Effects of a Water, Sanitation and Hygiene Mobile Health Program on Respiratory Illness in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program

Acute respiratory infections are a leading cause of morbidity and mortality among young children globally. The objective of this study was to evaluate the impact of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) handwashing with soap and water treatment mobile health (mHealth) program on respiratory illness among diarrhea patients and their household members in urban Dhaka, Bangladesh. A cluster-randomized controlled trial of the CHoBI7 mHealth program was conducted among diarrhea patient households in Dhaka, Bangladesh. Patients were randomized to three arms: standard recommendation on oral rehydration solution use, health facility delivery of CHoBI7 plus mHealth (weekly voice and text messages) (no home visits), and health facility delivery of CHoBI7 plus two home visits and mHealth. Respiratory symptoms were assessed during monthly clinical surveillance over the 12-month surveillance period. Respiratory illness was defined as rapid breathing, difficulty breathing, wheezing, or coughing. Two thousand six hundred twenty-six participants in 769 households were randomly allocated to three arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with two home visits. Compared with the standard message arm, participants in the mHealth with no home visits arm (Prevalence Ratio [PR]: 0.88 [95% CI: 0.79, 0.98]), and the mHealth with two home visits arm (PR: 0.88 [95% CI: 0.79, 0.98]) had significantly lower respiratory illness prevalence over the 12-month program period. Our findings demonstrate that the CHoBI7 mHealth program is effective in reducing respiratory illness among diarrhea patient households.

Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling

Background In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa. Methods A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children’s survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality. Results Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1–3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24–48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality. Conclusion Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn’t have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

Background High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria. Methods The study used the most recent secondary dataset from Nigeria’s Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05. Results The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74–0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above. Conclusion Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.

Effect of the COVID-19 pandemic on health facility delivery in Ethiopia; results from PMA Ethiopia’s longitudinal panel

Objectives To examine the effect of COVID-19 on health facility delivery in Ethiopia. Design We used longitudinal data with a pre-post exposure to the pandemic to assess change in facility delivery patterns nationally and by urban and rural strata. We conducted design-based multivariable multinomial logistic regression comparing home, lower-level facility, and hospital delivery with date of birth as a spline term, with a knot indicating births before and on/after April 8, 2020. Setting Six regions in Ethiopia, covering 91% of the population. Participants Women were eligible to participate if they were currently pregnant or less than six weeks postpartum and were recontacted at six weeks, six months, and one year postpartum. 2,889 women were eligible and 2,855 enrolled. Data used in this paper come from the six-week interview, with a follow-up rate of 88.9% (2,537 women). Results In urban areas, women who delivered during the COVID-19 pandemic had a 77% reduced relative risk of delivering in a hospital relative to women who delivered prior to the pandemic (aRRR: 0.23, 95% CI: 0.07–0.71). There were no significant differences between the pre- and COVID-19 periods within rural strata where the majority of women deliver at home (55.6%). Overall, the effect was non-significant at a national level. Among women who delivered during the COVID-19 pandemic, 20.0% of urban women said COVID-19 affected where they delivered relative to 8.7% of rural women (p-value = 0.01). Conclusion We found that delivery patterns in urban areas changed during the early months of the COVID-19 pandemic, but there was no evidence of large-scale declines of hospital delivery at the national level. Concerns about COVID-19 transmission in health facilities and ensuring lower-level facilities are equipped to address obstetric emergencies are critical to address. COVID-19 will likely slow progress towards increasing rates of institutional delivery in urban areas in Ethiopia.

Effects of antenatal care visits and health facility delivery on women's choice to circumcise their daughters in sub-Saharan Africa: evidence from demographic and health surveys

Background This study examines the association between maternal healthcare service utilisation and circumcision of daughters in sub-Saharan Africa (SSA). Methods This study is based on a cross-sectional study design that draws on analysis of pooled data from current demographic and health surveys conducted between 2010 and 2019 in 12 countries in SSA. Both bivariate and multivariable binary logistic regression models were employed. Results Mothers who had four or more antenatal care visits were less likely to circumcise their daughters compared with those who had zero to three visits. Mothers who delivered at a health facility were less likely to circumcise their daughters than those who delivered at home. With the covariates, circumcision of daughters increased with increasing maternal age but decreased with increasing wealth quintile and level of education. Girls born to married women and women who had been circumcised were more likely to be circumcised. Conclusions This study established an association between maternal healthcare service utilisation and circumcision of girls from birth to age 14 y in SSA. The findings highlight the need to strengthen policies that promote maternal healthcare service utilisation (antenatal care and health facility delivery) by integrating female genital mutilation (FGM) information and education in countries studied.

Factors influencing place of delivery among women residing in Ifakara Town Council, Kilombero District, Tanzania

Background: This study was done to assess factors influencing place of delivery among women residing in Ifakara Town Council, Kilombero district, Tanzania. Method: A community based descriptive cross-sectional study was conducted in February 2021. A total of 135 child bearing women from 3 randomly selected wards of Ifakara Town Council were involved in the study. Structured pre-tested questionnaire with key information was used to collect desired data. Results: More than half 55.6% of the women had health facility delivery and 44.4% of them had home delivery. The most common reason for home delivery was sudden onset of labor 50.4%. Other reasons for home delivery were age of 26 and above, parity of four, and education of mother. Conclusion: Maternal health services, such as antenatal care, skilled assistance during delivery and post-natal care, adequate equipment in health facilities, play a major role of in the reduction of maternal morbidity and mortality. Therefore, efforts should be made both at community and government levels to increase health facility delivery.

Is Decision-Making For Health Care Related To Health Facility Delivery Among Married Women In Uganda? Analysis From DHS 2016

Background Most maternal and neonatal deaths occur in low and middle incomes, and more than half takes place within the first day of birth. These deaths could be prevented if delivery was attended to by skilled health professionals in the health facilities. Empirical studies have reported several factors associated with low facility-based delivery. Limited literature is available on the relationship between women autonomy and health facility delivery in Uganda. This study aims to establish the relationship between decision-making for health care and health facility delivery among married women in Uganda. Method: The data used for the cross-sectional study was from the Uganda Demographic Health Survey 2016. The study used a sample of 1541 women who gave birth within five years before the survey. Proportions, odds ratio and 95% confidence interval were used to estimate the health facility delivery for each independent variable using the level of significance of p < 0.05. Binary logistics regression was used to calculate the odds ratio for the different variables. Results: 49% of the women could decide by themselves to seek care. Although 94% of the women attended ANC during the last pregnancy, only 75% of the married women delivered their most recent child in the hospital/health facility. There was regional variation for facility-based delivery (Western AOR 0.441, CI 0.285-0.684; Eastern 0.568, CI 0.395-0.816; Central 0.587, CI 0.361-0.952). Older women are less likely to deliver in a health facility compared to younger ones (25-29years AOR 0.559, CI 0.356-0.877; 30-34years AOR 0.530, CI 0.342-0.823, 35-39years AOR 0.406, CI 0.252-0.652; 40-44year AOR 0 .569, CI 0.345-0.938; 45-49years AOR 0.485, CI 0.288-0.814). Women who were aged 20-29years were more likely to deliver in a health facility (AOR 1.55 CI 1.141-2.109). Women in the middle, richer and richest wealth index have higher odds of delivering in the hospital compared to women in the poorest wealth index (Middle AOR 1.544, CI 1.053-2.264; richer AOR 1.863, CI 1.211-2.866; Richest AOR 4.104, CI 2.051-8.213). Women who do not have problems with transport are more likely to deliver in the hospital (AOR 1.503, CI 1.168-1.935). Conclusion: Decision-making for health has no association with health facility delivery. The factors associated with health facility delivery among married women were the current age of the woman, age of the woman at the birth of the first child, distance to the facility, wealth, region and place of residence. The government needed to develop strategies that will improve health facility distribution per capita, invest in infrastructure that will reduce the distance to the health facility, invest in projects that will improve wealth index and carry out health promotion targeting older women and considers geographical variations.

Regional differentials in early antenatal care, health facility delivery and early postnatal care among women in Uganda

This study aimed at examining regional differentials in maternal healthcare services in Uganda. Using a sample of 1,521 women of reproductive ages (15-49) from Eastern and Western sub-regions of Uganda, and non-linear Oaxaca’ Blinder Multivariate Decomposition method, we assessed differentials in utilization of early antenatal care, health facility delivery and early postnatal care services among the women, henceforth, establishing main predictors of regional inequalities that will enable policymakers to make better evenly interventions and focused decisions. The study reveals that differentials in the utilization of maternal healthcare services are not only hindered by social and economic barriers, but also widespread disparities in the utilization of existing services. Significant differentials were attributed to both variation in women’s characteristics and effects of coefficients. Findings showed that the gap in early antenatal care would reduce on average by 31.6% and 34.7% of differences in availability of community health workers and media exposure respectively, were to disappear. Furthermore, the gap would increase on average by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth respectively. The gap in health facility delivery would reduce on average by 24.6% and 37.2% of differences in community health worker availability and media exposure were to disappear respectively and increase on average by 54.9% in the absence of variations in effects of maternal education. The gap in EPNC would reduce on average by 18.5% and 17.17% of differences in maternal education and community health worker availability were to disappear respectively and increase on average by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth respectively. Progress towards equitable maternal health care should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.

Maternal Social Support and Determinants of Health Facility Delivery in Rural Ethiopia

Background: Maternal mortality continues to decrease in the world but remains the most important health problems in low-income countries. Although evidence indicates that social support is important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess social support in influencing health facility childbirth in Ethiopia. Methods: A cross-sectional survey data on 3304 women aged 15–49 years from an Innovating for Maternal and Child Health in Africa project in three districts of Ethiopia, were analyzed, including data on social support and important factors. Using multivariate logistic regression, we examined the association between health facility birth, social support, and included variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level.Result: Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth.Conclusions: Social support was critical to enhance health facility delivery, especially if women’s close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women’s general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth and also actions that increase women's healthcare decision could be effective in improving health facility delivery.

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.