Birth Attendants Research Articles

Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda

IntroductionNeonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings...

Feasibility and acceptability of a novel biomedical device to prevent neonatal hypothermia and augment Kangaroo Mother Care in Kenya: Qualitative analysis of focus group discussions and key Informant Interviews.

Hypothermia is a leading newborn complication, especially among premature and/or low birth weight infants. Within low/middle-income countries where incubators and radiant warmers are often in short supply, leading to gaps in the thermal care chain, neonatal hypothermia underlies high rates of newborn morbidity and mortality. Kangaroo Mother Care/Skin-to-skin care is an effective method for prevention of hypothermia in premature and low birthweight babies but can be very burdensome for families and healthcare providers. Our international multidisciplinary team has developed a prototype for a wearable biomedical device ("NeoWarm") to provide continuous thermal care and augment kangaroo mother care practices in low-resource settings. The objective of this study was to assess the feasibility and acceptability of NeoWarm and to obtain user design feedback for an early prototype from among adult end-users in Western Kenya. We performed key informant interviews (n = 17) among healthcare providers and 5 focus group discussions (FGDs) among 3 groups of adult stakeholders of premature babies, including: (1) parents/family members of premature babies aged 6 weeks or less (3 FGDs); (2) healthcare providers of newborns (e.g., nurses; physicians; 1 FGD); (3) community opinion leaders and stakeholders (e.g., traditional birth attendants; pastors; village elders; 1 FGD). Content and thematic analyses of transcripts indicate that NeoWarm is acceptable and feasible in promoting facility-based kangaroo mother care in the Kenyan setting. Novel findings derived from respondents include (1) the ability of the device to potentially overcome several barriers to traditional kangaroo mother care methods and (2) user-driven encouragement to expand the use case of the device to potentially include community-based kangaroo mother care and neonatal transport. User design feedback obtained during the interviews informed several key design iterations for subsequent prototypes of the device.

DISTANCE TO HEALTH FACILITIES WITH LOW DELIVERY ASSISTANCE BY HEALTH PERSONNEL IN THE WORKING AREA OF BIBIDA HEALTH CENTER PANIAI DISTRICT CENTRAL PAPUA

Maternal and newborn complications and deaths mostly occur in the period around childbirth. This is partly because help is not provided by health workers who have midwifery competence. In 2021, 56.3% of births were assisted by health workers in Papua Province. At the Bibida Community Health Center, 32% of births were assisted by health workers. The aim of this research is to examine the relationship between the distance to health facilities and the low level of birth assistance by health workers in the Bibida Health Center working area. The type of research used is quantitative, employing a descriptive design with a cross-sectional approach. This research was conducted from October 2023 to November 2023 in the Bibida Health Center working area, Paniai Regency, Central Papua. The population in this study consisted of all postpartum mothers in the Bibida Community Health Center working area in July, August, and September. Samples were selected using a total population technique, resulting in 35 samples. Computerized univariate and bivariate data processing was conducted using the chi-square statistical test. The research findings showed that the percentage of births assisted by non-health workers was 62.9%, while the percentage of births in relation to the distance to health facilities was 54.3%. The statistical analysis results indicated a significant relationship between the distance to health facilities (p-value = 0.000) and the level of birth assistance by health workers.

Barriers to use of institutional childbirth services: a qualitative study in the rural Jimma Zone, Ethiopia

Background/Aims Institutional birth and skilled birth attendants are two important elements of preventing maternal and newborn deaths. In Ethiopia, despite improved health access, many women give birth without skilled assistance. This study was conducted to identify barriers to institutional childbirth in the Jimma Zone, Ethiopia. Methods An exploratory qualitative case study was conducted, incorporating 16 focus group discussions and 18 in-depth interviews carried out in the Jimma Zone, Ethiopia in 2019. The participants were purposefully recruited and included members of the Women's Development Army, religious leaders, health extension workers, midwifery nurses, primary healthcare unit directors and women of reproductive age. Data were transcribed and translated into English and thematically analysed. Results Five themes emerged from the data: knowledge gaps, beliefs about pregnancy and childbirth, poor access to healthcare services, lack of resources and poor community involvement in institutional childbirth. Conclusions Healthcare services should be aware of local beliefs and cultural norms when encouraging the use of institutional childbirth services. The Ministry of Health must ensure that all services are equipped with adequate resources, both in terms of medical supplies and staff.

Quality Assessment of Interactive Mobile Application - Maternal and Infant Care for Tribal Birth Attendants.

Digital health interventions can overcome geographical barriers and prepare health-care providers for better health outcomes in rural and remote tribal areas, however, it has not been explored among traditional birth attendants (TBAs). A mobile application, "maternal and infant care" (MAI) for capacity building of tribal birth attendants was developed and its quality was evaluated using the Mobile Application Rating Scale for user's interest in and satisfaction with the esthetics, information, and functionality. Thirteen Android user TBAs with the MAI application were piloted with the MARS checklist. Engagement, functionality, esthetics, and information quality; and one subjective quality scale having 29 items were used. The application was found to be entertaining excellent rating (mean score ± standard deviation) (4.00 ± 0.58), and scored high on performance (3.77 ± 0.93); layout design (3.85 ± 0.90); subjective quality (4.23 ± 0.93), however, scored minimum on interest; gestural design; visual appeal, etc. MAI is a user-friendly, culturally acceptable Android app that can be used for the capacity building of frontline workers.

Safe Motherhood Initiative

Abstract In the quest to create global maternal health care protocols, African Indigenous birthing epistemologies are often overlooked in research, policy, and advocacy aiming to improve maternal health and reduce the maternal mortality ratio (MMR). The global maternal health strategy, the Safe Motherhood Initiative (SMI), excludes Indigenous birthing knowledge by requiring all childbirth to be attended by only birth attendants trained in the Western medical paradigm. This forms the bedrock of the assumed authoritative expertise of the Western medical birthing approach. Despite the campaign for sole reliance on SMI, Africa’s MMR remains the highest compared to other regions. Nigeria, Africa’s most populous country, also has the third-highest MMR in the world as of 2020. This failure of SMI to reduce MMR for Nigeria and Africa more broadly calls for the inclusion of marginalized Indigenous birthing knowledge for its epistemological and practical significance. Using Nigeria as a case study, with a transnational connection with the United States, the article argues that excluding African birthing knowledge and methods in SMI promotes epistemic and obstetric violence. Adopting the reproductive justice framework as a decolonial tool, the article asserts that African Indigenous birthing knowledge is simultaneously valid and valuable for holistic approaches to maternal health.

Refugee women’s and providers’ perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad

BackgroundGlobally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual’s needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings.MethodsWe conducted a qualitative study to understand Sudanese refugee women’s experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers’ perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC.ResultsOverall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected.ConclusionsDespite providers’ commitment to offering person-centered care and women’s generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.

Perception and Utilization of Traditional Birth Attendants by Pregnant Women Attending Primary Health Care Clinics in Bosso Local Government Area, Niger State, Nigeria

Background: Traditional Birth Attendants (TBAs) play a significant role in maternal healthcare in Nigeria, particularly in rural areas. This study assessed the perception and utilisation of TBAs among pregnant women attending primary health care clinics in Bosso Local Government Area, Niger State, Nigeria.
 Methods: A cross-sectional study was conducted among 218 registered pregnant women attending antenatal clinics in selected primary health centres. A semi-structured intervieweradministered questionnaire was used to collect data, which were analysed using Epi Info software. Data was presented with frequency tables and charts and test for association between categorical variables was done using Chi square. P value was set at <0.05.
 Results: The study found that 40.1% of respondents utilised TBA services, while 59.9% did not. The services accessed from TBAs included routine antenatal care (61.2%), normal delivery (54.2%), special bath (13.5%), concoction for mothers (56.8%), and family planning (41.7%). The reasons for utilising TBAs were cheaper services (84.5%), cultural acceptability (24.7%), proximity to home (91.8%), belief in more compassionate care (74.2%), and limited knowledge of alternative services (3.1%). Most TBA users (85.6%) expressed satisfaction with the services. The study also revealed associations between TBA utilisation and socio- demographic characteristics such as age, religion, tribe, educational status, and occupation.
 Conclusion: The study highlights the continued utilisation of TBAs for maternal healthcare services in the study area, driven by various factors, including affordability, cultural acceptability, and proximity. Efforts should be directed towards improving knowledge and awareness about alternative healthcare options and promoting safe practices among TBAs. The findings underscore the need for culturally sensitive and inclusive maternal healthcare interventions that address different population groups' unique needs and preferences.

Challenges and Impact of Male Midwives in the Improvement of Midwifery Practice in Nigeria

This study explores the Challenges and Impact of Male Midwives in the Improvement of Midwifery Practice in Nigeria. Midwifery practice in Nigeria has been a cornerstone of maternal and newborn healthcare for decades, primarily carried out by female midwives. According to the World Health Organization (WHO), midwives in Nigeria provide essential services such as antenatal care, skilled birth attendance, and postnatal care, contributing significantly to improving maternal and infant health outcomes. Materials and Methods: Literature search was conducted from empirical studies utilising 4 database: PubMed, Goggle scholar, Semantics scholar, Research gate using the keywords, male midwives, maternal and child health, male involvement, male midwifery education, gender issues in midwifery. The study analyzed the importance of males in midwifery practice, challenges faced by male midwives and male willingness to involve in midwifery practice. These challenges faced by male midwives in Nigeria may include, overcoming societal norms, navigating gender biases, and addressing workplace dynamics. While specific studies on this topic in Nigeria is limited, broadening the scope of research may help shed light on potential challenges. Conclusion: In conclusion, implementing these strategies in a coordinated manner will enable policymakers, healthcare leaders, and advocacy groups work together to promote gender equality in midwifery practice and create a more inclusive and supportive healthcare environment for all.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Effects of free maternal healthcare on stunting in children under five years of age: Evidence from Ghana

AbstractMotivationAddressing stunting in early childhood can have lasting effects on an individual's health, productivity, and well‐being in adulthood. By understanding the relationship between maternal healthcare policies and stunting, policy‐makers can design interventions that contribute to a healthier and more productive society.PurposeThis study investigated the effect of providing free healthcare to pregnant mothers on child stunting.Approach and methodThe article uses doubly robust difference‐in‐difference estimator, drawing on Ghana Demographic and Health Survey.FindingsFree healthcare to mothers reduced stunting in the treatment regions by 12.3%. Evidence suggests the reform may have influenced children under the age of five through antenatal and delivery care attendance during pregnancy. Assistance during antenatal care and childbirth by health professionals improved significantly.Policy implicationsMaternal health investment yields great health benefits for children from in utero to their fifth birthday. Maternal fee exemptions should be continued to maintain and further improve stunting reduction in children. Government should prioritize improving access to quality maternal healthcare services, including antenatal and skilled birth attendance and emergency obstetric care.

"…He's not beating me"-Socio-cultural construction of intimate partner violence and traditional birth attendants: implications for maternal & child health in rural communities in Hohoe, Ghana.

Most research on Intimate Partner Violence (IPV) focuses on the physical, sexual and psychological abuse, with less focus on the financial abuse. This study explores nursing mothers' experiences and perceptions of financial and material support from their significant others and traditional birth attendants' (TBA) observations of support to nursing mothers in their communities. Using purposive sampling, focus groups and interviews were conducted primarily in Ewe language among nursing mothers and TBAs in rural communities in Hohoe, Volta region, Ghana. All discussions were audio-recorded and transcribed for analysis. Thematic analysis guided by the social constructivist framework was used in data analysis. Twenty-seven women participated in the study, ranging in ages from 19 to 82 (20 nursing mothers; 7 TBAs). Most participants were married (19) and about 65% reported working outside the home (10 nursing mothers; 7 TBAs). Two themes emerged from the data analysis: Lack of support from partners for housekeeping chores and finances; and TBAs as mediators. Nursing mothers who reported lack of financial support did not perceive it as abuse, rather as hinderance to their efforts to care for their children. TBAs act as mediators interceding on behalf of nursing mothers with their husbands and fathers of their children, while also seeking resources to support them. Understanding the perceptions and socio-cultural meanings women attached to IPV experience is essential for effective intervention to reduce IPV. In addition, TBAs can be a resource in intervening to alleviate IPV in their communities, thereby improving maternal and child health.

Factors Impacting Quality of Skilled Birth Attendant Services in Rural India

Availability of skilled birth attendant (SBA) is a crucial factor in reducing mortality rates among mothers and children. The lower- and middle-income countries show low use of these service causing increased risk of maternal and child mortality. While there has been a remarkable improvement in the coverage of SBA-monitored deliveries in India, its impact on outcome indicators such as perinatal and neonatal mortality rates have not been significant. Although the country performs better than the world average in the former, its performance is poor in the latter. This raises question on the quality of SBA services in India. The present study examines SBA services in the context of availability of attendants, infrastructural support and level of training of the SBAs in the rural areas of the four large states in India—Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. The findings are that SBA lack sufficient training to provide the services effectively. The effectiveness of their services is also hampered by the absence of the essential infrastructure at public health facilities. Moreover, there is congestion and overcrowding at the higher level of facilities such as PHCs and CHCs as compared to village level sub-centres.

Assessing the Quality and Coverage of Maternal Postnatal Care in Bangladesh: A Comparative Analysis of Quality Postnatal Care among Home and Facility Births.

Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. From 2010 to 2016, postnatal care coverage within 48 h of delivery by a qualified provider rose from 23% to 47%. Of the births, 94% were facility births that received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, type of birth attendant, delivery method, and financial readiness. Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. This study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC.

Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso.

Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.

Knowledge, Practices and Attitudes of Traditional Birth Attendants towards Intermittent Preventive Treatment for Malaria Prevention among Pregnant Women within Ondo West Local Government Area of Ondo State, Nigeria

Intermittent preventive treatment (IPT) for malaria among pregnant women is a recommendation of the World Health Organization (WHO) to combat the various adverse outcomes of malaria in pregnant women. This adverse outcomes includes low birth weight, preterm delivery, severe anemia, maternal morbidity and mortality especially among primigravids. Traditional Birth Attendants (TBAs) has emerged as a significant influence in our society, particularly in the realm of maternal care and childbirth. Several economic, religious and socio-cultural factors have contributed to the preference of some pregnant women for the services of TBAs over medical facilities. Therefore, the study was carried out to assess the knowledge, practices and attitudes of traditional birth attendants within Ondo West Local Government area towards IPT for pregnant women reporting to them for care and delivery. The design employed in the study was descriptive cross-sectional survey. Data were collected by means of an adapted semi-structured interviewer administered-questionnaire. The analysis of the data was done using SPSS version 26.0. Demographic parameters were summarized with simple percentages and non-parametric chi-square test was used to determine the different associations of the variables. P values less than 0.05 were considered statistically significant. The findings indicated that most of the TBAs have good knowledge of the malaria vector and factors promoting the transmission of malaria. Majority (mean=82.9%) also demonstrated excellent understanding of the symptoms associated with malaria in pregnancy however, their knowledge on the risk associated with malaria in a pregnant woman remains comparably low (mean=61.1%) thereby affecting significantly their attitudes and practice to intermittent preventive treatment for malaria prevention. This is because 50% of the TBA have not heard about IPT (P=0.01) and therefore do not administer treatment to asymptomatic pregnant women as recommended by WHO (P=0.00) and report of this study shows that majority (57.40%) of them attend to more than 31 pregnant women in a year. There is need for a government-sponsored partnership between formal health workers and TBAs in this study to ensure they are trained, retrained and equipped. The integration of the TBAs into maternal health care will ensure the sustenance of government policy on the free treatment of all pregnant women intermittently for malaria as recommended by WHO.

Management of the third stage of labour by Basotho traditional birth attendants.

Historically and to date, women still give birth at home with the support of elderly, experienced women who live within their communities. In Lesotho, traditional birth attendants (TBAs) are sometimes the only option for pregnant women living far from facilities. Women are vulnerable during the third stage of labour; therefore, correct management is crucial to limit undesirable outcomes. Postpartum haemorrhage and postpartum sepsis remain the leading direct causes of maternal mortality. This study aimed to explore and describe how Basotho TBAs manage the third stage of labour. The study was conducted in Lesotho, at Bolahla and Sejakhosi. These villages have the highest number of women giving birth at home. An explorative and descriptive design with a qualitative approach was used. Semistructured interview guide was utilised to conduct individual in-depth interviews about how the TBAs manage the third stage of labour and their support needs concerning this phase. The TBAs were purposively sampled. The data were analysed thematically. Four themes emerged: challenges TBA experience in the management of the third stage of labour, management of the placenta by Basotho traditional birth attendants, support during the management of the placenta by Basotho traditional birth attendants, and management during emergencies. This study demonstrated that if TBAs are supported, they can contribute to the health of the mother and baby. This study's findings can be valuable to healthcare professionals to understand better how TBAs in Lesotho manage the third stage of labour and the support they need.

Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria.

Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria. This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15-49 years) and not pregnant in five years prior the survey (n = 7,847). The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20-8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44-0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55-0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39-0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79-2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34-0.62). This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.

Factors Influencing Obstetric Fistula among Women of Childbearing Age at Banadir Hospital, Somalia

This study focuses on the factors influencing obstetric fistula among the women of childbearing age at Banadir hospital, Somalia. The specific objectives of the study include: to identify the factors that contribute to obstetric fistula among women of childbearing age at Banadir Hospital in Somalia, to assess the impact of obstetric fistula on the physical, emotional, and social well-being of affected women at Banadir Hospital in Somalia and to explore potential interventions and strategies to prevent and manage obstetric fistula among women of childbearing age at Banadir Hospital in Somalia. The study also employed quantitative research approach research method to investigate the factors that contribute to obstetric fistula among women of childbearing age at Banadir Hospital in Somalia. The study utilised close-ended questionnaire instrument data collected from the respondents of the study was entered, coded, sorted, organized and analyzed using Statistical Package Software Science (SPSS) version 28. The findings of the study on factors that contribute to obstetric fistula among women of childbearing age at Banadir Hospital in Somalia which they include: lack of access to skilled obstetric care, poverty prevent women from seeking appropriate medical care during pregnancy and childbirth, lack of education, cultural and social factors, lack of access to clean water and sanitation and gender inequality. The impact of obstetric fistula on the physical, emotional, and social well-being of affected women at Banadir Hospital in Somalia include: chronic incontinence leading to foul-smelling leaks of urine and/or feces, which can cause skin irritation and infections, painful sores and ulcers in the genital area, malnutrition and dehydration due to difficulty in eating and drinking, chronic pelvic and abdominal pain, increased risk of reproductive health issues, including infertility and recurrent infections, feelings of shame, guilt, and isolation due to the stigma associated with obstetric fistula, depression, anxiety, and low self-esteem, loss of sense of self-worth and identity and trauma and social exclusion and discrimination from family, friends, and community members. The potential interventions and strategies to prevent and manage obstetric fistula among women of childbearing age at Banadir Hospital in Somalia entail: increasing access to skilled birth attendance by providing more trained healthcare providers, improving access to emergency obstetric care by ensuring that women have access to timely and appropriate medical care during childbirth, promoting family planning and contraception by empowering women to make informed choices about family planning and access to contraception, addressing cultural and social determinants by tackling underlying social norms and cultural practices that may contribute to obstetric fistula.

Appraisal of universal health insurance and maternal health services utilization: pre- and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia.

The Indonesian government introduced universal health insurance through the National Social Security System (JKN) in 2014 to enhance overall healthcare. This study compares maternal health care (MHC) service utilization before and after JKN implementation in Indonesia. Using 2012 and 2017 data from Indonesia Demographic and Health Surveys (DHS), we conducted a two-period cross-sectional design study following the Anderson model. We assessed how the JKN policy and population characteristics influenced healthcare utilization for women aged 15-49 who had given birth in the last 5 years. Multivariable logistic regression models were used to assess the impact of the JKN policy and related factors. In two waves of Indonesia DHS with 14,782 and 15,021 subjects, this study observed a significant increase in maternal healthcare service utilization post-JKN implementation. Women were more likely to have at least four antenatal care visits (adjusted odds ratio, AOR = 1.17), receive skilled antenatal care (AOR = 1.49), obtain skilled birth assistance (AOR = 1.96), and access facility-based delivery (AOR = 2.45) compared with pre-JKN implementation. This study revealed a significant positive impact of JKN on enhancing MHS utilization. The introduction of universal health insurance coverage likely reduced financial barriers for specific demographics, resulting in increased service utilization. Our study may offer valuable insights for Asian countries with similar demographics and health insurance implementations.