Quality of antenatal care service provision in health facilities across sub–Saharan Africa: Evidence from nationally representative health facility assessments

Abstract Background The COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services. Result Overall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households. Conclusions Availability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.

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Abstract 233: Diagnostic and Treatment Capacity for Heart Failure in Sub-Saharan Africa: an Analysis of Uganda and Kenya

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.233 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Selma Durakovic ◽

Herbert Duber ◽

Gregory Roth

Keyword(s):

Heart Failure ◽

Inpatient Care ◽

Health Facilities ◽

Sub Saharan Africa ◽

Survey Question ◽

Hiv Counseling ◽

Reduced Ejection Fraction ◽

Treat Heart Failure ◽

Nationally Representative ◽

Sub Saharan

Background: There is increasing recognition that heart failure is a significant component of disease burden in Sub-Saharan Africa (SSA) and that better strategies for heart failure management are needed. However, relatively little is known about the capacity to diagnose and treat heart failure in this region. Objectives: In this study, we seek to better understand the health system’s capacity to diagnose and treat heart failure in Uganda and Kenya, in order to inform policy planning and interventions. Methods: We analyzed data from a nationally-representative survey of health facilities in Uganda and Kenya, conducted by the Institute for Health Metrics and Evaluation (IHME) as part of the Access, Bottlenecks, Costs, and Equity (ABCE) project. A structured survey instrument was administered at each facility between 2011 and 2012. In this study we examine the availability of cardiac diagnostic technologies, medications for heart failure, and emergency transportation to an inpatient facility. A package of medications for heart failure with reduced ejection fraction (HFrEF) was defined from local formulary guidelines as including beta-blocker (propranolol or atenolol), ACE inhibitor (captopril or lisinopril), and furosemide. Facility-level data was analyzed by platform type (hospital vs health center), ownership (public vs private), inpatient care availability, and location (urban, semi-urban, or rural). Results: We analyzed 197 health facilities in Uganda and 143 in Kenya after excluding dispensaries, pharmacies, and HIV counseling centers. Among facilities responding to this survey question, functional and staffed ECG was available in 24% of facilitiesin Uganda and 36% of facilities in Kenya. However, this survey question was left unanswered by approximately 70% of the facilities in each country. In regards to treatment capabilities, 37% of Ugandan and 24% of Kenyan facilities reported availability of a basic package of heart failure medications on the day the survey was administered. This was driven predominantly by the low availability of ACE inhibitors, which were available in only 41% of Ugandan and 29% of Kenyan facilities. Of the facilities with medication availability, 26% of Ugandan and 32% of Kenyan facilities had a significant stock out (8+ days) of at least one of the medications in the prior quarter. Of the facilities that did not offer inpatient care, 41% of Ugandan and 66% of Kenyan facilities were prepared for emergency transportation. Conclusion: Few facilities in Uganda and Kenya were prepared to perform necessary tests to diagnose and manage heart failure. Less than half of the facilities in both countries had the medications needed to treat HFrEF. Further investment in cardiac care will be required by these developing health systems if they are to address the growing burden of heart failure.

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Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review

Global Health Research and Policy ◽

10.1186/s41256-021-00206-2 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Mai-Lei Woo Kinshella ◽

Sarina Prasad ◽

Tamanda Hiwa ◽

Marianne Vidler ◽

Alinane Linda Nyondo-Mipando ◽

...

Keyword(s):

Health Facility ◽

Exclusive Breastfeeding ◽

Health Facilities ◽

Barriers And Facilitators ◽

Sub Saharan Africa ◽

Respectful Maternity Care ◽

Hiv Positive ◽

Breastfeeding Practices ◽

Sub Saharan ◽

Facility Births

Abstract Background Sub-Saharan Africa carries a disproportionate burden of under-five child deaths in the world and appropriate breastfeeding practices can support efforts to reduce child mortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa. Methods A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414). Results Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive. Conclusion There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.

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Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0262411 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262411

Author(s):

Adugnaw Zeleke Alem ◽

Yigizie Yeshaw ◽

Alemneh Mekuriaw Liyew ◽

Getayeneh Antehunegn Tesema ◽

Tesfa Sewunet Alamneh ◽

...

Keyword(s):

Logistic Regression ◽

Antenatal Care ◽

Regression Model ◽

Health Facility ◽

Associated Factors ◽

Logistic Regression Model ◽

Sub Saharan Africa ◽

Timely Initiation ◽

Sub Saharan ◽

Ssa Countries

Background Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries. Methods The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15–49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). Results In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8–38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25–34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely. Conclusion Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

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Correlates of antenatal care utilization among women of reproductive age in sub-Saharan Africa: evidence from multinomial analysis of demographic and health surveys (2010–2018) from 31 countries

Archives of Public Health ◽

10.1186/s13690-020-00516-w ◽

2020 ◽

Vol 78 (1) ◽

Author(s):

Sulaimon T. Adedokun ◽

Sanni Yaya

Keyword(s):

Higher Education ◽

Antenatal Care ◽

Health Facility ◽

Health Surveys ◽

Sub Saharan Africa ◽

Care Utilization ◽

Demographic And Health Surveys ◽

Antenatal Care Utilization ◽

Sub Saharan ◽

Socioeconomic And Demographic Factors

Abstract Background Despite a global reduction of about 38% in maternal mortality rate between 2000 and 2017, sub-Saharan Africa is still experiencing high mortality among women. Access to high quality care before, during and after childbirth has been described as one of the effective means of reducing such mortality. In the sub-region, only 52% of women receive at least four antenatal visits. This study examined the factors influencing antenatal care utilization in sub-Saharan Africa. Methods Data from Demographic and Health Surveys (DHS) of 31 countries involving 235,207 women age 15–49 years who had given birth to children within 5 years of the surveys were used in the study. Multinomial logistic regression model was applied in the analysis. Results About 13% of women in sub-Saharan Africa did not utilize antenatal care while 35 and 53% respectively partially and adequately utilized the service. Adequate utilization of antenatal care was highest among women age 25–34 years (53.9%), with secondary or higher education (71.3%) and from the richest households (54.4%). The odds of adequate antenatal care utilization increased for women who are educated up to secondary or higher education level, from richest households, working, living in urban areas, exposed to media and did not experience problem getting to health facility or obtaining permission to visit health facility. Conclusions This study has revealed information not only on women who did not utilize antenatal care but also on women who partially and adequately utilized the service. The study concluded that the correlates of antenatal care utilization in sub-Saharan Africa include socioeconomic and demographic factors, getting permission to visit health facility, unwillingness to visit health facility alone and problem encountered in reaching the health facility.

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Assessment of Quality of Antenatal Care Services and Its Determinant Factors in Public Health Facilities of Hossana Town, Hadiya Zone, Southern Ethiopia: A Longitudinal Study

Advances in Public Health ◽

10.1155/2020/5436324 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Trhas Tadesse Berehe ◽

Lebitsi Maud Modibia

Keyword(s):

Public Health ◽

Antenatal Care ◽

Care Service ◽

Health Facilities ◽

Southern Ethiopia ◽

Skilled Attendant ◽

Her Family ◽

Public Health Facilities ◽

Hadiya Zone

Background. Antenatal care is a care that links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth, and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Therefore, the main aim of this study was to determine the quality of ANC in Hadiya Zone, Southern Ethiopia. Method. A longitudinal facility-based study design was conducted among 1123 mothers whose gestational age of less than 16 weeks was identified and followed until birth and 40 days after birth to detect whether they gained the acceptable standard of quality of ANC from July 2017 to June 2018. A structured, predefined, and pretested observation check list and Likert scales were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. Data was entered into Epi Info version 3.5 and transferred to STATA Version 14 software and cleaned by reviewing frequency tables, logical errors, and checking outliers. Generalized estimating equation (GEE) analysis was applied to get the average response observation of each visit of quality of ANC in the health facilities. Result. This study showed that the overall magnitude of good quality of antenatal care service that was provided in the whole visit at Hosanna Town’s public health facilities was 1230 (31.38%). The most frequently identified problems were inability to take full history, lack of proper counseling, poor healthcare provider and client interaction, and improper registration and there was a variation in providing quality of care in each visit. Quality of antenatal care was significantly associated with residence, educational status gravidity, parity, and visit. In conclusion, the overall quality of antenatal care is low, so the health facilities need further modification on the identified problems.

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Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO’s antenatal care guideline

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzy105 ◽

2018 ◽

Vol 31 (1) ◽

pp. 43-48 ◽

Cited By ~ 3

Author(s):

Patrick Opiyo Owili ◽

Miriam Adoyo Muga ◽

Bomar Rojas Mendez ◽

Bradley Chen

Keyword(s):

Quality Of Care ◽

Antenatal Care ◽

Sub Saharan Africa ◽

Care Guideline ◽

Sub Saharan

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Quality of antenatal care services in selected health facilities of Kaski district, Nepal

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20182142 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2182 ◽

Cited By ~ 3

Author(s):

Pabitra Bastola ◽

Dipendra Kumar Yadav ◽

Himlal Gautam

Keyword(s):

Antenatal Care ◽

Care Service ◽

Blood Pressure Measurement ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Danger Signs ◽

Care Services ◽

Assess Quality

Background: Antenatal care service is an evidence based interventions given to the pregnant women. Objective of the study was to assess quality of antenatal care services in selected health facilities of Kaski district, Nepal.Methods: A cross sectional study was conducted in selected health institutions in Kaski district of Nepal during June to November 2017. Two hundred seven participants were selected from health facilities of Kaski district. Structured questionnaires were employed as tool for data collection.Results: This study showed that 50.7 percent respondents waited less than 35 minutes for receiving service. More than half of the total respondents (63.3%) reported that the consultation time provided for them was less than 20 minutes. All respondents reported that weight and blood pressure measurement was undertaken while none of them reported that height was measured. It was found that maximum number of participants (99.0%) were received iron/folate tablets and tetanus vaccination. Similarly, 97.6% of participants reported that they were counselled on nutrition and 96.6% of reported they get counselling on danger signs. In overall, 48.3% of the respondents were satisfied with the services they received and 43% of the respondents received good quality ANC service from different health institutions.Conclusions: In overall satisfaction of antenatal care services was found to be low and more than half of respondent does not received good quality ANC services.

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