Comparative study of knowledge, attitudes, and practices of maternal health care utilization in rural and urban areas of Mysuru, India

achieve the sustainable development goals in India. Despite government initiatives, lack of utilization of available maternal health care remains a major issue. This study aimed to determine the social and cultural driving forces behind maternal health care utilization, and the knowledge, attitudes and practices among rural and urban women.Methods: Participants were pregnant and lactating women receiving care at primary health centers in or surrounding Mysuru. Quantitative variables were assessed with cross-sectional analysis of a survey of maternal health knowledge, attitudes, and practices. Qualitative data were gathered using focus group discussions regarding health care utilization. The analysis included 56 urban women and 36 rural women (n=92).Results: There was a statistically significant difference in overall knowledge (p=0.004) between urban and rural women with rural participants having more overall knowledge. There are significant positive correlations (p=0.01) between knowledge and practice, knowledge and attitude, and the practice and attitude domains.Conclusions: The knowledge gap between urban and rural women may be attributed to the prevalence of accredited social health activists (ASHAs) in rural communities. Incentivizing more urban women to become ASHAs can help close this gap between the two environments. Strategies dedicated to broadening the fund of health care education of the community will in turn improve on practice.

Family planning communication through mass media and health workers for promoting maternal health care utilization in Nigeria

Studies have demonstrated that health communication programmes, through community health workers or mass media, are a key strategy to promote awareness and uptake of essential maternal health services. This study investigated whether or not family planning communication through mass media and health workers has any association with maternal health care utilization uptake in Nigeria. Cross-sectional data were extracted from the 2003–13 Nigeria Demographic and Health Surveys. The study sample comprised 41,938 women aged 15–49 years who had a live birth during the 5 years preceding the survey. Outcome variables were adequacy of antenatal care visits and place of delivery. Receiving family planning messages from the radio, TV, newspapers, a family planning worker or during a health facility visit were considered as possible sources of exposure to family planning information. Radio (32.6%) was the most commonly reported source of family planning information, followed by TV (17.5%) and newspapers (6.1%). Less than one-tenth of respondents were visited by family planning workers (9.5%) and about one-third visited a health facility during the previous 12 months (30.3%). Those who reported receiving family planning information from the three types of mass media and who had contact with a family planning worker and/or health facility were more likely to have at least eight antenatal care contacts (odds ratio for TV use=1.172, 95% CI=1.058–1.297) and deliver at a health facility (odds ratio for TV use=1.544, 95% CI=1.350–1.766). These findings indicate that family planning communication through mass media and health workers could potentially improve the utilization of antenatal and health facility delivery services in Nigeria.

The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization

Background Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. Methods Drawing from the Demographic Health Survey (2015–2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15–49 years old, who had given birth in five years before the month of the interview and living in both rural and urban Tanzania. The maternal health care utilization was assessed by four variables (i.e., antenatal care, skilled delivery assistance, the before and after discharging postnatal care). The independent variables were wealth, education, residence, parity, occupation, age, and the head of the household’s sex. We used bivariate statistics and logistic regression to examine the rural-urban differences in the influence of education and wealth on maternal health care utilization. Results Significantly lower use of maternal health care in rural than urban areas demonstrated a stark rural-urban divide in Tanzania. We documented socioeconomic inequalities in maternal health care utilization in the form of lower odds of the utilization of such services among women with lower levels of education and household wealth. The educational inequalities in the utilization of skilled delivery assistance (or = 0.37, 95% CI: 0.16, 0.86; p = 0.021) and (before discharge) postnatal care (or = 0.60, 95% CI: 0.38, 0.95; p = 0.030) were significantly wider in rural than urban areas. The differences in the odds of the utilization of skilled delivery assistance between women in poorer wealth quintile and women in richer household wealth quintile were also significantly wider in rural areas than in urban areas. However, the statistically significant rural-urban divides in the impacts of socioeconomic status on antenatal care and (after discharge) postnatal care were not observed. Conclusion This study establishes the need for consideration of the rural-urban context in the formulation of policies to reduce disparities in maternal health care utilization in Tanzania.

Men and maternal health care utilization in India and in selected less-developed states: evidence from a large-scale survey 2015–16

Male involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women’s antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015–16). Husband’s knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife’s ANC visits. Furthermore, men’s presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of ‘unnecessary’ maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

Understanding the Improvement in Full Childhood Vaccination Coverage in Ethiopia Using Oaxaca–Blinder Decomposition Analysis

In Ethiopia, full vaccination coverage among children aged 12–23 months has improved in recent decades. This study aimed to investigate drivers of the improvement in the vaccination coverage. The Oaxaca–Blinder decomposition technique was applied to identify the drivers using data from Ethiopian Demographic and Health Survey conducted in 2000 and 2016. The vaccination coverage rose from 14.3% in 2000 to 38.5% in 2016. The decomposition analysis showed that most of the rise in vaccination coverage (73.7%) resulted from the change in the effect of explanatory variables over time and other unmeasured characteristics. Muslim religion had a counteracting effect on the observed increase in vaccination coverage. The remaining 26.3% of the increase was attributed to the change in the composition of the explanatory variables between 2000 and 2016, with maternal educational level and maternal health care utilization as significant contributors. The findings highlight the need for further improvements in maternal health care utilization and educational status to maintain the momentum towards universal coverage of childhood vaccination. Targeted intervention among Muslim-dominated communities is also needed to improve the current situation. Besides which, future studies need to be conducted to identify additional potential modifiable factors.

Determinants of Maternal Health Care Utilization in the Era of Free Maternity Services in Busia County, Kenya

Purpose. The main objective was to establish determinants of maternal health care utilization and specifically to assess the trends of maternal health care utilization and determine the predictors of maternal health care service utilization in the era of free maternity policy in Busia County. Methodology. It was a cross-sectional study design. The study was conducted between February and April 2019. The research targeted mothers within childbearing age of 15-49 years and a sample size of 634 mothers was used. Quantitative data were analyzed using SPSS version 22.0. Descriptive statistics was used to describe results on socio-demographic characteristics while inferential statistics employed bivariate and multivariate logistic regressions to investigate determinants of maternal health care utilization. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant. Results. In 2010, FANC increased by 5.6% from 2010 (pre-free maternity period) to 2017 (post-free maternity era). There was also an increase of 2.2% cases of health facility deliveries during pre-free maternity period (2010) and post-free maternity period (2017). Eleven predictors of maternal health care utilization were identified. Among them were respondent being a farmer (OR = 2.6; 95% CI: 1.4-4.8; p = 0.002), the status of the infrastructure of the nearest health facility maternity being good (OR = 3.2; 95% CI: 1.1-9.6; p = 0.03), fare for the public vehicle being USD 0.2 (OR = 3.4; 95% CI: 1.6-7.1; p = 0.001), all maternal health services being available in the nearest health facility (OR = 3.1; 95% CI: 1.8-5.4; p<0.0001), difficulty to attend MCH services due to non-suitability of working days (OR = 2.7; 95% CI: 1.5-4.7; p=0.0008), there being some services that clients pay for (OR = 3.3; 95% CI: 1.5-7.4; p=0.004), services being provided by nurses (midwives) (OR = 2.3; 95% CI: 1.0-4.9; p=0.04) , baby checkup being done within 24 hours by nurses (OR = 18.8; 95% CI: 8.0-44.0; p<0.0001. In conclusion, free maternity care program has led to increased utilization of facility ANC visits and deliveries in the study area. Barriers related to utilization of maternal health care services included unreliable transport especially at night, limited infrastructure and low socio-economic status of the women in the study area. National and county governments need to put in place strategies which will help them to jointly assess, map and plan investments to improve utilization of maternal health care services through prioritizing investments in human resource, infrastructure and commodities based on the anticipated demand for such services. A unique contribution to theory, practice, and policy: The study findings identified key factors that are unique to the mothers in Busia County on predisposing factors, enabling factors and the need characteristics that determine utilization of maternal health care in the era of Free Maternity services in the study area. These results contribute to both maternal health care utilization and policy change that could directly meet the social setting, geographical location and cultural needs of the people of Busia County.

Assessment of maternal health services utilization in Pakistan: the role of socio-demographic characteristics

BackgroundHigh-quality prenatal care has a significant positive impact on maternal and infant health as it helps timely diagnosis and treatment of pregnancy complications.ObjectiveTo examine factors associated with the utilization of maternal health care using the optimal count regression model.MethodsA sample of 16,314 women of reproductive ages (15–49) was used. Andersen and Newman's behavioral model of health services utilization was employed for the selection of covariates. Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial (ZINB), Poisson hurdle, and negative binomial hurdle models were fitted and compared to identify the best model. Maternal health care utilization is found associated with maternal age and education, area of residence, domestic violence, the income level of family, access to media, knowledge about AIDS, parity, birth order, and having a child who later died.ResultsZINB model is found to be best fitted for the observed data resulting strong influence of mother's education and income level of the family on maternal health care utilization.ConclusionInterventions to improve maternal care services utilization should address individuals and systems to reduce social and economic marginalization.