Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

Background: In the year 2000, member states of the United Nations pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio by 2015 in line with Millenium. Development Goal 5, but this could not be achieved. This pledge became imperative given the high maternal mortality being recorded, especially among developing countries. The high maternal deaths in developing countries have been attributed partly to the lack of access to skilled birth attendants during delivery. Objective: This study aimed to investigate factors that influence the utilization of health facility delivery services among pregnant women in the Jomoro District of the Western Region of Ghana. Methods: The study used data from a cross-sectional survey among women aged 18 - 49 yr. living in the Jomoro District of Ghana and had given birth between 2012 and 2016 (n = 374). The study participants were randomly selected from women who attended child welfare clinics on clinic days with their babies in eighteen communities. The study used a structured questionnaire to solicit for information about the women’s demographic and socio-economic characteristics, community characteristics and health systems factors likely to influence their decision to seek skilled delivery care as well as their experiences relating to their last delivery. Bivariate analyses were performed between the primary dependent variable and background characteristics of the respondents. Factors influencing the choice of place of delivery were estimated by multiple logistic regression analysis. Data analysis was performed using STATA Statistical Software, Release 14. Results: About 61.0% (n= 228/374) of the women had their last delivery at a health facility while the remaining 38.8% (n= 145/374) delivered at home without skilled assistance. In multivariate analysis, women aged 25 – 29 yr. were less likely to have a skilled delivery (aOR, 0.40; 95% CI: 0.17 - 0.93). Also, professional women had 4.77 odds of having skilled delivery (aOR, 4.77; 95% CI: 1.53 - 14.93). Distance to the nearest health facility also had a statistically significant association with skilled delivery. Women living at 10 – 19 km to a health facility were less likely to have a skilled delivery (aOR, 0.56; 95% CI: 0.32 - 0.97). In addition, the presence of a midwife at a health facility increased the odds of skilled delivery among women (aOR, 4.59; 95% CI: 2.47 - 8.55). Conclusion: Interventions aimed at increasing the uptake of delivery care services to achieve the SDG’s target on maternal mortality must consider improving the socio-economic wellbeing of women in addition to removing the physical and health system barriers impeding access and utilisation of delivery care services.

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Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0242325 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242325

Author(s):

Mohammad Habibullah Pulok ◽

Gowokani Chijere Chirwa ◽

Jacob Novignon ◽

Toshiaki Aizawa ◽

Marshall Makate

Keyword(s):

Health Facility ◽

Socioeconomic Inequality ◽

Care Service ◽

Skilled Birth Attendance ◽

Household Wealth ◽

Facility Delivery ◽

Delivery Care ◽

Health Facility Delivery ◽

Care Services ◽

Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

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When, where and who? Accessing health facility delivery care from the perspective of women and men in Tanzania: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-018-3357-6 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Thecla W. Kohi ◽

Lilian T. Mselle ◽

Justine Dol ◽

Megan Aston

Keyword(s):

Qualitative Study ◽

Health Facility ◽

Facility Delivery ◽

Delivery Care ◽

Health Facility Delivery

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The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-1708-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 16

Author(s):

C. M. Gitobu ◽

P. B. Gichangi ◽

W. O. Mwanda

Keyword(s):

Public Health ◽

Health Care ◽

Maternal Health ◽

Neonatal Mortality ◽

Health Facility ◽

Health Care Policy ◽

Facility Delivery ◽

Health Facility Delivery ◽

Care Policy ◽

Delivery Services

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Factors associated with health facility delivery in Kitui County: a cross sectional study

F1000Research ◽

10.12688/f1000research.23419.1 ◽

2020 ◽

Vol 9 ◽

pp. 522

Author(s):

Mathew Munyamaara Mutiiria ◽

Gabriel Gatimu Mbugua ◽

Doris Marwanga

Keyword(s):

Multivariate Analysis ◽

Maternal Mortality ◽

Health Facility ◽

Cross Sectional Study ◽

Facility Delivery ◽

P Value ◽

Sectional Study ◽

Health Facility Delivery ◽

Cross Sectional ◽

Factors Associated

Background: High maternal mortality rate is a major public health concern in developing countries. Skilled birth delivery is central to reducing maternal mortality, yet health facility delivery remains low in Kitui County, Kenya. Our study estimated prevalence of unskilled delivery and identified factors associated with health facility delivery in Kitui County. Methods: A cross-sectional study was conducted December 2017-February 2018. 245 women from five administrative wards were interviewed. A structured questionnaire was used to collect data. Variables that had p value ≤0.05 in bivariate analysis were included in multivariable regression model to assess for confounders. Variables with a p value of ≤0.05 in multivariate analysis were considered statistically significant at 95% CI. Results: We interviewed 245 (240 analyzed) women from the five wards; the majority were 16-25 years age group (45.5%; 110/240). Mean age was 27±6.6 years. Prevalence of health facility delivery was 50.4%. Distance from a health facility, number of children in a household, occupation of the respondent’s partner, number of antenatal clinic (ANC) visits and means of transport were significant factors for not delivering in a health facility. On multivariate analysis, women who lived >5km from health facility were less likely to deliver in a health facility (AOR =0.36; 95% CI 0.15- 0.86). Women who attended ≥ 4 ANC visits were 4 times more likely to deliver in a health facility (95% CI 2.01-8.79). Conclusions: More than half of the respondents delivered in a health facility. A long distance from the health facility is a hindrance to accessing ANC services. Inadequate ANC visits was associated with home delivery. Improving accessibility of health care services and health education on family planning would increase delivery at a health facility. We recommend Kitui County introduce five satellite clinics/ambulatory services for expectant women to access ANC and maternal services.

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Impact of Free Delivery Care on Health Facility Delivery and Insurance Coverage in Ghana’s Brong Ahafo Region

PLoS ONE ◽

10.1371/journal.pone.0049430 ◽

2012 ◽

Vol 7 (11) ◽

pp. e49430 ◽

Cited By ~ 77

Author(s):

Susie Dzakpasu ◽

Seyi Soremekun ◽

Alexander Manu ◽

Guus ten Asbroek ◽

Charlotte Tawiah ◽

...

Keyword(s):

Health Facility ◽

Insurance Coverage ◽

Facility Delivery ◽

Delivery Care ◽

Health Facility Delivery ◽

Brong Ahafo Region ◽

Brong Ahafo

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Expanding Access to Health Facility Delivery in Nigeria: Progress, Challenges and Opportunities

10.21203/rs.3.rs-275633/v1 ◽

2021 ◽

Author(s):

Anthony Idowu Ajayi ◽

Oluwafemi Emmanuel Awopegba ◽

Matthew Tobiloba Obisesan ◽

Charlotte Nwogwugwu ◽

Eyitayo Omolara Owolabi

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Facility ◽

Health Care Services ◽

Facility Delivery ◽

Maternal Health Care ◽

Health Facility Delivery ◽

Care Services ◽

Access To Health ◽

Challenges And Opportunities

Abstract Background Nigeria has the highest maternal deaths counts globally, and this reflects poor access to quality maternal health care services. Previous research on access to health facility delivery has not sufficiently probed the within-country inequalities in access to and progress in expanding maternal health care services in Nigeria. Our study fills this gap by examining the progress, challenges, and opportunities in expanding access to health facility delivery in Nigeria. Methods Data of 37,928 and 40,567 live births in the 2013 and 2018 Nigeria Demographic and Health surveys (NDHS) respectively were analysed in this study. NDHS employs a multistage sampling and is representative of both the country and each of the 36 states and Federal Capital Territory (FCT). We used descriptive statistics to examine the trend in health facility delivery in Nigerian states and presented the results using maps. Also, we used logistic regression analysis to examine progress in expanding access to health facility delivery across Nigerian states. Results The proportion of births delivered in health facilities increased from 35.8% in 2013 to 39.4% in 2018, representing a 3.6% increment. After adjusting for relevant covariates, women were 17% more likely to deliver in health facilities in 2018 than in 2013 surveys. However, progress in expanding access to health facility delivery was uneven across the country. While the odds of delivering in a health facility significantly increased for women living in 13 of the 36 states and FCT, the odds reduced significantly in seven states and no progress was recorded in 17 states. Conclusion There was a slight improvement in access to health facility delivery in Nigeria between 2013 and 2018. However, progress remains uneven across the states with only 13 states recording some progress. Four states stood out, recording over a three-fold relative increase in odds of health facility deliveries. These states implemented maternal health care policies that not only made services free but also improved infrastructure and human resources for health. Thus, providing examples of what works in improving access to services for other states to follow.

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Association between place of delivery for pregnant mothers and neonatal mortality: a systematic review and meta-analysis

European Journal of Public Health ◽

10.1093/eurpub/ckz060 ◽

2019 ◽

Vol 30 (4) ◽

pp. 743-748 ◽

Cited By ~ 1

Author(s):

Eshetu E Chaka ◽

Mulugeta Mekurie ◽

Ahmed Abdulahi Abdurahman ◽

Mahboubeh Parsaeian ◽

Reza Majdzadeh

Keyword(s):

Developing Countries ◽

Neonatal Mortality ◽

Publication Bias ◽

Health Facility ◽

Meta Analysis ◽

Facility Delivery ◽

Inverse Association ◽

Health Facility Delivery ◽

Test Statistic ◽

Major Health Problem

Abstract Background Neonatal mortality is a major health problem mainly in the developing countries and its reduction was remain stagnant during the era of Millennium Development Goal. Current global health policies emphasize institutional deliveries as a pathway to achieving reductions in neonatal mortality in developing countries. There are inconsistent conclusions of evidence about this fact, mainly in developing countries. Therefore, this study was conducted to assess the association between health facility delivery and neonatal mortality. Methods We systematically searched EMBASE, PubMed, ISI Web of Science and Scopus through 18 March 2018 and then updated on 14 February 2019. I2 test statistic was used to assess heterogeneity. Publication bias was checked using a funnel plot and meta-bias test. Random-effects model was used to determine the pooled effect size. Results Nineteen articles were included in the meta-analysis. The pooled odds ratios (ORs) indicated that health facility delivery was significantly associated with the odds of neonatal mortality (OR = 0.48; 95% CI: 0.38, 0.58). This significant inverse association was consistently found regardless of study design, geographical region and quality of the study. There is evidence of publication bias with high heterogeneity between studies (I2 = 84.5%). Conclusion The odds of neonatal mortality were much likely lower among those delivered at a health facility than those delivery at home. Therefore, encouraging delivery in a health facility and minimizing any barrier to health facility are important. Further longitudinal studies based on larger, more representative samples are therefore needed to further assess the underlying relationships.

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Prevalence and determinants of the place of delivery among reproductive age women in sub–Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0244875 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244875

Author(s):

Kenneth Setorwu Adde ◽

Kwamena Sekyi Dickson ◽

Hubert Amu

Keyword(s):

Maternal Mortality ◽

Health Facility ◽

Facility Delivery ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Health Facility Delivery ◽

Place Of Delivery ◽

Reproductive Age Women ◽

Sub Saharan ◽

Ssa Countries

Introduction Maternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA. Materials and methods This was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA. Results The overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57–0.61) of delivering at a health facility compared with urban women. Conclusions Our findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women.

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