scholarly journals Maternal Health Care Among Refugees and Host Communities in Northern Uganda: Access, Quality, and Discrimination

2021 ◽  
Vol 2 ◽  
Author(s):  
Siri Aas Rustad ◽  
Helga Malmin Binningsbø ◽  
Haakon Gjerløw ◽  
Francis Mwesigye ◽  
Tony Odokonyero ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Facility ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Host Community ◽  
Northern Uganda

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value < 0.05) but are 8% points more likely to give birth at a health facility (p-value < 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value < 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value < 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.

scholarly journals Traditional practices influencing the use of maternal health care services in Indonesia

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257032
Author(s):  
Ni Ketut Aryastami ◽  
Rofingatul Mubasyiroh
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Maternal Health Services ◽  
Community Empowerment ◽  
Maternal Health Care ◽  
Health Care Facilities ◽  
Traditional Practices ◽  
Birth Attendance

Background Maternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia. Methods We used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates. Results Traditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services. Discussion Not all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

Utilization of Maternal Health Services: An Experience from Squatter Settlement in Nepal

2021 ◽  
Vol 11 (10) ◽  
pp. 88-98
Author(s):  
Sharmila Ranabhat ◽  
Suman Baskota ◽  
Rama Thapa
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Care Services ◽  
Family Income ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Care Services ◽  
Maternal Health Care Services

Maternal health care services should be accessible to all women during pregnancy, delivery, and the postpartum period. The majority of maternal deaths can be prevented if women utilize maternal health care services appropriately. This study aimed to assess the utilization of maternal health services and explore the barriers in accessing maternal health care services. This descriptive cross-sectional study was conducted among 48 mothers over the age of 18 with one or more children. The data was obtained by interview and focus group discussion using the structured questionnaires and checklists, which included socio-demographic characteristics, and utilization of antenatal care, delivery practice, and postnatal care services. Among 48 mothers, only 35.41% used complete antenatal care services, 66.66% received TT vaccine during pregnancy, 54.16% delivered their last child at the hospital, and only 27.08% received postnatal services as recommended by the World Health Organization. The antenatal care services and delivery services were utilized suboptimally, and postnatal care visits were significantly lower. Socio-economic factors such as family income and education of women correlated considerably with maternal health care utilization. Women with higher education levels and higher family income were more likely to go for frequent antenatal check-ups, have TT vaccinations, deliver in hospitals, and visit more postnatal check-ups than women with lower education levels and lower family income. The findings indicate that there are unmet needs of maternal health care access to women living in the squatters of Nepal. It is therefore important to implement targeted incentive programs and maternal health awareness campaigns to increase the utilization of maternal health services among women living in squatter settlements in Nepal. Key words: Antenatal, Delivery, Postnatal, Maternal health services, Squatter.

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

2019 ◽  
Author(s):  
Ruth Atuhaire
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Facility ◽  
Structural Equation ◽  
First Trimester ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Mediating Factor

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

scholarly journals Savings ownership and the use of maternal health services in Indonesia

2019 ◽  
Vol 34 (10) ◽  
pp. 752-761
Author(s):  
Soyoon Weon ◽  
David W Rothwell ◽  
Shailen Nandy ◽  
Arijit Nandi
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Facility ◽  
Care Delivery ◽  
Maternal Health Services ◽  
Reproductive Age ◽  
Percentage Points ◽  
The Impact ◽  
Use Of Health Services

Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.

Antenatal Care in Sudan: A Qualitative Study Into Accessibility and Quality of Maternal Health Services in Khartoum

2018 ◽  
Vol 8 (2) ◽  
pp. 77-86
Author(s):  
Rayan Mohamed-Ahmed ◽  
Muna Abdel Aziz ◽  
Richard Walker
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Cost Effective ◽  
Maternal Health Services ◽  
Modern Medicine ◽  
Group Discussions ◽  
Maternal Deaths ◽  
Physical Barriers

Antenatal care is shown to be a cost-effective intervention for reducing rates of maternal mortality. However, utilization of maternal health services in Sudan remains low and maternal deaths high. This study aims to investigate why Sudanese women do not attend antenatal care, satisfaction with services and views on improving uptake. Focus group discussions took place, with 30 women who had delivered in the past year, in five areas in Khartoum. Themes in transcripts were identified. Factors that can affect a woman’s choice to attend antenatal care extend beyond physical barriers and include misconceptions of it’s use, conflict between faith and modern medicine and dissatisfaction with previously used services. The care provider’s perceived lack of empathy, unpunctuality and lack of health promotion can also contribute to underutilization.

scholarly journals Effect of Free Maternal Health Care Program on Health-seeking Behavior of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study

2017 ◽  
Vol 5 (3) ◽  
pp. 370-382 ◽  
Author(s):  
Betta Edu ◽  
Thomas U. Agan ◽  
Emmanuel Monjok ◽  
Krystyna Makoweicka
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Service Utilization ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Maternal Health Service ◽  
Service Utilisation ◽  
Cross River ◽  
Cross River State

BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of “PROJECT HOPE” where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria.METHOD: A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program.RESULTS: Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system.CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

scholarly journals PENGELOMPOKAN KABUPATEN/KOTA DI JAWA TIMUR BERDASARKAN PROGRAM PELAYANAN KESEHATAN IBU

2019 ◽  
Vol 3 (1) ◽  
pp. 9-16
Author(s):  
Ainun Nufus
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Local Governments ◽  
Program Planning ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Maternal Health Service ◽  
Complete Linkage ◽  
Cluster 2

Maternal health services are one of the basic health efforts that must be carried out by the local government. Good maternal health services affect the degree of maternal health. Maternal health degrees are measured by the Maternal Mortality Rate (MMR). One of the cases is the increasing return of MMR in East Java Province in 2016. The main causes of high MMR in East Java are bleeding and preeclampsia. Local governments try to reduce MMR by optimizing maternal health care efforts in various work areas.                    The purpose of this study is to apply the analysis of cluster complete linkage to describe the distribution of areas of achievement of maternal health care programs in East Java Province in 2016. The data used in the analysis of cluster complete linkage is the scale of data ratios. This type of research is non-reactive using secondary data. The data used in this study is the maternal health service profile data obtained from the program planning and budget sub-section of the East Java Provincial Health Office in 2016.                    The results of cluster analysis research were conducted to produce 2 optimum districts clusters, with the highest statistical pseudo-f value of  92,420. Cluster 1 produced 4 district members, while Cluster 2 produced 34 members.                    The conclusion of this study shows that between cluster 1 and cluster 2 has different characteristics. The naming of each cluster is based on the characteristics of the average value of the achievement of the maternal health care program. Cluster 1 is a group of districts whose program achievement status is below the target, while Cluster 2 is a group of districts whose program achievement status is above the target.

scholarly journals Has Muslim Got Benefited from the National Health Mission? A Situational Analysis of Maternal Health Services in India

2020 ◽  
Vol 30 (5) ◽  
Author(s):  
Nasim Ahamed Mondal ◽  
Balhasan Ali ◽  
Md Illias Kanchan Sk
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Health Care Services ◽  
Muslim Women ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Confounding Factors ◽  
Care Services ◽  
Maternal Health Care Services

BACKGROUND: It is a marked recognition that when the population is disaggregated by religion, wide disparities in the utilization of maternal health care services can be observed. The study was aimed to analyze the levels and trends of maternal health services among Muslims in India. The study also delineated the investigation of confounding factors attributed to maternal health services among the selected population.METHODS: The study utilized the data from the third and fourth round of National Family Health Survey (NFHS), conducted in 2005-06 and 2015-16 respectively. The bivariate and multivariate logistic regression models were employed to accomplish the study objectives.RESULT: There is an increasing trend in the distributional patterns of all three indicators (full ANC, SBA and PNC) during the last two successive surveys. Muslim women belonging to Southern States were seen to be utilizing more maternal health care services as compared to Muslim women in the Northern States. Muslim populated States like Assam, Bihar, Jharkhand, Uttar Pradesh and West Bengal were far cry to achieve the MDG-15 target of utilization of 100 percent skilled birth attendants in 2015. Education, media exposure and wealth status appeared to be major confounding factors for determining the utilization of maternal health services.CONCLUSION: The study revealed that the utilizations of maternal health services among Muslims have progressed during the last decade. It can be concluded that the NHM policy has played an instrumental role in increasing the utilization of maternal health services among Muslims.

scholarly journals Determinants of Maternal Health Care Utilization among Ever-Married Rabari Women of Udaipur District, Rajasthan

2017 ◽  
Vol 7 (3) ◽  
pp. 453
Author(s):  
Ayushi Sharma
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Health Care Utilization ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Control Measures ◽  
Care Utilization ◽  
Maternal Health Care Utilization ◽  
Development Goals

<div><p><strong>Background</strong>: Improving maternal health is one of the eight Millennium Development Goals. It is widely accepted that the use of maternal health services helps in reducing maternal morbidity and mortality. The utilization of maternal health services is a complex phenomenon and it is influenced by several factors. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The objective of this study was to estimate the effects of individual, community and district level characteristics on the utilization of maternal health services with special reference to antenatal care (ANC), skilled attendance at delivery and postnatal care (PNC)</p><p><strong>Methods</strong>: The present paper focuses in understanding the maternal health care utilization by the ever married Rabari women of Udaipur District, Rajasthan. A purposive random sampling method was used to collect data from 122 ever married women of age group 15-49 years by using pretested and modified demographic schedule.</p><p><strong>Results: </strong>The results of this study showed that 63.11% of the respondents used ANC during their most recent pregnancy whereas only 10.65% women received PNC within two weeks of delivery. In the last delivery, 36.06% mothers were assisted by doctors and 50.81% assisted by nurse. Regarding components of ANC utilization 85.24% women reported intake of IFA (Iron and Folic Acid) tablets during pregnancy, while 77.04% of the women received Tetanus Toxoid (TT) Injection. The study reflects that higher utilization of ANC services are there and PNC services are mostly neglected among the women. The study also reflected upon the use of Birth Control Measures (BCM) among the woman. The lesser number of sample size may bind us from recommending much. But, Mothers should be motivated continuously and with every generation of nation they give birth to, they should utilize such health services for the future of the healthy society.</p></div>

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