Institutional Delivery Research Articles

Determinants of rural‑urban child malnutrition disparities in Ethiopia

Child malnutrition is a significant issue in Ethiopia, with high prevalence rates. However, there is limited information on the rural‑urban disparities in child malnutrition of all its forms (stunting, wasting, and underweight) in the country. Therefore, this study aimed to address this gap by analysing data from the 2019 Ethiopian Demographic Health Survey (EDHS). This study examined the rural‑urban child malnutrition gaps in Ethiopia using an extended Oaxaca-Blinder decomposition technique. The analysis reveals significant ruralurban disparities in prevalence rates of wasting, underweight, and stunting. The findings highlighted that children in rural areas are more malnourished than their urban counterparts. Additionally, the study identified key determinants of these disparities, including maternal and parental education, household economic status, women’s age at first birth, childbirth size, and working status of women. The results also indicate that institutional delivery, household size, and dependency ratio contribute to widening the rural‑urban disparities in child malnutrition. This study highlighted the importance of targeted policies and interventions to address these disparities and reduce child malnutrition at the national level.

Resident Unions: Why Now and Will They Change Medical Education and Health Care?

During the COVID-19 pandemic, resident unions proliferated. While unionization resulted in increased compensation and benefits, the process of union negotiations may have created adversarial relationships between residents and their institutions' leadership, who residents depend on for supervision and the development of clinical expertise. Such adversarial relationships could affect the learning environment, which is critical to the delivery of high-quality care. In this commentary, the authors suggest that academic medical centers should offer residents an authentic seat at the institutional care delivery leadership table, ensuring residents' full participation in key organizational decisions. Doing so represents an alternative to unionization, with its potentially adversarial relationships, while still achieving a key goal of residents-to be included in the decisions that affect them and the care they provide. In this way, residents can use their unique understanding of the institutions' strengths and weaknesses to improve the quality of patient care and the learning environment. Such engagement can also help residents achieve competence in systems-based practice and provide a vital link between institutions and the patients and community they serve through health policy and advocacy activities.

Exploring Indigenous Ways of Childbirth Management and its Perinatal Outcomes During Cyclonic Periods in Hilly Tribal Homebirth Settings: A Qualitative Observational Study

Objective This study explores the cultural-based management of childbirth vulnerabilities in the hilly regions during cyclone periods, where the land mass has been frequently exposed to floods during and aftermath of cyclones due to low-high cyclonic depressions in the Bay of Bengal coast. Methods The present study was a community-based qualitative observational study conducted for three weeks immediately after the two cyclonic periods occurred between October and December 2022. With the purposive sampling method, 21 postpartum mothers were selected on the inclusion criteria, of having had childbirth around the cyclonic period of ‘Sitrang’ (late October 2022) and ‘Mandous’ (early December 2022). Semi-structured in-depth interview schedules were employed to document socio-demographic profiles and probed for their cultural ways of managing childbirth complications and neonatal exposures to infections during the cyclonic period. Results Views of 21 mothers were coded into three themes with two sub-themes each according to repeated frequencies of information. The themes were (a) Striving for Safe Childbirths; (b) Surviving with Traditional Capacities; (c) Strength and Sustenance. The results indicated that home deliveries were considered safest over institutional deliveries except in the cases of complicated childbirths confirmed difficult by the traditional birth attendants (TBA). Rough climatic conditions compounded by geographical distance, lack of appropriate financial help and timely transportation facilities were the major prevailing factors influencing their childbirth practices during the cyclonic periods. Conclusion Disasters do not alone influence childbirth outcomes, but the evidence is still mixed. The expediency of birth technology has effectively managed childbirth vulnerabilities. Ensured sleep, rest and enough food had also been disturbed during and aftermath cyclones. The results showed an urgent need for focused planning on tribal areas for gestation, birthing and postpartum people during natural disasters.

Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification

BackgroundThe worldwide rise in cesarean section rate is a major public health concern and cause of significant debate. Despite multiple studies showing that higher cesarean rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean births increases continuously. In the Republic of Moldova, the cesarean section has increased from 15.75% in 2012 to 27.42% in 2022, however, the perinatal mortality remains unchanged - constituting 11.6‰. In order to understand the factors that determine the increasing trend of cesarean section and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean section rates. ObjectiveTo assess changes in cesarean section rates and trends and to evaluate the contribution of different obstetrical populations to overall cesarean rates in Municipal Clinical Hospital using the Robson Classification. Study DesignA cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study includes 13882 women who gave birth in 2017, 2019, and 2022 in this hospital. All births were classified into 10 Robson groups, using six basic variables (parity, cesarean section delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi INFO program. ResultsThe overall cesarean section rate was 20.02% (2779/13882) with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252), P=0.0003. Approximately one-third 39.55% (1099/2279) of all cesarean deliveries were performed before the labor onset. The main contributor in all study years is Group 5 - 34.44% (957/2779). The next valuable group as a contributor to the overall cesarean rate are the women from Group 2 representing 14.14% (393/2779), followed by women of Group 1 with 11.98% (333/2779). ConclusionsThe use of the Robson Ten-groups classification offers a clear and detailed record of the cesarean section trends, and due to its simplicity and exclusivity, it can be implemented in the Republic of Moldova as well. The main contributors to the overall cesarean rate are women with a previous cesarean delivery - Group 5, followed by nulliparous women of Group 2 and Group 1.

“Push out” and “pull in” factors of institutional delivery among rural women in central Myanmar

“Push out” and “pull in” factors of institutional delivery among rural women in central Myanmar

How to Take Modern Healthcare Facilities to Rural India

COVID times has proved that modern healthcare facilities available in urban India can be carried to rural India. The way COVID has been managed, controlled and citizens have been vaccinated is a testimony to the fact that in spite of splurging population, we have been able to reach out to the healthcare needs of majority. Objective of this commentary is to study the present state of rural health, compare it with urban areas and check the feasibility of adoption of NinC’s Indian model of Innovation for improving the same. This commentary is based on Literature survey. Results have concluded that coverage of primary healthcare services, such as antenatal care, institutional deliveries and insurance coverage is very low among the rural poor population. Effective adoption of Ninc model would change the rural healthcare scenario.

Level of institutional delivery service utilization and associated factors among women who gave birth in the past 12 months, Ga’an libah district, Marodijeh region, Somaliland: a community-based cross-sectional study

BackgroundInstitutional delivery has been considered one of the important strategies to improve maternal and child health and significantly reduce birth-related complications. However, it is still low in developing countries though there are some improvements. even among the community who has access to the health institutions weather health center and hospital including Somaliland. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in the last 12 months in Ga’an libah district, Marodijeh region, Somaliland.MethodsThe community-based cross-sectional study was conducted among women who gave birth in the last 12 months from September to December 2022. A simple random sampling technique was employed to select study participants from a total of sample population. Data was collected using semi-structural administered questionnaire through interviewing women. Data was collected with online mobile data collection (Kobo collect). SPSS version 25.0 was used for data management, entering and analysis. Bivariate and multivariable logistic regression models were fitted to determine the presence of a statistically significant association between independent variables and the outcome variable with p-value < 0.05.ResultLevel of Institutional delivery services utilization in Ga’an libah district was 53.9% [95% Cl 48.2–59.6] gave birth at health institutions. Women who can read and write local were (AOR 2.18, 95% CI 1.08–4.56, p<0.01), Women with their husband can be capable to read and write are [(AOR = 6.95, 95% Cl 2.82–21.58, p<0.002]). Additionally, ability to cost transportation for referral [AOR 5.21, 95% Cl 2.44–11.13, p<0.001]. not good services available [AOR 0.07, 95%Cl 0.01–0.10, p<0.02]. lack of maternal health and child knowledge [AOR 0.034, 95% Cl 0.02–0.57, p<0.01]. were observed associated with level of institutional deliver services utilization.ConclusionThe institutional delivery service utilization was relatively high compared to national demographic health services in the study area. A large proportion of women gave both at home without a skilled attendant. Therefore, this finding has important policy implications since changes in the cost of the health service and perceived quality would mean changes in client satisfaction as well as their choice, as well emphasize to expectant women can receive medical advice and ambulance for referrals.

Association between neonatal mortality and births not weighed among 400 thousand institutional deliveries in 32 low- and middle-income countries.

Low birthweight (LBW) children have a higher risk of neonatal mortality. All institutional deliveries, therefore, should be weighed to determine appropriate care. Mortality risk for newborns who are not weighed at birth (NWB) is unknown. This paper used logit regression models to compare the odds of death for NWB neonates to that of other neonates using data on 401 712 institutional births collected in Demographic and Health Surveys from 32 low- and middle-income countries. In the pooled sample, 2.3% died in the neonatal period and 12% were NWB. NWB neonates had a high risk of mortality compared to normal birthweight children (Adjusted odds ratio [AOR] 5.8, 95% CI: 5.3, 6.5). The mortality risk associated with NWB was higher than for LBW. The neonatal mortality risk associated with NWB varied across countries from AOR of 2.1 (95% CI: 1.22, 3.8) in Afghanistan to 94 (95% CI: 22, 215) in Gabon. In the pooled sample, the 12% of children who were NWB accounted for 37% of all neonatal deaths. The association between NWB and neonatal mortality may suggest a need to focus on the quality of institutions related to newborn care. However, further studies are needed to determine causality. A health emergency or death may also cause NWB.

Women of reproductive age's use of maternal healthcare services and associated factors in Liben district, East Borena zone, Oromia Regional State, Ethiopia.

One of the most important health interventions for reducing maternal morbidity and death is the use of maternal healthcare services. In Ethiopia, maternal healthcare services are not well utilized, particularly in rural pastoralist communities, despite their significance. Therefore, the purpose of this study was to evaluate the use of maternal healthcare services and the characteristics that are related to it in the East Borena zone. Techniques: In September 2020, a community-based cross-sectional survey was carried out in Liben with 416 randomly selected mothers. Mothers who had given birth within the 12 months before the study comprised the respondents. Questionnaires given by interviewers were used to gather the data. The data were transferred to SPSS version 20 for analysis after being entered into Epi-Info version 4.1 for coding. The Kolmogorov-Smirnov, Hosmer, and Lemeshow goodness of fit tests were employed, along with descriptive statistics. Additionally, multivariate and binary logistic regression analyses were carried out. 95% CI and the odd ratio were used to examine the relationship between the outcome and predictive variables. At least one prenatal visit was received by 60% of moms. Only 21.2% and 17.5% of women had given birth in a medical facility and made use of early postnatal care services. The use of antenatal care was strongly correlated with maternal education [AOR = 2.43 (95% CI: 1.22-4.89)], decision-making capability [AOR = 2.40 (95% CI: 1.3-23.3)], felt compassionate and respectful treatment [AOR = 0.30 (95% CI: 0.18-0.50)], and intended current pregnancy [AOR = 0.22 (95% CI: 0.12-0.37)]. Moms b/n ages 15-19 had a 3.7-fold higher probability of giving birth in a hospitals than moms b/n ages 35 and 49 [AOR = 1.74 (95% CI: 1.02-3.08)]. Mothers who lived far away were 1.02 times less likely to give birth at a hospital than those who could reach one within an hour (AOR = 1.74;95% CI: 1.02, 3.08). While recent use of antenatal care [AOR = 5.34 (95% CI: 1.96-8.65)], planned current pregnancy, and knowledge of using postnatal care were shown to be strongly correlated with danger indicators [AOR = 2.93 (95% CI: 1.59-5.41)], knowledge of danger signs [AOR = 3.77 (95% CI: 2.16-6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery. Overall the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Thus, promoting institutional services, raising community knowledge, empowering women to make decisions, and enhancing the infrastructure of the health sector.

Factors affecting early initiation of breastfeeding among mothers of urban area of Jabalpur district, Madhya Pradesh, India: A community-based cross-sectional study.

Early initiation of breastfeeding reduces infant mortality and morbidity and prolongs the duration of breastfeeding. The present study was conducted to assess the prevalence of early initiation of breastfeeding and factors associated with early initiation of breastfeeding in the urban area of Jabalpur district of Madhya Pradesh. The present community-based cross-sectional study was conducted in an urban area of Jabalpur district of Madhya Pradesh from March 2017 to July 2018 on 370 recently delivered mothers. Data were collected by interview, using the pretested structured questionnaire and analyzed using SPSS, version 20. Significance was set at the value of P < 0.05. The prevalence of early initiation of breastfeeding was found to be 45.4%. The percentage of mothers initiating breastfeeding earlier increased when they belonged to the higher age group, nuclear family, were educated, employed, counseled during antenatal visits, non-primigravida and delivered in health institutions. It was also observed that type of delivery, socioeconomic status of mothers, birth weight of baby and occupation of husband are not significantly associated with the early initiation of breastfeeding. Increasing literacy amongst the population, promoting marriages at an appropriate age, counseling pregnant women regarding early initiation of breastfeeding during antenatal care visits and institutional deliveries can significantly increase the prevalence of early initiation of breastfeeding in the mothers of urban areas of Jabalpur district, Madhya Pradesh.

Under-five mortality during the war in Tigray: A community-based study

BackgroundChild mortality is one of the key indicators of the Sustainable development goals. The Ethiopian healthcare system in general and Tigray’s healthcare system in particular has shown a remarkable progress in terms of reducing maternal, neonatal, and under-five mortality in the last couple of decades. However, the war erupted in November 2020 caused the healthcare system to collapse and little is known about the status of child mortality in Tigray. Thus, this study aimed to examine the magnitude and causes of under-five child mortality in the embattled Tigray region was conducted from October 2020 – May 2022.MethodsA cross-sectional community-based survey was employed. The study included all zones except the western zone and some areas of eastern and north western Tigray bordering Eritrea. These areas were skipped for security reasons. Based on multistage cluster sampling, 121 tabiyas in districts were selected. Census was conducted to survey 189,087 households in the 121 Tabiyas. A locally developed household screening tool and the latest world health organization verbal autopsy instrument were used. The Verbal Autopsy data was processed using the Inter-VA–5.1 (probabilistic modeling) to assign the cause of death. Under-five mortality rate (U5MR) was calculated per 1000 live births with a 95% confidence interval (CI).ResultsIn the present study, out of 29,761 live births, 1761 under-five children died giving an under-five mortality rate of 59(95% CI, 57–62) per 1000 live births. Deaths in the neonatal period and post-neonatal period accounted for 60% and 19.9% of the deaths respectively. Overall, the top 3 causes of under-five child mortality in the present study were: Perinatal asphyxia (n = 277,18%,) prematurity (n = 235,16%) and diarrheal diseases (n = 162, 12.5%). In those who died after first month of life, diarrheal diseases, lower respiratory tract infection, sever acute malnutrition and HIV were the main causes of death. Concerning the place of death, 61.6% of the children died at home.ConclusionThe present study revealed the doubling of under-five mortality in Tigray from where the figure stood in the pre-war period. The leading causes of death in under-five mortality are potentially preventable in situation where the healthcare system is functioning. Restoring the healthcare system and its apparatus, improving access to skilled institutional delivery, smooth perinatal transition, improving nutrition status of children, access to full course of vaccines could ameliorate the staggering under-five mortality rate in the war in Tigray.

Enhancing maternal health service utilization among highly vulnerable pregnant women through a human-centered design process: Study protocol for a quasi-experimental study in Oromia, Ethiopia

Background Disproportionate uptake of and access to maternal and child health services remain significant challenges across and within countries. Differing geographic, economic, environmental, and social factors contribute to varying degrees of vulnerabilities among individuals, which manifest as disparities in maternal and newborn health outcomes. Designing solutions according to need is vital to improve maternal and child health outcomes. In this paper, we describe our study protocol on evaluating the effectiveness of an intervention package developed through a human-centered design (HCD) process in improving maternal health service uptake among vulnerable pregnant women in rural areas of Ethiopia. Methods The study has two distinct phases. For both phases, solutions will be developed leveraging HCD approaches to improve institutional delivery and antenatal care uptake among vulnerable pregnant women. Final solutions will be implemented in collaboration with community health workers and health officers. A community-based, quasi-experimental, mixed-method study design is used to assess differences between intervention and control arms. A panel sample will be enrolled after screening for pregnancy and vulnerability level and surveyed at baseline and midline in Phase 1. In Phase 2, a post-only study will be conducted in the same intervention and control sites. Pregnant women will receive refined solutions for six months, which will be evaluated using end-line assessment. Qualitative interviews will be conducted among vulnerable pregnant women and healthcare providers. Conclusions and Implications Our sequential approach to evaluating initial solutions, which in turn will be used to inform the enhancement of solutions, will provide practical insights into how solutions are accepted among vulnerable women and how they can be better integrated into women’s lives and health systems. Our findings on program effectiveness and implementation research will be disseminated to the Ethiopian Ministry of Health and its partners to inform large-scale implementation at the national level.

Efficacy in Utilization of Computer Artificial Intelligence in Instructional Delivery of Business Education Courses: Business Education Lecturers Perceptions

The study titled &amp;quot;efficacy in Utilization of computer artificial intelligence in instructional delivery of business education courses: business education lecturers perceptions&amp;quot; aimed to investigate the perceptions of business education lecturers towards the utilization of artificial intelligence (AI) in instructional delivery of Business Education courses. The researches employ a mixed-methods approach, combining surveys and interviews to gather quantitative and qualitative data. A sample of business education lecturers from various institutions in Cross River State was used for the study and data was collected through the use of a structured questionnaire administered to one hundred and thirty one (131) Business Education Lecturers in tertiary institution in Cross River State, Nigeria. Data obtained were analyzed using mean scores and standard deviation. The findings revealed that business education lecturers in Cross River State have a negative perception towards the utilization of AI in instructional delivery of accounting. However, there is a significant difference in the perceptions of male and female lecturers towards the utilization of AI in instructional delivery. The study concluded that AI would enhance the quality of instructional delivery in business education institutions in Cross River State, Nigeria. The study recommends that business education institutions in Cross River State should embrace the use of AI in instructional delivery of accounting to improve the quality of education and equip students with relevant skills for the job market. Training programs on the use of AI in instructional delivery should be organized for business education lecturers to equip them with the necessary skills to effectively use AI in their instructional deliveries. The study highlights the potential benefits of incorporating AI into instructional delivery of accounting in business education institutions in Cross River State.

Effectiveness of men in maternity health (MiM) intervention on male involvement in maternal health care to improve maternal health outcomes in Naypyitaw, Myanmar

Background Maternal health care (MHC) is critical for safe motherhood and preventing maternal deaths in Myanmar, but the institutional delivery rates are not yet optimal, increasing preventable maternal deaths. To address this issue, involving men in supporting MHC has been recognized as a strategy to improve MHC outcomes. This study aimed to assess the effectiveness, acceptability, and feasibility of men in maternity health (MiM) intervention on male involvement in MHC and its influence on knowledge, attitudes, and practices related to maternal health and institutional delivery rates in Naypyitaw, Myanmar. Methods This study employed a mixed-methods approach with quantitative surveying of the male partners and qualitative interviewing of both male and female partners and health stakeholders. A 6-month MiM education program on pregnancy complications, antenatal care, delivery care, and birth preparedness was provided to the intervention group. Before and after the intervention, comparisons between intervention and control groups were made. Results The socio-demographic characteristics of male partners were comparable between the intervention and control groups during the pre-intervention assessment. Before MiM intervention, notable differences in male partners’ knowledge, attitudes, birth preparedness and complication readiness practices regarding MHC were not evident between these two groups. After completing the MiM, significant score improvement, including higher ID rates compared to the control group (p&lt;0.001), was observed. The acceptability and feasibility of the MiM program were contributed by positive responses from qualitative findings, highlighting remarkable changes in the perspectives of male partners in supporting MHC. However, challenges, including financial limitations, cultural influences and a shortage of trained personnel, were encountered. Conclusion The MiM program effectively promotes male involvement in MHC, leading to improved MHC outcomes. The MiM intervention offers a promising, evidence-based model to enhance ID rates in Myanmar, requiring tailored approaches to address cultural and financial factors.

Vitamin A supplementation status and associated factors among children aged 6-59 months in Tanzania: a multi-level analysis.

Vitamin A supplementation every 4-6 months is an economical, rapid, and effective strategy to enhance vitamin A status and minimize child morbidity and mortality due to vitamin A deficiency in the long run. Therefore, this study was aimed at investigating the level as well as the factors influencing VAS status among children aged 6-59 months in Tanzania. This analysis relied on data from the 2022 Tanzania Demographic and Health Survey (TDHS). The study used a weighted sample of 9,382 children aged 6-59 months. Given the effect of clustering and the binary character of the outcome variable, we employed a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine statistical significance, considering the model with the lowest deviation that best fits the data. In this study, vitamin A supplementation among children aged 6-59 months was found to be 53.18% [95% CI: 52.17, 54.19]. Mother's/caregiver's working status; Working [AOR = 1.59, 95% CI: 1.34, 1.89], ANC follow-up [AOR = 1.71, 95%CI: 1.34, 2.2], and health facility delivery [AOR = 1.55, 95%CI: 1.25, 1.91] were individual-level factors associated with vitamin A supplementation. Whereas administrative zones of Western [AOR = 2.02, 95% CI: 1.16, 3.52], Southern highlands [AOR = 3.83, 95% CI: 2.02, 7.24], Southern administrative zone [AOR = 2.69, 95% CI: 1.37, 5.3], and South West highlands [AOR = 0.56, 95% CI: 0.33, 0.95] were community-level factors associated with vitamin A supplementation. The proportion of VAS among children in Tanzania is low compared to UNICEF's target of 80. Mother's/caregiver's working status, antenatal care, place of delivery, community-level media exposure, and administrative zones were significantly associated factors with vitamin A supplementation. Therefore, interventions should be designed to improve the uptake of VAS. Provision and promotion of ANC and institutional delivery and strengthening of routine supplementation are recommended to increase coverage of childhood vitamin A supplementation. Moreover, special focus should be given to regions in the south-western highlands.

Study to explore the facilitators and barriers of infant and young children feeding (IYCF) practices among mothers of infants and young children attending referral centres - A MMR

Ideal infant and young children feeding, (IYCF) includes initiation of breastfeeding within half an hour to one hour of birth, exclusive breastfeeding for six months of birth. The Government is spending huge amount of time and sources towards improving the health of mother and children still the mothers are not aware of importance of IYCF practices. The aim of the study was to explore the facilitators and barriers of IYCF practices among mothers of infants and young children attending urban and rural Health centers at Madurai. The majority of the mothers (86.6%) had inadequate level of feeding practices. In the qualitative phase the researcher noted facilitators and barriers. The facilitators were appropriate ante natal health check-ups, institutional deliveries etc Regarding the barriers influence of social media, economic crisis, cultural barriers etc. the researcher concluded that still continuous step to be taken by VHN in the health centres to promote IYCF practices.

Enhancing service delivery via Work-Integrated Learning (WIL) at uMzimkhulu Local Municipality, South Africa

Municipalities in South Africa face numerous challenges that hinder efficient service delivery. One of these challenges is the lack of implementation of required services, leading to citizen dissatisfaction and protest actions. This study aims to investigate methods for improving service delivery in public institutions in South Africa through the implementation of work-integrated learning (WIL) programmes. Data for this study was collected from the uMzimkhulu local municipality in KwaZulu-Natal, specifically from the Harry Gwala District. A total of 56 participants took part in the study, including 28 WIL students and 28 mentors. This ensured representation from all departments within the municipality. Two separate sets of questionnaires were used to collect data from these two groups. Data analysis was performed using the Statistics Packaging for Social Sciences (SPSS) version 27. The study identified several challenges that currently hinder the effective implementation of WIL programmes within the municipality. As a result, it is recommended that the municipality provide training for WIL students and establish efficient monitoring and evaluation processes for the WIL programmes. Additionally, the municipality should involve students in WIL programmes in matters related to progressive initiatives and provide further support to enhance their ability to handle client services. It is also advised that the municipality prioritise the development of facilities and resources for WIL students to fully engage them in their work.

Maternal health care services utilization and associated factors among women in Zoba Maekel, Eritrea 2022: a community based study

Introduction: Studies reveal that regular utilization of maternal health care services reduces maternal morbidity and mortality in which these services are affected by complex factors which may be similar across populations. Methods: A community based cross sectional study was conducted from February to May of 2022. A total of 607 women who gave birth in the last 2 years and residing in the area for at least 6 months were selected by two stage cluster sampling technique. A predesigned and pretested questionnaire was used to collect data via face to face interview technique. Chi-square test and multivariable logistic regression were used for data analysis using SPSS (Version 26). Results: Magnitude of maternal health care services utilization was found as; attending antenatal care 99.9%, institutional delivery 99.3% and postnatal care 91.4%. The majority (91.4%) were aware of postnatal care. The proportion (91.5%) of women who utilized postnatal care among those with awareness about it was significantly greater (p&lt;0.001) than the proportion of women who utilized it and with no awareness (63.5%). The nationwide lockdown due to COVID- 19, sudden onset of labor, feeling well were barriers to attending antenatal care, institutional delivery and postnatal care services respectively. Conclusion: Prevalence of antenatal care, institutional delivery and postnatal care services was higher than the national estimate. Improving the quality of care around the time of pregnancy, birth and postpartum is recommended to continuously sensitize the community about the services and further increase the utilization.

Does living in major towns favor institutional delivery in Somalia?

In developing countries, institutional delivery is a key proven intervention that reduces maternal mortality and can reduce maternal deaths by approximately 16%-33%. In Somalia, only 32% of births are delivered in a health facility with the assistance of a skilled healthcare provider. We aimed to investigate the factors hindering women from giving birth at healthcare facilities in major towns in Somalia, where most of the health facilities in the country are concentrated. A community-based health survey was carried out in 11 major towns in Somalia between October and December 2021. A structured and pretested questionnaire was used to collect data from 430 women who gave birth in the last five years. Women were recruited through convenient sampling. Descriptive statistics were used to summarize the data, and binary and multivariable logistic regression analysis was performed. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the associations. The overall prevalence of institutional delivery was 57%. Approximately 38% of women living in Mogadishu and 53% living in another ten towns give birth at home. Women who had poor knowledge of the importance of health facility delivery had nearly four times higher odds of delivering at home (AOR 3.64 CI: 1.49-8.93). Similarly, those who did not receive antenatal care (AOR 2.5, CI: 1.02-6.39) and those who did not receive a consultation on the place of delivery (AOR 2.15, CI: 1.17-3.94) were more likely to give birth at home. The reasons for home delivery included financial reasons, the long distance to the health facility, and the fact that it was easier to give birth at home. The study found that home delivery is high in major towns in Somalia and is associated with a lack of understanding of the importance of health facility delivery, not using ANC, and not receiving consultancy about where to give birth. Primary health care should strengthen information, education, and communication activities. Since the health care system in Somalia is overwhelmingly private, the government may consider access to free and within-reach ANC and health facility delivery for women and girls from families who cannot pay the ANC and childbirth delivery cost.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.