Utilization Of Maternal Care Services Research Articles

Obstetric Service Delivery Trends and Healthcare Staffing at a Teaching Hospital in Southwest Nigeria

Background: Maternal health is a critical component of public health worldwide, reflecting a society's commitment to the well-being of its women and children. The provision of obstetric services, encompassing antenatal care, delivery and postnatal care, plays a pivotal role in reducing maternal mortality and ensuring positive birth outcomes. However, the quality and accessibility of obstetric services are influenced by various factors, including healthcare infrastructure, staffing levels and healthcare policies. Objective: To determine obstetric service delivery trends and healthcare staffing at a teaching hospital in southwest Nigeria Methodology: This study utilized a retrospective cohort design to examine the utilization of maternity care services among women at Ekiti State University Teaching Hospital, Nigeria. Data spanning from January 2016 to December 2023 were collected from obstetric records. Analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: a total of 9,855 deliveries were recorded, with 4,145 Caesarean sections and 5,767 spontaneous vaginal deliveries, giving a Caesarean section rate of 42%. Overall, there seems to be some fluctuations in the total number of deliveries over the years, with the highest number observed in 2019 (1482) and the lowest in 2021 (868). The number of consultants, senior residents, junior residents, house officers, nurses and other support staff varied over the years, with different staffing levels observed in each year. Conclusion: this study contributes to a better understanding of obstetric service delivery trends and healthcare staffing dynamics, offering valuable insights for healthcare resource allocation and policymaking. The findings underscore the importance of monitoring caseloads and staffing levels to ensure quality maternal and infant healthcare delivery.

The individual- and community-level women's empowerment and utilization of maternity care services in Afghanistan: a multilevel cross-validation study.

This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15-49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15-49 y.

Vaccination dropout and wealth related inequality among children aged 12-35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey.

Vaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12-35 months in remote and underserved areas of Ethiopia. This study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12-35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout. A total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24-10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15-2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21-2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87-40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24-2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38-2.52)]. Vaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout.

Factors associated with delayed initiation and non-exclusive breastfeeding among children in India: evidence from national family health survey 2019-21

BackgroundIn India, more than half of the newborns experience delayed breastfeeding, and non-exclusive breastfeeding is practiced in 63% of babies below the age of six months. The goal of this study is to investigate the extent to which external environment, demographic and socioeconomic, pregnancy and birthing characteristics, as well as utilization of maternal care services, are associated with delayed initiation and non-exclusive breastfeeding among children in India.MethodsData was gathered from the fifth round of the National Family Health Survey (NFHS), which was conducted in 2019-21. This study used information on 85,037 singleton infants aged 0–23 months and 22,750 singleton infants aged 0–5 months. Delayed initiation of breastfeeding and non-exclusive breastfeeding was used as outcome variables in this study. Unadjusted and adjusted multivariable binary logistic regression was performed to analyse the association of delayed breastfeeding and non-exclusive breastfeeding with selected background characteristics.ResultsFactors significantly associated with increased risks of delayed initiation of breastfeeding included infants from in the central region (OR 2.19; 95% CI 2.09, 2.29), mothers in the 20 to 29 years age group at the time of childbirth (OR 1.02; 95% CI 0.98, 1.05), caesarean deliveries (OR 1.97; 95% CI 1.90, 2.05). The likelihoods for non-exclusive breastfeeding significantly increased among children belonging to the richest household status (OR 1.30; 95% CI 1.17, 1.45), mothers who had less than nine months of pregnancy period (OR 1.15; 95% CI 1.06, 1.25), and mothers who gave birth in non-health facility (OR 1.17; 95% CI 1.05, 1.31).ConclusionsThe connections between several different categories of factors and non-exclusive breastfeeding and delayed breastfeeding initiation show the need for comprehensive public health programmes using a multi-sectoral approach to promote breastfeeding behaviours in India.

Situational Analysis of Access to Essential Healthcare Services in Nigeria: Implication for Trans-Sectorial Policy Considerations in Addressing Health Inequities

Background: Socioeconomic factors influence health outcomes and the distribution of health resources within and between countries globally. In Nigeria, there are various socio-economic factors that have been reported to be responsible for health inequities across the different geopolitical zones. Objective: To assess health inequities in relation to socio-economic factors that affect access to essential health care services in Nigeria, using family planning, maternal care, and childcare as indicators. Method: The study involved a cross-sectional secondary analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) and a literature review of transdisciplinary approaches to addressing health inequities. Result: The overall result from the findings suggests a strong influence of geographical and socioeconomic factors in the distribution of healthcare services. Specifically, family planning services were more readily available and accessible in the Southern zones of Nigeria than in the Northern zone of Nigeria, which could be attributed to socio-cultural, religious, and access-related barriers. Results also showed that access to most maternal and child health care services was often skewed towards the southern zones, which could be due to the presence of more healthcare workers who provide these services coupled with higher access to maternal care, hence a higher uptake and utilization of maternal care services. Also, children in the northern zones had lesser odds of receiving basic and age-appropriate vaccination than those in other regions, which could be attributed to the supply-side disparities that exist between the northern and southern regions. Conclusion: This study concludes that level of educational attainment, wealth quintiles, as well as financial barriers, are the major socio-economic factors that influence access to maternal and childcare services.

Utilization of Maternal Care Services and Level of Satisfaction Among Clients in a Teaching Hospital in Ghana

The study investigates the extent to which mothers are satisfied with the maternity services they receive at Tamale Teaching Hospital. The study adopted a descriptive research design. Primary and secondary sources of data were used for the research. Likert scale questionnaires were used in the collection of the data. A quantitative approach was adopted to analyze the data. From the study, respondents agreed that they are provided with access to high-quality care throughout the phases of pregnancy, labour and delivery. They also averred that they receive screening at the maternal and child health to ensure safe delivery. Again, it emerged that respondents get education on proper diet during pregnancy and lactation and the benefits of physical exercises. Additionally, it came up that respondents do not receive considerate and respectful care at all times and under all circumstances, without recognition of their dignity, values and beliefs, respect the rights of the patient. Respondents do not know the name and professional status of those providing services to them. Respondents do know refusing treatment to the extent permitted by law and are informed of the medical consequences of that refusal in the Tamale Teaching Hospital. Thus, it is recommended that the management of Tamale Teaching Hospital should organize training for health providers to encourage them to communicate client information to them during the provider-client interaction. Management should work to improve on the waiting time and contact time for their clients to be satisfied with their service provision. Management of Tamale Teaching Hospital should carry out client satisfaction surveys routinely to improve the quality of Anti-Natal Care. The primary health care authorities should make adequate provision of maternal and child health services a priority given its importance in minimizing maternal and infant morbidity and mortality.

Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda.

Background:Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda.Methods:This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth.Results:The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI: 1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI: 1.01- 8.4); antepartum hemorrhage (aOR 8.5, 95% CI: 2.4-30.7); malpresentation (aOR 6.29; 95% CI: 2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI: 2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI: 3.2-13.7).Conclusion and Global Health Implications:Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community.

Development of behaviour change communication model for improving male participation in maternal and child health services among Saharia Tribes in Gwalior district of Madhya Pradesh: a mixed method approach

Background: Behaviour of men, their beliefs and attitudes affect the maternal health outcomes of women and their babies. The exclusion of men from maternal health care services could lead to few women seeking maternal health services. A study was conducted for development of a Behaviour change communication (BCC) model for improving the male participation in utilization of maternal and child health services among Saharia tribes of Gwalior district of Madhya Pradesh and to assess its feasibility.Methods: Mixed method approach, both quantitative and qualitative, were used in the study. Couple interviews were conducted to assess the level of maternity care services utilization and level of male participation in maternity care. Focused Group Discussions (FGDs) and Key informants’ Interviews (KIIs) were conducted to assess the community perspective and barriers of male participation. In the exploratory phase, there were couple interviews, key informant interviews and focus group discussions and data analysis, followed by development of a Behavior Change Communication (BCC). Feasibility of the model was assessed through three principles, i.e., acceptance, integration with the current programme and short term impact of BCC.Results: Based on the findings of couple interviews, FGDs and KIIs, a BCC model was developed to improve the male involvement in maternal and child health and its feasibility was assessed.Conclusions: The developed BCC model went successfully through the three principles of the feasibility and therefore it can be implemented in Saharias for improving the male participation in maternity care and for improving the utilization of maternity care services.

Effect of social integration on childbirth return among internal migrant pregnant women: a nationally representative study in China

BackgroundSocial integration has been demonstrated to be associated with the health care use among migrants, but few studies have focused on migrant pregnant women. This study aims to explore the association between social integration and childbirth at woman’s hometown (childbirth return) of internal migrant pregnant women in China.MethodUsing the data of “Monitoring Data of Chinese Migrants” in 2014, a total of 3412 internal migrant pregnant women were included in this study. Social integration was measured by economic integration, acculturation, and identification. The childbirth locations of internal migrant pregnant women were divided into current residency and the woman’s hometown. Univariate logistic regression and two multivariable logistic regression models were employed to assess the association between social integration and childbirth return among internal migrant pregnant women.ResultOur study finds that 24.56% of migrant pregnant women choose to have a childbirth return. As for social integration, those who have their own house (OR = 0.351 95% CI 0.207–0.595) in current residence, who have been staying in current residence for at least 5 years (OR = 0.449; 95% CI 0.322–0.626), and who are willing to stay in the current residence for a long time (OR = 0.731; 95% CI 0.537–0.995) are less likely to have a childbirth return. Apart from social integration, our results also show that those migrant pregnant women who are older, who have higher education level, who have at least two family members in current residence, with a migration reason of work and business, who have established health record in the current residency, and who were not covered by medical insurances, are less likely to have a childbirth return.ConclusionSocial integration is negatively associated with childbirth return among internal migrant pregnant women in China. To improve the utilization of maternal care services for migrant pregnant women in current residence, targeted policies should be made to improve social integration status for migrant pregnant women.

Can Combining Performance-Based Financing With Equity Measures Result in Greater Equity in Utilization of Maternal Care Services? Evidence From Burkina Faso.

Background: As countries reform health financing systems towards universal health coverage, increasing concerns emerge on the need to ensure inclusion of the most vulnerable segments of society, working to counteract existing inequities in service coverage. To this end, selected countries in sub-Saharan Africa have decided to couple performance-based financing (PBF) with demand-side equity measures. Still, evidence on the equity impacts of these more complex PBF models is largely lacking. We aimed at filling this gap in knowledge by assessing the equity impact of PBF combined with equity measures on utilization of maternal health services in Burkina Faso. Methods: Our study took place in 24 districts in rural Burkina Faso. We implemented an experimental design (clusterrandomized trial) nested within a quasi-experimental one (pre- and post-test design with independent controls). Our analysis relied on self-reported data on pregnancy history from 9999 (baseline) and 11 010 (endline) women of reproductive age (15-49 years) on use of maternal healthcare and reproductive health services, and estimated effects using a difference-in-differences (DID) approach, purposely focused on identifying program effects among the poorest wealth quintile. Results: PBF improved the utilization of few selected maternal health services compared to status quo service provision. These benefits, however, were not accrued by the poorest 20%, but rather by the other quintiles. PBF combined with equity measures did not produce better or more equitable results than standard PBF, with specific differences only on selected outcomes. Conclusion: Our findings challenge the notion that implementing equity measures alongside PBF is sufficient to produce an equitable distribution in program benefits and point at the need to identify more innovative and contextsensitive measures to ensure adequate access to care for the poorest. Our findings also highlight the importance of considering changing policy environments and the need to assess interferences across policies.

Assessment of maternal health services utilization in Pakistan: the role of socio-demographic characteristics

Abstract Background High-quality prenatal care has a significant positive impact on maternal and infant health as it helps timely diagnosis and treatment of pregnancy complications. Objective To examine factors associated with the utilization of maternal health care using the optimal count regression model. Methods A sample of 16,314 women of reproductive ages (15–49) was used. Andersen and Newman's behavioral model of health services utilization was employed for the selection of covariates. Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial (ZINB), Poisson hurdle, and negative binomial hurdle models were fitted and compared to identify the best model. Maternal health care utilization is found associated with maternal age and education, area of residence, domestic violence, the income level of family, access to media, knowledge about AIDS, parity, birth order, and having a child who later died. Results ZINB model is found to be best fitted for the observed data resulting strong influence of mother's education and income level of the family on maternal health care utilization. Conclusion Interventions to improve maternal care services utilization should address individuals and systems to reduce social and economic marginalization.

Status of maternal health care services: An assessment study in slums of Kolkata.

Background and Aims:Mothers constitute an important and priority group in any community due to their high pregnancy related morbidities and mortality. The prevention of pregnancy related complications was possible with proper utilisation of maternal health care services. This study was conducted with the aim of assessing the utilisation of maternal health care services among mothers with younger child aged ≤3 years in slums of Kolkata, West Bengal and to find out the factors associated with it.Methodology:It was a community-based, observational study with cross-sectional design conducted in slums of Kolkata from June 2017 to May 2018. 30 slums [under Kolkata municipal corporation] were selected by cluster sampling technique using probability proportionate to size method. 10 mothers were selected from each slum and a total of 300 mothers were selected for the study. A pre-designed, pre-tested, structured schedule was used for data collection.Results:The mean age of the mothers was 23.83 (±3.64) years with the age ranging from 18 to 35 years. 75.7% mothers were registered in 1st trimester of pregnancy and 100% mothers received ≥4 antenatal check-ups. But only 78% mothers consumed ≥100 IFA tablets and only 23.3% mothers consumed ≥360 calcium tablets in antenatal period. 80.3% of the mothers had unsatisfactory utilisation of maternal health care services. Unsatisfactory utilisation of maternal care services was significantly associated with the younger age of the mothers, a smaller number of pregnancies and teenage marriage.Conclusion:Utilisation maternal health care services was not satisfactory among mothers in slums of Kolkata. Awareness generation and behaviour change communication among mothers is necessary for proper utilisation of the services.

Changes in Maternal Care During the Healthcare Reforms in the Republic of Georgia

Since 1991, the health system of the Republic of Georgia has passed through several phases of reform. Privatization and marketization of the healthcare system are among the major reforms. The aim of this study was to analyze the changes in the utilization of, and access to maternal care services during the period 1999–2010. Secondary analysis was done using data from three national reproductive health surveys (RHS). From three RHSs we selected 7,684 women who experienced childbirth/s during 5-years prior to each survey. We analyzed data on pregnancy outcome, type of childbirth, access and utilization of prenatal, natal and immediate postnatal care, and looked at associations with maternal age, ethnicity, educational level, employment status, residence, religion, and economic status. Binary and multinomial regressions were the main statistical models used along with descriptive statistics. We found that the overall utilization of prenatal care services was quite high; in the first wave, it was 92.1% then increased to 95.1% and 98.1% in the second wave and in the third wave respectively. However, utilization of postnatal services was quite low. According to RHS 1999–2000 only 10.7% of mothers utilized postnatal services, which increased to 23.3% in 2010. Women of age group 30–34 were more likely not to use prenatal care services than the other age groups. Rural dwellers, women with lower education level, and women with lower income were less likely to utilize prenatal check-ups. According to the findings from the survey, there were improvements in access to prenatal and natal care as well as utilization of maternal care services over the years. Overall, the use of maternal care has improved during the reforms.

Survival Analysis of Birth Defect Infants and Children with Pneumonia Mortality in Ghana

Despite the global decline in infant and child mortality rate, Ghana has failed to record any substantial improvement. In this study, we investigated the effects of some selected risk factors on infant and child survival in Ghana. This study used data from Komfo Anokye Teaching Hospital. 295 infants and children were followed up and time to first occurrence of death was recorded for each infant and child. The life table and Kaplan-Meier methods and the Cox proportional model were used for statistical analyses. The log-rank test statistic was used to test for difference in the survival curves. The results showed that the risk of death among those with birth defects or pneumonia was relatively higher and there is statistically significant difference in the risk of dying between infants with birth defects and those with no birth defects. Also, there is statistically significant difference in the risk of death between children with pneumonia and those with no pneumonia. Our analyses showed that birth defects, preterm birth, accidents, and pregnancy complications are significant risk factors of infant survival. Also, pneumonia, preterm birth, accidents, and diarrhoea are significant risk factors of child survival. Maternal care services should be made available and accessible and mothers should be educated on the importance of maternal care services utilization in order to reduce or mitigate the risk of infant and child mortality. Also, initiating the immunization activities with PCV-13 and Rota-Virus Vaccines, which will reduce Pneumonia and diarrhoea and will improve survival of infants and children under five, should be encouraged or implemented.

Maternal Factors and the Utilization of Maternal Care Services Associated with Infant Feeding Practices among Mothers in Rural Southern Nepal.

This study aimed to investigate the maternal factors and utilization of maternal care services associated with infant feeding practices in rural areas of Southern Nepal. Data from a cluster randomized controlled trial ‘MATRI-SUMAN’(Maternal Alliance for Technological Research Initiative on Service Utilization and Maternal Nutrition) conducted between 2015–2016 were analyzed. A total of 426 pregnant women in their second trimester were recruited from the MATRI-SUMAN trial, which was conducted on six villages in rural areas of the Dhanusha district, Nepal. A total of 379 mothers that had ever breastfed their infants, and followed for at least seven months after birth were included in the analysis. Multivariate logistic regression analysis was used to identify independent risk factors associated with child feeding practices after controlling for potential confounders. Of the 379 mothers, 41.4%, 53%, and 43% initiated breast feeding within the first hour of birth (EIBF), practiced exclusive breastfeeding (EBF), and initiated timely complementary feeding (CF) at six months, respectively. Multiple logistic regression results revealed that maternal education (secondary or higher), an occupation in the service/business/household sectors, receipt of MATRI-SUMAN intervention, more than four ANC (antenatal care) visits, and delivery in a health facility were associated with higher odds ratios of EIBF. Similarly, mothers with a primary, secondary and higher level of education, that worked in the service/business/household sectors, primiparous mothers, those that received MATRI-SUMAN intervention, visited ANC more than four times, and made a PNC (postnatal care) visit had higher odds ratios of EBF, while mothers who were 35–45 years of age were less likely to have used EBF. In addition, education to the secondary or a higher level, a male baby, receipt of MATRI-SUMAN intervention and a PNC visit had higher odds ratios of CF initiation at six months. The promotion of maternal ANC visits, birth at a health institution, and postnatal visits should be recommended in order to improve child feeding practices in Nepal.

Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya

Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya. Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare.
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Challenges of Maternal and Prenatal Care in Nigeria

Background and aim: Evidence in the literature indicates that maternal health care by a skilled birth attendant is one of the key strategies for maternal survival. However, the rate of maternity care utilization and reduction of maternal death is very low in Nigeria. This study was designed to explored factors influencing women utilization of maternal and prenatal care in Nigeria. Hence, the need to understand factors that serves as barriers to accessing maternal and prenatal care in Nigeria using the Socio-ecological Model (SEM). Methods: A mixed method was employed for this study. Data collection used questionnaires and in-depth interviews. Questionnaires were distributed to 330 respondents of which 318 of them were retrieved and qualitative in-depth interviews were conducted for 6 participants. The study was conducted in one of the tertiary health facilities in Nigeria, amongst mothers aged 15-45 years. Statistical Package for Social Sciences (SPSS) was used in analyzing the quantitative data whilst a qualitative content analysis was done for the qualitative data. Results: The study established that education, income level, costs associated with seeking care, distance and time taken to travel were significantly associated with maternity health care services utilization. The study concludes that; costs of treatment, distance and time, income level, staff attitude and women’s autonomy were critical in determining women utilization of maternity care services.

Investigating the Determinants of Maternal Care Services Utilization in the Brong Ahafo Region of Ghana

Ghanaian governments have made some social interventions in order to reduce risks associated with pregnancy and child delivery. However, most pregnant women do not seek maternal care. Previous studies have examined factors contributing to maternal care services utilization in Ghana using national data which limit such study applicability in some areas with specific background characteristics. These studies have mostly limited it to rural areas where the utilization is very low. This study seeks to bridge the gaps identified by exploring the factors which influence maternal care utilization in urban and rural communities in the Brong Ahafo Region of Ghana. The Chi-Square test of association and the logistic regression models are used to analyze data obtained from the 2014 Ghana Demographic and Health Survey (DHS). The data analyses were carried out using R and STATA softwares. The results revealed that women with at least 5 children were less likely (OR = 0.374, 95% CI: 0.173 - 0.796) to utilize antenatal care compared to those who had less than five live births. Educated women are three times likely (95% CI: 1.929 - 5.257) to deliver at a health facility compared to uneducated women. Women from the rich wealth quintile were nearly 16.9 times more likely (95% CI: 4.816 - 107.124) to deliver in a health facility compared to those from the poor wealth quintile. On the other hand, residing in rural communities makes it less likely (OR = 0.569, 95% CI: 0.350 - 0.913) for women to receive postnatal care within 2 months of delivery compared to living in urban communities. This study has demonstrated that maternal educational level plays a crucial role in maternal health care service utilization in the region. Therefore, government policies and programs aimed at providing more educational opportunities for girls in the region should be reinforced.

Inequalities in maternal health care utilization in Benin: a population based cross-sectional study

BackgroundEnsuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes.MethodsThis paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15–49 years in 2006 and 2012 respectively. Women’s characteristics were reported in percentage, mean and standard deviation.ResultsMean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13–1.52), 1.69 (OR = 1.69; 95% CI = 1.20–2.37) and 1.38 (OR = 1.38; 95% CI = 1.16–1.65) times as likely to utilize maternal health care services after adjusting for other covariates.ConclusionThe findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.

Determinants of Maternal Care Services Utilization within Conjugal Context in Lagos State

Antenatal care attendance is an essential component of maternal health and critical to reducing high maternal and child mortality in Nigeria. This study focused on factors that influence maternal healthcare services utilization at the conjugal level. The study was carried out among ever-married men and women in Shomolu, Lagos State, between March and June, 2017. Both quantitative and qualitative approaches were adopted to implement the study. At the quantitative level, cross-sectional survey was adopted while In-Depth Interview (IDI) was used at the qualitative level. The probability sampling technique was adopted to select a sample size of 480 respondents for the quantitative aspect of the study, while 36 participants were purposively selected for the qualitative aspect. The study examined the relationship between men's perception of the influence of antenatal clinic attendance on pregnancy outcome and their approval of wives' antenatal clinic attendance. It equally investigated the relationship between educational attainment and perception of non-attendance of antenatal clinic among women, and the relationship between requirement to obtain husband's permission and number of antenatal care attendance among women. Results showed that no relationships exist between men's perception of antenatal care attendance and their approval for wives' attendance of antenatal care facility. However, educational attainment among men was found to be positively related to their perception of antenatal clinic attendance. Similarly, test result showed a relationship between women's perception of antenatal care attendance and number of attendance, with t(83.395) = 7.718, p<0.001.