Birth In Health Facility Research Articles

Factors Causing Low Coverage of Childbirth at Health Care Facilities in the Paramasan Health Center Working Area

Childbirth in health facilities is a government recommendation to reduce MMR/AKB. This is stated in the legal basis of Permenkes No. 21 of 2021. The reduction in MMR and IMR in remote areas has not been as expected, because many remote communities have not given birth in health facilities, the contributing factors are areas that are mountainous areas and difficult to reach, low educational background, weak socioeconomics, and poor access to health services, The largest contributor in Banjar Regency is Puskesmas Paramasan. Puskesmas Paramasan is a remote area. Based on data in 2023 the percentage of women giving birth at health facilities is 36%, giving birth at home is 64%. Objective to determine the factors causing the low coverage of childbirth in health care facilities in the working area of Puskesmas Paramasan. This study is a type of analytical survey with a cross sectional approach. the population in this study were mothers who had given birth, sampling using total sampling, the data used were quantitative with primary data sources. Mothers with low knowledge were 24 people (57.1%) high knowledge 18 people (42.9%). Low family support as many as 19 people (45.2%) high family support 23 people (54.8%). Maternity mothers who gave birth in health facilities were 24 people (57.1%) who did not give birth in health facilities 18 people (42.9%). The results of the analysis using the Fisher axact test found that there is a relationship between maternal knowledge and delivery in health facilities in the Paramasan Puskesmas Working Area, there is a relationship between family support and delivery in health facilities in the Paramasan Puskesmas Working Area.

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.

A cluster randomized controlled trial to assess the impact of the ‘Caring for Providers to Improve Patient Experience’ (CPIPE) intervention in Kenya and Ghana: study protocol

BackgroundPoor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention, which includes five strategies, targeting provider stress and bias as intermediate factors to improve PCMC and address inequities.MethodsThe trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will be assessed among healthcare workers in the study health facilities and among women who give birth in the study health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness.DiscussionThis trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health.Trial registrationClinicalTrials.gov: NCT06085105. Protocol version and date: v2-11-07-23

Estimates and determinants of health facility delivery in the Birhan cohort in Ethiopia.

Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aimed to measure the prevalence and determinants of health facility delivery in the Amhara region in Ethiopia. From December 2018 to November 2020, we conducted a longitudinal study from a cohort of 2801 pregnant women and described the location of delivery and the association with determinants. We interviewed a subset of women who delivered in the community and analyzed responses using the three delays model to understand reasons for not using health facility services. A multivariable poisson regression model with robust error variance was used to estimate the presence and magnitude of association between location of delivery and the determinants. Of the 2,482 pregnant women followed through to birth, 73.6% (n = 1,826) gave birth in health facilities, 24.3% (n = 604) gave birth at home and 2.1% (n = 52) delivered on the way to a health facility. Determinants associated with increased likelihood of delivery at a health facility included formal maternal education, shorter travel times to health facilities, primiparity, higher wealth index and having attended at least one ANC visit. Most common reasons mothers gave for not delivering in a health facility were delays in individual/family decision to seek care. The proportion of deliveries occurring in health facilities is increasing but falls below targets. Interventions that focus on the identified social-demographic determinants and delays are warranted.

Analysis of Risk Factors of Husband's Readiness and Involvement in Accompanying Wives in Childbirth: An Observational Study in Bengkulu City, Indonesia

The husband's role in assisting wives in childbirth has a significant impact on the birth experience and the health of the mother and baby. This study aims to analyze the risk factors that influence the role of husbands in accompanying their wives in childbirth in Bengkulu City, Indonesia. Analytical observational research was conducted on 200 married couples who gave birth in health facilities in Bengkulu City. Data was collected through questionnaires, interviews, and participant observation. Data analysis was carried out using logistic regression to identify risk factors related to the husband's role in accompanying wives in childbirth. The results showed that significant risk factors related to the husband's role in assisting wives in childbirth were the husband's education level (OR = 2.34; 95% CI: 1.21-4.53), the husband's knowledge about childbirth (OR = 3.12; 95% CI: 1.68-5.79), husband's attitude towards the role of mentoring (OR = 2.87; 95% CI: 1.45-5.68), social support from the family (OR = 1.98; 95% CI: 1.05-3.73), and previous birth experience (OR = 2.15; 95% CI: 1.12-4.14). This research identifies several risk factors that influence the husband's role in assisting wives in childbirth. Interventions aimed at increasing husbands' education, knowledge, and positive attitudes towards the role of companionship, as well as strengthening social support from the family, can increase husbands' involvement in the childbirth process.

Factors Influencing Health Facility Births: Insights from the 2017 Pakistan Demographic Health Survey

Factors Influencing Health Facility Births: Insights from the 2017 Pakistan Demographic Health Survey

Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal

IntroductionAdverse pregnancy outcomes (APOs) include stillbirth, preterm birth, and low birthweight (LBW). Studies exploring the impact of weather factors and air pollution on APOs are scarce in Nepal. We examined the impacts of prenatal exposure to temperature, precipitation, and air pollution (PM2.5) on APOs among women living in Kavre, Nepal. MethodsWe conducted a hospital and rural health centers-based historical cohort study that included health facility birth records (n = 1716) from the Nepali fiscal year 2017/18 through 2019/20. We linked health records to temperature, precipitation, and PM2.5 data for Kavre for the six months preceding each birth. A random intercept model was used to analyze birthweight, while a composite APO variable, was analyzed using multivariable logistic regression in relation to environmental exposures. ResultsThe proportion of LBW (<2500 gm), preterm birth (babies born alive before 37 weeks of gestation), and stillbirth was 13%, 4.3%, and 1.5%, respectively, in this study. Overall, around 16% of the study participants had one or more APOs. Total precipitation (β: 0.17, 95% CI 0.01 to 0.33, p = 0.03) had a positive effect on birthweight in the wetter season. Negative effects for mean maximum (β: 33.37, 95% CI -56.68 to −10.06, p = 0.005), mean (β: 32.35, 95% CI -54.44 to −10.27, p = 0.004), and mean minimum temperature (β: 29.28, 95% CI -49.58 to −8.98, p = 0.005) on birthweight was also observed in the wetter season. ConclusionA positive effect of temperature (mean maximum, mean, and mean minimum) and total precipitation on birthweight was found in the wetter season. This study emphasizes the need for future research using larger cohorts to elucidate these complex relationships in Nepal.

Respectful maternity care interventions to address women mistreatment in childbirth: What has been done?

IntroductionOver the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities.MethodsA PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected.ResultsTen articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback.DiscussionThese results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour.ConclusionThe specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.

Determinants of immediate postpartum long acting reversible contraceptive utilization among women who gave birth in public health facilities in northwest Ethiopia: unmatched case-control study design

Background The aftermath of childbirth plays a vital role in addressing unmet family planning requirements and is instrumental in mitigating the risks associated with pregnancies that are closely spaced. Recognizing factors that indicate immediate postpartum utilization of long-acting reversible contraceptives is essential for crafting focused initiatives. This helps meet unaddressed family planning needs and contributes to the reduction of maternal and child mortality rates in the country. Therefore, this research aimed to pinpoint factors influencing the utilization of long-acting reversible contraceptives immediately after childbirth among women delivering in public health facilities in northwest Ethiopia. Methods A facility-based unmatched case-control study was carried out, involving 342 postpartum women (comprising 108 cases and 216 controls) who delivered in public health facilities in northwest Ethiopia. Data collection involved employing a structured interviewer-administered questionnaire, and binary logistic regression analysis was conducted. The statistically significant association between independent factors and the outcome variable was assessed using the adjusted odds ratio with a 95% confidence interval, considering a p-value less than 0.05. Result The educational status of women at secondary level and above (AOR=2.314, 95% CI=1.645-5.043), adherence to ANC follow-up (AOR=2.930, 95% CI=1.829-4.769), lack of desire to have a child (AOR=1.421, 95% CI=1.026-2.006), receiving counseling (AOR=3.029, 95% CI=2.085-5.988), and possessing knowledge (AOR=1.642, 95% CI=1.086-3.186) were identified as significantly correlated with immediate postpartum LARC utilization at p &lt;0.05. Conclusion In this investigation, the utilization of immediate postpartum long-acting reversible contraceptives (LARC) was significantly linked to women’s educational attainment, attendance at antenatal care (ANC), their desire for additional children, counseling, and knowledge about immediate postpartum LARC. To promote family planning in the postnatal phase, it is recommended to prioritize maternal education, offer comprehensive counseling and health education, and enhance adherence to targeted ANC services.

Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data.

Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India. We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch's t-test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike's Information Criterion (AIC) and adjusted R2 values to identify the best-fit model. We find no significant difference between urban and rural areas (P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India. Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.

Predictors of late initiation of breastfeeding practice in Ethiopia: a multilevel mixed-effects analysis of recent evidence from EDHS 2019

ObjectivesTo identify the predictors of late initiation of breastfeeding practice in Ethiopia.DesignCross-sectional study design.SettingEthiopia.ParticipantsA total of 1982 weighted samples of mothers with children aged under 24 months were included.Outcome measureLate...

Study of Factors Associated with Inappropriate Complementary Feeding Among Children Aged 6 to 23 Months, Western Health Region of the Gambia, 2020

Introduction: Inappropriate complementary feeding practices are a major cause of morbidity and mortality in the first two years of life. The aim was to investigate factors associated with inappropriate complementary feeding practices among mothers of children aged 6-23 months in the Western Health Region of The Gambia. Methodology: This was a cross-sectional, descriptive and analytical study conducted from 14 September to 14 October 2020. The study population consisted of mothers of children aged 6 to 23 months attending reproductive and child health clinics and enrolled in the &amp;quot;Every Child Counts - My Child Project&amp;quot; immunization and vaccination program. Simple random sampling was used to select participants using the project. Data were collected by means of a questionnaire administered by telephone interview and concerned the socio-demographic characteristics of the mothers, the professional and economic characteristics of the parents, the socio-demographic characteristics of the children, diet and complementary feeding practices. Results: The mean age of the mothers was 28.3 (±5.4) years and that of the children 14.2 (±4.8) months. Minimum dietary diversity was 33.3%, minimum meal frequency 88% and minimum acceptable dietary intake 14.5% for all children aged 6-23 months. Non-respect of minimum dietary diversity was associated with the child&amp;apos;s female sex, with an OR = 16.3 [1.83-145.7], with the occurrence of both diarrhea and Acute Respiratory Infection (ARI) in the two weeks preceding the survey, with an OR = 27.2 [4.26-39.8], and with the child&amp;apos;s birth in a public health facility, with an OR = 55.1 [1.53-197.7]. Children whose mothers were aged between 25 and 34 and whose fathers did not work had a higher risk of non-respect of the dietary diversity, with OR = 54.1 [2.4 6- 118.5] and OR = 22.5 [2.32 - 31.9] respectively. The factors associated with non-respect of the minimum meal frequency were the advanced age of the children: 12 to 17 months with an OR= 28.6 [1.65 - 49.5] and 18 to 23 months with an OR= 18.9 [1.67 - 215.0] and a history of both ARI and diarrhea with an OR=. 52,9 [1,61 - 173,7]. Non-respect of the minimum acceptable dietary intake was associated with older children aged 18 to 23 months OR= 14.4 [2.25- 93.0] and those whose mothers had vocational training OR=.24.2 [1.27- 46.3]. Conclusion: Complementary feeding practices are not very satisfactory. It is important to strengthen nutrition education in order to improve infant and young child feeding practices.

Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015–2016: a cross-sectional study

ObjectivesThis study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar.Study designCross-sectional study design.Setting and populationWe used secondary data from the Myanmar Demographic...

Spatial variation and determinants of delayed breastfeeding initiation in Ethiopia: spatial and multilevel analysis of recent evidence from EDHS 2019

BackgroundDespite the World Health Organization’s firm recommendation to start breastfeeding during the first hour after delivery, nearly 54% of children in low- and middle-income countries are unable to initiate breastfeeding within the recommended time frame. Understanding the initiation of breastfeeding is essential for optimal child health and maternal well-being.MethodsThis study was conducted using the recent Ethiopian Demographic and Health Survey (EDHS) data (2019) on a weighted sample of 1982 Ethiopian mothers of children aged under 24 months. The data extraction was conducted between August 1 and 30, 2023. Delayed’ initiation of breastfeeding is defined as failure to initiate breastfeeding within one hour after birth. STATA version 17 was used for non-spatial analysis. ArcGIS Pro and Sat Scan version 9.6 were used to map the visual presentation of delayed breastfeeding initiation. Global Moran’s I was computed to determine whether delayed breastfeeding initiation is randomly distributed, clustered, or dispersed. Getis-Ord Gi* Spatial Statistics was done to identify significant spatial clusters of cold and hot spot areas. Multilevel mixed-effect logistic regression analysis was computed to identify determinants of delayed breastfeeding initiation.ResultsThe prevalence of delayed breastfeeding initiation is 26.4% (95% CI 24.4, 28.3). Significant clustering of delayed initiation of breastfeeding practice was found in the Somali region. Less clustering was identified in Northern Amhara, Addis Ababa and Dire Dawa. Being a young mother (15–24 years) (AOR 1.66; 95% CI 1.06, 2.62), no antenatal care (AOR 1.45; 95% CI 1.04, 2.02), cesarean section (AOR 4.79; 95% CI 3.19, 7.21) and home birth (AOR 1.53; 95% CI 1.14, 2.06) were found to be determinants of delayed initiation of breastfeeding.ConclusionsIn Ethiopia, delayed breastfeeding initiation is distributed non-randomly. Significant hotspot areas were identified in the eastern part of Ethiopia. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on promoting health facility birth and increasing antenatal care visits. Further emphasis should be considered on supporting young mothers and those giving birth via cesarean section to improve timely breastfeeding initiation.

Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda

ObjectiveTo assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births.SettingThree subcounties of Lira district in Northern Uganda.DesignA cluster...

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

AbstractBackgroundRwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.MethodsA secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.ResultsMore than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.ConclusionResults suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.

Client’s Experiences on Skilled Delivery Services among Women of Reproductive Age in Rural Communities in Kenya

Background: Globally Skilled delivery services are critical aspects to combat Maternal and neonatal mortality. In Kenya, skilled deliveries account for 62% of all deliveries; unskilled deliveries pose a higher risk of maternal and neonatal mortality and morbidity. The maternal mortality ratio in Kenya is currently 462 per thousand live births, with 40% of these deaths occurring at home. The main objective of the study was to explore the experiences of women of reproductive age on skilled delivery services.&#x0D; Materials And Methods: The baseline study was conducted between November 2022 and January 2023. It employed a cross-sectional research design involving 347 women of reproductive age. The study aimed to examine their current practices, challenges, and experiences with skilled delivery services. Focus Group Discussions (FGDs) were conducted with 48 recently delivered women (within one year), as well as with 48 Community Health Volunteers (CHVs) and 10 Community Extension Workers (CHEWs). In-depth interviews were also held with local health facility administrators. Quantitative data analysis was performed using SPSS version 25.0. Measures of central tendency were employed for continuous data tabulation. The analyzed data was then presented through charts, tables, and frequencies. The qualitative data underwent thematic arrangement and analysis using NVIVO version 13 and then triangulated with descriptive data.&#x0D; Results: The results revealed that (90.6%) of women's previous childbirth experiences influenced their utilization of skilled birth attendance services in subsequent pregnancies. Women who had never given birth in health facilities or had chosen home births were less likely to utilize skilled birth attendance services.&#x0D; Conclusion and Recommendations: This study identified factors influencing skilled birth attendance use in Kandara SubCounty, highlighting the role of previous childbirth experiences, health facility-related factors, and danger signs during pregnancy. To improve utilization, interventions should focus on health facility conditions, health worker attitudes, and community awareness programs.

Two out of every three pregnant women who gave birth in public health facilities of Tullo Woreda were dissatisfied with deliveries services, Eastern Ethiopia.

The level of maternal satisfaction with delivery services significantly affects health service utilization among women. Ethiopia's healthcare system and health facilities' quality have not much improved, which may contribute to women's generally poor levels of satisfaction and there was a limited study about client satisfaction on delivery services in the study area. Thus, the purpose of this study was to assess level of maternal satisfaction with delivery service and its associated factors among women who gave birth in Tullo Woreda public health facilities, Eastern Ethiopia. A facility-based cross-sectional study was conducted from 1 to 30 September 2020 among 355 women who gave birth in Tullo Woreda public health facilities, Eastern Ethiopia Data were collected using a pretested structured questionnaire through a face-to-face interview and entered into Epidata version 3.1 and analyzed using statistical package for the social sciences (SPSS) version 25. The prevalence was reported using a 95% confidence interval and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at a p-value of <0.05. The overall satisfaction of mothers on delivery service was 33.5% (95% CI: 27.81, 39.13). Factors such as having no antenatal care (ANC) for the index pregnancy (AOR = 0.33; 95% CI: 0.19, 0.56), women who came to health centers on foot (AOR = 0.17; CI: 0.04, 0.74) and by auto-rickshaw (AOR = 0.16; 95 % CI: 0.04, 0.64), mothers who did not satisfied with toilet service at the delivery room (AOR = 0.49; 95% CI: 0.12, 0.86) and who were not satisfied with maternal drugs availability (AOR = 0.65; 95% CI: 0.11, 0.95) were predictors of maternal satisfaction. This study pointed out that only 33.5% of women were satisfied with delivery care services provided in public health facilities of the study area. Factors such as not having ANC, using foot and auto-rickshaw as means of transportation, availability of drugs, and toilets were predictor of maternal satisfactions. Awareness creation for the benefit of ANC follow-up and delivery in the health facilities and providing safe transportation during referral time may help mothers get a timely healthcare service, which may increase client satisfaction. The concerned entities must pay attention in timely availability of drugs and improving the toiles, which play a role in shaping and molding level of satisfaction of women.

Length-of-stay and factors associated with early discharge after birth in health facilities in Guinea by mode of birth: Secondary analysis of Demographic and Health Survey 2018.

The immediate postpartum period (first 24 hours after birth) represents a critical time for women and newborns. Postnatal length-of-stay varies globally; in Guinea, a 24-hour facility stay following childbirth is recommended, with an emphasis on providing frequent monitoring of mother and newborn for the first 6 hours. This study describes postpartum length-of-stay following facility-based births in Guinea, and investigates factors associated with early discharge. This cross-sectional study analysed secondary Demographic and Health Survey data covering the most recent livebirths during 2013-2018. We included 2,763 women who gave birth vaginally or by caesarean section in healthcare facilities. Early discharge following vaginal birth was defined according to two cut-offs (<24 hours and <6 hours); early discharge following caesarean section was defined as <72 hours. We assessed socio-demographic, obstetric and health-system factors associated with early discharge using binary and multi-variable logistic regression. Among women with a vaginal birth, 81.5% were discharged <6 hours, with a median length-of-stay of 3 hours. 28% of women who had caesarean section were discharged <72 hours. Odds of discharge <6 hours among women who gave birth vaginally were lower for births in non-government hospital(aOR = 0.55[95%CI = 0.35;0.85]), and multiple births(aOR = 0.54[95%CI = 0.31;0.94]); while the odds were higher in five of the 8 regions compared to Boké. Among women who gave birth by caesarean section, odds of discharge <72 hours were lower for births in government hospitals(aOR = 0.09[95%CI = 0.03;0.3]), and girl newborns(aOR = 0.15[95%CI = 0.05;0.48]).This study showed that postpartum length-of-stays in Guinea is on average shorter than the local recommendations, with the majority of postpartum women with vaginal births spending less than 6-hours in health facilities after birth. Early discharge was associated with type of facility of birth and region. This warrants an in-depth exploration of reasons related to women's and families' preferences, health workers' practices, resource availability, and whether/how early discharge affects postpartum quality-of-care and health outcomes.

Perlindungan Hak Layanan Kesehatan Ibu Bersalin di Rumah Sakit Umum Daerah Kabupaten Kepulauan Mentawai

The degree of public health in a country is influenced by the existence of health facilities. Law of the Republic of Indonesia Number 17 of 2023 concerning Health states that health service facilities are places and/or tools used to provide health services to individuals or communities using promotive, preventive, curative, rehabilitative and/or palliative approaches carried out by the Government. Central, Regional Government, and/or the community. The health facilities in question consist of health service facilities, pharmaceutical facilities and medical equipment, as well as government-owned health education institutions that produce health workers. In Indonesia, protecting the right to health services is part of the implementation of health efforts as regulated by Law Number 17 of 2023 concerning Health. Therefore, maternal health services have become an inseparable part of the state's guarantee of the right to health. Even though this law is still relatively new, this and existing legal products do not yet regulate the rights to health services for birthing mothers specifically and comprehensively. The research method used is normative law by studying several things such as legal principles, document studies, and using various secondary data such as statutory regulations, court decisions, legal theory, and can be the opinions of scholars. Seeing the importance of protecting the right to health services for mothers who are giving birth, the author sees that the Law of the Republic of Indonesia Number 17 of 2023 concerning Health does not specifically have any special provisions for protecting the rights of mothers who are giving birth to get health services so this research will have the aim of the birth of the Law. Law of the Republic of Indonesia Number 17 of 2023 concerning Health provides protection for the right to good health services for mothers giving birth in health facilities in general and at the Mentawai Islands District General Hospital in particular.