Facility-based Delivery Research Articles

Pregnant Women's Views Regarding Maternity Facility-Based Delivery at Primary Health Care Facilities in the Province of KwaZulu-Natal in South Africa.

For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries, including South Africa, take place outside a health facility and without skilled birth attendants. Therefore, this has made it difficult to achieve the Sustainable Development Goals of global reduction in maternal mortality, which is a key health challenge globally, especially in developing countries and sub-Saharan Africa in particular. The study aimed to explore and describe the views of pregnant women regarding facility-based delivery. Focus group discussions were used to gather information from pregnant women. Information was collected from six groups of pregnant women who had delivered babies at the primary health care facilities in the past 5 years. Results showed several factors associated with the failure to use institutional delivery services, such as the lengthy distance from the health care facility, lack of transport, lack of transport fare, shortages of skilled staff, failure to disclose pregnancy, cultural and religious beliefs, and staff attitudes.

Pragmatic cluster-randomized trial of home-based preventive treatment for TB in Ethiopia and South Africa (CHIP-TB)

BackgroundEach year, 1 million children develop TB resulting in over 200,000 child deaths. TB preventive treatment (TPT) is highly effective in preventing TB but remains poorly implemented for household child contacts. Home-based child contact management and TPT services may improve access to care. In this study, we aim to evaluate the effectiveness and cost-effectiveness of home-based contact management with TPT initiation in two TB high-burden African countries, Ethiopia and South Africa.MethodsThis pragmatic cluster randomized trial compares home-based versus facility-based care delivery models for contact management. Thirty-six clinics with decentralized TB services (18 in Ethiopia and 18 in South Africa) were randomized in a 1:1 ratio to conduct either home-based or facility-based contact management. The study will attempt to enroll all eligible close child contacts of infectious drug-sensitive TB index patients diagnosed and treated for TB by one of the study clinics. Child TB contact management, including contact tracing, child evaluation, and TPT initiation and follow-up, will take place in the child’s home for the intervention arm and at the clinic for the control arm. The primary outcome is the cluster-level ratio of the number of household child contacts less than 15 years of age in Ethiopia and less than 5 years of age in South Africa initiated on TPT per index patient, comparing the intervention to the control arm. Secondary outcomes include child contact identification and the TB prevention continuum of care. Other implementation outcomes include acceptability, feasibility, fidelity, cost, and cost-effectiveness of the intervention.DiscussionThis implementation research trial will determine whether home-based contact management identifies and initiates more household child contacts on TPT than facility-based contact management.Trial registrationNCT04369326. Registered on April 30, 2020.

Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching.

Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.

Socioeconomic inequalities in maternal healthcare utilization: An analysis of the interaction between wealth status and education, a population-based surveys in Tanzania.

Limited scientific, evidence has so far described the interactions between socioeconomic factors and the gap of inequalities in maternal healthcare utilization. This study assessed the interaction between wealth status and education to identify women with greater disadvantage. This analysis used secondary data from the three most recent rounds (2004, 2010, and 2016) of the Tanzania Demographic Health Survey (TDHS). Maternal healthcare utilization was assessed based on six services (outcomes) which are i) booking during the first trimester (bANC), ii) at least four antenatal visits (ANC4+), iii) adequate antenatal care (aANC), iv) facility-based delivery (FBD), v) skilled birth attendance (SBA), vi) cesarean section delivery (CSD). The concentration curve and the concentration index were used to measure socioeconomic inequality in maternal healthcare utilization outcomes. The interaction coefficients suggest that each unit increase in the wealth status is significantly associated with higher odds of utilizing all maternal healthcare services for women with primary and secondary or higher education compared to those with no education (booking during the first trimester [AOR = 1.30; 95% CI: 1.08-1.57], at least four antenatal visits [AOR = 1.16; 95% CI: 1.01-1.33], facility-based delivery [AOR = 1.29; 95% CI: 1.12-1.48], skilled birth attendance [AOR = 1.31; 95% CI: 1.15-1.49]). The highest wealth-related inequality in bANC (EI: 0.166), at least four antenatal visits (EI: 0.259), FBD (EI: 0.323) and skilled birth attendance (EI: 0.328) (P < 0.05) was observed among women with primary and secondary or higher education. These findings provide strong evidence that there is an interaction effect between education attainment and wealth status in socioeconomic inequalities of maternal health services utilization. Therefore, any approach which will address both women's education and wealth status might be the first step to reducing socioeconomic inequalities in maternal health services utilization in Tanzania.

Examining the relationship between armed conflict and coverage of maternal and child health services in 35 countries in sub-Saharan Africa: a geospatial analysis

Armed conflict is on the rise in sub-Saharan Africa and affects public infrastructures, including health systems, although evidence on population health is sparse. We aimed to establish how these disruptions ultimately affect health service coverage. We geospatially matched Demographic and Health Survey data with the Uppsala Conflict Data Program Georeferenced Events Dataset, covering 35 countries for the period from 1990 to 2020. We relied on linear probability models with fixed effects to capture the effect of nearby armed conflict (within 50 km of the survey cluster) on four service coverage indicators along the continuum of maternal and child health care. We also investigated effect heterogeneity by varying conflict intensity and duration, and sociodemographic status. The estimated coefficients represent the decrease in the probability (in percentage points) of the child or their mother being covered by the respective health service following deadly conflicts within 50 km. Any nearby armed conflict was associated with reduced coverage for all examined health services, with the exception of early antenatal care: early antenatal care (-0·5 percentage points, 95% CI -1·1 to 0·1), facility-based delivery (-2·0, -2·5 to -1·4), timely childhood vaccination (-2·5, -3·1 to -1·9), and treatment of common childhood illnesses (-2·5, -3·5 to -1·4). For all four health services, the negative effects increased for high-intensity conflicts and were significant throughout. When examining conflict duration, we did not find negative effects on the treatment of common childhood illnesses in prolonged conflicts. The analysis on effect heterogeneity revealed that, except for timely childhood vaccination, the negative effects of armed conflict on health service coverage were more pronounced in urban settings. Our findings suggest that health service coverage is significantly affected by contemporaneous conflict, but health systems can adapt to provide routine services, such as child curative services, in situations of prolonged conflict. Our analysis underlines the importance of studying health service coverage during conflict both at the finest possible scales and across different indicators, pointing at the need for differential policy interventions. None. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Predicting facility-based delivery in Zanzibar: The vulnerability of machine learning algorithms to adversarial attacks

BackgroundCommunity health worker (CHW)-led maternal health programs have contributed to increased facility-based deliveries and decreased maternal mortality in sub-Saharan Africa. The recent adoption of mobile devices in these programs provides an opportunity for real-time implementation of machine learning predictive models to identify women most at risk for home-based delivery. However, it is possible that falsified data could be entered into the model to get a specific prediction result – known as an “adversarial attack”. The goal of this paper is to evaluate the algorithm's vulnerability to adversarial attacks. MethodsThe dataset used in this research is from the Uzazi Salama (“Safer Deliveries”) program, which operated between 2016 and 2019 in Zanzibar. We used LASSO regularized logistic regression to develop the prediction model. We used “One-At-a-Time (OAT)” adversarial attacks across four different types of input variables: binary – access to electricity at home, categorical – previous delivery location, ordinal – educational level, and continuous – gestational age. We evaluated the percent of predicted classifications that change due to these adversarial attacks. ResultsManipulating input variables affected prediction results. The variable with the greatest vulnerability was previous delivery location, with 55.65% of predicted classifications changing when applying adversarial attacks from previously delivered at a facility to previously delivered at home, and 37.63% of predicted classifications changing when applying adversarial attacks from previously delivered at home to previously delivered at a facility. ConclusionThis paper investigates the vulnerability of an algorithm to predict facility-based delivery when facing adversarial attacks. By understanding the effect of adversarial attacks, programs can implement data monitoring strategies to assess for and deter these manipulations. Ensuring fidelity in algorithm deployment secures that CHWs target those women who are actually at high risk of delivering at home.

Uptake of reproductive, maternal and child health services during the first year of the COVID-19 pandemic in Uganda: A mixed methods study.

Use of reproductive health (RH), maternal, newborn and child health (MNCH) services in Uganda is suboptimal. Reasons for this are complex; however, service-delivery factors such as availability, quality, staffing, and supplies, contribute substantially to low uptake. The COVID-19 pandemic threatened to exacerbate existing challenges to delivery and use of high-quality RH and MNCH services. We conducted a mixed methods study, combining secondary analysis of routine electronic health management information system (eHMIS) data with exploratory key informant interviews (KII) to examine changes in health service uptake over the course of the pandemic and to understand service delivery adaptations implemented in response. We analyzed eHMIS data for four services (family planning, facility-based deliveries, antenatal visits, and immunization for children by one year), comparing them across four time periods: pre-COVID-19, partial lockdown, total lockdown and post lockdown. Additionally, KIIs were used to document adaptations made for continuity of health services. Use of services declined substantially during total lockdown; however, rebounded quickly to earlier observed levels, during the post lockdown for all four services, especially for immunization for children by one year. KIIs identified several health services delivery adaptations. At the community level, these included: community outreaches, training some mothers as community liaisons to encourage others to seek health services, and support from local leaders to create call centers to facilitate clients transport during travel restrictions. Health facilities creatively used space to accommodate social distancing and shifted providers' roles. District leadership reassigned health workers to facilities closest to their homes, provided vehicle passes to staff, and ambulances to transport pregnant women in critical need. WhatsApp groups facilitated communication at district level and enabled redistribution of supplies. Ministry of Health produced critical guidelines for continuity of health services. Implementing partners provided and redistributed commodities and personal protective equipment, and provided technical support, training and transport.

Increasing health facility childbirth in Ghana: the role of network and community norms

BackgroundReducing pregnancy-related deaths in Sub-Saharan Africa through increases in health facility births may be achieved by promoting community norms and network norms favoring health facility births. However, the process of how both norms shift attitudes and actions towards facility delivery is little studied. We examined the association of network and community norms with facility birth, following a quality improvement intervention to improve facility births in Ghana.MethodsA 2015 mixed methods evaluation of a Maternal and Newborn Health Referral (MNHR) project in Ghana included a cross-sectional survey of women (N = 508), aged 15–49 years; in-depth interviews (IDIs) with mothers (n = 40), husbands (n = 20) and healthcare improvement collaborative leaders (n = 8); and focus group discussions (FGDs) with mothers-in-law (n = 4) and collaborative members (n = 7). Multivariable logistic regression was used to examine the association of network and community norms with facility birth. Thematic analysis of the qualitative data was conducted to explain this relationship.ResultsThe network norm of perceived family approval of facility delivery (AOR: 5.54, CI: 1.65–18.57) and the community norm of perceived number of women in the community that deliver in a facility (AOR: 3.00, CI: 1.66–5.43) were independently associated with facility delivery. In qualitative IDIs and FGDs both norms were also collectively perceived as influencing facility delivery. However, network norms were more influential in women’s utilization of facility-based pregnancy-related care. Healthcare improvement collaboratives were important in swaying both network and community norms toward facility-based delivery by offering pregnancy-related health information, antenatal care, and support for facility delivery.ConclusionQuality improvement initiatives impact both community and network norms. To be most impactful in advancing facility-based pregnancy-related care, these initiatives should focus on highlighting the shifting trend toward facility delivery in rural communicates and promoting support for facility delivery among women’s personal networks.

Uterine Rupture at Federal Teaching Hospital, Katsina: A Five Year Review

Background: Uterine rupture, despite being one of the most devastating obstetric complication associated with significant maternal and perinatal morbidities and mortality, is still prevalent in developing countries. Objectives: To determine the prevalence, aetiologic risk and other contributing factors, complications as well as outcome of Obstetric Uterine rupture at Federal Teaching Hospital, Katsina. Study Design: A Five year retrospective study that reviewed uterine rupture in Obstetrics and Gynaecology department of Federal Teaching Hospital, Katsina from 1st January 2010 to December 31st 2014. Results: There were 42 uterine ruptures out of 9995 deliveries, with an incidence of 4.2 per 1000 deliveries. The mean age of the patients was 31yrs± 0.9. The highest incidence was among unbooked patients (85%). The diagnosis was made pre-operatively in 88.1% of the cases. Major risk factors were prolonged obstructed labour (26.2%), previous caesarean section scar (19%) and Oxytocin infusion in unscarred (14.3%) and scarred Uteri (11.9%) as well as use of Misoprostol (11.9%). Majority of the ruptures occurred anteriorly (52.4%) while scar dehiscence accounted for 23.8% of cases. Repair with bilateral tubal ligation was the most frequent mode of treatment (47.6%), while hysterectomy was done for patients with extensive ruptures (34.3%). The commonest complication was postoperative Anaemia (38.1%). There were two maternal deaths, with a case fatality rate of 4.8%, while the perinatal mortality was 78.6%. Conclusion: Uterine rupture is still a major cause of maternal and perinatal morbidities and mortality in our setting. Antenatal care with skilled facility-based deliveries will reduce its incidence and associated complications.

How do we improve maternal and child health outcomes in Ghana?

Maternal and infant mortality includesa number of health challenges in Ghana, with outcomes among the worst in the subregion and the world. Our aim here was to provide insights into how Ghana has approached these challenges, with a view to making suggestions for the future. Ghana has made significant gains in reducing infant and maternal deaths in the past decade through initiatives like the Free Maternal Care Policy, the Community-based Health Planning Services, and the National Health Insurance Policy. These policies have improved financial access to maternal and obstetric health services, facility-based delivery, and antenatal care services in particular. However, a number of challenges still hinder access to maternal and child health outcomes. Poor infrastructure, human resource challenges, poor access to essential medicines, poor quality of care, and superstitious and cultural beliefs have been noted in the literature. We suggest that while providing the necessary human and financial resources, other initiatives including the promotion of maternal health education, supervised home delivery, and zero maternal death interventions should be encouraged to help improve maternal and child health outcomes in Ghana.

Persistent barriers to achieving quality neonatal care in low-resource settings: perspectives from a unique panel of frontline neonatal health experts

Background Despite increasing rates of facility-based deliveries, neonatal mortality rates remain persistently high in low-resource settings (LRS). This has catalysed international focus on understanding and enabling quality newborn care. We aimed to understand persistent barriers to Quality of Care (QoC) and to identify quality improvement priorities from the perspective of a panel of neonatal experts with first-hand experience of delivering newborn care in low-resource settings (LRS). Methods We conducted 13 semi-structured interviews with neonatal health experts via Skype. All interviews were recorded and transcribed verbatim. We adopted an inductive thematic analytical approach. Ethical approvals were not required. Results Twenty-two experts were invited to participate, of whom 16 responded and 13 agreed to take part (five neonatologists, six paediatricians and two advanced neonatal nurse practitioners). Participants had a mean of 13 (±7 SD) years working in LRS. Lack of physical resources including basic equipment and infrastructure such as running water, combined with limited human resources, education and specialist neonatal training were cited as key barriers to delivering quality care. In addition, weak leadership at the community, local and national level were thought to hinder progress. Poor communication within clinical teams, limited documentation and lack of standardised and locally appropriate guidelines were also identified as challenges. Digital technologies were perceived to have potential for data capture and enabling standardised care. However, some highlighted that unreliable internet access and possible stigma may hinder implementation. Conclusions With less than 10 years to reach the Sustainable Development Goals (SDGs), it is critical to ensure access to quality care for all sick and vulnerable newborns admitted to health facilities. Clinical leaders in low resource settings need to be empowered to define local agendas and advocate for critical resources in order to close the gap between local and global quality of care priorities.

The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries

ABSTRACT Background The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. Objective We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. Methods We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. Results For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: −5.1%, −1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. Conclusions Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.

Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana.

Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana. A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills. We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant. The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

Creating Reproductive Health Behavioral Profiles for Women of Reproductive Age in Niger Using Cross-Sectional Survey Data: A Latent Class Analysis.

Objectives: To identify health behavioral profiles for women of reproductive age in Niger. Methods: We interviewed married women of reproductive age in Niger in April 2021 (N = 2,709). Latent class analysis based on sociodemographic and behavioral determinants was used to identify classes of women related to use of antenatal care, facility delivery, and modern family planning (FP) use. Results: We found similar classes between the use of antenatal care and facility-based delivery classes with the first class composed of less educated and poor women with weaker behavioral determinants while the second class was more educated and had stronger behavioral determinants. In the facility-based delivery class was the presence of a third class that was poor and uneducated with low levels of knowledge and social norms, but in contrast had much higher levels of positive attitudes, self-efficacy, and partner communication than the first class. A fourth class of younger, more educated women with strong behavioral determinants emerged related to FP. Conclusion: The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimizing maternal and reproductive health.

Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis.

Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12-23 months in Ethiopia. A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. Complete basic childhood vaccination among children aged 12-23 months had a significant variation in Ethiopia (Moran's I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region's Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region's (SNNPR) Gedeo and Sidama zones; and the Oromia region's Bale and Guji zones. The second significant cluster was found in the Afar region's zones 1, 4, and 5, as well as the northern Somali region's Siti zone. In the multivariable multilevel analysis, maternal age 20-24, 25-29, 35-39, and 40-44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.

Usability and acceptance of a mobile health wallet for pregnancy-related healthcare: A mixed methods study on stakeholders' perceptions in central Madagascar.

Several sub-Saharan African countries use digital financial services to improve health financing, especially for maternal and child health. In cooperation with the Malagasy Ministry of Health, the NGO Doctors for Madagascar is implementing a mobile health wallet for maternal health care in public-sector health facilities in Madagascar. Our aim was to explore the enabling and limiting factors related to the usability and acceptance of the Mobile Maternal Health Wallet (MMHW) intervention during its implementation. We conducted a cross-sectional, mixed methods study with mothers and pregnant women and facility- (FBHWs) and community-based (CHWs) health workers from public-sector health facilities in three districts of the Analamanga region in Madagascar. We used a convergent design in collecting and analyzing quantitative and qualitative data. We performed one-stage proportional sampling of women who had signed up for the MMHW. All FBHWs and CHWs at primary care facilities in the intervention area were eligible to participate. 314 women, 76 FBHWs, and 52 CHWs were included in the quantitative survey. Qualitative data were extracted from in-depth interviews with 12 women and 12 FBHWs and from six focus group discussions with 39 CHWSs. The MMHW intervention was accepted and used by health workers and women from different socioeconomic backgrounds. Main motivations for women to enroll in the intervention were the opportunity to save money for health (30.6%), electronic vouchers for antenatal ultrasound (30.2%), and bonus payments upon reaching a savings goal (27.9%). Main motivation for health workers was enabling pregnant women to save for health, thus encouraging facility-based deliveries (57.9%). Performance-based payments had low motivational value for health workers. Key facilitators were community sensitization, strong women-health worker relationship, decision making at the household level, and repetitive training on the use of the MMHW. Key barriers included limited phone ownership, low level of digital literacy, disinformation concerning the effects of the intervention, and technical problems like slow payout processes.

Forms of Support and Experiencing Maltreatment and Disrespect During Childbirth at a Health Facility: A Self-Reported Cross-Sectional Study in Ghana.

One method to enhance maternal health outcomes in underdeveloped nations is to help women and encourage them to give birth in medical facilities (skilled delivery). Yet, impediments to facility birth have reportedly included fear of abuse and contempt during labour and delivery. The purpose of this study was to evaluate the self-reported experiences of postnatal women and the types of abuse and disrespect they encountered during delivery. One hundred and thirteen (313) women were chosen at random from three healthcare facilities in the Greater Accra area for a cross-sectional study. STATA 15 was used to analyze the data. According to the study, more than half of the postnatal women (54.3%) were urged to have support people present during labour and delivery. Approximately 75.7% said they had been mistreated in some way, with physical violence accounting for 19.8% and undignified care for 9.3%. About 7.7% (n = 24) of the women were detained or confined against their will. The study's findings indicate that labour-related abuse and disrespect are common. Without improving the birthing experience for women, expanding medical facilities might not result in the skilled or facility-based deliveries that are intended. The quality of maternal health care should be monitored, and hospitals should train their midwives in providing excellent patient care (customer care).

Neonatal Birth Trauma and Its Predisposing Factors Among Newborns Admitted to Public Hospitals in Eastern Ethiopia: A Cross-Sectional Study.

Objectives: This study is to investigate the magnitude and predisposing factors for neonatal birth trauma in public hospitals in eastern Ethiopia. It is a major cause of neonatal morbidity and mortality. Despite its higher burden, evidence is limited in eastern Ethiopia. Methods: A cross-sectional study was conducted on 492 newborns selected using systematic random sampling. Data were analyzed using a binary logistic regression model. Statistical significance was set at P < .05. Results: The magnitude of neonatal birth trauma was 16.9% with 95% CI: 13.7-20.5%). In multivariable analysis, instrumental delivery, early preterm (<34 weeks), macrosomia, fetal malpresentation, male sex and, facility-based delivery such as hospital and health center-based delivery were factors associated with neonatal birth trauma. Conclusions: The magnitude of neonatal birth trauma was relatively high. Promoting health facilities-based delivery, prevention of preterm birth, the early decision on the mode, and minimizing instrumental deliveries help reduce neonatal birth trauma.

Intrapartum violence during facility-based childbirth and its determinants: A cross-sectional study among postnatal women in Tanzania.

Violence during childbirth indirectly contributes to maternal and neonatal morbidity and mortality. It also causes intrapartum health consequences such as prolonged labor, postpartum hemorrhage, and postpartum psychological problems, including postpartum depression, post-traumatic stress disorder, and other negative feelings that lead to a decreased desire for facility delivery and increase the events of home deliveries which reduce the quality of life. In Tanzania, several efforts have been made to promote respectful maternity care. However, violence during childbirth continues to create a critical barrier for facility-based delivery and is in need of considerable attention throughout the health system. This study aimed to assess types of intrapartum violence and its determinants among postnatal women in the Dodoma Region, Tanzania. A cross-sectional study using a questionnaire to interview postnatal women at the exit point after being discharged from the health facility to assess intrapartum violence and its determinants. This study was conducted in Dodoma Region involving 307 postnatal women from April to June 2022. A simple random method was used to select respondents. The Chi-square and Fisher's exact tests were used to assess the association between the categorical variables. The predictors of intrapartum violence were determined using binary logistic regression analysis. Statistical analysis was performed using Statistical Package for Social Science version 25.0. P < 0.05 was considered to be significant. Overall, 307 postnatal women participated in the study. Among them, 158 (51.5%) postnatal women experienced at least one form of intrapartum violence. The most common forms of intrapartum violence included breach of confidentiality 205 (66.8%), undignified care/verbal abuse 178 (58%), physical abuse 139 (45.3%), and denial or neglected care by midwives 113 (36.8%). Husband employment, urban residence, and being referred from primary hospitals were significant determinants associated with intrapartum violence (adjusted odds ratio = 0.233, 95% confidence interval = 0.057-0.952, p = 0.043, adjusted odds ratio = 2.67, 95% confidence interval = 1.13-10.93, p = 0.026 and adjusted odds ratio = 3.673, 95% confidence interval = 1.131-11.934, p = 0.030, respectively). Violence during childbirth was highly prevalent in this study. Understanding the prevalence and types of intrapartum violence is important in order to promote changes in all levels of the health system. This study reveals the need for key interventions to effect change at many levels; including an interventional study to educate women and birth partners on client rights, and strengthening the health system to meet the needs of women during labor and childbirth. Policies and systems that support respectful maternity care are urgently needed in this setting, including universal training of health professionals in respectful maternity care.

“We Beat Them to Help Them Push”: Midwives’ Perceptions on Obstetric Violence in the Ashante and Western Regions of Ghana

Obstetric violence has been recognized as a major impediment to facility-based delivery, increasing the risk of preventable complications and maternal mortality. In Ghana, studies on women’s birth experiences reveal enormous and brutal acts of violence during delivery; however, inquiries into why midwives abuse women have not been extensively studied. This study explored the perspectives of midwives on the drivers of obstetric violence in the Western and Ashante Regions of Ghana. A qualitative study was conducted involving 30 in-depth interviews with midwives in eight health facilities. The data were analyzed thematically using NVivo 12. The results of the study reveal a normalization of violence in the delivery room and the intensity of violence is heightened during the second stage of labor. Midwives reported perpetrating or witnessing physical violence, abandonment of women, stigmatization of HIV women, verbal abuses such as shouting, and the detention of women in the health facilities. Midwives abuse women as a result of the pressures of the midwifery profession, poor maternal efforts of women, disrespect of midwives, women’s disobedience, and uncooperative attitudes. The culture of acceptability of obstetric violence is a major driver, contributing to its normalization. Midwives do not consider obstetric violence as abuse, but rather, as a delivery strategy which aids a successful delivery. It is therefore justified and viewed as a necessary part of the delivery process. There is a critical need for retraining midwives on alternative birthing strategies devoid of violence.