Influencing factors of unmet needs for child spacing among selected countries experiencing high maternal-mortality in sub-Saharan Africa

Background: Maternal complication and death has been implicated in unintended pregnancy. The indicator for measuring the risk of unintended pregnancy is unmet need for family planning (FP). It is necessary to explore the current situation of unmet need for child spacing (UNCS) as well as its influencing factors among countries that are experiencing high maternal mortality ratio. We aimed to unveil the prevalence of UNCS and its associated factors in Nigeria, Liberia and Sierra Leone.Methods: We analysed the data from DHS phase VII survey, a cross- sectional study conducted from year 2017 to 2018 across several countries. Total records of 25,539, 5,553, and 10,050 were extracted for Nigeria, Liberia and Sierra Leone respectively. Explored variables were UNCS, demographic characteristics and husband’s partners profile. Data was analysed using SPSS version 25. Descriptive statistics, test of association (chi-square) and binary logistic regression were used during the data analysis (α0.05).Results: UNCS was high in Nigeria (15.9%), Liberia (22.5%) and Sierra Leone (21.9%). In Nigeria, Liberia and Sierra Leone, 40%, 37% and 49.1% were uneducated respectively. The proportion of married women were 89% in Nigeria, 32% in Liberia and 70.2% in Sierra Leone. Also, female headship of household (OR: 1.29, 95%CI: 1.09-1.54) was associated with UNCS relative to male headship of household.Conclusions: UNCS was high in the three countries. Factors like educational status of women, age, as well as women as head of the households should be given much attention in the efforts to reduce UNCS as identified in this study.

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Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

Journal of Lumbini Medical College ◽

10.22502/jlmc.v5i2.151 ◽

2017 ◽

Vol 5 (2) ◽

pp. 58-63

Author(s):

Junu Shrestha ◽

Sangeeta Gurung ◽

Ashika Shrestha ◽

Anjali Subedi

Keyword(s):

Health Care ◽

Maternal Mortality ◽

Rural Areas ◽

Care Center ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Medical Personnel ◽

Educational Status ◽

Cross Sectional ◽

Maternal Deaths

Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients. Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.

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Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4317 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Tabeta Seeiso ◽

Mamutle M. Todd-Maja

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Geographic Location ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Danger Signs ◽

In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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Prevalence and risk factors of worry among teachers during the COVID-19 epidemic in Henan, China: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-045386 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045386

Author(s):

Yanqing Wang ◽

Quanman Li ◽

Clifford Silver Tarimo ◽

Cuiping Wu ◽

Yudong Miao ◽

...

Keyword(s):

Influencing Factors ◽

Age Groups ◽

Educational Status ◽

Henan Province ◽

Anxiety Level ◽

Cross Sectional Survey ◽

Cross Sectional ◽

School Location ◽

Fear Level ◽

Attention Level

ObjectiveTo evaluate the level of worry and its influencing factors during the COVID-19 epidemic among teachers in Henan Province in China.Study designA cross-sectional study was conducted.MethodsWe designed a cross-sectional survey that included 88 611 teachers from three cities in Henan Province, China between 4 February 2020 and 12 February 2020. Level of worry was measured using a five-item Likert scale, with 1 being ‘not worried’ and 5 being ‘very worried’. The OR and 95% CI of potential influencing factors for level of worry among study participants were estimated using ordinal logistic regression models.ResultsAbout 59% of teachers reported being ‘very worried’ about the COVID-19 epidemic. The proportion of female teachers was higher than of male teachers (60.33% vs 52.89%). In all age groups considered in this study, a ‘very worried’ condition accounted for the highest proportion. The age group 40–49 years had the lowest proportion of participants who were very worried, 52.34% of whom were men and 58.62% were women. After controlling for potential confounding factors, age, education level, type of teacher, school location, attention level, fear level, anxiety level and behaviour status were all related to level of worry (all p<0.05).ConclusionDuring the COVID-19 epidemic, there was a high proportion of teachers who were ‘very worried’ about the situation in Henan Province, China. Our study may remind policymakers to consider factors including age, educational status, type of teacher, school location, source of information on COVID-19, attention level, anxiety level, fear level and behaviour status to alleviate worry.

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Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

10.21203/rs.2.11153/v2 ◽

2019 ◽

Author(s):

Sulaiman Lakoh ◽

Hannah Rickman ◽

Momodu Sesay ◽

Sartie Kenneh ◽

Rachael M. Burke ◽

...

Keyword(s):

Sierra Leone ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cd4 Count ◽

Sub Saharan Africa ◽

World Health ◽

Categorical Variables ◽

Hiv Patients ◽

Cross Sectional ◽

Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

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Knowledge of Neonatal Danger Signs and Its Associated Factors among Mothers Attending Child Vaccination Centers at Sheko District in Southwest Ethiopia

International Journal of Pediatrics ◽

10.1155/2020/4091932 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Tewodros Yosef ◽

Tadesse Nigussie ◽

Adane Asefa

Keyword(s):

Associated Factors ◽

Educational Status ◽

Sub Saharan Africa ◽

Good Knowledge ◽

Health Seeking ◽

Public Health Importance ◽

Cross Sectional ◽

Southwest Ethiopia ◽

Danger Signs ◽

Child Vaccination

Background. Even though a great improvement in the last twenty years, the problem of newborn deaths is still remaining. In 2017 alone, an estimated 2.5 million neonatal deaths occurred worldwide, around 39 percent of all deaths in sub-Saharan Africa. Early detection of neonatal illness is an important step towards improving newborn survival. If mothers know the appropriate manifestations of the causes of death in newborns (neonatal danger signs), it is possible to avert related mortality, because of the health-seeking behavior of mothers highly relies on their knowledge of neonatal danger signs. Objective. To assess knowledge of neonatal danger signs and its associated factors among mothers attending child vaccination centers at Sheko District in Southwest Ethiopia. Methods. A facility-based cross-sectional study was conducted among 351 mothers who attended health centers for child vaccination in Sheko District from March 17 to April 30, 2018. A consecutive sampling method was used to select study participants. Data were collected by using structured questionnaires through face-to-face interviews. Data were entered using EPI-DATA version 3.1 and analysed using SPSS version 21. Results. Of the 351 mothers interviewed, 39% (137) had good knowledge of neonatal danger signs. The study also found that mothers aged 29-40 years (AOR=2.37, 95% CI [1.35-4.17], P=0.003), educational status of primary and above (AOR=2.68, 95% CI [1.48-4.88], P=0.001), attending ≥ 4 antenatal care visits during pregnancy (AOR=3.57, 95% CI [2.10-6.06], P<0.001), and history of postnatal attendance after birth (AOR=2.33, 95% CI [1.16-4.65], P=0.017) were significantly associated with good knowledge of neonatal danger signs. Conclusion. The proportion of mothers with good knowledge of neonatal danger signs was remarkably low. Since the problem is a public health importance in developing countries, particularly in Ethiopia, which determines future generations. Great efforts are needed to create awareness for mothers on the importance of the early identifying neonatal danger signs plus to avert the high magnitude of neonatal mortality.

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Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03276-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ayele Geleto ◽

Catherine Chojenta ◽

Tefera Taddele ◽

Deborah Loxton

Keyword(s):

Caesarean Section ◽

Maternal Mortality ◽

Addis Ababa ◽

Caesarean Section Rate ◽

National Level ◽

Maternal Mortality Ratio ◽

P Value ◽

Inverse Association ◽

Cross Sectional ◽

Significant Inverse Association

Abstract Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

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Midwifery workforce profile in Limpopo Province referral hospitals

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v6i1.573 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Sam T. Ntuli ◽

Gboyega A. Ogunbanjo

Keyword(s):

Maternal Mortality ◽

Registered Nurses ◽

Maternity Care ◽

Work Experience ◽

Limpopo Province ◽

Sub Saharan Africa ◽

Cross Sectional ◽

Referral Hospitals ◽

Negative Effect ◽

Sub Saharan

Background: In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas.Objective: To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa.Method: A cross-sectional descriptive study was conducted in all maternity units of Limpopo’s public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0.Results: The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study.Conclusion: This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province.

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Delaying first pregnancy in reducing burden of unintended pregnancy among married adolescents in urban slums of Bangladesh

Journal of Health Research ◽

10.1108/jhr-05-2018-034 ◽

2018 ◽

Vol 32 (4) ◽

pp. 298-306 ◽

Cited By ~ 2

Author(s):

Fauzia Akhter Huda ◽

Anisuddin Ahmed ◽

Hassan R. Mahmood ◽

Faisal Ahmmed ◽

Alessio Panza ◽

...

Keyword(s):

Unintended Pregnancy ◽

Adolescent Girls ◽

Design Methodology ◽

Educational Status ◽

Urban Slums ◽

Age Difference ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Content Type ◽

One Year

Purpose The purpose of this paper is to assess the effect of delaying first pregnancy in reducing burden of unintended pregnancy (UP) among married adolescent girls in urban slums of Bangladesh. Design/methodology/approach This cross-sectional survey was conducted among 783 married adolescents in five urban slums of Bangladesh during January 2013–January 2014. Findings Half of the respondents’ first pregnancy was reported as unintended. Of the respondents, 58 percent with no school education had experienced UP which was 38 percent among respondents with eight year’s education. Respondents who did not willingly agreed to their marriage experienced more UP (61 percent) than those who were agreed/got married by their own choice (51 percent). Respondents having five years of age difference with their husbands experienced more UP (58 percent) than those with ten years of age difference (46 percent). Respondents aged 14 years at first conception experienced 63 percent UP, while the respondents aged 18 years had 35 percent UP experience. Of the respondents, 66 percent who became pregnant within one year of marriage reported their pregnancy as unintended which was 29 percent among those who delayed their first pregnancy for three years. Originality/value Significant association was observed between pregnancy intention with respondents’ educational status (p=0.03), age difference with husbands (p=0.02), age at first conception (p<0.01) and delaying first pregnancy (p<0.001).

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IMPACT OF MATERNAL MORTALITY ON SUSTAINABLE DEVELOPMENT IN THE SELECTED WEST AFRICAN COUNTRIES

ACTA ECONOMICA ◽

10.7251/ace1931051a ◽

2019 ◽

Vol 17 (31) ◽

Author(s):

Joseph Afolabi Ibikunle

Keyword(s):

Health Care ◽

Sustainable Development ◽

Maternal Mortality ◽

Maternal Mortality Ratio ◽

West African ◽

African Countries ◽

The West ◽

Cross Sectional ◽

Cross Sectional Dependence ◽

The Impact

Over half a million females die every year as a result of pregnancy and birth complications. The vast majority of these fatalities can be avoided. SDG 3.1’s objective is to reduce the global maternal mortality ratio by 2030 to below 70 per 100,000 live births. Despite a number of policies put in place maternal mortality in Africa remains unacceptably high. This study investigates the impact of maternal mortal- ity on sustainable development in 9 selected West African countries for the period from 1990 to 2015. Data used were adjusted net savings, maternal mortality, consumer price index, per-capita income and financial development. The second-generation econometric methods were employed: cross sectional dependence, slope homogeneity, Westerlund cointegration, Eberhadt and Teal AMG regression, and the Emirmahmutoglu and Kose bootstrap Granger causality test. Findings confirm the following: First, cross-sectional dependence and slope heterogeneity exist among the West African countries. Second, there is a long run relationship between maternal mortality and sustainable development. Third, maternal mortality impacted negatively and signifi- cantly on sustainable development. Fourth, the direction of causality varies across countries between maternal mor- tality and sustainable development. Lastly, causality runs from maternal mortality to sustainable development when analyzing the causal relationship among all countries. The findings suggest that the West African government needs to commit more funding to the health care sector and ensure access to free healthcare service to pregnant women or at low cost with quality and effective health care services if the countries must attain sustainable development by 2030.

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Prevalence and Determinants of Maternal Mortality in Southeastern Iran (2013 - 2017): A Retrospective Cross-Sectional Study

Medical - Surgical Nursing Journal ◽

10.5812/msnj.119527 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Marzieh Ghasemi ◽

Narjes Noori ◽

Ghazaleh Parnian ◽

Erfan Ayubi ◽

Farangis Narouei

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Maternal Mortality Ratio ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Common Cause ◽

Elevated Liver Enzymes ◽

Mortality Ratio ◽

Pregnant Mothers

Background: Recognizing the factors affecting maternal death can lead to the adoption of strategies to prevent similar deaths. Objectives: This study was performed to investigate the prevalence and causes of pregnant mothers' death in the population covered by Zahedan University of Medical Sciences. Methods: In this retrospective, descriptive, cross-sectional study, the files of 126 pregnant mothers who died during 2013 - 2017 were evaluated. Demographic and obstetrics information and variables related to maternal mortality, such as maternal mortality ratio (MMR), the cause of mother’s death, the time of mother’s death, and place of death, were evaluated in general and separately in each city (i.e., Zahedan, Khash, Saravan, and Chabahar) based on descriptive statistics and according to the nature of the variables. Results: Maternal mortality ratio in Zahedan was 174.96 per 100,000 case, in Khash 190.56 per 100,000 cases, in Saravan 371.87 per 100,000 cases, and in Chabahar 384.03 per 100,000 cases. Bleeding was the most common cause of death (42.53%), 61.9% of pregnant women were living in rural areas, 80.2% died in the third trimester of pregnancy, and 42.9% died in first 24 hours after delivery. The most common underlying disease was hypertension, 70.6% of mothers died in hospitals, and 47.6% were illiterate. The most common cause of maternal death in Zahedan was cardiac disease, in Khash it was hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, eclampsia, and preeclampsia, and in Saravan and Chabahar the leading cause was bleeding. Conclusions: Maternal mortality ratio was high in Sistan and Baluchestan. The investigation of the causes of maternal deaths showed that some of these deaths are avoidable. It is also necessary to improve midwifery emergencies management with intensive monthly courses to increase team capabilities for making the best use of golden time measures.

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