Facility Delivery Research Articles

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

Assessing the impact of the COVID-19 restrictions on HIV testing services in Malawi: an interrupted time series analysis

Background: Restrictions on public gatherings and movement to mitigate the spread of COVID-19 may have disrupted access and availability of HIV services in Malawi. We quantified the impact of these restrictions on HIV testing services in Malawi. Methods: We conducted an interrupted time series analysis of routine aggregated programme data from 808 public and private, adult and paediatric health facilities across rural and urban communities in Malawi between January 2018 and March 2020 (pre-restrictions) and April to December 2020 (post restrictions), with April 2020 as the month restrictions took effect. Positivity rates were expressed as the proportion of new diagnoses per 100 persons tested. Data were summarised using counts and median monthly tests stratified by sex, age, type of health facility and service delivery points at health facilities. The immediate effect of restriction and post-lockdown outcomes trends were quantified using negative binomial segmented regression models adjusted for seasonality and autocorrelation. Results: The median monthly number of HIV tests and diagnosed people living with HIV (PLHIV) declined from 261 979 (interquartile range [IQR] 235 654–283 293) and 7 929 (IQR 6 590–9 316) before the restrictions, to 167 307 (IQR 161 122–185 094) and 4 658 (IQR 4 535–5 393) respectively, post restriction. Immediately after restriction, HIV tests declined by 31.9% (incidence rate ratio [IRR] 0.681; 95% CI 0.619–0.750), the number of PLHIV diagnosed declined by 22.8% (IRR 0.772; 95% CI 0.695–0.857), while positivity increased by 13.4% (IRR 1.134; 95% CI 1.031–1.247). As restrictions eased, total HIV testing outputs and the number of new diagnoses increased by an average of 2.3% each month (slope change: 1.023; 95% CI 1.010–1.037) and 2.5% (slope change:1.025; 95% CI 1.012–1.038) respectively. Positivity remained similar (slope change: 1.001; 95% CI 0.987–1.015). Unlike general trends noted, while HIV testing services among children aged <12 months declined 38.8% (IRR 0.351; 95% CI 0.351–1.006) with restrictions, recovery has been minimal (slope change: 1.008; 95% CI 0.946–1.073). Conclusion: COVID-19 restrictions were associated with significant but short-term declines in HIV testing services in Malawi, with differential recovery in these services among population subgroups, especially infants. While efforts to restore HIV testing services are commendable, more nuanced strategies that promote equitable recovery of HIV testing services can ensure no subpopulations are left behind.

The effect of health facility births on newborn mortality in Malawi.

We examine the effect of health facility delivery on newborn mortality in Malawi using data from a survey of mothers in the Chimutu district, Malawi. The study exploits labour contraction time as an instrumental variable to overcome endogeneity of health facility delivery. The results show that health facility delivery does not reduce 7-day and 28-day mortality rates. In a low-income country like Malawi where the healthcare quality is severely compromised, we conclude that encouraging health facility delivery may not guarantee positive health outcomes for newborn births.

Birth Preparedness and Complication Readiness among Pregnant Women in Rural Area of District Sonipat, Haryana, India: A Cross Sectional Community Based Study

Introduction: Birth Preparedness and Complication Readiness (BPCR) is an important intervention included by WHO as essential elements of antenatal care package. It is often delivered to pregnant women through their active participation by health care provider during antenatal care or initiated/followed up through visits to the homes of pregnant women by community health workers. Objectives: To determine the knowledge and practice regarding BPCR and to identify factors associated with it among rural pregnant women. Method: Cross-sectional study was conducted in rural field practice area of Community Medicine Department of a medical teaching institutes. A total of 210 pregnant women who were in the second and third trimesters of pregnancy were selected by simple random sampling and interviewed for data collection. Results: Mean age of study subjects was 24.14 + 3.88 years.The highest number of women was in the age group of 20-29 years (84.8%). More than half (57.6%) mothers had observed at least two or more components of BPCR. Maximum number of females had identified facility for delivery (63.8%) followed by transportation (60.9%). Identification of potential blood donor by mothers was low (14.3%). Bleeding was most commonly identified danger symptom in all three phases of child bearing. Knowledge regarding danger signs was significantly associated with birth preparedness. Conclusion: In the present study, practice of all components of BPCR by mothers was very low. Bleeding was the most commonly identified danger symptom during all three phases i.e., pregnancy, child birth and after birth.Knowledge regarding other danger signs was highly inadequate.

Males' perceptions and practices towards maternity care in rural southeast Nigeria: Policy implication of participatory action research for safe motherhood.

High maternal death is attributable to developing countries' health systems and sociocultural factors This study assessed the effect of participatory-action research on males' perception and practice towards maternity care and safe motherhood in rural southeast Nigeria. A pre-post-intervention study design was employed to study 396 male partners of pregnant women selected through cluster sampling in rural communities in southeast Nigeria. Males' perceptions and practices towards maternity care and safe motherhood were assessed using an interviewer-administered five-point Likert scale questionnaire. A community-participatory intervention was implemented comprising advocacy, and training of community volunteers, who then educated male partners of pregnant women on safe motherhood and facilitated emergency saving and transport schemes. A post-intervention assessment was conducted six months later, using the same questionnaire. Good perception and good practices were determined by mean scores >3.0. Continuous variables were summarised using mean and standard deviation, and categorical variables using frequencies and proportions. A comparison of the mean scores pre- and post-intervention mean scores were compared, and the mean difference was determined using paired T-test. Statistical significance was set at a p-value <0.05. The perception that male partners should accompany pregnant women for antenatal care had the least mean score at the pre-intervention stage, 1.92 (0.83). However, the mean score increased for most variables after the intervention (p<0.05). The mean score for maternity care practices increased post-intervention for accompanying pregnant women to antenatal care, facility delivery, and helping with household chores (p<0.001), with a composite mean difference of 0.36 (p<0.001). Birth preparedness/complication readiness practices-saving money, identifying transport, skilled providers, health facilities, blood donors and preparing birth kits, were good, with a composite mean score that increased from 3.68(0.99) at pre-intervention to 4.47(0.82) at post-intervention (p<0.001). Males' perceptions and practices towards safe motherhood improved after the intervention. This highlights that a community-participatory strategy can enhance males' involvement in maternal health and should be explored. Male partners accompanying pregnant women to clinics should be advocated for inclusion in maternal health policy. Government should integrate community health influencers/promoters into the healthcare systems to help in the provision of health services.

Outcomes of Diabetes Care Intervention on Knowledge and Practice of Self-care in Some Rural and Urban Healthcare Facilities, Edo State

Abstract: Background: Diabetes Mellitus (DM) is on the increase in Nigeria; consequently, there is a need to promote self-care practices among all patients. The study aimed to evaluate outcomes of diabetes care intervention on knowledge and practice of self-care among diabetes patients in rural and urban healthcare facilities in Edo State. Materials and Methods: In a descriptive cross-sectional, data on knowledge and practice of selfcare among Diabetes patients were collected using self-developed and Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Analysis was both descriptive and inferential. Paired t-test was performed to compare the results from diabetes patients from General Hospital (GH), Abudu and Specialist Hospital (SH), Benin, and results were considered significant with P<0.05. Results: There was a significant difference (P<0.05) in the knowledge of self-care among patients. Diabetes patients in specialist hospital, Benin had a better knowledge of self-care (mean score >3) than those in general hospital, Abudu. Diabetes patients from general hospital, Abudu (rural) comply more with a mean practice of diabetes self-care in general exercise (5.58±1.42) and specific exercises (5.44±0.98). Diabetes patients from specialist hospital, Benin test their blood sugars themselves and the number of times recommended. After 6 months of educational intervention on diabetes care, knowledge and practice of diabetes selfcare improved significantly (p<0.05) across the various domains, but with better performance in specialist hospital, Benin. Conclusion: The study justifies a low quality of diabetes care delivery in both rural and urban health care facilities and significantly improved with educational interventions. Keywords: Diabetes, Prevalence, Self-care, Knowledge, Practice.

Implementing a Community-Based Participatory Approach to Promote Health Facility Delivery among Women of Reproductive Age in Kanamai Area, Kilifi County

Maternal utilization has been low over the years in Kenya. Approaches to establish safe motherhood through promotion of health facility have been equally fronted. This study applied certain aspects of community education approach encompassing group discussion and community dialogue to provide a clear insight of how the approach is a vital tool. Community based cross sectional study was conducted in Kanamai sub-location, Kilifi County to recruit 232 women selected by simple random sampling technique. The data were collected using pre-tested semi-structured questionnaires and the collected data was coded, entered, cleaned, and analysed using R for Windows (version 4.0.3). Sixty-nine percent (69%) of women advocated for the delivery at the designated health facilities. Independent factors that were found to influence health facility based delivery in this study were being employed (OR = 12.42, 95% CI: 6.25 - 24.70, p&lt;0.0001), having given birth to 3-4 children, (OR = 2.56, 95% CI: 6.25 - 24.70, p=0.0062) and rating of both group discussion (OR = 0.15, 95% CI: 0.03 -0.66, p=0.0041) and community dialogue (OR = 0.21, 95% CI: 0.08 - 0.59, p=0.0013) to be low. Leading by the example set by the government of offering free maternal services, engaging the key stakeholders through approaches such as group discussion and community dialogue could go a long way in increasing delivery in the health facilities thus tremendously lowering mortality rate for both the baby and the mother which could otherwise occur when the mother doesn’t get services of a specialized personnel. Keywords: Advocacy, Delivery, Community Education Group Discussion, Community Dialogue.

Proportion and factors influencing client satisfaction with delivery services in health facilities in the Sissala East Municipality, Ghana: A cross-sectional study.

Client satisfaction is the difference between the healthcare services delivered and the needs of the client. Anecdotal evidence suggests the quality of maternal health and delivery services in Ghana especially in the Upper West Region is appalling. Moreover, there is a paucity of data on clients' satisfaction with maternal and delivery services rendered by healthcare. This study, therefore, assessed clients' satisfaction with delivery services and their associated factors. This analytical cross-sectional study included 431 women who had delivered in the last 7 days from four health facilities within Sissala East Municipality using a multistage and simple random sampling technique. A well-structured questionnaire was used to collect sociodemographic and client satisfaction data. All statistical analyses were done using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism Version 8.0. A p < 0.05 was considered statistically significant. Clients' satisfaction with general delivery services was rated as 80.3% and was significantly associated with process-related factors (p < 0.0001) and structural-related factors (p < 0.0001) of the health facilities. This study found that health facilities' delivery services differed significantly and were associated with clients' satisfaction (p < 0.0001). Moreover, age group (p = 0.0200), occupation (p = 0.0090), kind of delivery (p = 0.0050), and delivery outcome (p < 0.0001) were significantly associated with client satisfaction with delivery services. More than two-thirds of women are satisfied with delivery services within selected health facilities in the Sissala East municipality, although satisfaction within health facilities differs. Furthermore, age group, occupation, kind of delivery, delivery outcome, process, and structural-related factors significantly contribute to client satisfaction with delivery services. To provide more comprehensive coverage of customers' satisfaction with delivery services in the municipality, strategiessuch as free maternal health initiatives and health education on the significance of facility delivery should be reinforced.

Health facility delivery service utilization and its associated factors among women in the pastoralist regions of Ethiopia: A systematic review and meta-analysis.

Utilizing health facility delivery services is one of the pillars of lowering maternal mortality. However, the coverage of health facility delivery service utilization continues to be uneven around the world. In Ethiopia, particularly among pastoralist regions, health facility delivery service utilization is less common. Therefore, the purpose of this study was to determine the pooled prevalence of health facility delivery service utilization and identify the associated factors among women in the pastoralist regions of Ethiopia. A comprehensive systematic search was carried out in PubMed/MEDLINE, Hinary, Cochrane Library, Google Scholar, Google, and Ethiopian online university repositories. Studies were appraised using the JBI appraisal checklist. The analysis was done using STATA version 16. The pooled analysis was conducted using DerSimonian and Laird random-effects model. I 2 test and Eggers & Begg's tests were used to assess the heterogeneity and publication bias, respectively. p < 0.05 was set to determine the statistical significance of all the tests. The pooled prevalence of health facility delivery service utilization was 23.09% (95% CI: 18.05%-28.12%). Have ANC visit during pregnancy (OR = 3.75, [95% CI: 1.84-7.63]), have information regarding maternal health service fee exemption (OR = 9.51, [95% CI: 1.41-64.26]), have a nearby health facility (OR = 3.49, [95% CI: 1.48-8.20]), and women attend secondary and above education (OR = 3.06, [95% CI: 1.77-5.29]) were found to be significant associated factors. Health facility delivery service utilization is very low in pastoralist regions of Ethiopia, and ANC follow-up, distance from the health facility, women's educational status, and information regarding maternal health service fees were identified as significant associated factors. Consequently, strengthening ANC services, introducing free health services to the community, and constructing health facilities for the nearby residents are recommended to improve the practice.

Sociocultural practices, beliefs, and myths surrounding newborn cord care in Bayelsa State, Nigeria: A qualitative study.

Persisting sociocultural beliefs have continued to significantly influence the adoption of recommended newborn care practices by women in Sub-Saharan Africa. This study aimed at identifying the sociocultural practices, beliefs, and myths surrounding newborn cord care by women residing in Bayelsa State, Nigeria. This was a qualitative study that involved 24 women and 3 traditional birth attendants (TBAs) in three focus group discussions and three in-depth interviews respectively. Interview guides were used to lead the discussions and the interviews which were audiotaped, translated and then transcribed. Thematic analysis was done using NVivo QSR version 12.2 Pro. Several themes describing various sociocultural practices, beliefs, and myths surrounding cord care were uncovered. Most women preferred to be delivered by a TBA who usually cuts the infant's cord with a razor blade and ties the stump with hair or sewing thread. Substances used for cord care included methylated spirirt, "African never-die" leaf, and "Close-Up" toothpaste. All the participants agreed that methylated spirit was a potent antiseptic for cord care but none of them had heard about nor used chlorhexidine gel. It was a common belief that abdominal massage and the application of substances to the cord were solutions to common cord-related problems. Mothers, TBAs and relatives were influential regarding choices of cord care practices. Sociocultural practices, beliefs, and myths are still major barriers to the adoption of recommended cord care practices by women in Bayelsa State. Interventions should be targeted at improving delivery in health facilities and educating women in the community on good cord care practices.

Factors Associated with Maternal Health Services Utilization Among Lao Adolescents: A Nationwide Retrospective Cross-sectional Study

Addressing the social determinants of health that affect adolescent pregnancy is paramount to eliminating disparities and achieving health equity toward reducing the maternal mortality rate. The Lao People’s Democratic Republic has a high adolescent childbearing rate, which can negatively impact maternal and child health. We conducted a retrospective cross-sectional study that used data from the pooled Lao Social Indicator Survey II of 2017 to clarify the social contextual factors associated with the utilization of adolescent antenatal care and facility deliveries. We analyzed data from 663 adolescents aged 10-19 years at delivery and extracted the factors associated with maternal healthcare utilization based on social determinants. Those factors were area and region of residence, educational status, marital status, the ethnolinguistic group of the household head, and economic strata. A multiple logistic regression analysis was performed to determine the factors associated with those factors. The results showed that social factors strongly associated with the use of antenatal care were higher educational status and higher economic strata. On the other hand, the social factors associated with facility delivery were being in an ethnic majority and having a higher economic status. Thus, it is essential to establish interventions targeting those factors, such as lower educational status, lower socioeconomic status, and being from an ethnic minority, to increase adolescents' antenatal care visits and facility deliveries. This study’s results can be used to inform nurses and midwives in their efforts to eliminate socioeconomic disparities. This can be done by enhancing the provision of antenatal care consultations and facility deliveries in Lao, thus helping to achieve better health for adolescent mothers, their infants, and their families.

Effects of the ECHO tele-mentoring program on HIV/TB service delivery in health facilities in Zambia: a mixed-methods, retrospective program evaluation

BackgroundIn the quest to ensure that quality healthcare is provided to all citizens through building healthcare worker capacity and extending reach for expert services, Zambia’s Ministry of Health (MoH) in collaboration with its partners PEPFAR through the CDC and HRSA, began to implement the Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program across the country through the Health Workers for the 21st Century (HW21) Project and University Teaching Hospital HIV/AIDS Project (UTH-HAP). This ECHO tele-mentoring approach was deemed pivotal in helping to improve the human immunodeficiency virus (HIV) service delivery capacity of health care workers.MethodThe study used a mixed method, retrospective program evaluation to examine ECHO participants’ performance in the management of HIV/AIDS patients in all the 10 provinces of Zambia.Case presentationA phenomenological design was applied in order to elicit common experiences of ECHO users through focus group discussions using semi-structured facilitation guides in four provinces (Eastern, Lusaka, Southern and Western) implementing ECHO tele-mentoring approach. These provinces were purposively selected for this study. From which, only participants that had a monthly frequency of ECHO attendance of ten (10) and above were selected. The participants were purposively selected based on the type of cadre as well as facility type so that the final sample consisted of Doctors, Nurses, Midwives, Clinical Officers, Medical Licentiates, Pharmacy and Laboratory Personnel. All sessions were audio recorded and transcribed by the data collectors. A thematic content analysis approach was adopted for analyzing content of the interview's transcripts.ResultsEnhanced knowledge and skills of participants on HIV/TB improved by 46/70 (65.7%) in all provinces, while 47/70 (67.1%) of the participants reported that ECHO improved their clinical practice. Further, 12/70 (17.1%) of participants in all provinces reported that presenter/presentation characteristics facilitated ECHO implementation and participation. While, 15/70(21.4%) of the participants reported that ownership of the program had contributed to ECHO implementation and participation. Coordination, another enabler accounted for 14/70 (20%). Inclusiveness was reported as a barrier by 16/70 (22.8%) of the participants while 6/70 (8.6%) of them reported attitudes as a barrier (8.6%) to ECHO participation. In addition, 34/70 (48.6%) reported poor connectivity as a barrier to ECHO implementation and participation while 8/70 (11.5%) of the participants reported that the lack of ownership of the ECHO program was a barrier. 22/70 (31.4%) reported that increased workload was also a barrier to the program’s implementation.ConclusionConsistent with its logical pathway model, healthcare providers’ participation in ECHO sessions and onsite mentorship contributed to improved knowledge on HIV/TB among health care providers and patient health outcomes. In addition, barriers to ECHO implementation were intrinsic to the program its self, such as coordination, presenter and presentation characteristics other barriers were extrinsic to the program such as poor connectivity, poor infrastructure in health facilities and negative attitudes towards ECHO. Improving on intrinsic factors and mitigating extrinsic factors may help improve ECHO outcomes and scale-up plans.

Determinants of health facility delivery among young mothers aged 15 – 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey

BackgroundYoung mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women.MethodsA nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15–24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA)..ResultsOf the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 – 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility.ConclusionStrategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

Complication experience during pregnancy and place of delivery among pregnant women: a cross-sectional study

BackgroundUnlike other causes such as abortion, obstetric complications like hemorrhage, and hypertensive disorders of pregnancy, which are difficult to resolve for women who give birth out of health facilities are persisted or increased to be the cause of maternal mortality in Ethiopia. Direct obstetric complications resulted in the crude direct obstetric case fatality rate in this country. This study aimed to assess the relationship between Complication Experience during Pregnancy and Place of Delivery among Pregnant Women.MethodA community-based cross-sectional study was conducted to assess the baseline information as a part of a randomized control trial study. The sample size that was calculated for the cohort study with the assumptions to detect an increase in a minimum acceptable diet from 11 to 31%, with 95% CIs and 80% power, an intra-cluster correlation coefficient of 0·2 for a cluster size of 10 was used for this study. Statistical analysis was done using SPSS version 22.ResultThe prevalence of self-reported pregnancy-related complications and home delivery were 79(15.9%, CI; 12.7–19.1) and 46.90% (95%CI; 42.5–51.1) respectively. Women who did not face vaginal bleeding were five times AOR 5.28(95% CI: 1.79–15.56) more like to give birth at home than those who faced this problem. Women who did not face severe headache were nearly three AOR 2.45(95%CI:1.01–5.97) times more like to give birth at home.ConclusionThis study concluded that home delivery was high among the study participants whereas pregnancy-related complications such as vaginal bleeding and severe headache were identified as protective factors for facility delivery. Hence, the researchers recommended the incorporation of “storytelling” into the existing health extension program packages to improve facility delivery which shall be applied after the approval of its effectiveness by further research.

Knowledge, attitude, practice and determinants of exclusive breastfeeding among women in Ethiopia: Systematic review and meta-analysis

ObjectiveThis study aimed to assess the pooled estimate of Ethiopia's women's knowledge, attitudes, practices, and determinants of exclusive breastfeeding. MethodsPubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region, study setting, and publication. The pooled odds ratio for associated factors was also computed. ResultsOut of 995 studies reviewed, 33 met our eligibility criteria and were included in this meta-analysis study. The total number of study participants was 13,397. The pooled prevalence of good knowledge, positive attitude, and poor practice of kangaroo mother care were 74.2% (95% CI: 62.9–85.4), 77.2% (95%CI: 68.3–86.0), and 58.3% (95% CI: 49.9–66.6), respectively. In sub-group analysis, the highest prevalence of knowledge was in institution-based studies (78.3%) and unpublished studies (76.3%). A positive attitude was also highest in institutional-based studies (81%). The highest practice prevalence was in Afar (68%) and the lowest was in Addis Ababa (34.6%).Women who had a secondary level of education (AOR = 3.3; 95%CI: 1.8–6.0) were a housewife (AOR = 3.1; 95%CI: 2.1–4.7), delivered vaginally (AOR = 2.0; 95%CI: 1.4–2.9), health facility delivery (AOR = 3.3; 95%CI: 2.1–5.1) and attending antenatal care were predictors of exclusive breastfeeding. ConclusionAlthough women have good knowledge and positive attitude toward exclusive breastfeeding, there is a significant gap in exclusive breastfeeding practice. Maternal education, occupation, vaginal delivery, institutional delivery, and antenatal care visit were predictors of exclusive breastfeeding. It is recommended to strengthen maternal and child health services.

District-Level Patterns of Health Insurance Coverage and Out-of-Pocket Expenditure on Caesarean Section Deliveries in Public Health Facilities in India

Reducing catastrophic out-of-pocket expenditure (OOPE) and increasing the rates of institutional deliveries are part of the Sustainable Development Goals (SDGs). India has made significant progress on the maternal and child health front in recent years. India’s National Health Mission (NHM) has been able to increase rates of institutional deliveries. In the present study, we aim to ascertain district-level patterns of percentage of health insurance coverage in the National Family Health Surveys NFHS 4 and NFHS 5. We also aim to ascertain district-level patterns of out-of-pocket expenditure on C-section deliveries in public health facilities in NFHS 4 and NFHS 5. The present study explores district-level data associated with health insurance coverage (%) and out-of-pocket expenditure in a public health facility (in INR) observed across NFHS 4 and NFHS 5. A spatial analysis was carried out using QGIS 3.26 (Mac version) and GeoDA 1.20.0.8. A visual assessment of the maps across NFHS 4 and NFHS 5 shows improvement in insurance coverage at the district level across the two surveys. Despite an increase in insurance coverage, North East India has experienced an increase in OOPE for C-section deliveries. Rajasthan and various parts of South India have experienced a decrease in OOPE for C-section deliveries. Kerala has experienced a rise in insurance coverage and OOPE for C-section deliveries. Univariate LISA cluster and significance maps revealed that Kerala and Tamil Nadu, the eastern coast of India and parts of Mizoram are hot spots, whereas Jammu and Kashmir and parts of Uttar Pradesh and Gujarat are cold spots. Both these findings are significant. Rajasthan emerges as a significant hot spot along with parts of Assam and a few districts on the eastern coast of India in Tamil Nadu and Andhra Pradesh. Jammu and Kashmir, Ladakh, parts of Uttar Pradesh, Maharashtra, and Karnataka have emerged as significant cold spots. The South Indian states of Kerala and Tamil Nadu are no longer hot spots indicating geospatial variations across time. An increase in the number of hot spots across NFHS 4 and NFHS 5 indicates rising out-of-pocket expenditure for C-sections despite growth in health insurance coverage. The present study does not offer any evidence to suggest that health insurance coverage decreases OOPE on C-section deliveries at government facilities. With RSBY having been launched in 2008 and Ayushman Bharat in 2018, high levels of OOPE on C-section deliveries at government facilities raise serious concerns about the efficacy of PFHIs in reducing OOPE. The government would need to plug the well-documented weaknesses of PFHIs, such as fraud, double charging, poor enrolment, and lack of awareness in addition to the unfortunate phenomena of “tips” and “tie ups” mentioned earlier that plague the public healthcare system, if we are to see any reduction in OOPE in the foreseeable future.

Spatial distribution and determinants of newborn care within 2 days of postpartum period among women with at least one antenatal care visit in Ethiopia: Mixed effect multilevel analysis.

Neonatal mortality is pervasive in developing countries like Ethiopia. Though the risk of neonatal mortality is preventable through consolidating simple, low-cost, and less time-consuming essential care, there is a scarcity of evidence about the spatial distribution of newborn care in Ethiopia. The current study aimed to demonstrate spatial distribution and determinants of newborn care within 2 days of the postpartum period in Ethiopia. A cross-sectional study was employed based on Ethiopian demographic and health survey 2016 data and 2796 post-partum period women were included. Arc GIS version 10.7 and SaTScan version 9.6 software were used. Mixed effect analysis was done by STATA version 14 software. Bivariate analysis was done and variables with a p value<0.2 were taken as a candidate for multilevel multivariable logistic regression. Intra Class Correlation Coefficient (ICC), Proportion Change in Variance (PCV), and Median Odds Ratio (MOR) were used for model comparison and an Adjusted Odds Ratio (AOR) with respect to a 95% confidence interval was used for declaring statistical significance. In the multivariable analysis, a p-value≤0.05 was considered as a cut point of statistical significance with the outcome variable. The spatial distribution of newborn care was not random and the overall prevalence was 48.39%. Secondary educational level (Adjusted Odds Ratio (AOR = 1.5;95% CI 1.06,2.62), college and above (AOR = 2.47; 95% CI 1.22,5.01), number of antenatal cares three (AOR = 1.5; 95% CI 1.10, 2.04), antenatal care four and above (AOR = 1.6; 95% CI 1.22; 2.19), place of delivery (AOR = 9.67; 7.44, 12.57) and child is a twin (AOR = 3.33; 95% CI 1.23, 9.00) were variables significantly associated with newborn care. Newborn care practice in Ethiopia is below half per hundred participants. Even the distribution was not random. There is a need to pay attention to those cold spot areas and factors significantly associated with newborn care. Improving women's educational levels secondary and above, and consolidating the continuation of antenatal care and health facility delivery were the priority areas to improve newborn care in Ethiopia. Maternal and neonatal health program managers and policymakers should pay attention to those cold spots of newborn care to achieve the sustainable development goal.

Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America

South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments.In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future.In China, improvements in women’s reproductive, maternal, neonatal, child, and adolescent health are critical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented attention. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues.The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world’s regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia.Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.

Amazon’s distribution space: constructing a ‘labour fix’ through digital Taylorism and corporate Keynesianism

Abstract Amazon is one of the largest e-commerce corporations in the world and has built a reputation for fast, low-cost service. To rapidly and efficiently move goods from production to consumption, however, Amazon relies on a logistics network that entails significant investments in infrastructure (physical and human) and these investments present a challenge for capital accumulation. In this paper, I examine the labour practices that Amazon employs within its distribution work spaces to address this challenge. The analysis is based on a case study of Amazon’s distribution facilities (fulfilment centres and delivery stations) in Montreal, Quebec. It draws on ethnographic research as a community organizer and semi-structured interviews with workers (present and former), trade union representatives and public policy experts to identify Amazon’s key strategies. Building on past studies on the platform economy, I illustrate how Amazon relies on ‘digital Taylorism’ (Staab &amp; Nachtwey, 2016), involving the use of digital technologies to structure and control the labour process and surveil workers, as a key strategy. However, I further illustrate how Amazon seeks to balance the harmful effects of digital Taylorism with what I term ‘corporate keynesianism’ (i.e., social welfare benefits) to attain a ‘labour fix’, i.e., the steady supply of precarious, compliant labour needed to sustain the logistics machine.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis

BackgroundNowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn’t take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia.MethodCross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively.ResultsDropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran’s index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3–4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking.ConclusionsDropout from health facility delivery after ANC booking was high as the government’s effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women’s education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.