Maternal health care service utilization in post-war Liberia: analysis of nationally representative cross-sectional household surveys

Sanni Yaya,Ghose Bishwajit,Olalekan A Uthman,Michael Ekholuenetale

doi:10.1186/s12889-018-6365-x

Abstract

BackgroundPost-war Liberia has a fast-growing population and an alarming maternal mortality ratio (MMR). To provide a better understanding about healthcare system recovery in post-war country, we explored the changes in maternal healthcare services utilization between 2007 and 2016.MethodsWe used 2007 and 2013 Liberia Demographic and Health Survey (LDHS) and the 2016 Malaria Indicator Survey (MIS) in this study. The outcomes of interest were: place of delivery and antenatal care visits. Univariate analysis was conducted using percentages and means (standard deviations) and multiple binary multivariable logistic models were used to examine the factors associated with the outcome variables.ResultsBetween 2007 and 2016, the percentage of adequate ANC visits increased from 71.20 to 79.8%, and that of facility-based delivery increased from 40.90 to 74.60%. The odds of attending at least four ANC visits and formal institutional delivery were low among women residing in rural area, but high among women with higher education, used electronic media, and lived in high wealth index households. Additionally, attending ANC at least four times increased the odds of facility-based delivery by almost threefold.ConclusionThe findings suggest that key maternal healthcare utilization indicators have improved substantially, especially facility-based delivery. However, a large proportion of women remain deprived of these life-saving health services in the post-war era. Greater healthcare efforts are needed to improve the quality and coverage of maternal healthcare in order to enhance maternal survival in Liberia.

Highlights

Post-war Liberia has a fast-growing population and an alarming maternal mortality ratio (MMR)
No or inadequate access to maternal healthcare services increases the risks of a range of pregnancy and obstetric complications that can result in higher rates of maternal morbidity and mortality that in turn lowers the chances of child survival
Data source Datasets used in this study were obtained from the 2007 and 2013 rounds of Liberia Demographic and Health Surveys (LDHS) and 2016 Malaria Indicator Survey (MIS)

Summary

Introduction

Post-war Liberia has a fast-growing population and an alarming maternal mortality ratio (MMR). Low utilization of contraceptive methods and high teenage pregnancies are prominent contributors to maternal death, as approximately 60% of neonatal deaths occur among adolescent women compared to about 6% for those above 19 years, which indicates the need to delay child birth through access to improved sexual and reproductive health care services [9]. Basic Package of Health Services (BPHS) was constructed as cost-effective and evidence-based interventions, necessary to improve maternal health by identifying high-priority services in health care facilities [11] This approach was adopted in other post-war countries, such as Afghanistan, Sierra Leone and South Sudan, and has been recognized with increasing access to health care and reduction morbidity and mortality [12,13,14,15]. The least skilled birth attendance was in the northern central region of the country [16]

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