Birth Attendants Research Articles

The nexus between poverty and maternal healthcare utilization with a focus on antenatal care visits and choice of place of birth in Somaliland.

Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland. Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit. Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region. Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.

Benefits of simulation on multidisciplinary management of severe pre-eclampsia/severe eclampsia in 15 health districts in eastern Democratic Republic of Congo: A randomized educational trial.

The purpose of the present study was to assess the benefits of simulation for advancing knowledge and assisting healthcare staff in optimization of procedures when managing severe pre-eclampsia/eclampsia (sPE/E). A randomized educational trial was conducted with two groups: Group I received theoretical training, while group II received the same training along with simulation scenarios based on the management of sPE/E. The study involved 199 healthcare providers, including physicians, midwives, skilled birth attendants, and nurses. The study analyzed the percentage of correct answers on both the multiple-choice questions (MCQ) and the objective structured clinical examinations (OSCE) to evaluate theoretical knowledge and clinical skills objectively. Statistically significant differences were found immediately after training between groups I and II, whose mean percentages were 65.0% (±11.2) versus 71.0% (±9.8) (P < 0.001). A statistically significant reduction in the percentage of correct answers was found in both groups and demonstrated a discrepancy between immediate post-training test and post-training test at 3 months scores of 11.6% (±1.3) in group I versus 7.2% (±0.6) in group II. OSCE1 and OSCE2 scores were significantly higher in group II than in group I (P < 0.001). Simulation combined with theoretical training would appear to be an interesting method of training for advancing knowledge and improving skills of healthcare providers in their management of sPE/E. Our goal is for this method to be used to reduce real-life maternal mortality in the South Kivu region of the Democratic Republic of Congo.

Prevalence and determinants of skilled birth attendance among young women aged 15–24 years in Northern Nigeria: evidence from multiple indicator cluster survey 2011 to 2021

BackgroundChildbirth among adolescents and young mothers has been linked to various complications, including perinatal mortality, preterm births, low birth weight, and infections, which collectively contribute to the high burden of neonatal and maternal mortality. Despite some progress, the prevalence of skilled birth attendance, proven to improve maternal and newborn health outcomes, remains consistently low in Northern Nigeria. This study assessed the prevalence and determinants of Skilled Birth Attendance (SBA) among young women ages 15–24 years in Northern Nigeria.MethodsThis pooled cross-sectional study included 6,461 young women aged 15–24 years from 2011, 2016 and 2021 multiple indicator cluster surveys in Nigeria. We used a binary logistic regression model to assess the factors associated with skilled birth attendance at 95% confidence intervals (CIs) with computed adjusted odds ratios (aORs).ResultsThe prevalence of skilled birth attendance among young women in Northern Nigeria increased from 25.6% in 2011 to 33.1% in 2021. Women who were atleast 18 years of age at first marriage had 2.48 higher odds of SBA (aOR 2.48, 95% CI = 1.54–4.00) compared those less than 18 years of age at first marriage after controlling for confounders. Young women from rich household wealth quintile were more likely to utilize SBA (aOR 1.84, 95% CI = 1.11–3.14) compared to young women from poor household wealth quintile. In terms of education, those women who had secondary (aOR = 2.52, 95% CI = 1.77–3.56) and higher education (aOR = 10.01, 95% CI = 2.21–49.31) had higher odds of SBA compared to those with no education. Individual women with media exposure had 59% higher likelihood (aOR = 1.59, 95% CI = 1.16–2.19), women who attended 4 or more antenatal care visits during their last pregnancy demonstrated 2.28 times higher odds (aOR = 2.28, 95% CI = 1.67–3.09), while those who reported no intention for their last pregnancy were 37% less likely (aOR = 0.63, 95% CI = 0.42–0.96) to utilize SBA.ConclusionA slight increase in the prevalence of skilled birth attendance was observed over the 10-year period. For a significant boost in skilled birth attendance among young women in Northern Nigeria, particular attention needs to be paid to girls’ child education, delay in marriage, economic empowerment of young women, and strategic ways of leveraging trained community health workers (CHIPs) to bring reproductive healthcare close to young women living in rural areas.

Barriers to utilization of skilled birth attendance among post-natal women in a North Horr ward, Marsarbit County, Kenya: A cross-sectional study

Barriers to utilization of skilled birth attendance among post-natal women in a North Horr ward, Marsarbit County, Kenya: A cross-sectional study

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Spatial patterns of maternal and neonatal continuum of care use and its correlations with women’s empowerment

BackgroundThe continuum of care (CoC) in maternal health refers to the continuity of individual reproductive health care across the antenatal, intrapartum, and postnatal periods. The CoC is an indicator of the quality of maternal and newborn health outcomes and women’s empowerment is crucial to improving maternal and neonatal health service access and utilisation.ObjectiveTo examine the spatial patterns of continuum of care use for maternal and neonatal health services and its correlation with women’s empowerment.MethodsWe analysed data from the Ethiopian Demographic and Health Surveys (EDHS) of 2011 and 2016. All women aged 15–49 who had live births in the preceding five years of the DHS surveys were included in the analysis. We measured the continuum of care using the modified co-coverage index (CoCI), which consisted of six indicators. Women’s empowerment was assessed using a validated survey-based Women’s Empowerment (SWPER) index. We used the Getis-Ord-Gi* spatial analysis tool to portray locations with clusters of CoC service use and spatial correlations between CoC use and women empowerment.ResultsNone of the newborn-mother pairs in the 2011 survey received the entire continuum of care and only 2.5% of newborn-mother pairs received the full range of continuum of care services in the 2016 survey. In 2016, 6.9% of mother-newborn pairs received the basic CoC services (four or more antenatal care [ANC] visits, skilled birth attendance [SBA], and postnatal care [PNC]), and no mother-newborn pair received all three services at the same time in 2011. The Amhara, Afar, and Somali regional states had the least CoC service use in both surveys. There was a positive spatial correlation between CoC use and women’s empowerment domains.ConclusionOur analysis showed that the use of four or more ANC visits, SBS, newborn PNC, Bacillus Calmette-Guérin (BCG) vaccine uptake, and tetanus toxoid protection at birth were low in Ethiopia. Women empowerment domains were found to have a positive spatial correlation with CoC services use. To improve and preserve continuity of care, it is critical to leverage every maternal health facility encounter to encourage sustained service usage at each step of the continuum. Government policies should prioritise women’s empowerment and raise public awareness of maternity services.

ANALYSIS OF INFANT MORTALITY IN THE WORKING AREA OF NORTH MUSI RAWAS REGENCY IN 2024

Infant deaths are caused by the top three causes of death, namely LBW, asphyxia and infection. Meanwhile, the highest cause of other neonatal deaths was caused by intrapulmonary complications such as respiratory and cardiovascular disorders. This research aims to determine the picture of infant mortality in the working area of ​​North Musi Rawas Regency in 2024. The design of this research is quantitative with a case control approach. The population in this study were all mothers who gave birth in North Musi Rawas Regency in January 2023. The sample in this study was 99 people, with sampling using case and control 3:1. Namely cases as many as 33 respondents and controls as many as 66 respondents, with the inclusion criteria being willing to become respondents by filling out a consent form, and parents of toddlers. This research was carried out on March 30 - April 29 2024. Primary data was collected by interviews using questionnaires. Bivariate data analysis used the Chi-Square test. The results of the study showed that there was a relationship between birth attendant (p value 0.01), place of delivery (p value 0.002), birth weight (p value 0.006), ANC visits (p value 0.00), and comorbidities (p value 0, 00) with the incidence of infant deaths in the working area of ​​North Musi Rawas Regency in 2024. The most dominant factor in the incidence of infant deaths in the working area of ​​North Musi Rawas Regency in 2024, namely birth weight (p value 0.004) (OR 0.261). The conclusion is that there is a relationship between birth attendants, place of delivery, birth weight, ANC visits and comorbidities. The Health Service should coordinate with the Community Health Center to carry out scheduled posyandu activities.

Predictors and Outcome of Surgical Repair of Obstetric Fistula at a Private Hospital of Dhaka City

Background: Obstetric fistula remains a significant public health issue in low-resource settings, with high prevalence in countries like Bangladesh. The condition often results from prolonged, obstructed labor, compounded by socio-cultural factors such as early marriage, financial constraints, and lack of access to skilled birth attendants. This study aimed to explore the socio-demographic characteristics and surgical outcomes of women undergoing fistula repair at a private hospital in Dhaka, Bangladesh. Methods: This observational descriptive study included 62 women who underwent obstetric fistula repair between September 2010 and September 2012. Data were collected on socio-demographic characteristics, fistula details, and surgical outcomes through a structured booklet completed at various stages of patient care. Surgical success, complications, and post-operative outcomes were analyzed to identify factors influencing recovery and success rates. Result: The study found that 100% of participants were married at an early age, with significant financial barriers reported by all. A majority (87.10%) had home deliveries attended by unskilled birth attendants. Surgical repair was successful in 88.71% of cases, with a small proportion (11.29%) of unsuccessful repairs. Residual stress incontinence was noted in 4.84% of participants. The mean hospital stay was 17.52 days, with 95.16% of participants requiring continuous catheterization for 7 to 10 days. Conclusion: The high success rate of surgical repairs is promising, but the persistence of socio-cultural barriers and residual complications highlights the need for improved access to maternal healthcare and enhanced post-operative care. Addressing these issues is critical for reducing the burden of obstetric fistula and improving outcomes for affected women.

The Impact of Socio-Economic Factors on Maternal Health in Rural Africa

Maternal health was a critical indicator of societal well-being, reflecting the quality of healthcare systems and socio-economic conditions. In rural Africa, maternal health outcomes were alarmingly poor, with high maternal mortality rates persisting despite global efforts. This review explored the impact of socio-economic factors on maternal health in rural Africa, focusing on economic barriers, educational attainment, gender inequality, access to healthcare services, and social support networks. Economic barriers such as poverty and healthcare costs significantly limit access to essential maternal care. Educational attainment influences health literacy and the utilization of maternal healthcare services, with higher education levels correlating with better health outcomes. Gender inequality and entrenched cultural norms restrict women’s autonomy and decision-making power, negatively affecting maternal health. Access to healthcare services in rural areas is severely constrained by geographic isolation, inadequate infrastructure, and resource limitations. Social support networks, including family, friends, community members, and traditional birth attendants, play a crucial role in maternal health by providing emotional, informational, and practical support. This review used a comprehensive analysis of existing literature to discuss these factors and propose solutions to improve maternal health outcomes in rural Africa. Strategies such as financial assistance programs, expanding educational opportunities, empowering women, improving healthcare infrastructure, and strengthening social support networks are essential for addressing these challenges. By implementing these targeted interventions, significant improvements in maternal health can be achieved, leading to healthier mothers and stronger communities in rural Africa. Keywords: Maternal Health, Socio-Economic Factors, Rural Africa, Gender Inequality, Healthcare Access.

Factors That Influence the Incidence of Retained Placenta in Maternity Women in Kanekes Village, Baduy Tribe, Indonesia

Introduction: The World Health Organization (WHO) states that one of the causes of bleeding is retained placenta. Retained placenta accounts for 2-3% of maternal deaths in developing countries. Various factors, including maternal, uterine, and retention factors, influence placental retention. The study aimed to determine the factors affecting the incidence of retained placenta in mothers giving birth in Kanekes Village, Baduy Tribe, Indonesia. Material and Methods: This research uses an analytical survey method with a case-control design. There were 27 cases of placental retention experienced by women who gave birth vaginally. The researcher created the data collection format sheet instrument himself. The statistical test used is the chi-square test. Results: The relationship between age and the incidence of retained placenta from 54 respondents was obtained from the chi-square statistical test on the age variable with a p = 0.010 &lt;0.05 value. The relationship between parity and the incidence of retained placenta (p = 0.04). However, non-significant results were found in the relationship between birth assistance and the incidence of retained placenta (p = 0.750). Conclusions: The results show a relationship between age and parity factors and retained placenta incidence. However, in the birth assistance variable, the results show no relationship between birth assistance factors and the incidence of placental retention.

O69 - "If I don't...who will?" - Voices of Village Birth Attendants in Papua New Guinea

O69 - "If I don't...who will?" - Voices of Village Birth Attendants in Papua New Guinea

Temporalities of oxytocin for labour augmentation: a mixed-methods study of time factors shaping labour practices in a busy maternity unit in Tanzania

BackgroundHigh rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania.MethodsMixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards.ResultsBirth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women’s labour progression. This resulted in co-existence of ‘too early’ and ‘too late’ use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks.ConclusionsTime scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool.

Women's experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology.

Embracing women's experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women's continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences. The purpose of this article is to describe women's experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya. The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili. An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis. Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women's view on the MNH continuum. The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution:The embrace of women's experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

A study of neonatal morbidity and mortality patterns in very low birth weight neonates admitted in the neonatal intensive care unit at Al-Ameen Medical College and Hospital, Vijayapura

Background: Meticulous documentation of morbidity and mortality is essential for elucidating health patterns. The perinatal and neonatal periods, though brief, are pivotal in revealing the health and socio-biological conditions of vulnerable populations. This study seeks to analyze complex morbidity and mortality trends among neonates in a tertiary NICU. Methods: All VLBW neonates admitted to our NICU from April 2023 to March 2024 were analyzed. We gathered comprehensive maternal data, including age, socioeconomic status, and health risk factors. Excluding congenital anomalies, the study assessed demographic profiles, short-term morbidity, and outcomes. Results: In our NICU, 280 very low birth weight (VLBW) neonates were admitted, with 155 males (55.3%) and 125 females (44.7%). The mean birth weight was 1.240±0.110 kg for males and 1.270±0.105 kg for females. Among these, 170 (60.7%) were small for gestational age (SGA), 60 (21.4%) appropriate for gestational age (AGA), and 50 (17.9%) intrauterine growth restricted (IUGR). The gestational age distribution was: less than 28 weeks, 17 (6%); 28-32 weeks, 155 (55.3%); 32-34 weeks, 47 (16.9%); and 34-36 weeks, 61 (21.8%). Of the 280 neonates, 208 (74.2%) survived, while 72 (25.8%) did not. The leading causes of mortality were sepsis, with 39 deaths (54.2%), and respiratory distress syndrome, with 27 deaths (37.6%). Conclusions: Birth asphyxia, prematurity, jaundice, neonatal sepsis, and respiratory issues significantly contribute to neonatal mortality and morbidity. To mitigate these, it is vital to enhance prenatal care, ensure skilled birth attendance, expand NICU facilities, implement routine screenings, enforce stringent infection control and educate parents.

Identification of mothers with mental health problems is accidental: perceptions of health care providers on availability, access, and support for maternal mental health care for adolescent mothers in Malawi

BackgroundIntegration of maternal mental health into primary health care is considered a strategy to improve access to mental health support in low- and middle-income countries (LMICs). Health care workers’ (HCWs) and traditional practitioners’ (traditional healers, herbalists, traditional birth attendants, spiritual healers, prophets, and community health volunteers) perceptions of the availability and management of adolescent mothers’ maternal mental health care were explored in rural Malawi. Recognizing and identifying the barriers associated with access to maternal mental health support is essential to improving the mental health of adolescent mothers.MethodsA descriptive qualitative design (DQ) was used to explore HCWs’ and traditional practitioners’ perceptions of maternal mental health services for adolescent mothers. In-depth interviews were conducted with HCWs (n = 6), and three focus group discussions were conducted with 30 community-based traditional practitioners. Participants were purposefully recruited because they provide formal or informal health services to adolescent mothers during the postnatal period at Mitundu Rural Hospital and its catchment area in Lilongwe District, in Malawi. Interviews were analyzed using reflective thematic analysis and inductive thinking.ResultsThematic analysis found four themes to describe access to maternal mental health care for adolescent mothers. Participant perceptions were themed around health system challenges and how cultural background and beliefs influence access to mental health care and support. The themes were: (1) Inadequate staff development; (2) Limited resources (medication and infrastructure); (3) Limited policy and guidelines implementation; and (4) Cultural background and belief influence on help-seeking. HCWs suggested improving pre-service and in-service training to improve mental health assessment of mothers, while traditional practitioners wanted to increase their awareness of mental health issues.ConclusionParticipants emphasized that multifaceted factors influenced access to mental health support. These factors affect the assessment, treatment, and support of adolescent mothers and help-seeking by mothers. Therefore, strengthening the healthcare system and empowering providers with the knowledge and skills to recognize at-risk mothers and provide timely support is essential.

Ungoverned Spaces Among Informal Health Providers in Nigeria and Health Security Implications

Ungoverned spaces refer to systems that are evasive of government regulations. They manifest in health systems when health authorities struggle to regulate certain healthcare providers. The current study underscored Informal Health Providers (IHPs) such as Patent Medicine Vendors (PMVs), Herbalists, Traditional Birth Attendants (TBAs), etc., as typical of ungoverned heath spaces in Nigeria and a threat to citizens’ health security. Interviews and group discussions were used to collect data from 90 participants. The findings showed some groups of IHPs without interface with government health authorities. Although PMVs and TBAs had some interface with the government, the study still found many aspects of their practices that were not governed. Unions of the IHPs could be parallel to health authorities. Indeed, IHPs can provide care in difficult contexts where formal healthcare is lacking, however, their continuous ungoverned operations could undermine citizens’ rights to quality healthcare, which conflicts with the ideals of the social service workforce. Therefore, future research should focus on co-designing policies and programs that can help to pull IHPs into an effectively governed pool.

Understanding Socioeconomic Inequalities in Zero-Dose Children for Vaccination in Underserved Settings of Ethiopia: Decomposition Analysis Approach.

Despite considerable global efforts to enhance vaccine distribution in low-income countries, a significant number of children remain unvaccinated, particularly in Ethiopia. The underlying socioeconomic challenges in these regions are recognized as primary contributors to the low vaccination rates. However, the reasons for this persistent disparity in Ethiopia's remote and underserved regions need further analysis. The study employed a cross-sectional design and was conducted as part of the Project HOPE Zero-Dose Evaluation from 1 February to 31 July 2022. Concentration indices were utilized to quantify the extent of inequality, with further decomposition aimed at identifying contributing factors to this disparity. The findings underscored that populations with lower socioeconomic status encounter high numbers of children receiving no vaccinations. Key factors influencing the number of zero-dose children included distance from healthcare facilities (61.03%), economic status of the household (38.93%), absence of skilled birth assistance (20.36%), underutilization of antenatal care services (<four visits; 8.66%), lack of postnatal care (8.62%), and rural residency (7.69%). To reduce the number of zero-dose children in Ethiopia, it is essential to implement context-specific strategies that address socioeconomic barriers and integrate innovative approaches with community engagement. This approach will help to ensure equitable access to vaccines for children across all socioeconomic statuses.

Trend, and multivariate decomposition of perinatal mortality in Ethiopia using further analysis of EDHS 2005–2016

BackgroundPerinatal mortality is a global health problem, especially in Ethiopia, which has the highest perinatal mortality rate. Studies about perinatal mortality were conducted in Ethiopia, but which factors specifically contribute to the change in perinatal mortality across time is unknown.ObjectivesTo assess the trend and multivariate decomposition of perinatal mortality in Ethiopia using EDHS 2005–2016.MethodsA community-based, cross-sectional study design was used. EDHS 2005–2016 data was used, and weighting has been applied to adjust the difference in the probability of selection. Logit-based multivariate decomposition analysis was used using STATA version 14.1. The best model was selected using the lowest AIC value, and variables were selected with a p-value less than 0.05 at 95% CI.ResultThe trend of perinatal mortality in Ethiopia decreased from 37 per 1000 births in 2005 to 33 per 1000 births in 2016. About 83.3% of the decrease in perinatal mortality in the survey was attributed to the difference in the endowment (composition) of the women. Among the differences in the endowment, the difference in the composition of ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and birth attendant significantly decreased perinatal mortality in the last 10 years. Among the differences in coefficients, skilled birth attendants significantly decreased perinatal mortality.Conclusion and recommendationThe perinatal mortality rate in Ethiopia has declined over time. Variables like ANC visits, taking the TT vaccine, urban residence, occupation, secondary education, and skilled birth attendants reduce perinatal mortality. To reduce perinatal mortality more, scaling up maternal and newborn health services has a critical role.

Integrating Traditional Medicine with Modern Healthcare: Addressing Maternal and Mental Health in Uganda

Traditional medicine in Uganda, deeply rooted in cultural and historical practices, plays a significant role in addressing maternal and mental health challenges. This review explores the integration of traditional medicine with modern healthcare systems, aiming to enhance maternal and mental health outcomes while preserving cultural heritage. Traditional practices, including herbal remedies, spiritual healing, and the role of traditional birth attendants (TBAs), provide crucial support, particularly in rural areas with limited access to modern medical facilities. The review examines the contributions of traditional medicine to maternal health, including prenatal, labor, and postnatal care, and its role in mental health through spiritual and community-based practices. Despite the valuable contributions, integrating traditional and modern healthcare presents challenges such as cultural barriers, regulatory issues, and the need for standardization. Efforts to integrate these approaches include policy development, educational initiatives, and collaborative health programs. The National Drug Authority (NDA) plays a pivotal role in regulating and standardizing traditional medicine practices, ensuring safety and efficacy through research and quality control measures. Economic impacts of traditional medicine include income generation, local trade, and affordable healthcare options, although practitioners face challenges like lack of formal recognition and regulatory issues. Public perception is influenced by cultural beliefs and trust in traditional practices, with increasing acceptance of integrated approaches in urban areas. In conclusion, integrating traditional medicine with modern healthcare in Uganda offers a promising path towards a more inclusive and culturally sensitive healthcare system. By addressing challenges through mutual respect, collaboration, and evidence-based practices, Uganda can enhance maternal and mental health outcomes and build a more comprehensive healthcare system. Keywords: Traditional Medicine, Modern Healthcare, Maternal, Mental Health in Uganda

Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis.

The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.