Abstract
ObjectiveIn Togo, substantial progress in maternal and child health is needed to reach global development goals. To better inform clinic and community-based health services, this study identifies factors associated with maternal and child health care utilization in the Kara region of Northern Togo.MethodsWe conducted a population-representative household survey of four health clinic catchment areas of 1,075 women of reproductive age in 2015. Multivariable logistic regression was used to model individual and structural factors associated with utilization of four maternal and child health services. Key outcomes were: facility-based delivery, maternal postnatal health check by a health professional within the first six weeks of birth, childhood vaccination, and receipt of malaria medication for febrile children under age five within 72 hours of symptom onset.Results83 percent of women who gave birth in the last 2 years delivered at a health facility. In adjusted models, the strongest predictor of facility delivery in the rural catchment areas was proximity to a health center, with women living under three kilometers having 3.7 (95% CI 1.7, 7.9) times the odds of a facility birth. Only 11 percent of women received a health check by a health provider at any time in the postnatal period. Postnatal health checks were less likely for women in the poorest households and for women who resided in rural areas. Children of polygamous mothers had half the odds of receiving malaria medication for fever within 72 hours of symptom onset, while children with increased household wealth status had increased odds of childhood vaccination and receiving treatment for malaria.ConclusionOur analysis highlights the importance of risk stratification analysis to inform the delivery and scope of maternal and child health programs needed to reach those with the least access to care.
Highlights
Our analysis highlights the importance of risk stratification analysis to inform the delivery and scope of maternal and child health programs needed to reach those with the least access to care
The burden of poor maternal and child health outcomes in Togo has remained persistently high over the past decade, with an estimated maternal mortality ratio of 398 deaths per 100,000 live births and an under five child mortality rate of 88 deaths per 1,000 live births [1,2]
The Togolese government has committed to global initiatives such as the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), the main objective of which is to expand the availability of use of quality maternal health services [4]
Summary
The burden of poor maternal and child health outcomes in Togo has remained persistently high over the past decade, with an estimated maternal mortality ratio of 398 deaths per 100,000 live births and an under five child mortality rate of 88 deaths per 1,000 live births [1,2]. Progress in reducing these rates has been slow and variable. Togo did not achieve Millennium Development Goal (MDG) four or five, which are global targets to reduce child and maternal mortality rates by two-thirds and three-quarters their 1990 levels by 2015, respectively. With support from the GAVI Alliance, Togo has provided the pentavalent vaccine at no cost through its Expanded Immunization Program (EIP) since 2008 [7]
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