Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana

Background. A critical public health issue is maternal mortality. Around 810 women die per day from pregnancy and childbirth, with approximately 99 percent of these deaths recorded in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA), more than half of these mortalities are registered. The situation is remarkably similar in Ghana, with maternal mortality standing at 319 deaths per 100,000 live births in 2015. Methods. Using data from 2014 Demographic and Health Surveys, the study examined the association between women empowerment and skilled birth attendance among women in rural Ghana. Results. Women with medium decision-making ( OR = 0.75 , CI = 0.61 , 0.93), low knowledge level ( OR = 0.55 , CI = 0.40 , 0.76), high acceptance of wife beating ( OR = 0.68 , CI = 0.51 , 0.90), with less than 4 ANC visits ( OR = 0.25 , CI = 0.19 , 0.32), whose partner had higher education ( OR = 1.96 , CI = 1.05 , 3.64), and who had a big problem with the distance getting to the health facility ( OR = 0.63 , CI = 0.50 , 0.78) had a significant association with skilled birth attendants. Decision-making power, women’s knowledge level, acceptance of wife beating, antenatal care visit, partner’s education, getting medical help for self, and distance to health facility were seen to have a significant association with skilled birth attendants among women in Ghana. Conclusion. Efforts to increase the current SBA should concentrate on the empowerment of women, male involvement in maternal health problems, women’s education, and participation in the ANC. There is a need to review current policies, strategies, and services to improve maternal health conditions.

Socioeconomic inequalities in access and use of skilled birth attendants during childbirth in Ghana: a decomposition analysis

Background Equitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana. Methods Research was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities. Results The results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women. Conclusion This study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.

Practices of Skilled Birth Attendants about AMTSL in Prevention of Post-Partum Haemorrhage: Cross-sectional Study

Aim: To assess the practices of SBAs about AMTSL working in labour room at tertiary level of care in-order to minimize the accidence of PPH. Study Design: Cross-sectional descriptive study. Methodology: This study with enrolled SBAs (n=120) was done following ethical review committee’s (ERC) approval at Government tertiary care hospitals of the Lahore-Pakistan. For data collection a WHO standardized check list as a questionnaire was used to assess the practices of SBAs. Results: Results showed that there were gaps in competencies of SBAs about AMTSL working in labour room. Most of the steps that are S1, S3, S4, S8, S12, S13, S14 and S15 were not done by the majority of the SBA working in labour room. Almost 12 (10%) out of 120 SBAs just got 60% and above marks, 100 (83.3%) out of 120 got marks between40 to 59% and only 8 (6.7%) got less than 40% marks. Conclusion: We concluded that SBAs had unsatisfactory knowledge about standardized check list of AMTSL by WHO and their practices were not according to standard. Keywords: Skilled Birth Attendants, Labour Stages, Post-partum Haemorrhage and Practices.

Factors influencing partograph recording among skilled birth attendants at Mzuzu Central Hospital, Northern Malawi

Background/Aims Malawi has very high maternal and neonatal mortality rates, often resulting from complications during labour and delivery. Complete recording of a partograph during labour monitoring has been associated with a reduction and prompt management of fatal complications. Although the partograph is an essential tool for monitoring women during labour, there is limited evidence on the status of its recording and associated factors among skilled birth attendants in northern Malawi. The aim of this study was to assess partograph recording and explore factors affecting its recording among skilled birth attendants at the Mzuzu Central Hospital in Malawi. Methods The study used a descriptive cross-sectional design with mixed methods. The study involved a retrospective review of 369 patient partographs, using a data extraction sheet to gather quantitative data, which were analysed using descriptive statistics. Qualitative data were collected through individual in-depth interviews with seven skilled birth attendants working at the hospital, using a semi-structured interview guide and analysed by content analysis. Results Of the 369 partographs that were reviewed, recording was complete in only 12.7% of fetal assessments, 13.3% of maternal assessments and 24.7% of sections recording the progress of labour. The most completely recorded parameter was liquor (71.8%), followed by cervical dilatation (70.5%). The least completely recorded parameters were temperature (13.6%) and urine protein (2.2%). Factors that influenced the recording of a partograph included skilled birth attendants' general knowledge on the partograph, the availability of equipment for assessments, supportive supervision, staffing levels, attendance to in-service training and clients' perception of the frequency of assessments. Conclusions Skilled birth attendants at Mzuzu Central Hospital partially complete partographs during labour. Staffing levels, availability of equipment for assessments, in-service training and supportive supervision are all factors that affect complete partograph recording. Therefore, it is essential to implement strategies that can promote complete partograph recording in order to reduce maternal and newborn morbidity and mortality at this health facility.

Utilization of Skilled Birth Attendants and Associated Factors Among Women Having Children Less Than Two Years in Bench-Shako, South West of Ethiopia,2020

Introduction:-Skilled attendant delivery is considered the most critical intervention in reducing maternal death and ensuring safe motherhood. But, the level of maternal morbidity and mortality in Ethiopia is among the highest in the world: indicate the proportion of births occurring at health facilities is low. Globally, about 289,000 women die each year due to preventable causes, yielding a maternal mortality rate of 210 per 100,000 live births. In Ethiopia, institutional delivery is low 34%. From the treatable and preventable woman deaths, 16 % occurs during delivery.To mitigate maternal death by identifying the utilization of skilled birth attendants and associated factors among women children less than two years is important.Objective: Assess the utilization of skilled birth attendants and associated factors among the women children less than two years in South West, Ethiopia, 2020G.C.Methods and Materials: Community-based cross-sectional study design was employed to collect data from 294 women children less than two years in Mizan- Amen, Bench Shako zone, 2020.Structured questionnaires were to collect the data by face-to-face interviews of a systematically selected participant. The data were analysed by SPSS software version 21.Results: Among the respondents (294), 30.6% of them had utilized skilled birth attendants. The contributing factors associated with the utilization of skilled birth attendants were:-Age of the respondents (21–25), governmental employees, having antenatal care follow-up, and nearest to the health facility.Conclusions: Generally, this study has indicated the skilled birth attendance was low. Mothers with government-employed, Age in years, having antenatal care follow-up, and nearest to the health facility in less than 30minutes were predictors of skilled birth attendant.

Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach

Background: The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target. Objectives: This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian univer- sity teaching hospital. Methods: A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth re- cords from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining ante- natal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics. Results: The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of non- first time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth. Conclusion: The rate of episiotomy was higher than global recommended standards and primips are disproportionately af- fected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation. Keywords: Episiotomy; birth; pregnant women; vagina; Nigeria.

Birth preparedness and related factors: a cross-sectional study in Tanzania City area

Background Birth preparedness could be the key factor that influences the choice of birthplace with skilled birth attendants. To reduce the high maternal mortality of Tanzania, a large study was planned to develop a smartphone app to promote birth preparedness in a city area of Tanzania. This study aimed to identify factors that influence birth preparedness in the city area of Tanzania. Methods Pregnant women were asked to complete the Birth Preparedness Questionnaire during antenatal visits using tablets. Multiple linear regression analyses were performed to determine the sociodemographic and obstetric characteristics that influenced the factors. Results A total of 211 participants were included in the analysis. Distance from the nearest health facility negatively influenced the total score of the Birth Preparedness Assessment (β= 0.7, p = 0.02). Education higher than college positively influenced the total score (β = 4.76, p = 0.01). Decision-making of birthplace by other people (not women) negatively influenced Family Support (β=1.18, p = 0.03). Having jobs negatively influenced Preparation of Money and Food (β=-1.02, p < 0.01) and positively influenced the knowledge (β = 0.75, p = 0.03). Being single positively influenced Preparation of Money and Food (β = 0.35, p = 0.19) and Preference of Skilled Birth Attendants (β = 0.42, p = 0.04). Experience of losing a baby negatively influenced the knowledge (β=0.80, p < 0.01) and Preference of Skilled Birth Attendants (β=0.38, p = 0.02). Conclusions The findings showed an updated information on pregnant Tanzanian women living in an urban area where rapid environmental development was observed. Birth preparedness was negatively affected when women reside far from the health facilities, the birthplace decision-making was taken by others beside the women, women have jobs, and when women have experienced the loss of a baby. We hope to use the information from this study as content in our future study, in which we will be applying a smartphone app intervention for healthy pregnancy and birth preparedness. This information will also help in guiding the analysis of this future study. Although generalization of the study needs careful consideration, it is important to reconsider issues surrounding birth preparedness as women’s roles both in the family and society, are more, especially in urban settings.

Accuracy of the Community Maternal Danger Score Algorithm for Predicting Pregnant Women Requiring Skilled Birth Attendants and at High-risk for Mortality

BackgroundHigh rates of maternal mortality in low-and-middle-income countries (LMICs) are associated with the lack of skilled birth attendants (SBAs) at delivery. Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs. We sought to develop a low-cost maternal risk tool, the Community Maternal Danger Score (CMDS), to identify pregnant women who need an SBA at delivery.MethodsTo design the CMDS algorithm, an initial literature review was conducted to identify predictors of the need for an SBA. Medical records of women who delivered at the Federal Medical Centre in Makurdi, Nigeria (2019-2020) were examined for predictors identified from the literature review. Outcomes associated with the need for an SBA were recorded: caesarean section, postpartum hemorrhage, eclampsia, and sepsis. A maternal mortality ratio (MMR) was determined. Multivariate logistic regression analysis and area under the receiver operating curve (AUC) were used to assess the predictive ability of the CMDS algorithm.ResultsSeven factors from the literature predicted the need for an SBA: age (under 20 years of age or 35 and older), parity (nulliparity or grand-multiparity), BMI (underweight or overweight), fetal size (less than 35cm or 40cm and over), adverse obstetrical history, signs of pre-eclampsia, and co-existing medical conditions. These factors were recorded in 589 women of whom 67% required an SBA (n=396) and 1% died (n=7). The MMR was 1,189 per 100,000 (95%CI: 478-2,449). Signs of pre-eclampsia, obstetrical history, and co-existing conditions were highly associated with the need for an SBA. Age was found to interact with parity, suggesting that the CMDS requires adjustment for younger multigravida and older primigravida women. The CMDS algorithm had an AUC of 0.73 (95%CI: 0.69-0.77) for predicting whether women required an SBA, and an AUC of 0.85 (95%CI: 0.67-1.00) for in-hospital mortality.ConclusionsThe CMDS is a low-cost, evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi. Non-specialist health workers can use the CMDS to standardize patient assessment and encourage pregnant women to seek an SBA in preparation for delivery, thus improving care in countries with high rates of maternal mortality.