Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

Background: This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe.Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

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A study on the Analysis of the Effects of Government Health Expenditure on Maternal Mortality in 25 Sub-Saharan Africa Countries

10.7176/ppar/9-9-09 ◽

2019 ◽

Keyword(s):

Maternal Mortality ◽

Health Expenditure ◽

Sub Saharan Africa ◽

Government Health ◽

Sub Saharan ◽

Government Health Expenditure

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Magnitude, Trends and Causes of Maternal Mortality: A 7-year Review at a Tertiary Hospital in Rivers State, Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i130357 ◽

2020 ◽

pp. 103-109

Author(s):

P. A. Awoyesuku ◽

D. A. MacPepple ◽

B. O. Altraide

Keyword(s):

Maternal Mortality ◽

Postpartum Haemorrhage ◽

Maternal Mortality Ratio ◽

Tertiary Hospital ◽

Sub Saharan Africa ◽

Annual Reports ◽

Maternal Deaths ◽

Middle Income ◽

Mortality Ratio ◽

Sub Saharan

Background: Maternal mortality ratios (MMR) are still unacceptably high in many low- and middle-income countries especially in sub-Saharan Africa. Background Data for the causes of maternal deaths are needed to inform policies to improve maternal healthcare and reduce maternal mortality. Objective: This study sought to determine the magnitude and trend in maternal mortality and the causes at a tertiary hospital over a seven-year study period. Methodology: This was a retrospective review of maternal mortality and causes from 2012 to 2018. Data on number of maternal deaths, deliveries and causes of death were retrieved from the departmental annual reports and hospital records and entered into Microsoft Excel 2013. Data were presented as line graphs, charts and frequency tables. Results: One hundred and ten (110) maternal deaths occurred out of 17,080 total births during the study period giving an overall MMR of 644. The MMR increased progressively from 580 in 2012 to 785 in 2018 with a sharp rise to the highest and subsequent decline to the lowest, values at the midpoint. The commonest causes of maternal deaths were Pre-eclampsia (PET) and Eclampsia 44(40%), Postpartum Haemorrhage (PPH) 25(22.7%) and Ruptured Uterus 13(11.8%). Conclusion: The maternal mortality ratio is high and the trend is worsening. The leading causes of maternal deaths were PET/Eclampsia and Postpartum haemorrhage accounting for about two-thirds of all deaths. Efforts must be geared towards improvements in the management of these cases, if this trend is to be reversed.

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Joining the dots: a plea for precise estimates of the maternal mortality ratio in sub-Saharan Africa

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2009.02337.x ◽

2009 ◽

Vol 116 ◽

pp. 7-10 ◽

Cited By ~ 4

Author(s):

SP Munjanja

Keyword(s):

Maternal Mortality ◽

Maternal Mortality Ratio ◽

Sub Saharan Africa ◽

Mortality Ratio ◽

Sub Saharan

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Health Expenditure Targeting, Financial Protection and Maternal Mortality in Sub-Saharan Africa.

SRIWIJAYA INTERNATIONAL JOURNAL OF DYNAMIC ECONOMICS AND BUSINESS ◽

10.29259/sijdeb.v4i3.191-210 ◽

2020 ◽

Vol 4 (3) ◽

pp. 191

Author(s):

Peter Igbaudumhe Sede

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Health Expenditure ◽

Sub Saharan Africa ◽

High Rate ◽

Common Denominator ◽

Financial Protection ◽

Maternal Mortality Rate ◽

Policy Concern ◽

Sub Saharan

AbstractThe slow reduction in maternal mortality rate in Sub-Saharan Africa is a serious cause for policy concern. This has not only retained the sub region in the web of leading region in high rate of reproductive health challenges but spells signals of poverty and low economic growth. The study therefore, examined the efficacy of health expenditure targeting and financial protection in reducing maternal mortality in 44 Sub-Saharan Africa countries. The study adopts fixed effect panel data modelling technique. Results show that financial protection is correctly signed but not statistically significant while relative health expenditure targeting is both correctly signed and statistically significant in reducing maternal mortality. Recommendation is that health expenditure should generally be increased so as to increase the slope of decrease in maternal mortality rate in Sub-Saharan Africa and health expenditure should be more targeted against GDP as common denominator.

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The Impact of Health Expenditures on Health Outcomes in Sub-Saharan Africa

Journal of Developing Societies ◽

10.1177/0169796x19826759 ◽

2019 ◽

Vol 35 (1) ◽

pp. 134-152 ◽

Cited By ~ 1

Author(s):

Edward Nketiah-Amponsah

Keyword(s):

Life Expectancy ◽

Maternal Mortality ◽

Health Outcomes ◽

Health Expenditure ◽

Health Expenditures ◽

Determinants Of Health ◽

Sub Saharan Africa ◽

Under Five ◽

Per Capita ◽

Sub Saharan

This article investigates the core macroeconomic and social determinants of health expenditures as well as the effect of health expenditures on select critical health outcomes (life expectancy, under-five mortality and maternal mortality) in recent years in sub-Saharan Africa (SSA). The study utilizes data on 46 sub-Saharan African countries covering the period 2000–2015. The results indicate that gross domestic product (GDP) per capita, physician per 1,000 population, population aged above 65 years and under-five mortality rate are the most significant determinants of health expenditure in the region. Overall, health expenditure is less income-elastic, not rising as a portion of GDP in wealthier nations. Health expenditure was found to exert a positive and significant impact on all three health outcomes. Specifically, a 1 percent increase in health expenditure per capita resulted in a 0.5 percent reduction in under-five mortality and a 0.35 percent fall in maternal mortality, while improving life expectancy by 0.06 percent. The results suggest that steady increases in health expenditures over time have the tendency to improve health outcomes in SSA.

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Effectiveness of Community Based Interventions in Reducing Maternal Mortality in Sub-Saharan Africa: A Systematic Review

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2020/v41i930314 ◽

2020 ◽

pp. 9-21

Author(s):

O. Orjingene ◽

J. Morgan

Keyword(s):

Maternal Mortality ◽

Health Workers ◽

Direct Reduction ◽

Maternal Mortality Ratio ◽

Sub Saharan Africa ◽

Community Based Interventions ◽

Community Based ◽

Birth Attendance ◽

Sub Saharan ◽

Natal Care

Background & Aim: Maternal mortality ratio for sub- Saharan Africa in 2010 was estimated to be about 600 per 100,000 live births, which is approximately higher than what is obtainable in advanced countries. To this end, several community-based interventions have been put in place by governments and developmental partners in the region to address the situation. This review aimed to seek evidence from existing literature on the level of effectiveness of these interventions in improving maternal health outcomes in the region. The literature search process resulted in retrieval of six full text studies that were written in English, published between 2000 and 2019 and were focused on intervention based at the community level which resulted in the reduction of maternal deaths in some sub-Saharan African countries. The Critical Appraisal Skills Programme (CASP) tool was used to critically review retrieved literature. Findings: Findings from the articles reviewed show that community based interventions with direct reduction on maternal mortality were implemented in Ethiopia and Nigeria and were effective since maternal mortality declined by 64% and 43.5% respectively. Other community based interventions did not directly address reduction in maternal mortality but rather addressed leading causes of maternal mortality such as home and unskilled birth attendance, low Ante-Natal Care (ANC) & Post-Natal Care (PNC) services utilization, Eclampsia, delay in accessing care and Postpartum Hemorrhage (PPH). Such interventions were implemented in Nigeria, Zambia, Tanzania and the Democratic Republic of Congo and were proved to be effective in reducing maternal mortality. Conclusions and Recommendations: Based on the literatures reviewed, it was concluded that community based interventions were effective in reducing maternal mortality in Sub-Saharan Africa. The following recommendations were made based on gaps observed in the implementation of some interventions. Introduction of emergency transport scheme in countries where they do not exist as despite the existence of maternity waiting homes and dedicated maternity ambulances in Zambia, many expectant mothers still had difficulty reaching the health facilities in time to deliver, Engagement and training of more health workers so as to avoid human resources challenges that may be associated with increased demand for health facility deliveries.

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Protocol for a scoping review to identify and map in-service education and training materials for midwifery care in sub-Saharan Africa from 2000 to 2020

BMJ Open ◽

10.1136/bmjopen-2020-047118 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047118

Author(s):

Joanne Welsh ◽

Mechthild M Gross ◽

Claudia Hanson ◽

Hashim Hounkpatin ◽

Ann-Beth Moller

Keyword(s):

Scoping Review ◽

Maternal Mortality Ratio ◽

Newborn Care ◽

Education And Training ◽

Sub Saharan Africa ◽

Midwifery Care ◽

Training Materials ◽

Service Training ◽

Sub Saharan ◽

And Training

IntroductionMaternal and neonatal mortality are disproportionally high in low-and middle-income countries. In 2017 the global maternal mortality ratio was estimated to be 211 per 100 000 live births. An estimated 66% of these deaths occurred in sub-Saharan Africa. Training programmes that aim to prepare providers of midwifery care vary considerably across sub-Saharan Africa in terms of length, content and quality. To overcome the shortfalls of pre-service training and support the provision of quality care, in-service training packages for providers of midwifery care have been developed and implemented in many countries in sub-Saharan Africa. We aim to identify what in-service education and training materials have been used for providers of midwifery care between 2000 and 2020 and map their content to the International Confederation of Midwives’ Essential Competencies for Midwifery Practice (ICM Competencies), and the Lancet Midwifery Series Quality Maternal and Newborn Care (QMNC) framework.Methods and analysisA search will be conducted for the years 2000–2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Sciences Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a hand search of literature from international partner organisations will be performed. Information retrieved will include study context, providers trained, focus of training and design of training. Original content of identified education and training materials will be obtained and mapped to the ICM Competencies and the Lancet Series QMNC.Ethics and disseminationA scoping review is a secondary analysis of published literature and does not require ethical approval. This scoping review will give an overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa. Mapping the content of these education and training materials to the ICM Competencies and The Lancet Series QMNC will allow us to assess their appropriateness. Findings from the review will be reflected to stakeholders involved in the design and implementation of such materials. Additionally, findings will be published in a peer-reviewed journal, and used to inform the design and content of an in-service training package for providers of midwifery care as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) study, (https://alert.ki.se/) a multi-country study in Benin, Malawi, Tanzania and Uganda.Trial registration numberPACTR202006793783148; Post-results.

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