Utilisation of Skilled Delivery in Ghana: A Systematic Review

Background: Access to a doctor, nurse, or a midwife during childbirth is key to the global effort to reduce maternal mortality ratios. Ghana has recorded significant improvements in maternal care over the past three decades. However, despite many policies aimed at improving health care for pregnant women such as the free maternal care policy, many Ghanaian women still deliver without a skilled birth attendant present. This systematic review, therefore, sought to identify the various factors affecting utilisation of skilled birth attendance in Ghana. Methods: PubMed Central, African Journals Online (AJOL), CINAHL Plus with Full Text (EBSCO), and Science Direct were searched for studies from January 2010 to December 2020. A broad range of search terms was used. Studies included had diverse designs, were conducted among Ghanaian pregnant women, and had skilled delivery as an outcome of interest. The quality of studies was assessed. Due to the diversity of types of studies included in this systematic review (including qualitative, descriptive, and evaluative studies that ranged from simple bivariate analyses to complex multivariate modelling), a meta-analysis was neither possible nor appropriate. We, therefore, conducted a narrative synthesis of the search findings. Results: Twenty-four (24) studies met our inclusion criteria for this review. Included studies comprised sixteen (16) cross-sectional studies and eight (8) qualitative studies. The sample size of the included studies cumulatively was 86,998 participants. The emerging themes were: health system factors (10); maternal and family factors (5); and sociodemographic factors (9). Conclusion: In general, health system factors; maternal and family factors; and sociodemographic factors were found to influence skilled delivery services in Ghana. Therefore, in order to ensure that there is a skilled birth attendant present at every birth, efforts should aim at addressing social and cultural factors which have been identified as key determinants to utilisation of skilled delivery in Ghana.

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Barriers in access to cancer treatment in Europe: a systematic review of the European Literature

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1126 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Jachmann ◽

K Klingberg ◽

M C Zapata-Garcia ◽

D S Srivastava ◽

A Exadaktylos ◽

...

Keyword(s):

Systematic Review ◽

Cancer Therapy ◽

Health System ◽

Cancer Treatment ◽

Grey Literature ◽

European Countries ◽

Cancer Site ◽

Cancer Drugs ◽

System Factors

Abstract Background Within NCD`s, Cancer accounts for the 2nd most frequent cause after Cardiovascular diseases and in some European countries it´s the leading cause of premature deaths. One of the challenges within cancer therapy can be found in inequity in access to cancer treatment, because this causes worse health outcomes, which are attributable to the accessibility of health care and thus avoidable. The objective of the systematic review was to identify barriers in access to cancer treatment in Europe (inter-country) and within 6 European countries (intra-country): Spain, Germany, Switzerland, Finland, Bulgaria, UK. Methods To obtain data scientific (PubMed, CINAHL, Embase) and grey literature were searched using keywords relating to inequity in access to cancer therapy in Europe. Collected Abstracts of published articles in English between 01/2013 and 05/2018 were reviewed independently. Identified barriers in access to cancer therapy were grouped into 2 categories: patient and health system/provider factors, followed by thematic analysis for each category. Results Out of 786 unique articles, 14 were included in the systematic review. The most frequent cited barriers within Europe were patient socioeconomic status (n = 7, 50%), age (n = 4, 28.6%) and reimbursement and availability of cancer medicine (n = 4, 28.6%). Conclusions This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized. The amount of available studies with main focus on barriers in access to cancer therapy in Europe varies by equity stratifier, cancer site and type of treatment and seems to be very limited, showing a need for future investigations upon this topic with possibly uniform scales. Key messages This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized.

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A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia

International Journal of Population Research ◽

10.1155/2012/532154 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Adebola Adedimeji ◽

Nareen Abboud ◽

Behailu Merdekios ◽

Miriam Shiferaw

Keyword(s):

Health System ◽

Pregnant Women ◽

Health Workers ◽

Contextual Factors ◽

Sub Saharan Africa ◽

Mother To Child Transmission ◽

Child Transmission ◽

Utilization Of Services ◽

System Factors ◽

Mother To Child

Objectives. Despite the availability of services to prevent mother-to-child transmission (PMTCT) of HIV, socio-cultural, health system and operational factors constrain many pregnant women from accessing services or returning for followup thereby increasing the risk of vertical transmission of HIV to newborns. We highlight and describe unique contextual factors contributing to low utilization of PMTCT services in Arba-Minch, Ethiopia. Methods. Qualitative research design was utilized to obtain data through focus group discussions and in-depth interviews with antenatal clinic attendees, health workers health facilities in the study area. Results. Awareness of PMTCT services and knowledge of its benefits was nearly universal, although socioeconomic, cultural and health system factors, including stigma and desire to prevent knowledge of serostatus, impede access to and utilization of services. Health system factors—lack of appropriate followup mechanisms, inadequate access to ARV drugs and poorly equipped manpower also contribute to low utilization of services. Conclusion. Reducing mother-to-child transmission of HIV in sub-Saharan Africa will be more effective when unique contextual factors are identified and addressed. Effectiveness of PMTCT interventions rests on a well functioning health system that recognize the importance of social, economic, cultural contexts that HIV positive pregnant women live in.

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Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

10.21203/rs.3.rs-234691/v1 ◽

2021 ◽

Author(s):

Gloria Gbenonsi ◽

Mouna Boucham ◽

Zakaria Belrhiti ◽

Chakib Nejjari ◽

Inge Huybrechts ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Health Care ◽

Health System ◽

Assessment Tool ◽

Treatment Delay ◽

Sub Saharan Africa ◽

Quality Assessment Tool ◽

System Factors ◽

Sub Saharan

Abstract BackgroundBreast cancer patients in sub-Saharan Africa experience long delays between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing delays in treatment has not been widely investigated. This review aimed to identify existing information on health system factors that influence treatment delays in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program quality-assessment tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence treatment delay in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that treatment delay among women with breast cancer in sub-Saharan Africa is influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

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Assessing Health System Factors Affecting Access and Delivery of IPTp-SP and ITN to Pregnant Women Attending ANC Clinics in Ghana-A Quantitative Study

10.21203/rs.3.rs-424064/v1 ◽

2021 ◽

Author(s):

Virtue Fiawokome De-Gaulle ◽

Pascal Magnussen ◽

Joseph Kamgno ◽

Wilfred Mbacham ◽

Verner Ndudiri Orish ◽

...

Keyword(s):

Health System ◽

Pregnant Women ◽

Health Workers ◽

Care Delivery ◽

Health Planning ◽

Intermittent Preventive Treatment ◽

Health Staff ◽

Factors Affecting ◽

Delivery Practices ◽

System Factors

Abstract Introduction: Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions.Methods: A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results: Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390). Despite the availability of SP, 15% (75) of all eligible women were not offered the medication and 37% (44) of inappropriate delivery was due to stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions: IPTp-SP was appropriately delivered to 76% of clients as compared to 59% in the case of ITN. Despite stock availability, IPTp-SP and ITN were not delivered to some eligible women. This highlights health worker related factors influencing delivery.

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Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03312-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Biruhtesfa Bekele Shiferaw ◽

Lebitsi Maud Modiba

Keyword(s):

Data Analysis ◽

Health System ◽

Pregnant Women ◽

Health Facility ◽

Supply Side ◽

Major Theme ◽

Related Factors ◽

Skilled Delivery ◽

North West ◽

North West Ethiopia

Abstract Background Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. Methods This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. Results Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. Conclusions This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service.

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Assessing health system factors affecting access and delivery of IPTp-SP and ITN to pregnant women attending ANC clinics in Ghana

BMC Health Services Research ◽

10.1186/s12913-021-07055-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Virtue Fiawokome De-Gaulle ◽

Pascal Magnussen ◽

Joseph Kamgno ◽

Wilfred Mbacham ◽

Verner N. Orish ◽

...

Keyword(s):

Health System ◽

Pregnant Women ◽

Health Workers ◽

Care Delivery ◽

Health Planning ◽

Intermittent Preventive Treatment ◽

Health Staff ◽

Factors Affecting ◽

Delivery Practices ◽

System Factors

Abstract Introduction Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. Methods A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.

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Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis

BMJ Global Health ◽

10.1136/bmjgh-2021-006453 ◽

2021 ◽

Vol 6 (12) ◽

pp. e006453

Author(s):

Muhammad Ashar Malik ◽

Lara Riedige Rohm ◽

Pieter van Baal ◽

Eddy van Doorslaer van Doorslaer

Keyword(s):

Child Health ◽

Pregnant Women ◽

Maternal Care ◽

Care Seeking ◽

Difference In Difference ◽

Maternal Healthcare ◽

Healthcare Seeking ◽

Birth Attendance ◽

And Child Health ◽

Care Seeking Behaviour

IntroductionPakistan is a country with high maternal and infant mortality. Several large foreign funded projects were targeted at improving maternal, neonatal and child health. The Norway-Pakistan Partnership Initiative (NPPI) was one of these projects. This study aims to evaluate whether NPPI was successful in improving access and use of skilled maternal healthcare.MethodsWe used data from three rounds (2009–2010, 2011–2012 and 2013–2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM). A difference-in-difference regression framework was used to estimate the effectiveness of NPPI and its different programme components with respect to maternal healthcare seeking behaviour of pregnant women. Various parts of the PSLM were combined to examine the healthcare seeking behaviour response of pregnant women to exposure to NPPI.ResultsTrends in maternal care seeking behaviour of pregnant women were similar in districts exposed to NPPI and control districts. Consequently, only a weak and insignificant impact of NPPI on maternal care seeking behaviour was found. However, women in districts which used vouchers or which implemented contracting were more likely to seek skilled assistance with their delivery.ConclusionWe conclude that the objective to improve access to and use of skilled care was not achieved by NPPI. The small effects identified for vouchers and contracts on skilled birth attendance hold some promise for further experimentation.

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Determinants of Antenatal Healthcare Utilisation by Pregnant Women in Third Trimester in Peri-Urban Ghana

Journal of Tropical Medicine ◽

10.1155/2018/1673517 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Jones Asafo Akowuah ◽

Peter Agyei-Baffour ◽

Dadson Awunyo-Vitor

Keyword(s):

Antenatal Care ◽

Health System ◽

Pregnant Women ◽

Information Management System ◽

Regression Result ◽

Third Trimester ◽

District Health ◽

Socioeconomic Determinants ◽

Care Utilisation ◽

System Factors

Access to quality healthcare still remains a major challenge in the efforts at reversing maternal morbidity and mortality. Despite the availability of established maternal health interventions, the health of the expectant mother and the unborn child remains poor due to low utilisation of interventions. The study examined the socioeconomic determinants of antenatal care utilisation in peri-urban Ghana using pregnant women who are in their third trimester. Two-stage sampling technique was used to sample 200 pregnant women who were in their third trimester from the District Health Information Management System software. Well-structured questionnaire was the instrument used to collect data from respondents. Descriptive statistics and inferential statistics including binary logit regression model were used to analyse the data with the help of SPSS and STATA software. The results showed varying utilisation levels of ANC. From the regression result, age, household size, and occupational status were identified as the important socioeconomic determinants of antenatal care utilisation among the respondents. The important system factors which influence antenatal care utilisation by the respondents are distance to ANC, quality of service, and service satisfaction. The study concludes that socioeconomic and health system factors are important determinants of antenatal care utilisation. Stepping up of interventions aimed at improving the socioeconomic status and addressing health system and proximity challenges could be helpful in improving antenatal care utilisation by pregnant women in Ghana.

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Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

BMC Public Health ◽

10.1186/s12889-021-11296-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gloria Gbenonsi ◽

Mouna Boucham ◽

Zakaria Belrhiti ◽

Chakib Nejjari ◽

Inge Huybrechts ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Health Care ◽

Health System ◽

Assessment Tool ◽

Sub Saharan Africa ◽

Quality Assessment Tool ◽

Time Intervals ◽

System Factors ◽

Sub Saharan

Abstract Background Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. Methods PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. Results From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. Conclusion The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

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