Vaginal or Caesarean Delivery?  A Comparative Study of Factors Associated  with the Choice Method of Childbirth Delivery  in Kenya and Egypt

Background: Childbirth delivery today is becoming a complex process. There exist linkages between choice method of childbirth delivery, whether vaginal or caesarean section, and socioeconomic, maternal, and pregnancy-related factors. Study objectives: To compare the choice method of childbirth delivery among women of childbearing ages in Kenya and Egypt. Specifically, the study sought to (a) show patterns of caesarean section births in the two countries using women’s background characteristics, (b) estimate levels and differentials of caesarean births in the two countries and, (c) investigate the socio-economic, maternal and pregnancy-related factors that determine the choice of caesarean section deliveries in the two countries Data and methods: Data was derived from the 2014 Kenya and Egypt demographic and health surveys women-file. The data was fitted in the Statistical Package for Social Sciences in which descriptive and binary logistic regression analyses were conducted. Results: Majority of Egyptian women (53.5%) gave birth by caesarean section compared to Kenyan women (7.8%). At descriptive analysis level, all the study variables were significant at ρ<0.05 and less, save for marital status. At inferential level, there were higher odds of caesarean section delivery among Egyptian women in middle and rich households (1.318 and 1.701, respectively) compared to those from poor households. Among Kenyan women, those aged 25-34 and 35-49 were 1.335 and 1.690 more likely to delivery by caesarean section compared to their colleagues in the 15-24 age group. Pertaining to the number of antenatal care visits, Egyptian women who had no antenatal care visits were 0.761 less likely, while those with 5-8 and at least 9 antenatal care visits were 1.296 and 1.783, respectively, more likely to delivery by caesarean section compared to their colleagues with 3-4 antenatal care visits. Such a trend was observed among Kenyan women for 5-8 and 9+ antenatal care visits, at the odds of 1.234 and 2.053 respectively. Childbirth deliveries in private health facilities had the odds of 2.060 and 1.438 in Egypt and Kenya, respectively, compared to delivery in public health facilities. Conclusion: The results suggest that the main contributory factors behind the choice method of childbirth delivery are household wealth (Egypt), maternal age (Kenya), number of antenatal care visits (both Kenya and Egypt), and place of delivery (both Kenya and Egypt).

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Determinants of utilization of maternal health care services among mothers in Harare, Zimbabwe

10.21203/rs.2.15879/v2 ◽

2019 ◽

Author(s):

Eunice Nyarambi ◽

Paddington Tinashe Mundagowa ◽

Prosper Chonzi ◽

Elizabeth Chadambuka

Keyword(s):

Health Care ◽

Maternal Health ◽

Antenatal Care ◽

Health Care Services ◽

Care Delivery ◽

Maternal Health Care ◽

Health Facilities ◽

Related Factors ◽

Care Services ◽

Maternal Health Care Services

Abstract Background: Provision of quality maternal health care services is an essential component in ensuring a healthy mother-baby dyad both pre- and post-delivery. In Africa, antenatal care, postnatal care, and skilled birth attendances are very low when compared to high-income countries. The continent has a high burden of maternal and infant morbidity as well as mortality rates. According to the Harare Annual Report of 2016, the number of women seeking maternal health care services was gradually declining from 2014 and pregnant women reported various challenges in accessing health care services. Methods: A 1 to 1 case-control study was conducted in Harare West South Western District using pretested interviewer-administered questionnaires. The study was carried out at all three clinics in the district and a total of 73 cases and 73 controls were selected using a systematic random sampling method. Quantitative data were analyzed using Epi Info statistical package and qualitative data was analyzed thematically. Results: The median ages for cases and controls were 29 and 24 years, respectively and the age-group 19 to 24 years constituted the majority of participants (41%). Predictors of utilization of services were young age ( < 24 years), birth order of < 2, maternal and paternal occupation, and religion. Enabling factors included: asking for permission to seek care, absence of transport challenges, a shorter distance to the health facility, affordability of health services, and a higher household income. Besides the shortage of skilled staff at the clinics, mothers endured long waiting hours to be served. The majority of the cases (78.1 %) and controls (72.6%) preferred to be attended by male nurses. Mothers were required to pay a $25 fee for booking and city medical staff rarely visited the clinics. Conclusion: The utilization of maternal health care services in Harare is dependent on the individual, household, and system-related factors. There was a need to articulate policies and design maternal health care programs that target socially and economically marginalized women. Creating women-friendly health facilities with extended hours for the antenatal care, delivery care and post-natal care services for mothers can help to decongest the health facilities.

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Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis

Tropical Medicine and Health ◽

10.1186/s41182-021-00343-x ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Betregiorgis Zegeye ◽

Mpho Keetile ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Married Women ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Related Factors ◽

Factors Associated ◽

Software Analysis ◽

Sub Saharan

Abstract Background Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. Methods We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). Results The pooled results showed that about 50.7% (95% CI 48.2–53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0–69.1%) and West Africa (24.3%, 95% CI 22.4–26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32–2.84), women with educated husbands (aOR=1.40, 95% CI 1.11–1.77), wealthier women (aOR=3.12, 95% CI 1.95–4.99), women exposed to media (aOR=1.46, 95% CI 1.18–1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24–1.83). Conclusions Enhancing women’s education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.

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The changing temporal association between caesarean birth and neonatal death in Ethiopia: secondary analysis of nationally representative surveys

BMJ Open ◽

10.1136/bmjopen-2018-027235 ◽

2019 ◽

Vol 9 (10) ◽

pp. e027235

Author(s):

Engida Yisma ◽

Ben W Mol ◽

John W Lynch ◽

Lisa G Smithers

Keyword(s):

Caesarean Section ◽

Rural Women ◽

Neonatal Death ◽

Secondary Analysis ◽

Household Wealth ◽

Temporal Association ◽

Demographic And Health Surveys ◽

Neonatal Deaths ◽

Caesarean Birth ◽

Nationally Representative

ObjectiveTo examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016.DesignSecondary analysis of Ethiopian Demographic and Health Surveys.SettingAll administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016.ParticipantsWomen aged 15–49 years with a live birth during the 5 years preceding the survey.Main outcome measuresWe analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the ‘Three Delays Model’ to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia.ResultsThe adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.ConclusionsA naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.

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Examining inequality of opportunity in the use of maternal and reproductive health interventions in Sierra Leone

Journal of Public Health ◽

10.1093/pubmed/fdz023 ◽

2019 ◽

Vol 42 (2) ◽

pp. 254-261 ◽

Cited By ~ 1

Author(s):

Mluleki Tsawe ◽

A Sathiya Susuman

Keyword(s):

Reproductive Health ◽

Health Services ◽

Antenatal Care ◽

Sierra Leone ◽

Health Indicators ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Reproductive Health Services ◽

Dissimilarity Index ◽

Over Time

Abstract Background Poor countries, such as Sierra Leone, often have poor health outcomes, whereby the majority of the population cannot access lifesaving health services. Access to, and use of, maternal and reproductive health services is crucial for human development, especially in developing regions. However, inequality remains a persistent problem for many developing countries. Moreover, we have not found empirical studies, which have examined inequalities in maternal and reproductive health in Sierra Leone. Method We used data collected from the Sierra Leone Demographic and Health Surveys (DHS) conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for this study, including four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception. To measure inequalities, we adopted the Human Opportunity Index (HOI). Using this measure, we measured differentials over the two periods, and decomposed it to measure the contribution of the selected circumstance variables to inequality. Results Inequalities declined over time, as shown by the decrease in the dissimilarity index. Due to the drop in the dissimilarity index, the HOI increased for all the selected maternal and reproductive health indicators. Moreover, antenatal services were closer to equality compared to the other selected services. Overall, we found that household wealth status, maternal education and place of residence, are the most important factors contributing to the inequality in the use of maternal and reproductive health services. Conclusions Even though there are improvements in inequalities over time, there are variations in the way in which inequality within the different indicators has improved. In order to improve the use of maternal and reproductive health services, and to reduce inequalities in these services, the government will have to invest in: (i) increasing the educational levels of women, (ii) improving the standard of living, as well as (iii) bringing maternal and reproductive health services closer to rural populations.

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Determinants of utilization of maternal health care services among mothers in Harare, Zimbabwe

10.21203/rs.2.15879/v1 ◽

2019 ◽

Author(s):

Paddington Tinashe Mundagowa ◽

Eunice Nyarambi ◽

Elizabeth Chadambuka

Keyword(s):

Health Care ◽

Maternal Health ◽

Antenatal Care ◽

Health Care Services ◽

Care Delivery ◽

Maternal Health Care ◽

Health Facilities ◽

Related Factors ◽

Care Services ◽

Maternal Health Care Services

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The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study

Reproductive Health ◽

10.1186/s12978-021-01249-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Mariam Tanou ◽

Takaaki Kishida ◽

Yusuke Kamiya

Keyword(s):

Antenatal Care ◽

Health Center ◽

Travel Time ◽

Health Facilities ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Services Utilization ◽

The World ◽

Delivery Services ◽

Geographical Accessibility

Abstract Background The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones. Methods We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15–49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness. Results Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women’s residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin. Conclusions Geographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin.

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Stories of Change: How Rwanda Created an Enabling Environment for Reducing Malnutrition (P22-011-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz042.p22-011-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Elyse Iruhiriye ◽

Deanna Olney ◽

Jessica Heckert ◽

Gayathri Ramani ◽

Edward Frongillo ◽

...

Keyword(s):

Antenatal Care ◽

Parental Education ◽

Decomposition Analysis ◽

Household Wealth ◽

Care Quality ◽

Demographic And Health Surveys ◽

Drivers Of Change ◽

Development Organization ◽

Enabling Environment ◽

Regression Decomposition

Abstract Objectives Eliminating malnutrition is on many countries’ political agendas but knowledge of how enabling environments are created and used is needed. We assessed the drivers of change in stunting reduction among children <5 y of age in Rwanda and contributors to differential reduction over 10–25 y. Methods We conducted in-depth interviews on changes in nutrition with nutrition stakeholders at national (n = 32), district (n = 38), and community (n = 20) levels, and community focus group discussions (n = 40) in 10 purposefully selected districts in Rwanda's 5 provinces. In each province, we selected 1 district with decreased stunting and 1 where no change or an increase occurred (2010–2015). We also used regression decomposition analysis to investigate drivers of change in stunting with Demographic and Health Surveys (2005, 2010, and 2015) data. Results Respondents believed peace and security along with improved leadership and decentralization helped to create an enabling environment for change. Rwanda experienced increased political and institutional commitment to nutrition indicated by adoption of a multisectoral policy and reinforced with horizontal coordination platforms and plans at national and sub-national levels, but greater financial commitment is needed according to respondents. Vertical coordination across administrative levels improved through communication, staff working on nutrition at these levels, and relationships between nutrition actors. From respondent reports, health and agricultural programs and increased availability and use of health services helped improve nutrition; differences between study districts included climate change challenges, food insecurity, weak horizontal and vertical coherence, and weak implementation of coordination plans. Supporting this, giving birth in a health facility, attending ≥4 antenatal care visits, antenatal care quality, fertility, parental education, household wealth, and health insurance coverage drove stunting reduction from the regression decomposition analysis. Conclusions Leadership, commitment and horizontal and vertical coherence are important for creating enabling environments and providing programs and services that can lead to reduced malnutrition. Funding Sources Ministry of Foreign Affairs of Kingdom of Netherlands through SNV Netherlands Development Organization.

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Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017–18

BMC Public Health ◽

10.1186/s12889-021-12178-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pradeep Kumar ◽

Rashmi Rashmi ◽

T. Muhammad ◽

Shobhit Srivastava

Keyword(s):

Health Surveys ◽

Maternal Education ◽

Descriptive Analysis ◽

Decomposition Analysis ◽

Wealth Inequality ◽

Household Wealth ◽

Bivariate Analysis ◽

Demographic And Health Surveys ◽

Age At First Birth ◽

Contributing Factors

Abstract Background Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017–18. Methods The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017–18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017–18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting. Results The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017–18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother’s characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father’s characteristics, such as education explained 9% of this change. Conclusion The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children’s height and weight, and aim to significantly reduce inter-household inequalities.

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Incidence of Uterine Torsion and Related Factors in Buffaloes of Amul Milk Shed Area

THE INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY ◽

10.21887/ijvsbt.15.1.4 ◽

2019 ◽

Vol 15 (01) ◽

pp. 17-20

Author(s):

Chintan S Pateliya1 ◽

J A Patel ◽

A J Dhami ◽

S B Patel ◽

H L Makwana

Keyword(s):

Retrospective Study ◽

Survival Rate ◽

Caesarean Section ◽

Post Treatment ◽

Full Term ◽

Related Factors ◽

Factors Influencing ◽

Uterine Torsion

A study was carried out to find out the retrospective incidence of uterine torsion in buffaloes among obstetrical cases in Amul milk shed area and factors influencing it. Data on 1,13,772 obstetrical cases attended from January 2017 to June 2018 by Amul Veterinarians were collected. Moreover, 50 buffaloes suffering from uterine torsion were taken up during July-December, 2018 to know the side, site, degree of uterine torsion, parity as well as sex and viability of the calf and the dam after detorsion/Caesarean section in the same area. In the retrospective study, a total of 2000 cases of uterine torsion were recorded among total 1,13,772 bovine obstetrical cases, which encompassed 1.76%. Of the 2000 cases, 92.20 (1844) percent torsions were found in buffaloes only. Among 57,111 obstetrical cases attended in buffaloes, the incidence of uterine torsion was 3.23%. Moreover, the region/center-wise incidence of torsion cases varied from 1.30–19.36%. The highest incidence of uterine torsion was found in Anand region (19.36 %) followed by Kathlal (11.23 %) and Mahemdabad (10.14 %) regions, while the lowest incidence was in Virpur (2.06%), Petlad (1.46%) and Piplata (1.30%). It was concluded that buffaloes mostly experience right side (100%), post-cervical (82%) uterine torsion of 270–360° (66%), at full term of gestation (70%)with lower survivability of the calves (30%), however, the survival rate of the dams post-treatment was 90%.

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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094578 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4578

Author(s):

Nidhi Wali ◽

Kingsley E. E. Agho ◽

Andre M. N. Renzaho

Keyword(s):

South Asia ◽

South Asian ◽

Health Surveys ◽

Associated Factors ◽

Common Factor ◽

Household Wealth ◽

Health Concern ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

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