Institutional Delivery Service Research Articles

Predictors of institutional delivery in Sodo town, Southern Ethiopia

BackgroundWomen are more liable to die during or following delivery than during pregnancy but use of both delivery services and post-partum care is low.ObjectiveTo find out the prevalence and predictors of institutional delivery in Wolaita Sodo (Sodo) town, southern Ethiopia.MethodsA cross-sectional study was used to look at 844 women who had given birth in the previous five years in Sodo town. The study employed a multistage-sampling scheme. Codes were given for all identified women in selected kebeles (neighbourhoods) and a simple random-sampling technique was used after generating random numbers using the Statistical Package for Social Sciences (SPSS). SPSS was then used to carry out binary- and multiple logistic regressions. A 95% CI for the odds ratio was applied to judge the presence of relationships between variables.ResultsThe prevalence of institutional delivery-service utilisation in Sodo town was 62.2%. Husband educational status, parity, number of antenatal clinic visits, perceived quality of care and knowledge regarding pregnancy danger signs were independent predictors of utilisation of institutional delivery services.ConclusionInstitutional delivery service utilisation in Sodo town was much higher than the national figure. Findings in this study showed that promotion of antenatal care, involvement of men in maternal healthcare, provision of health education regarding the danger signs of pregnancy and improvement of service quality are recommended in order to sustain or even improve the current level of utilisation in the town.

Use of institutional delivery services in the Southern Nations, Nationalities, and People's Region, Ethiopia: a cross-sectional comparative mixed methods study

Use of institutional delivery services in the Southern Nations, Nationalities, and People's Region, Ethiopia: a cross-sectional comparative mixed methods study

Use of institutional delivery services in the Southern Nations, Nationalities, and People's Region, Ethiopia: a cross-sectional comparative mixed methods study

Background118 000 newborn babies in Ethiopia die each year and 500 000 pregnancy-related complications occur. Maternal mortality in Ethiopia is also very high (676 deaths per 100 000 livebirths); only 34% of mothers receive antenatal care and 10% of births took place in health facilities in 2011. We identified factors contributing to low use of institutional delivery services in the Southern Nations, Nationalities, and People's Region, Ethiopia. MethodsWe interviewed mothers who had given birth within the past year and organised six focus group discussions. We selected participants by multistage sampling proportional to the number of expected pregnancies in the 19 administrative zones in the region. We did univariate, bivariate, and multivariate analyses to assess 24 potential predictors of non-institutional delivery. We analysed focus group discussions with NVivo (version 10). FindingsWe interviewed 502 women from urban areas, 164 from rural pastoral areas, and 2231 from rural agrarian areas. 876 of 2897 (30·2%) births occurred in health institutions—412 of 502 (82·1%) births in urban areas, seven of 164 (4·3%) in rural pastoral areas, and 457 of 2231 (20·5%) in rural agrarian areas. Factors associated with non-institutional delivery include mother's education status (none vs grade 9 or higher: adjusted odds ratio [AOR] 3·91, 95% CI 2·76–5·56), mother's partner's educational status (primary vs none: AOR 0·65, 95% CI 0·49–0·86), occupation (merchant vs farmer: AOR 0·56, 95% CI 0·36–0·87), household financial decision-maker (male partner vs mother: AOR 2·12, 95% CI 1·52–2·95), monthly income (<700 birr vs ≥700 birr: AOR 1·77, 95% CI 1·43–2·18), use of antenatal clinic services (no use vs use: AOR 5·63, 95% CI 3·76–8·43), and knowledge of danger signs during delivery (don't know vs do know: AOR 2·16, 95% CI 1·83–2·55). Mothers with no education and who were aged younger than 18 years at their first marriage were more likely to give birth outside of a health institution compared with mothers who were educated to grade 9 or higher (AOR 3·91, 95% CI 2·76–5·56) and mothers who were aged 18 years and older at their first marriage (crude odds ratio 1·69, 95% CI 1·43–1·99). Mothers who planned their last pregnancy were less likely to give birth outside of a health institution compared with mothers who did not plan (AOR 0·48, 95% CI 0·37–0·63). InterpretationInstitutional delivery is still uncommon in the Southern Nations, Nationalities, and People's Region despite several interventions. Innovative approaches are needed to attract women to health facilities. FundingSave the Children International.

Use of institutional delivery services in Kassala, eastern Sudan

International Journal of Gynecology & ObstetricsVolume 123, Issue 1 p. 79-80 Brief communications Use of institutional delivery services in Kassala, eastern Sudan Ameer O. Abbaker, Ameer O. Abbaker Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorYasir Salih, Yasir Salih Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorAbdelAziem A. Ali, AbdelAziem A. Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, SudanSearch for more papers by this authorAbdulmutalab M. Imam, Abdulmutalab M. Imam Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorElsir A. Abdulla, Elsir A. Abdulla Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, SudanSearch for more papers by this authorIshag Adam, Corresponding Author Ishag Adam [email protected] Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanCorresponding author at: Faculty of Medicine, University of Khartoum, PO Box 112, 11111 Khartoum, Sudan. Tel.: + 249 912168988; fax: + 249 183771211.Search for more papers by this author Ameer O. Abbaker, Ameer O. Abbaker Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorYasir Salih, Yasir Salih Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorAbdelAziem A. Ali, AbdelAziem A. Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, SudanSearch for more papers by this authorAbdulmutalab M. Imam, Abdulmutalab M. Imam Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanSearch for more papers by this authorElsir A. Abdulla, Elsir A. Abdulla Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Kassala, SudanSearch for more papers by this authorIshag Adam, Corresponding Author Ishag Adam [email protected] Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, SudanCorresponding author at: Faculty of Medicine, University of Khartoum, PO Box 112, 11111 Khartoum, Sudan. Tel.: + 249 912168988; fax: + 249 183771211.Search for more papers by this author First published: 11 July 2013 https://doi.org/10.1016/j.ijgo.2013.04.018Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume123, Issue1October 2013Pages 79-80 RelatedInformation

Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study

IntroductionDespite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15–49 years in Tigray, Ethiopia.MethodsThe study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation.ResultsThe response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband’s occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands’ occupation.ConclusionsA relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.

Institutional Delivery Service Utilization in Woldia, Ethiopia

Introduction: Institutional delivery service utilization is essential to improve maternal and child health. However, little is known about institutional delivery service utilization in Woldia, Ethiopia. This study was aimed at assessing institu-tional delivery service utilization. Methods: Community based cross sectional study was done on 478. Census was carried out in two urban and one rural kebeles (the smallest administrative unit) to identify mothers who gave birth in the past five year. Mothers were selected by systematic random sampling technique. Quantitative data and qualitative data were collected by means of a pretested questionnaire and in-depth interview guide, respectively. Bivariate and multiple logistic regression analysis were done by using SPSS version 20; P-values ≤ 0.05 were considered as statically significant. Results: The study showed that 48.3% of institutional delivery service utilization. Mothers’ residences, educational status, being informed about place of delivery at their last pregnancy were main factors associated to institutional delivery service utilization. Conclusions: Institutional delivery service in Woldia was low. It is recommended that motivating mothers through formal education and awareness creation about the benefit of institutional delivery service utilization and the risk of home delivery should be given due attention by the local health workers.

Maternal delays in utilizing institutional delivery services, Bahir Dar, Ethiopia

Introduction: Timely referrals and access to appropriate health care had a great impact on reduction to maternal deaths and disabilities. Maternal delay is one of the contributing factors for high maternal mortality in developing countries. Maternal delays were categorized into three levels: delay in making the decision for seeking care, delay in arrival at a health facility, and delay in receiving adequate treatment. They have been named first, second, and third delay maternal delays; respectively. This study was aimed at assessing maternal delays in utilizing institutional delivery service sin Bahir Dar, North-Western Ethiopia. Methods: A cross sectional facility based study was conducted on a sample of 422 women attending at a public health facility for delivery services. The sample size was determined by using single population proportion formula and the study participants were selected by using a systematic random sampling method. Data were collected by means of a pre-tested, standardized questionnaire; analysis was carried out using SPSS version 16. Results: Data was collected from 410 laboring mothers. First delay, 155 (37.8%) of mothers was delayed in decision making for seeking care from the public health facility and the mean delay was 8 hours. Delay in seeking emergency obstetric care [EOC] was about seven fold among illiterate mothers (AOR, 6.71; 95%CI, 3.66 -12.29) than literate mothers; the odds of delay for EOC were three times more likely among mother were unable to make decisions by their own (AOR, 3.30; 95%CI, 1.25 -7.20) than those mothers who made the decisions of their own. Unemployed mothers were 4 times more likely to have the maternal delay in seeking EOC (AOR, 3.94; 95%CI, 2.36 -6.57) than employed mothers. Second delay, 130 (31.7%) of mothers had transportation problems in reaching health care facilities. Predictors in the first maternal delay were also the major contributing factors for this delay. The third delay, after their arrival at health facilities, 126 (30.7%) mothers reported that they did not get the services on time; the mean waiting time for getting the service was 4 hours. Conclusions: Many mothers were not getting institutional delivery care services in a timely manner, due to the “three maternal delays”. Mothers’ literacy, decision making power and employment status were the main predictors for delivery service utilization. Hence, emphasis should be given for awareness creation on the risks of maternal delays, designing income generating mechanism, women empowering for in decision making and ambulance services should be strengthened.

Prevalence of institutional delivery and associated factors in Dodota Woreda (district), Oromia regional state, Ethiopia

BackgroundGiving birth in a medical institution under the care and supervision of trained health-care providers promotes child survival and reduces the risk of maternal mortality. According to Ethiopian Demographic and Health Survey (EDHS) 2005 and 2011, the proportion of women utilizing safe delivery service in the country in general and in Oromia region in particular is very low. About 30% of the eligible mothers received Ante Natal Care (ANC) service and only 8% of the mothers sought care for delivery in the region. The aim of this study is to determine the prevalence of institutional delivery and understand the factors associated with institutional delivery in Dodota, Woreda, Oromia Region.MethodsA community based cross sectional study that employed both quantitative and a supplementary qualitative method was conducted from Jan 10–30, 2011 in Dodota Woreda. Multi stage sampling method was used in selection of study participants and total of 506 women who gave birth in the last two years were interviewed. Qualitative data was collected through focus group discussions (FGDs). Data was entered and analyzed using EPI info 3.5.1 and SPSS version 16.0. Frequencies, binary and multiple logistic regression analysis were done, OR and 95% confidence interval were calculated.ResultsOnly 18.2% of the mothers gave birth to their last baby in health facilities. Urban residence, educational level of mothers, pregnancy related health problems, previous history of prolonged labour, and decision made by husbands or relatives showed significant positive association with utilization of institutional delivery services (P < 0.05). While ANC attendance during the index pregnancy did not show any association.ConclusionInstitutional Delivery is low. Increasing accessibility of the delivery services and educating husbands not only mothers appear very important factors in improving institutional delivery. Health education on the importance of institutional delivery should also address the general population. The quality and content of the ANC services need to be investigated.

Factors associated with home delivery in Bahirdar, Ethiopia: a case control study.

BackgroundIn Ethiopia although pregnant mothers increasingly attend antenatal clinics, utilization of skilled delivery service remains very low. The individual or health system factors that affect women’s preferences for delivery places are not well known.MethodA case control study was conducted in July 2010 to assess factors associated with utilization of institutional delivery service. A total of 324 mothers who recently delivered and visited either postnatal care or sought immunization services were included. Cases (n = 108) were mothers who gave birth at home and controls (n = 216) were those who delivered at health facility. Pre-tested and standardized questionnaires were used to collect relevant data by trained data collectors. Logistic regression model was used to control for confounding.ResultThe likelihood of delivering at home was greater among mothers with inadequate knowledge of pregnancy related services (AOR = 62, 95% CI: 3, 128.4), those who started attending ANC after 24 weeks of gestation (AOR 8.7, 95% CI: 2.2, 33.3), mothers having no formal education (Adjusted OR 4.2, 95% CI 1.63, 11.27) and rural residents (AOR = 3.6, 95%CI: 1.4, 9.0).ConclusionThe predominant factors associated with home delivery services were lack of knowledge about obstetrics care, delay in starting Antenatal Care (ANC) follow up, having, Illiteracy and rural residence. Audience specific behavioral change communication should be designed to improve the demand for delivery services. Health professionals should take the opportunity to encourage mothers attend delivery services during ANC follow up. Improvements should be made in social conditions including literacy and major social mobilization endeavors.

What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India

Despite continuing efforts to promote skilled institutional delivery, eight women die every hour in India due to causes related to pregnancy and child birth. The objectives of this study were to assess the prevalence and the determinants of institutional delivery by skilled birth attendants in a rural population in Andhra Pradesh, India. This cross-sectional study used data from 'Young Lives', a longitudinal study on childhood poverty, and the study population was a cohort of 1419 rural, economically deprived women (from the Young Lives study) in Andhra Pradesh, India. The data are from round-1 of Young Lives younger cohort recruited in 2002 and followed until 2015. The participation rate of households was 99.5%. Prevalence of skilled institutional delivery was 36.8%. Women's education (odds ratio [OR] for secondary education 2.06; 95% confidence interval [95%CI] 1.33-3.19), desire to be pregnant (OR 1.89; 95% CI 1.12-3.22) and adequate prenatal care (OR 1.69; 95% CI 1.30-2.21) were found to be the positive determinants of skilled institutional delivery. High birth order (OR for second birth 0.44; 95% CI 0.32-0.60, OR for third birth 0.47; 95% CI 0.30-0.72 and OR for ≥fourth 0.47; 95% CI 0.27-0.81), schedule caste/schedule tribe social background (OR 0.70; 95% CI 0.53-0.93) and poor economic status of the household (OR for the poorest households 0.67; 95% CI 0.46-0.99) were negatively associated with skilled institutional delivery. Despite existence of supporting schemes, the utilisation of skilled institutional delivery services was low in the study population. Educated women and women with adequate prenatal care who have a desired pregnancy were more likely to utilise health institutions and skilled delivery care. There is a need for integrated approaches through maternal health, family planning and education programs, and a focus on uneducated, poor women belonging to disadvantaged social groups.

Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study

BackgroundReducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors.MethodsA community-based cross-sectional survey was conducted from April 1–20, 2011, among mothers who gave birth 12 months before the study began in Munesa Woreda, Arsi Zone, Oromia Region, Southeast Ethiopia. A stratified cluster sampling was used to select a sample of 855 participants.ResultsOut of all deliveries, only 12.3% took place at health facilities. Women who were urban residents (AOR = 2.27, 95%CI: 1.17, 4.40), women of age at interview less than 20 years (AOR = 6.06, 95%CI: 1.54, 23.78), women with first pregnancy (AOR = 2.41, 95%CI: 1.17, 4.97) and, women who had ANC visit during the last pregnancy (AOR = 4.18, 95%CI: 2.54, 6.89) were more likely to deliver at health institutions. Secondary and above level of mother`s and husband`s education had also a significant effect on health institution delivery with AOR = 4.31 (95%CI: 1.62, 11.46) and AOR = 2.77 (95%CI: 1.07, 7.19) respectively.ConclusionInstitutional delivery service utilization was found to be low in the study area. Secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery. Increasing the awareness of mothers and their partners about the benefits of institutional delivery services are recommended.

Health system challenges in delivering maternal health care: evidence from a poor urban neighbourhood in South India

Methods The paper draws on fieldwork conducted in KG Halli, a poor urban slum neighbourhood in Bangalore. The fieldwork is part of a larger urban health action research project (UHARP), carried out in this area since 2009. The project aims at enhancing quality of health care of residents in this area. This paper is based on data collected over a period of two years (2009-2011) through (1) household census (n = 9,299, response rate = 98.5%) using a questionnaire on socio-demographic characteristics, illness profile, health seeking behaviour, and healthcare expenditure; (2) interviews with healthcare providers (n = 16), and (3) observational field notes on issues related to maternal health including mapping of health facilities in the area. Data were analysed from the lens of a health system analysis framework developed by Van Olmen and colleagues [1] to identify larger systemic challenges in delivery of service. Results The mapping exercise shows that there are two government facilities and two private clinics providing antenatal care (ANC) and two private hospitals providing ANC and institutional delivery services for a population of over 44,500 in KG Halli. There is poor operational and administrative integration between different levels of care and facilities. A pregnant lady usually gets antenatal check-up at first-level care and delivers at maternity home (secondary level) or in a hospital at tertiary level. Referral to secondary or tertiary facilities is often based on informal understanding of rules among providers regarding registered ANC versus non-registered referred cases; the former determines the legitimacy for treatment in the secondary centre; secondary/tertiary government facilities that cater to most of the institutional deliveries are situated at a distance of around 6 km to 15 km from the area. Despite the distance and‘patient-unfriendly’ attitude of the health staff, women deliver in government centres (56% of total institutional deliveries). This is due to both perceived high cost of care in private sector and apprehension that cost and number of caesarean sections performed is high in private sector. Our survey results show that 60% of all caesarean sections were conducted in private hospital, whereas 40% in government hospitals during the study period. Women reported that the cost of a caesarean section in a private facility is five times more than in the government facility. We also found that oversight mechanisms to ensure quality of care in both government and private facilities are poorly implemented as KG Halli lies on the border of two administrative subdivisions and struggles to find a space between the ‘rural’

Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community - based cross sectional study

BackgroundReduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia.MethodsCommunity-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software.ResultsThe study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization.ConclusionsVery low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service.

Utilization of Institutional Delivery Services among Women Bringing their Children for BCG in Jos, Nigeria

Background: Home delivery, with or without the presence of a birth attendant is usually the cheapest option, but is associated with some risks. This study was done to determine the rate of home delivery and the presence of a skilled attendant at delivery among women in Jos. Methodology: The study was a cross-sectional study of all mothers of new born babies bringing in their babies for immunization for the first time in the child welfare clinic. A semi structured interviewer administered questionnaire was administered to the women noting their socio- demographic data, antenatal care, place of delivery, method of delivery and attendances at delivery. Results: A total of 359 women were recruited for the study with a response rate of 83%. The mean age of the respondents was 28 ± 5.6 years. Majority of the women (52.2%) were Hausa- Fulani; 135 (45.3%) had at least secondary school education. A significant number of the women; 288 (97.3%) attended at least one antenatal care clinic (ANC) while pregnant. The average number of ANC attended was two. 180(36.6%) delivered at home. Two hundred and eight (69.8%) were attended to by a trained health care worker. Ninety women (30.2%) were attended to by unskilled birth attendants. Of those that delivered at home, only 18.6% were attended to by skilled birth attendants while 82.4% were attended to by unskilled birth attendants (p<0.0001). Lower educational status and grand multiparity had a statistical significant association with home delivery all with a p<0.0001. Conclusion: Despite the attendance of women at ANC, the utilization of health services for delivery is still poor with a high percentage of home delivery in the absence of a skilled attendant at birth; even in a population that had apparently good health behaviour. Key Words Utilization; institutional delivery; home delivery; skilled attendants

The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire

Objective To conduct a needs assessment for emergency obstetric care (EmOC) to address the unacceptably high maternal and newborn mortality indices in Sierra Leone 8 years after the end of the civil war. Methods From June to August 2008, a cross-sectional survey was conducted of health facilities in Sierra Leone offering delivery services. Assessment tools were local adaptations of tools developed by the Averting Maternal Death and Disability program at Columbia University, New York, USA. Results There were enough comprehensive EmOC (CEmOC) facilities in the country but they were poorly distributed. There were no basic EmOC (BEmOC) facilities. Few facilities (37% of hospitals and 2% of health centers) were able to perform assisted vaginal delivery (AVD), and 3 potentially BEmOC facilities did not meet the standard only because they did not perform AVD. Severe shortages in staff, equipment, and supplies, and unsatisfactory supply of utilities severely hampered the delivery of quality EmOC services. Demand for maternity and newborn services was low, which may have been related to the poor quality and the high/unpredictable out-of-pocket cost of such services. Conclusion Significant increases in the uptake of institutional delivery services, the linkage of remote health workers to the health system, and the recruitment of midwives, in addition to rapid expansion in the training of health workers (including training in midwifery and obstetric surgery skills), are urgently needed to improve the survival of mothers and newborns.

Low use of skilled attendants' delivery services in rural Kenya.

The aim of the study was to estimate the use of skilled attendants' delivery services among users of antenatal care and the coverage of skilled attendants' delivery services in the general population in Kikoneni location, Kenya. Data collected from the registers at the Kikoneni Health Centre (KHC) from March 2001 through March 2003 were retrospectively reviewed. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Deliveries at the KHC were compared with expected births in the population to estimate the coverage of deliveries assisted by skilled attendants in the community. Of 994 women who attended the antenatal care clinic, 74 (7.4%) presented for delivery services. 5.4% of expected births in the population occurred in health facilities. The coverage of deliveries assisted by skilled attendants was far below the national and international goals. The use of institutional delivery services was very low even among antenatal care attendees. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality.

Atopy, immunological changes, and respiratory function in bronchiectasis

<h3>ABSTRACT</h3> <h3>Introduction:</h3> To ensure equitable and accessible services and improved utilization of institutional delivery it is important to identify what progress has been achieved, whether there are vulnerable and disadvantaged groups that need specific attention and what are the key factors affecting the utilization of institutional delivery services. In this study, we examined levels, trends, and inequalities in the utilization of institutional delivery services in low- and middle-income countries. <h3>Methods:</h3> We used nationally representative cross-sectional data from Demographic and Health Surveys (DHS) conducted during 1990–2018. Bayesian linear regression analysis was performed. <h3>Results:</h3> Among 74 countries, the utilization of institutional delivery services ranged from 23.7% in Chad to 100% in Ukraine and Armenia (with &gt;90% in 19 countries and &lt;50% in 13 countries) during the latest DHS rounds. Trend analysis in 63 countries with at least 2 surveys showed that the utilization of institutional delivery services increased in 60 countries during 1990–2018, with the highest increase being in Cambodia (18.3%). During this period, the utilization of institutional delivery services increased in 90.3% of countries among the richest, 95.2% of countries in urban, and 84.1% of countries among secondary+ educated women. The utilization of institutional delivery services was higher among wealthiest, urban, and secondary+ educated women compared to their counterparts. Greater utilization of private facilities for delivery was observed in women from the highest income group and urban communities, whereas highest utilization of public facilities was observed for women from the lowest income group and rural communities. <h3>Conclusions:</h3> The utilization of institutional delivery services varied substantially between and within countries over time. Significant disparities in service utilization identified in this study highlight the need for tailored support for women from disadvantaged and vulnerable groups.

Level and Factors Associated with Professional Commitment of Health Professionals Providing Institutional Delivery Services in Public Health Facilities, Southwest Ethiopia.

Professional commitment is beyond a commitment for a particular organization and implies the individuals' perspective towards their profession and the motivation that they have to stay in their job with willingness to strive and uphold the values and goals of the profession. In Ethiopia, uptake of institutional delivery services is low. However, the level and factors associated with professional commitment is not known so far. Hence, our objective is to assess the level and factors associated with commitment of health professionals providing institutional delivery services in public health facilities of Jimma Zone, Southwest Ethiopia. A facility-based cross-sectional study design was conducted from March 01-20, 2016. A total of 442 eligible health professionals were included from randomly selected 7 districts and 47 respective health facilities. Health professionals were requested to fill self-administered questionnaire. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P<0.05. All assumptions of linear regression and principal component analysis were checked. The percentage mean score of professional commitment was 72.71% (SD21.88). The percentage mean score for perceived maternal health goal scale was 68.37% with the total variance explained being 69.68%. Perceived staff interaction, work-life balance, affective organizational commitment, normative organizational commitment, personal characteristics and perceived maternal health goal were independent predictors of professional commitment. The percentages mean score of professional commitment was medium. Hence, Health professionals should foster their level of professional commitment to increase uptake of institutional delivery services.

Socio-cultural Beliefs and Practices Influencing Institutional Delivery Service Utilization in Three Communities of Ethiopia: A Qualitative Study.

The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services. A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically. The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility. Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth.

Utilization of Institutional Delivery Service in a Predominantly Pastoralist Community of Northeast Ethiopia.

Maternal mortality is high in sub-Saharan Africa, and most deaths occur around childbirth. In Ethiopia, most births happen at home without skilled delivery attendants, and particularly, the least utilization of skilled delivery is recorded in Afar Region. The factors that influence this utilization are not well documented in the region where utilization has been low. The aim of this study was to determine the prevalence of utilization of institutional delivery and associated factors. A cross-section study with pretested structural questionnaire was conducted from August 5 to September 27, 2015, among women who gave birth within 24 months preceding the survey. A multivariable logistic regression analysis was done to identify factors associated with utilization of institutional delivery. Out of the total 1842 women, only 339(18.4%) of mothers reported having delivered their youngest child at a health facility. Home delivery was preferred due to cultural norms, low-risk perception, and distance from a health facility. The odds of delivering in a health facility were higher for mothers who attended at least four antenatal visits during the index pregnancy (AOR=3.08,95%CI=1.91-4.96), those whose husbands were educated to secondary school (AOR= 1.86, 95% CI=1.34-2.60), and those that had at least secondary school level education themselves (AOR=1.52, 95% CI=1.03-2.23). Utilization of institution delivery among Afar communities is very low, and less educated mothers are lagging behind. Women's education and full attendance to antenatal care can help increase utilization of skilled delivery services. Qualitative studies to identify socio-cultural barriers are also essential.