aims at exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilization between 1997 and 2014. Data were analyzed using descriptive and multivariate regression methods. Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate antenatal care visit was comparatively higher among those in the lower wealth quintiles. Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilization of these services.

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Micro Credit: The Empowerment of Women

Business and Management Horizons ◽

10.5296/bmh.v2i1.4853 ◽

2014 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Md. Ariful Islam ◽

Mahmudul Hasan Siddiqui ◽

Kh. Fahim Hossain ◽

Md. Rayhan Islam

Keyword(s):

Rural Women ◽

Impact Analysis ◽

Secondary Data ◽

Rural Poor ◽

Credit Institution ◽

The Poor ◽

Long Run ◽

Poor Women ◽

The Impact ◽

Micro Credit

All Micro-credit institutions of Bangladesh claim that they bring the poor women from dead end situation to a promising position by providing a very small size of loan, which is given in cash. This paper attempts to critically examine the impacts of micro credit program of micro credit institution on the empowerment of the rural poor women. In this study some major indicators of women empowerment have been specified so as to make a judgment whether or not micro credit institution could actually reach the poor women. The details of the impact analysis in this sphere have been made by using both the qualitative and quantitative tools on the basis of secondary data. The estimates show hardly any significant relationship between micro credit institute operations and a strong position of the rural women in question.However the gloomy findings of this paper are expected to create awareness of the policy makers about the long run impact of micro credit programs of micro credit institution and followers on the rural poor women.

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Demand for Family Planning among Poor Women in Uganda: Analysis of the Uganda Demographic and Health Surveys

10.21203/rs.3.rs-39847/v2 ◽

2020 ◽

Author(s):

Allen Kabagenyi ◽

Pamela Kakande ◽

Vianney Owayezu

Keyword(s):

Family Planning ◽

Health Facility ◽

Low Income ◽

Rural Women ◽

Health Surveys ◽

Health Workers ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

The Poor ◽

Poor Women

Abstract Background: Family planning is one of the major cost-effective interventions to improve maternal health, reduce maternal and child mortality, and prevent unplanned pregnancies, yet its use remains low in sub-Saharan Africa, especially among the poor. In Uganda, little is known about the factors influencing the demand for family planning among the poor. This study examines the determinants of demand for family planning among poor women in a low income country.Methods: The study is based on data from the 2006, 2011, and 2016 Uganda Demographic and Health Surveys (UDHS). The analysis was carried using weighted samples of 2,238 in 2006, 2,164 in 2011, and 4,370 in 2016. Descriptive statistics, and binary logistic regressions presenting both the unadjusted and adjusted were used to examine the influence of different demographic, behavioral, and socioeconomic factors on poor women’s demand for family planning.Results: Our findings showed demand for family planning was 56% in 2006, 60% in 2011, and 65% in 2016 among women in the poorest and poorer household health quintiles who were married or in union. In all three surveys, women age 25-39 had higher odds of demand for family planning compared with women age 15-24 (AOR=1.5, 95% CI=1.1-1.9 in 2006, AOR=2.2, 95% CI=1.7-2.7 in 2011, AOR=1.7, 95% CI=1.5-2.0 in 2016). Women with no education had lower odds of demand for family planning compared with those with secondary education (AOR=0.4, 95% CI=0.3-0.6, pooled results). Also, in the 2011 UDHS, women who had heard about family planning on the radio had higher odds of demand (AOR=1.4, 95% CI=1.1-1.7, pooled) for family planning compared with those who had not, and in the 2006 survey women who had discussed family planning at a health facility had higher odds of demand for family planning (AOR=1.0, 95% CI=0.8-1.2) compared with women who had not done so.Conclusions: Demand for family planning is influenced by a woman’s age, educational attainment, religion, exposure to family planning messages on the radio, and discussion on family planning at a health facility. This study underscores the need for increased family planning counseling by health workers and more discussion about family planning at the health facility. The findings further suggest the need to provide increased adequate family planning services and information for the poor, uneducated, and rural women to meet the demand for family planning.

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An Exploration of the Unintended Consequences of Performance-Based Financing in 6 Primary Healthcare Facilities in Burkina Faso

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.83 ◽

2020 ◽

Cited By ~ 1

Author(s):

Anne-Marie Turcotte-Tremblay ◽

Idriss Ali Gali Gali ◽

Valéry Ridde

Keyword(s):

Burkina Faso ◽

Low Income ◽

Diffusion Of Innovations ◽

Secondary Data ◽

Healthcare Services ◽

Unintended Consequences ◽

Low Income Countries ◽

Structured Interviews ◽

Healthcare Facilities ◽

Performance Based Financing

Background: Performance-based financing (PBF) is promoted to improve the quality and quantity of healthcare services in low-income countries. Despite the complexity of the intervention, little attention has been given to studying its unintended consequences. Our objective is to increase evidence on the unintended consequences of PBF in Burkina Faso. Methods: Using the diffusion of innovations theory, we conducted a multiple case study. The cases were 6 healthcare facilities in two districts. Between April 2015 and 2016, we collected data through 101 semi-structured interviews, discussions, observations, and documents. We conducted thematic analysis using a hybrid deductive-inductive approach. Secondary data was used to illustrate the evolution of reported services. We conducted a cross-case synthesis to identify the results arising independently from more than 1 case. Results: A desirable unintended consequence of PBF was that 3 facilities limited the sale of non-prescribed medication to encourage patients to consult. Undesirable unintended consequences were found in the majority of facilities including fixation on measures rather than on underlying objectives, the pursuit of narrow and less relevant performance indicators, gaming, and teaching trainees improper practices. Providers in all facilities deliberately manipulated medical registers and documents, such that the reported quantity and quality of care differed from what was actually delivered. While most participants indicated that PBF was more advantageous than previous practices, the long payment delays were a source of dissatisfaction and demotivation across all facilities. Dissatisfaction also emerged in relation to the distribution of subsidies and the non-attribution of quality points for services delivered by certain staff considered "unqualified" in guidelines. Results in many facilities revealed suboptimal planning, a perception of the intervention as "budgetivorous," as well as tensions related to the principle of managerial autonomy. Conclusion: PBF led to numerous unintended consequences that could undermine the intervention’s effectiveness. The findings contribute to a more comprehensive picture of the consequences of implementing PBF. Policy-makers can use the results of this study to devise effective strategies before, during and after the implementation of the intervention to minimize undesirable unintended consequences and promote desirable ones.

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Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

10.21203/rs.3.rs-885444/v1 ◽

2021 ◽

Author(s):

Anne Niyigena ◽

Saidath Gato ◽

Barnabas Alayande ◽

Elizabeth Miranda ◽

Bethany Hedt-Gauthier ◽

...

Keyword(s):

Physical Health ◽

Functional Status ◽

Functional Recovery ◽

Low Income ◽

Rural Women ◽

Post Partum ◽

Intraoperative Complications ◽

Physical Health Outcomes ◽

Income Status ◽

Poor Functional Status

Abstract Background Women who deliver via cesarean section (c-section) experience short- and long-term complications that may affect their physical health and their ability to function normally. While physical health outcomes are routinely assessed and monitored, postpartum functional outcomes are not well understood from a patient’s perspective or characterized by clinicians. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. Methods Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities. We computed composite mean scores with a maximum score of 4.0 and scores ≤ 2.0 reflected poor functionality. We assessed functionality with descriptive statistics and logistic regression. Results Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 minutes had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, p = 0.037). High income patients had incrementally lower significant odds of poor functionality (aOR = 0.62 for every US$100 increase in monthly income, p = 0.04). Conclusion We found a high proportion of poor functionality 30 days post-c-section and while surgery lasting > 30 minutes and experiencing intra-operative complications was associated with poor functionality, a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.

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Birth preparedness and Complications Readiness among Women of Reproductive Age in Rural Benue State, Nigeria

The Nigerian Journal of Sociology and Anthropology ◽

10.36108/njsa/0202/81(0201) ◽

2020 ◽

Vol 18 (2) ◽

Author(s):

Joyce Rumun Akpenpuun ◽

Joy Nguavese Waroh ◽

Celina Amaechi Eze ◽

Nguemo Audu

Keyword(s):

Rural Communities ◽

Rural Women ◽

Rational Choice Theory ◽

Healthcare Services ◽

Reproductive Age ◽

Birth Preparedness ◽

Women Of Reproductive Age ◽

Maternal Healthcare ◽

Complication Readiness ◽

Pregnancy And Childbirth

In many sub-Saharan African countries, including Nigeria, pregnancy and childbirth complications are among the leading causes of mortality and morbidities among women of reproductive age especially in rural communities. This paper examined how women in rural Benue State prepare for births especially as it relates to utilization of maternal healthcare services to avoid potential pregnancy and childbirth related complications. It specifically investigated the factors that hinder rural women from birth preparedness and complication readiness (BPCR). The study which was anchored on Rational Choice Theory utilized intra method triangulation to elicit qualitative data from women of reproductive age (15-49), Woman leaders and community health personnel from 6 rural communities drawn from 3 local government areas in Benue State. Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were the main instruments used for data collection in order to capture the nuances involved. Findings indicate that utilization of maternal health services in preparation for births among rural women is poor. Cost of transportation, poor knowledge and concerns over cost of service were key barriers to BPCR. The study recommends that policy makers and all stake holders should intensify awareness on the needs and importance of BPCR, and that government should consider complete removal of user-fees on maternal healthcare services in order to improve BPCR.

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