Maternal Health-seeking Behavior Research Articles

Factors shaping decisions to utilize maternal health services among the urban poor of south Delhi: A longitudinal case study

Ending preventable maternal mortality remains one of the most critical challenges despite significant progress over past decades. Maternal mortality remains high and the burden of death is disproportionately higher among the marginalized population. Contrary to the view that those residing in urban areas have better access to quality health services, the health outcomes of the urban poor are not better than rural communities. Data on urban poor are concealed within urban averages, and few studies provide disaggregated data on spatial dimensions of population in urban areas. The study was conducted to understand variations and factors responsible for decisions to seek healthcare services for maternal healthcare. The study was conducted using qualitative case study design and qualitative data were collected from fifty pregnant women enrolled from two slums of south Delhi after informed consent. The slums were revisited twice after a gap of two/three years to understand changes in maternal health seeking behaviour of the communities. Data were analyzed using grounded theory methodology. The maternal health seeking behaviour among urban poor is determined by structural inequalities, predisposing factors of individuals including age, income, education, and parity. Other factors that had a bearing on their decision to seek care included legal status of the slums, and its inhabitants. Incremental changes in health seeking behaviour overtime was observed due to government policies/programs implemented to benefit the poor. It is essential to build a sensitive and responsive health system that is acceptable to the most marginalized to enhance access to health services.Understanding factors contributing to urban poor seek maternal health care services is necessary to build a sensitive and responsible heath system that is acceptable to the most marginalized and will ensure its use.

Public health insurance and birth outcomes: evidence from Punjab, Pakistan

Public health insurance targeted towards low-income households has gained traction in many developing countries. However, there is limited evidence as to the effectiveness of these programs in countries where institutional constraints may limit participation by the eligible population. This paper evaluates a recent health insurance initiative introduced in Pakistan and discusses whether eligibility for the programme improves maternal health seeking behaviour. The Prime Minister National Health Program provides free insurance coverage to low-income families. The programme is in the early phases of implementation and has, since 2016, only been rolled out in a few eligible districts within the country. This allows for a comparison of eligible households in districts where the programme has been introduced to those that are eligible to receive insurance at a future date. Using repeated cross-sectional data from multiple rounds of representative household survey, a difference-in-difference model has been estimated. Results show that at least for a specific beneficiary group (i.e. pregnant women), there has been a positive increase in utilization of hospital services. Furthermore, we provide evidence using mother fixed effects that the programme increased the likelihood of a child's birth being documented. Since possession of a birth certificate can secure civic rights for a child, this is an unintended but positive outcome of the programme.

Health Needs of Mothers of Infants in a Neonatal Intensive Care Unit : A Mixed-Methods Study.

Mothers with babies in the neonatal intensive care unit (NICU) face a host of challenges following childbirth. Limited information is available on these mothers' postpartum health needs and access to services. To identify health needs of NICU mothers, access to services, and potential service improvements. A mixed-methods study including a retrospective cohort study, in-depth interviews, and focus groups. Large, Level IV, regional referral, university-affiliated hospital in the United States. Mothers of live-born infants born from 1 July 2014 to 30 June 2016 (n= 6849). Interviews included 50 NICU mothers and 59 stakeholders who provide services to these mothers or their infants. Severe maternal morbidity, chronic health conditions, health care encounters from discharge through 12 weeks postpartum, maternal health needs, care access, and system improvements. Compared with mothers of well babies, NICU mothers had more chronic diseases, experienced more perinatal complications, and utilized more acute care postpartum. Qualitative analyses revealed the desire to be at the baby's bedside as a driver of maternal health-seeking behaviors, with women not seeking or delaying medical care so as to stay by their infant. Stakeholders acknowledged the unique needs of NICU mothers and cited system challenges, lack of clarity about provider roles, and reimbursement policies as barriers to meeting needs. The study was conducted within a single health care system, which may limit generalizability. Qualitative analyses did not explore the influence of fathers, other children in the home, or length of NICU stay. Universal screening and convenient access to maternal health services for NICU mothers should be explored to reduce adverse maternal health outcomes. Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.

Risky Fertility Behavior, Breastfeeding Practices and Neonatal Mortality Risk: Evidence from Repeated Cross-Sectional Nationally Representative Data

Background: Notwithstanding government efforts in improving maternal and child health, childhood mortality still remains a serious burden in the country, with neonatal mortality rate of 39 deaths and under-five mortality rate of 132 per 1,000 live births. This has implication on Sustainable Development Goals (SDGs) targeted towards reducing under-fiver mortality rate to 25 deaths per 1,000 live births by the year 2030. This study examined risky fertility behavior, breastfeeding practices, and neonatal mortality risk in Nigeria.
 Materials and methods: This study involved the analysis of secondary data, Nigeria Demographic and Health Survey (pooled dataset of the three most recent surveys, NDHS, 2008, 2013 and 2018). The sample size was a weighted sample of 94,062 women aged 15-49 years with 172, 252 live births for the ten years period. Descriptive statistics and cox-proportional hazard model were performed using Stata 14.1 software.
 Results: Nearly two thirds (64.0%) of births were high risk. The practice of breastfeeding among the women was quite poor, just (39.5%) initiated breastfeeding within one hour of childbirth, though (74.0%) reported breastfeeding their child for a minimum of 12 months. The independent effect of risky fertility behavior (RFB) was associated with elevated hazards of neonatal mortality, with the highest risk observed among births belonging to the multiple high-risk group (HR=2.1, p<0.01). Adjusting for breastfeeding practices, maternal/child characteristics and maternal health seeking behavior was associated with elevated hazard of neonatal mortality with the highest hazard observed among births belonging to the multiple high-risk group (HR=1.76, p<0.05). Other factors associated with elevated hazard for neonatal mortality are sex of the child, maternal level of education and breastfeeding duration.
 Conclusion: RFB was associated with elevated hazard for neonatal mortality, even after adjusting for breastfeeding practices, maternal and child characteristics and maternal health-seeking behavior thereby lending credence to Mosley and Chen theory.

Status of Maternal and Child Health Seeking Behavior among Women Aged 15-45 Years during Earthquake of 2015 in Nepal: A Mixed Method Study

Delivery of the maternal and child health services are generally affected during the time of disaster. This study aims to assess the maternal and child health service utilization in areas in Nepal affected by the 2015 earthquake. A mixed method study was carried in 29 Village Development Committees from nine earthquake-affected districts in Nepal. Quantitative data on maternal, neonatal and child health indicators before and after the earthquake were collected from the Health Management Information System. Focus group discussions and key informant interviews with different stakeholders were conducted to collect qualitative data. Quantitative data was analyzed using Microsoft Excel 2013. Qualitative data was analyzed manually using thematic analysis technique. Most of the indicators were comparable before and after the earthquake. Indicators such as Bacille Calmette-Guerin vs. Measles-Rubella vaccine drop-out rate, 1st antenatal care visit, delivery by skilled birth attendant and 1st postnatal care visit within 24 hours of delivery improved after the earthquake. Though most of the health facilities were damaged, health services resumed under tents or in open spaces. Some of the common problems among pregnant women included stomachache, headache, malnutrition, diarrhea, and mental stress. There was not much effect in the delivery of maternal neonatal and child health services. This reflects the coordinated efforts from government as well as non-government organizations and civil societies during and after the earthquake in Nepal.

Evaluation Of The Integrated Care Model: Child Morbidity Reduction In Mashonaland East, Zimbabwe

Zimbabwe has one of the highest prevalence rates on preventable child morbidity in the world. This is mainly attributable to the absence of an effective community health mobilisation structure that reaches all targeted households with correct and consistent social behaviour change interventions for better child and maternal health.
 To address this, a cluster randomised controlled trial was conducted to assess the effectiveness of a developed integrated community intervention approach in reducing child morbidity and improving maternal health outcomes. A total of 765 mother-child pairs (413 in the intervention and 352 in the control) from 2 districts in Mashonaland East province were recruited and followed up for 12 months. Only women with children aged 0 - 48 months at the beginning of the study were selected. Participants were selected (and recruited) through stratified random sampling from 30 villages/clusters (16 in the control and 14 in the intervention) out of the total of 43 villages in the 2 districts. The intervention arm received education on maternal and child health through an Integrated Care Model mobilisation system whereas participants in the control arm were mobilized and educated using the conventional mobilisation system. Baseline and end-line surveys were done to assess and compare baseline characteristics and secondary study outcomes. The primary outcome was child morbidity in the follow-up period of 12 months.
 The mean age of participating mothers was 28 years (SD = 6.8) and that of participating children was 18.2 months (SD = 4.0). The risk of child morbidity was 37.5% in the control and 22.0% in the intervention representing a relative risk of 1.7 [95% C.I (1.4-2.1)]. The incidence rate of child morbidity was 0.043 and 0.022 episodes per child year in the control and intervention arm respectively giving an incidence rate ratio of 2.0(p<0.001). This ratio meant that the chance of being a disease case in the control was double that in the intervention arm. Women in the intervention arm had statistically significant (p<0.001) higher knowledge about maternal and child health and better child care practices at the end of the study.
 There was strong evidence that the Integrated Care Model did not only reduce child morbidity but also improved maternal knowledge, health-seeking behaviour and care practices. Accordingly, governments in developing countries and countries in poor resource settings could strengthen their community health delivery systems by implementing this low-cost, sustainable and high-impact approach.

Maternal Decision-Making Input and Health-Seeking Behaviors Between Pregnancy and the Child\u2019s Second Birthday: A Cross-Sectional Study in Nepal

ObjectivesMaternal health-seeking behaviors are critical to improving maternal and child health in low-income countries. This study investigates associations between maternal decision-making input and their health-seeking behaviors in the first 1000-day period between pregnancy and a child’s second birthday in Nepal.MethodsWe used data from a cross-sectional survey conducted in 2018 in 16 districts of Nepal. Among the 3648 households surveyed, 1910 mothers of a child 0 to 24 months with complete data were included for analyses. Logistic regression was used to examine associations between decision-making input and the utilization of antenatal, delivery and postnatal care services, and attendance at health mothers’ group (HMG) meetings. We also used negative binomial regression to assess the relationship between her decision-making input and participation in growth monitoring and promotion (GMP) in the 6 months prior to the survey. For each relationship examined, we adjusted for clustering, as well as potentially confounding factors at individual and household levels.ResultsAfter adjusting for confounders, maternal decision-making input had a small but positive and significant association with receiving at least 4 antenatal care visits (OR = 1.09, 95% CI 1.02, 1.17), attendance at GMP in the 6 months prior to the survey (IRR = 1.02, 95% CI 1.00, 1.04), and HMG attendance (OR = 1.10, 95% CI 1.03, 1.17), but not with receiving at least 3 postnatal care visits or delivering in a health institution.Conclusions for PracticeOur findings indicated that empowering women and mothers in household decision-making might warrant greater attention when developing future policies and programs in Nepal.

Care-seeking behavior for neonatal jaundice in rural northern Nigeria

ObjectiveThis study determined the predictors of maternal knowledge and health-seeking behavior for neonatal jaundice in rural Kumbotso, northern Nigeria. Study designCross-sectional survey. MethodA total of 361 mothers were interviewed using structured questionnaires. Knowledge scores and care-seeking practices were determined. Adjusted odds ratios were generated from logistic regression models. ResultsThe proportion of respondents with good, fair and poor knowledge of neonatal jaundice were (46.0%, n ​= ​166), (24.1%, n ​= ​87) and (30.0%, n ​= ​108), respectively. Of the 117 mothers with a jaundiced child, (67.5%, n ​= ​79) and (20.5%, n ​= ​24) received treatment from health facilities and traditional healers, respectively, whereas (12.0%, n ​= ​14) resorted to home remedies. Maternal education Adjusted Odds Ratio (AOR) ​= ​2.39; 95% Confidence Interval (CI): 1.16–4.91) (secondary school versus no formal), source of information on neonatal jaundice (AOR ​= ​11.3; 95%CI: 5.84–21.93) (health worker versus ‘others’), recent delivery in a health facility (AOR ​= ​1.83; 95%CI: 1.06–3.14) and having a previously jaundiced child (AOR ​= ​5.06; 95%CI: 2.76–9.27) predicted knowledge. Preference for health facility treatment was predicted by a previously jaundiced child (AOR ​= ​10.04; 95%CI: 5.73–17.60), antenatal care (AOR ​= ​2.97; 95%CI: 1.43–6.15) (≥4 versus 0 visits), source of information on neonatal jaundice (AOR ​= ​2.33; 95%CI: 1.30–4.17) (health worker versus ‘others’), and maternal ethnicity (AOR ​= ​0.36; 95%CI: 0.14–0.96) (Hausa-Fulani versus ‘others’). ConclusionMaternal knowledge of neonatal jaundice was sub-optimal. Being educated, health facility delivery, having had a jaundiced child, and receiving information from health workers predicted good knowledge. Having a previously jaundiced child, antenatal care, obtaining information from health workers and maternal ethnicity predicted preference for health facility treatment. Policies and programs should be strengthened to focus on prevention, early detection and prompt management of neonatal jaundice.

Towards a digitally-enabled, community-based responsive health system in Tanzania: a formative study for the Afya-Tek digitised health initiative

BackgroundDigital innovation and technologies present vast opportunities in health care and health systems globally, especially in their potential to improve health information management and coordination between health providers. Health care outcomes in child, adolescent, and maternal health in Tanzania, a low-income country, are poor and partly the result of fragmented service provision, lack of clinical guidance to aid decision-making processes, and limited use of data. The Afya-Tek initiative aims to digitally link community members with community health volunteers, public health facilities, and private accredited drug dispensing outlets (ADDOs) to improve decision-making processes and quality of care along the continuum of care, and reduce inefficiency in referral systems. In this mixed-methods study, we aimed to investigate how digital innovation can best be integrated into communities and the local health system in the Kibaha urban and rural districts in the Pwani region of Tanzania. MethodsWe carried out quantitative and qualitative situational analyses of child, adolescent, and maternal health outcomes and related health-seeking behaviour using public health sytem indicators, alongside participant observations, in-depth interviews, and focus group discussions with community and health systems actors. Additionally, we assessed the perceived need and acceptability of digitally linking community health volunteers, public health facilities, and ADDOs. FindingsBetween November, 2019, and February, 2020, we conducted 30 participant observations, 191 in-depth interviews, and 26 focus group discussions. Respondents perceived the main disease burdens for children younger than 5 years to be diarrhoea, malaria, pneumonia, and urinary tract infections. Among pregnant women, these included anaemia, back and foot pain, headache, and bleeding, while for post-partum women respondents mentioned dizziness and frequent bleeding. Sick children younger than 5 years were taken directly to a health facility, whereas other community members primarily sought treatment and advice from ADDOs and only attended the health facility for ‘serious’ health problems. Adolescents preferred family planning services at ADDOs rather than at a health facility for reasons of privacy and stigma. Community members welcomed the idea of a digital health intervention and the possibility of biometric usage did not prompt concern. Workers from within the health system considered that digital technology could improve prompt treatment-seeking, reduce over-dispensing of medication by ADDOs, and minimise double registrations of patients at health facilities. There was a keen interest to use technology to improve care coordination between the three health system actors and assist patients as they navigate through multiple points of care. The inclusion of ADDOs in a digital platform was seen as an innovative approach and also a way to monitor their services. InterpretationThere was a general acceptance of community members and health system stakeholders towards, and hope in, the use of digital health interventions to link community health volunteers, public health facilities, and ADDOs. Our findings, including perceived burden of disease and related health-seeking behaviour, will inform the next phases of the Afya-Tek project in the co-development of the digital health intervention and its implementation, in order to ensure best practices and sustainable approaches in bringing preventive and curative care closer to communities, especially towards improving related child, adolescent, and maternal health outcomes in Tanzania. FundingFondation Botnar

My Baby\u2019s Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol

BackgroundStillbirth is a devastating pregnancy outcome that has a profound and lasting impact on women and families. Globally, there are over 2.6 million stillbirths annually and progress in reducing these deaths has been slow. Maternal perception of decreased fetal movements (DFM) is strongly associated with stillbirth. However, maternal awareness of DFM and clinical management of women reporting DFM is often suboptimal. The My Baby’s Movements trial aims to evaluate an intervention package for maternity services including a mobile phone application for women and clinician education (MBM intervention) in reducing late gestation stillbirth rates.Methods/designThis is a stepped wedge cluster randomised controlled trial with sequential introduction of the MBM intervention to 8 groups of 3–5 hospitals at four-monthly intervals over 3 years.The target population is women with a singleton pregnancy, without lethal fetal abnormality, attending for antenatal care and clinicians providing maternity care at 26 maternity services in Australia and New Zealand. The primary outcome is stillbirth from 28 weeks’ gestation. Secondary outcomes address: a) neonatal morbidity and mortality; b) maternal psychosocial outcomes and health-seeking behaviour; c) health services utilisation; d) women’s and clinicians’ knowledge of fetal movements; and e) cost. 256,700 births (average of 3170 per hospital) will detect a 30% reduction in stillbirth rates from 3/1000 births to 2/1000 births, assuming a significance level of 5%. Analysis will utilise generalised linear mixed models.DiscussionMaternal perception of DFM is a marker of an at-risk pregnancy and commonly precedes a stillbirth. MBM offers a simple, inexpensive resource to reduce the number of stillborn babies, and families suffering the distressing consequences of such a loss. This large pragmatic trial will provide evidence on benefits and potential harms of raising awareness of DFM using a mobile phone app.Trial registrationACTRN12614000291684. Registered 19 March 2014.VersionProtocol Version 6.1, February 2018.

Qualitative Study of Family Support for Women’s Health Seeking-Behaviour in Rural Areas District Sleman

Introduction: Health is a field that is very closely related to women's duties because the role of women is the reproductive role that is in the realm of the household. Health seeking behavior is preceded by a decision-making process that requires social support from spouses or other family members so that it can potentially improve the health status of women and children in the family. This study aims to explore the differences in family support for mothers in health seeking behavior when ANC, childbirth, and toddlers are sick in rural areas. Methods:The study was conducted using qualitative methods with in-depth interviews with 6 mothers, 6 husbands and 4 mother-in-laws who in their families had toddlers who had experienced illness in the last 3 months. The study was conducted in Banaran subvillage, Sleman District. Results :The results found that family support for maternal health seeking behavior during ANC, childbirth and when sick toddlers are always discussed by husband and wife, while the role of in-laws is very small, that is giving advice. In the condition of the childbirth, the family support not only from her husband and mother-in-laws but also from the whole extended family on the part of the mother who does not live in one house. Conclussions: In conclusion, mothers get considerable support from their families, both from their husbands, mother-in-laws or large families who do not live in the same house in health seeking behavior, especially during childbirth.

The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016

A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63–0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56–0.78), facility-based delivery (AOR 0.65; 95% CI 0.56–0.77), and postnatal care use (AOR 0.80; 95% CI 0.67–0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women’s restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women’s social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services.

Medical pluralism in maternal health-seeking behavior of rural women in Southern Ecuador

In rural Ecuador pregnant women face complex challenges navigating the terrain between traditional and biomedical maternal health care services. Semi-structured interviews were conducted in three rural communities in Southern Ecuador that have presented active Chagas disease transmission with women who were pregnant or have given birth within the last five years. This study was conducted to identify and understand the experiences of mothers in these communities and the decisions they make to maintain the wellness of themselves and their children. The researchers recorded women’s maternal health stories, analyzed their access to maternal health care, and explored factors influencing their birth location preferences and health seeking behaviors. The researchers found that women in this region are utilizing medical pluralism to sustain maternal health and the well-being of their children.

Maternal care practices and health-seeking behaviour for neonatal jaundice in Basawa Community, Zaria, Northwestern Nigeria

Neonatal jaundice (NNJ) is a common condition that occurs in newborns which is preventable and also easily treatable. However, delay in the presentation of infants with jaundice at the hospital is associated with increased morbidity and mortality. This study assessed the care practices and health-seeking behaviour for Neonatal Jaundice among mothers in Basawa community Zaria. The cross-sectional descriptive study was carried out in January 2017 among mothers aged 15–49 years. One hundred and seventy-two structured, interviewer-administered questionnaires were used to collect data. Data was analyzed using SPSS software version 21. The mean age of respondents was 34 ± 7.0 years, the main sources of information of respondents about NNJ were relatives (35%) and hospital staff (33.1%). Thirty percent of respondents stated that antenatal care is a preventive practice against neonatal jaundice, 52.3% of them believed that treatment of malaria in pregnancy could prevent neonatal jaundice. Most of the respondents (54%) exposed their jaundiced neonates to the sun, 51.7% took their children to the hospital and 37.2% used herbs. Only 16.9% of the respondents took their jaundiced children to the hospital immediately they noticed it and 16% did this within 24 hours of noticing jaundice in their neonates. The study findings showed inadequate knowledge and poor practices regarding NNJ. There is need for enlightenment and sensitization about the early recognition of NNJ and early presentation for treatment.Keywords: Basawa community, care practices, neonatal jaundice, Nigeria, mothers

Gender inequity as a barrier to women’s access to skilled pregnancy care in rural Nigeria: a qualitative study

Maternal mortality has been an issue of global importance, with continued efforts by the international development community towards its reduction. The provision of high quality maternal healthcare has been identified as a key strategy in preventing maternal mortality. Gendered intrahousehold power structures, gendered dynamics of resource allocation and women's limited ability in decision-making can have a huge impact on maternal health-seeking behaviour and overall health status. Using a gender lens, this study explores the root causes of women's limited access to and utilisation of maternal healthcare services in rural areas of Edo State, Nigeria. This qualitative study involved the analysis of data collected from gender- and age-desegregated focus group discussions (FDGs) in 20 communities in Etsako East and Esan South East local government areas of Edo State, Nigeria. Focus group participants comprised women between the ages of 15-45 y who have been pregnant within the last 5 y and their male spouses and partners of varying ages. A total of 20 FGDs were conducted. Coded transcripts were reviewed and analysed using the gender framework as an analytical guide. Most responses indicated that women did not entirely have the power to make decisions regarding when to seek care during pregnancy. Women's experiences of access to quality care showed intersecting areas of gender and social economic status (SES) and how they impact on access to health. Many of the responses suggested high levels of economic marginalisation among women with women being financially dependent on their spouses and partners for pregnancy healthcare-related costs. Furthermore, a man's financial status determined the type of care his spouse or partner sought. Women identified a high workload as an issue during pregnancy and a barrier to accessing maternal healthcare services. The role of men within households was generally perceived as that of financial providers, therefore a husband's support was commonly constructed to solely mean financial support. This paper brings attention to the role of gender and SES in producing and sustaining limitations to women's access to quality care. Interventions geared towards supporting women's financial independence is an important step towards improving their access to skilled healthcare, more so are interventions that improve women's decision-making capacities.

Exploring barriers to reproductive, maternal, child and neonatal (RMNCH) health-seeking behaviors in Somali region, Ethiopia.

IntroductionHealth-seeking behaviours are influenced by internal and external contributing factors. Internal factors include attitudes, beliefs and core values, life adaptation skills, psychological disposition whereas external factors include social support, media, socio-cultural, political, economic and biological aspects, health care systems, environmental stressors and societal laws and regulations. This study was meant to explore factors affecting health-seeking behaviors in the Somali regional state of Ethiopia. The study employed a cross-sectional study design using qualitative data collection tools. Data were collected from 50 individual interviews and 17 focused group discussions (FGD) on women of reproductive age and their partners, health extension workers (HEWs), health care providers and health administrators. To ensure representativeness, the region was categorized into three zones based on their settlement characteristics as agrarian, pastoralist and semi-pastoralist. Two districts (one from high and the other from low performance areas) were selected from each category. The data were entered, coded, categorized and analyzed using NVIVO version 11 software. The Socio-ecologic Model (SEM) was used for categorization.ResultsUsing the social ecological model, the following major barriers for health seeking behaviors were identified. Low socio-demographic and economic status, poor exposure to health information or mass media, detrimental preferences of breast feeding methods and short acting family planning (FP) methods were identified barriers at the individual level; male dominance in decision making, the influence of the husband and society and the role of word of mouth were identified barriers at the interpersonal level and lack of acceptance, fear of modern health practices, unclean health facility environment, lack of well-equipped facilities shortage of trained staffs and barriers relating to distance and transportation were barriers identified at organizational and policy level.ConclusionOverall, factors at various level affected health seeking behaviors of the Somali community. Socio-demographic and economic factors, non-responsive bureaucratic system, shortages or absence of medical supplies and human resources, lack of supportive supervision, a shortage of water and electricity at the health facility and an unclean service delivery environment are significant barriers to health-seeking behaviors for the community.

Strengthening the community support group to improve maternal and neonatal health seeking behaviors: A cluster-randomized controlled trial in Satkhira District, Bangladesh.

BackgroundAlthough achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities.MethodsA cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models.ResultThe major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section.ConclusionThe success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care.Trial registrationUMIN Clinical Trial Registry UMIN000031789.

English

Maternal health care service utilization is one of the components of the reproductive and child health interventions package with the aim of improving both maternal and child health. It is the health of the women during pregnancy, childbirth and postpartum period. Thus, the overall objective of this study is to investigate the perceived socio economic barriers to maternal health seeking behavior of rural women in Raya Alamata District. In doing so, the researcher employed qualitative methods substantiated by the quantitative data. In doing so, a sample of 359 HH units was selected from three ‘Tabias’ by using simple random sampling techniques. The qualitative data analyzed using thematic analysis whereas the quantitative data analyzed using descriptive statistics. According to the findings of the study, perceived social barriers such as shortage of qualified health workers, ill behavior of health workers, student’s internship and poor quality of maternal health services influence the health seeking behavior of the rural women of the study area. On the other hand, the perceived economic barriers such as access to resources, working conditions and cost of transportation and medical treatment also influence maternal health seeking behavior of the women of the study area.  Key words: Antenatal care, delivery care, maternal health, maternal health seeking behavior, postnatal care. &nbsp

Perceived Physical Barriers to Maternal Health Seeking Behavior among Rural Women: The Case of Raya-Alamata District, Southern Tigray, Ethiopia

Introduction: Maternal health is a state of complete physical, mental and social well-being of the mother; it is a resource for everyday life of the mother. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality. The use of antenatal, delivery and postnatal care services can be accessed through the number and timing of ANC visits, proportion of births delivered in health centers, attendants during delivery and antenatal care and number of postnatal visits. Health care services during pregnancy and after delivery are important for the survival and wellbeing of both the mother and the infant. Objective: The overall objective of this study is to investigate the perceived physical barriers to maternal health seeking behavior of rural women in Raya Alamata district. Methods: The researcher employed mixed research methods (both qualitative and quantitative). The study populations were reproductive women in the age category of 15-49. In doing so, a sample of 359 reproductive women was selected from three ‘Tabias’ by using simple random sampling techniques. The qualitative data analyzed using thematic analysis whereas the quantitative data analyzed using descriptive statistics. Result: Based on the finding this study, the majority of the respondents 31% were found between the age category of 25- 34 years, 87.5% were married, 93.6% belongs to Tigrian ethnic groups, 71.6% are followers of orthodox Christian, 60.7% were illiterate; and the majority 44.7% of the respondents earned an average monthly income of 501-1000 birr. Rural women also travelled 3.87 km, 5 km, 10 km and 6.4 km in average to get maternal health services from health posts, health centers, hospitals and private clinics respectively. Moreover, long distance and lack of transportation, inequitable distribution of health facilities, inconvenient topography and weather related problems were the major barriers for rural women to get maternal health services. These perceived physical barriers have affected the treatment seeking behavior of rural women especially throughout pregnancy, delivery and postnatal stages. Conclusion: The findings of this study give much emphasis into the perceived physical barriers to maternal health seeking behavior among rural women. The physical barriers restrained rural women from getting antenatal, delivery and postnatal care services which led to pregnancy complications, home delivery, and post-delivery problems which resulted in maternal morbidity and mortality.

Factors associated with non-utilization of maternal and child health services in Nigeria: results from the 2013 Nigeria demographic and health survey

This study aims to examine factors associated with non-utilization of maternal and child health services in Nigeria. Secondary data from the 2013 Nigeria Demographic and Health Survey were utilized. A sample of 18,712 women aged 15–49 years who had had a child in the 5 years preceding the survey was selected. Variables on demographic and socio-economic characteristics of the study sample were analysed. Data analysis was carried out using STATA version 12 software. Univariate, bivariate and multivariate analyses were conducted. We found that 48.83% of women had not made at least four antenatal care (ANC) visits, 62.34% delivered at home, while 71.43% had not received postnatal care (PNC). Multivariate analysis indicated that geo-political zone, location, women’s education, religion, socio-economic status, marital status and husband’s education were significantly associated with the non-utilization of ANC services, health facilities for delivery and PNC services. Our study concludes that maternal health-seeking behaviour is poor among women of reproductive age in Nigeria. In addition, demographic and socio-economic factors were significantly associated with the non-utilization of maternal and child health services. There is an urgent need for interventions to encourage the use of these services among women of reproductive age. Policy-makers need to design and implement policies targeted at women from the poorest households, who are less educated and living in rural areas or in the North West or South South region. This will assist in promoting change in maternal health-seeking behaviour.