Professional Commitment and Its Associated Factors among Institutional Delivery Services Providers in Public Health Facilities, In Shone District, Southern Ethiopia

Background: There is paucity of information on level of commitment among health professionals attending delivery service in public health facilities of low-income countries including Ethiopia. Hence, the aim of this study is to assess the level and factors associated with professional commitment among institutional delivery services providers at public health facilities in Shone District, Southern Ethiopia. Methods: A facility-based cross-sectional study design was conducted at primary level public health facilities in Shone District. All health facilities (one primary hospital and 7 health centers) were included in the study. Five hundred three study participants who fulfilled inclusion criteria in proportion to obstetric care providers in each public health facilities were selected by applying simple random sampling method. Self-administered Likert scale type of questionnaire was used. Data were analyzed using SPSS version 20. Bivariate and multivariable logistic regression analyses were done to see the association between dependent and explanatory variables. Results: The magnitude of professional commitment for obstetric care providers working in public health facilities of Shone district was 69.4%. In this study, those who worked at hospital, those who had positive attitude toward organizational commitment, and those who had positive attitude toward personal characteristics were 2.4, 2.3 and 1.76 times more likely committed to profession compared with their counterparts respectively. Conclusion: The professional commitment among institutional delivery service provision was medium as compared to other study finding. All health professional should manage their own personal characteristics to behave in good way to be committed for their profession. Organizational commitment had great influence on professional commitment.

Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

Background Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery. Method The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery. Result Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery. Conclusion The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account. Trial registration ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019.

Factors Affecting Utilization of Antenatal Care Services Among Women Visiting for Institutional Delivery in Tertiary Hospital, Bhairahawa, Nepal: A Cross Sectional Study

INTRODUCTION: Antenatal Care (ANC) services utilization during pregnancy plays an important role in prevention and management of pregnancy related complication thus improving the maternal and child health. Hence this study aimed to identify the factors influencing utilization of ANC service among women visiting for institutional delivery in tertiary hospital of Bhairahawa, Nepal. MATERIAL AND METHODS: Hospital based cross-sectional study was carried among 396 women admitted in the postnatal ward of Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal form September 2019 to December 2019 following ethical clearance and verbal consent from participants. Variables with significant association (p<0.05) in bivariate analysis were entered into multivariate logistic regressions to find the factors affecting utilization of antenatal care services. RESULTS: This study revealed that 18.43% of respondents did not receive any ANC services. Among those who were not receiving ANC service, 86.3% never felt the need for ANC services throughout the period of pregnancy. ANC service utilization was found to be associated with religion (AOR=3.15, 95% CI: 1.40-7.08) and husband education (AOR=5.09, 95% CI: 1.63-15.92). CONCLUSION: In spite of being an essential component for the care of pregnant women ANC services was not utilized by all of them as many of them did not felt the need of this service. Thus it is recommended to increase awareness regarding the available services and its importance by local stakeholders to prevent further morbidity and mortality.

The Extent of Universal Health Coverage for Maternal Health Services in Eastern Uganda: A Cross Sectional Study

Objective Monitoring essential health services coverage is important to inform resource allocation for the attainment of the Sustainable Development Goal 3. The objective was to assess service, effective and financial coverages of maternal healthcare services and their equity, using health and demographic surveillance site data in eastern Uganda. Methods Between Nov 2018 and Feb 2019, 638 resident women giving birth in 2017 were surveyed. Among them, 386 were randomly sampled in a follow-up survey (Feb 2019) on pregnancy and delivery payments and contents of care. Service coverage (antenatal care visits, skilled birth attendance, institutional delivery and one postnatal visit), effective coverage (antenatal and postnatal care content) and financial coverage (out-of-pocket payments for antenatal and delivery care and health insurance coverage) were measured, stratified by socio-economic status, education level and place of residence. Results Coverage of skilled birth attendance and institutional delivery was both high (88%), while coverage of postnatal visit was low (51%). Effective antenatal care was lower than effective postnatal care (38% vs 76%). Financial coverage was low: 91% of women made out-of-pocket payments for delivery services. Equity analysis showed coverage of institutional delivery was higher for wealthier and peri-urban women and these women made higher out-of-pocket payments. In contrast, coverage of a postnatal visit was higher for rural women and poorest women. Conclusion Maternal health coverage in eastern Uganda is not universal and particularly low for postnatal visit, effective antenatal care and financial coverage. Analysing healthcare payments and quality by healthcare provider sector is potential future research.

Spatial Pattern and Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 Ethiopian mini demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.

Association of Antenatal Care Visit with Utilization of Institutional Delivery Care Services in Afghanistan: Intersections Between Education, Wealth, and Household Decision-Making Autonomy

Background: The importance of antenatal visits in safe motherhood and childbirth is well documented. However, less is known how social determinants of health interact with antenatal care (ANC) visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the association of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.Methods: We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,581 women of reproductive age (15-49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results: Regression analyses adjusted for socioeconomic and demographic covariates suggest that women who had 4 or more ANC visits were 5.7 times (95% CI= 4.78, 7.11, P<0.001) more likely to use delivery care at a health facility and 6.5 times (95% CI= 5.23, 8.03; P<0.001) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions between ANC, education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion: Our findings suggest that the association of ANC visit with institutional delivery care services is stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

Maternity Care Services Utilization and Factors Associated with Institutional Delivery Among Postpartum Women in Dabat Demographic and Health Survey Site, Northwest Ethiopia: A Community Based Baseline Survey for MNCH Surveillance

Background Maternal continuum of care is identified to have a greatest impact on maternal and child survival. However, there is a wide variation in maternal health services utilization from place to place in Ethiopia. Therefore, knowing antenatal care, labor and delivery, and postnatal care uptake has paramount importance to take interventions. Methods A community-based cross-sectional survey was conducted among 1626 postpartum women. Descriptive statistics were done to characterize the study population and utilization of antenatal care, institutional delivery, and postnatal care services. Logistic regression analysis was employed to identify factors associated with institutional delivery. Results Nearly eighty percent, (79.7%, 95% CI: 77.7, 81.6), of women attended at least one antenatal care visit at any health facility. However, only less than one third (31.4%) used all the recommended antenatal care (ANC). About half, 820 (49.2%: 95% CI: 46.7, 51.8) women delivered their child in health institution. About half, 822 (50.6%, 95% CI: 48.2, 52.9) of postpartum women who participated in this study had at least one postnatal care (PNC) visit at health facilities. Being urban resident (AOR=8.18, 95%CI: 4.69, 14.26)), respondents of higher educational status (AOR= 4.99, 95%CI: 2.51, 9.90), being Orthodox Christian (AOR= 2.35, 95%CI: 1.15, 4.79), getting TT vaccination during pregnancy (AOR=1.54, 95%CI: 1.06, 2.23), and antenatal care utilization (AOR=2.97, 95%CI: 2.06, 4.27) were predictors for health facility/institutional delivery. Conclusions Though a significant proportion of the study participants initiated antenatal care, utilization of all the recommended antenatal care visits, facility delivery, and postnatal care services were low. Health professionals need to use the first antenatal care visit as a golden opportunity to attract and maintain pregnant women for the subsequent maternal health care services.

Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019

Background Inequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality. Methods Most recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality. Results The socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%). Conclusions To reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).

Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates

Background Routine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period. Methods We conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05. Results Approximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers. Conclusions Routine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces.