Maternal Health-seeking Behavior Research Articles

Behavioral Predisposing Factors in Mothers of Toddlers Affecting the Risk of Stunting Among Toddlers in Dairi Regency

Stunting a significant public health issue worldwide, particularly in low- and middle-income countries where access to adequate nutrition and healthcare is limited. This condition affects not only physical growth but also cognitive development and well-being. The study aimed to explore the impact of maternal behavioral factors, including nutrition, breastfeeding practices, and health-seeking behaviors, on the risk of stunting among toddlers. Method It is a cross sectional study with retrospective case control approach. A total of 120 mothers who had toddlers aged 6-24 months involved recruited from Puskesmas Pegagan Julu, Dairi District. Variables collected were knowledge, attitude and action of mothers, weight, height, age of children and exclusive breastfeeding consumption. Analyzed was performed through bivariate and multivariate logistic regression. Results a total 28.60% of toddlers were stunted, with significant links found between maternal nutritional knowledge (OR = 0.45, p < 0.05), exclusive breastfeeding for six months (OR = 0.60, p < 0.05), and regular health-seeking behavior (OR = 0.32, p < 0.01), and reduced stunting risk. Conversely, inadequate sanitation facilities were associated with increased stunting prevalence (OR = 2.76, p < 0.01).

Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews

Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.

The effect of health insurance coverage on antenatal care utilizations in Ethiopia: evidence from national survey.

About three-fourths of maternal near-miss events and two-fifths of the risk of neonatal mortality can be reduced by having at least one antenatal visit. Several studies have identified potential factors related to maternal health seeking behavior. However, the association between health insurance membership and antenatal care utilization was not well investigated in Ethiopia. Therefore, this study was aimed at assessing the effect of health insurance coverage on antenatal care use in Ethiopia. The study utilized data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). The analysis included a weighted sample of 3,919 women who gave birth in the last five years. A logistic regression model was employed to assess the association between antenatal care use and health insurance coverage and other covariates. The results were presented as adjusted odds ratios (AOR) at a 95% confidence interval (CI). Statistical significance was declared at a p-value <0.05 in all analyses. Antenatal care was used by 43% (95% CI: 41.46 to 44.56%) of Ethiopian women. Those with health insurance coverage had higher odds of antenatal care use than those without health insurance coverage. Women were 33% more likely to use antenatal care (ANC) if they were covered by health insurance. Age, Media access, marital status, education status, wealth index, and economic regions were also factors associated with antenatal care utilizations. According to our findings, less than half of Ethiopian women had four or more antenatal care visits. Health insurance membership, respondent age, media access, marital status, education status, wealth index, and economic region were factors associated with antenatal care utilization. Improving health insurance, women's economic empowerment, and education coverage are critical determinants of antenatal care utilization.

Does armed conflict lead to lower prevalence of maternal health-seeking behaviours: theoretical and empirical research based on 55 683 women in armed conflict settings

BackgroundWomen and children bear a substantial burden of morbidity and mortality due to armed conflict. Life-saving maternal and child health (MCH) services are low-quality in most conflict-affected regions. Previous studies...

Individual and Systemic Factors of Under-five Mortality in Nigeria: A Cox Proportional Hazard Model

Despite considerable efforts to reduce under-five mortality nationwide, Nigeria has fallen short of achieving the Millennium Development Goals (MDGs) target of 67 deaths per 1,000 live births by 2015. Of all the documented factors of under-five mortality, little evidence exists on the impact of systemic barriers and individual factors (maternal health-seeking behaviour) on under-five mortality in Nigeria. The study used a nationally representative sample from Nigeria Demographic and Health Survey (NDHS) 2013 dataset. The target population was 20,192 women aged 15-59 years who had given birth to 31,480 children five years before the survey. Stata software was used for data analysis. The risk of death was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Findings from the overall Model I-IV revealed individual factors (maternal health-seeking indicators) as significant factors of under-five deaths (p &lt; 0.05). Children whose mothers received antenatal care coverage (ANC) outside health care facilities (HCF) (HR: 1.60, CI: 1.0-2.4, p &lt; 0.05); or delivered outside HCF (HR: 1.02, CI: 0.7-1.5, p &lt; 0.05) had elevated hazard risk of death before age five. Conversely, children who were presented for postnatal check within two weeks of delivery (HR: 0.60, CI: 0.5-0.8, p &lt; 0.05), or delivered within the longer birth interval (HR: 0.67, CI: 0.6-0.8, p &lt; 0.001) had significantly lower hazard risk of death before age five. As part of systemic factors, children whose mothers were covered by health insurance scheme had significantly (HR: 0.52, CI: 0.2-1.2, p &lt; 0.001) lower risk of death when compared with their counterparts without health insurance coverage. The study emphasized the need to revitalize strategies and programs to improve women health seeking behaviour and investment in the health sector through health insurance, infrastructure, and supplies.

Household Vulnerability Dimensions, Maternal Health Practices and Childhood Immunization Status in Nigeria

Immunisation is considered one of the most cost-effective public health interventions for reducing childhood morbidity, mortality, and disability globally. However, while global achievement of over 70% coverage rates was sustained in the 1990s, wide variations exist between and within countries. In some developing countries, immunisation rates increased substantially, but in sub-Saharan Africa, immunisation rates plummeted, leaving millions of children vulnerable to life-threatening diseases. In Nigeria, coverage rates for routine immunisation of all antigens still fall below 50%. The study examined the overall influence of household vulnerability dimensions, maternal health practices on childhood immunization status in Nigeria. The study used secondary data from the 2013 Nigeria Demographic and Health Surveys (NDHS). The analytical weighted sample size was 5,824 women of reproductive ages (15-49 years) with a live birth in the past three years, whose children were within age 12-23 months at the time of the survey. The data were analyzed using frequency distribution, chi-square test and binary logistic regression. The results showed a decreasing regional variation in the proportion of fully immunized children from a high of 23.6% in the South-West, to a low of 9.1% in the North-East. The overall household vulnerability status showed that children in more and most vulnerable households were 62% (OR = 0.38; p &lt; 0.001; CI: 0.32-0.46) and 89% less likely (OR = 0.11; p &lt; 0.001; CI: 0.08-0.14) to receive full vaccination compared with their counterpart in non-vulnerable households. The study revealed a significant relationship between mothers’: i) Number of antenatal visits (OR = 1.66; p &lt; 0.05; CI: 0.25-23 1.77); ii) Quality of antenatal care (OR = 2.61; p &lt; 0.05; CI: 1.45-4.67); iii) Place of delivery (OR = 0.62; p &lt; 0.05; CI: 0.45-0.86); iv) Assistance during delivery (OR = 0.41; p &lt; 0.001; CI: 0.28-0.57); v) Time of postnatal check (OR = 1.81; p &lt; 0.001; CI: 1.49-2.19) and full childhood immunisation status. The study concluded that different dimensions of household vulnerability and maternal health-seeking behavior are key underlying factors of childhood immunization in Nigeria.

Maternal health-seeking behaviour of peri-urban women living with disability in Busiro South Health sub District, Wakiso district, Uganda: a community-based study.

We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data. A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving financial support from friends of partners (p < 0.001), distance of less than 5KM to the health facility (p = 0.024), friendliness of the health care providers (p=0.030) and availability of health providers (p < 0.001). There is an urgent need for a multi-sectoral approach to better healthcare-seeking behaviour.

Correlates of Child Mortality in Pakistan: A Hazards Model Analysis

This study investigated factors associated with child mortality in an area in Rawalpindi, one of the large cities of Pakistan. Using both demographic and anthropological methods, the research was conducted to specifically examine the process and mechanisms whereby a link is established between child mortality and its covariates. Controlling for the socioeconomic status as a determinant of child mortality, the study population was limited to a lower income stratum living in a homogeneous environment where all households had equal access to health-related and other facilities. Results of the proportional hazards model analysis on 1301 index children suggest that non-economic factors like maternal health-seeking behavior were related to high child mortality. The cultural norm of bearing a large number of children was the most significant correlate. In order of significance, this was followed by contraceptive use, current age of the mother, age at marriage, and the hygienic conditions of the household. The study provides strong evidence of familial clustering of mortality by order of the household.

Infant and Young Child Feeding Practices and Determinants of Exclusive Breastfeeding: A Study at the Bono Regional Hospital, Sunyani, Ghana

Optimal nutrition plays a key role in the survival and overall health outcome of young children. This study sought to assess infant and young child feeding (IYCF) practices and maternal socio-demographic factors and health-seeking behaviors affecting exclusive breastfeeding (EBF) practice. A descriptive cross-sectional study was conducted at the Child Welfare Clinic of the Bono Regional Hospital, Sunyani, Ghana. Two hundred and forty-five mothers with 6-23 months old infant pairs were recruited for the study through convenience sampling. Data were collected using semi-structured, interviewer-administered questionnaires. Statistical Package for Social Sciences (SPSS) version 25 was used to analyze the data. All infants (245) in the study had been breastfed at some point in time. Approximately, 5 in 10 infants (54.3%) were introduced to breast milk within the first hour of birth. EBF rate was 49.4%. More than 7 in 10 children (75.5 percent) were predominantly breastfed in their first 6 months of life. Eight in 10 infants (80.8%) were being fed complementary foods. In a multiple logistic regression analysis, maternal age and health education/counseling on EBF significantly predicted EBF practice. Mothers aged 35-49 years were more likely to practice EBF compared to those aged 15-24 years (AOR 0.47; 95% CI 0.24, 0.92). Also, mothers who received education/counseling on EBF during antenatal care were more likely to practice EBF than those who did not (AOR 2.68; 95% CI 1.29, 5.53). The rate of EBF was below the World Health Assembly approved target for 2025 (≥ 50%), suggesting a need for intervention.

Determinants of Mental Healthcare-Seeking Behavior of Postpartum Women in Ibadan, Nigeria.

The mental healthcare-seeking behavior of postpartum mothers has received little attention in Nigeria. Previous studies in the country have focused on determinants of physical health-seeking behavior, choice of maternal healthcare provider, prevalence, and determinants of maternal mental illness, yet, determinants of maternal mental health-seeking behavior among Nigerian women has been understudied. This study, therefore, examined the determinants of mental health-seeking behavior among postpartum women in Ibadan, Nigeria. Maternal mental illness, which was proxied using postpartum depression, was computed using the Edinburgh Postpartum Depression Scale. Data for the study were obtained through a survey method using a 9-page questionnaire. A 3-stage sampling technique was employed. The first stage was a stratified sampling to disaggregate the health facilities offering postnatal and immunization services on the basis of ownership of public and private healthcare providers. In the second stage, seven healthcare facilities comprising three (3) private and four (4) public healthcare were purposively selected based on the number of attendees. The final stage was a random selection of 390 postpartum mothers attending postnatal and immunization clinics across seven healthcare facilities. The prevalence of depression among the mothers was 20.8%. While only 39.5% of the depressed women sought care, 22.3% of the non-sufferers also sought mental healthcare. This revealed that both sufferers and non-sufferers sought mental healthcare. Also, a higher incidence of postpartum depression among the sufferers increased the likelihood of seeking mental healthcare. Age, family history of postpartum depression, and having the desired gender of child were determinants of mental health-seeking behavior. Among the sufferers of postpartum depression who failed to seek care, a low perceived need for mental healthcare, the perception that the depressive symptoms will go on their own, as well as fear of being stigmatized as a “weak mother”, were reasons for not seeking mental healthcare. Thus, to promote mental healthcare, the non-cost factors, like availability and accessibility to a mental healthcare facility should be addressed. To achieve this, mental healthcare sensitization programs should be integrated into maternal healthcare at all levels, and mothers attending antenatal clinics should be routinely screened for early symptoms of depression in the postpartum period.

Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study.

Early health care seeking could save neonates' lives and have a significant role in decreasing neonatal death, while delayed health care seeking has many contributions to neonatal mortality. Therefore, this study aimed to assess maternal health-seeking behavior for neonatal danger signs and associated factors among postpartum mothers in Southeast Ethiopia. A community-based cross-sectional study was conducted on a random sample of 400 women with sick neonates from June 1st, 2020 to 27th, November. A Modified Anderson and Newman behavioral model consisting predisposing, enabling, need, and health system factors were utilized and participants were interviewed by using structured questionnaires. Multivariate logistic regression analysis was used to identify factors associated with maternal health-seeking behavior. Adjusted odds ratios (AOR) were reported with their corresponding 95% confidence interval (CI) to determine the strength of the association. The statistical significance was declared at P < .05. Slightly higher than two-fifths, (44%, 95% CI: 39.2-48.9) of the respondents' have appropriate healthcare-seeking behavior for neonatal danger signs. Postnatal care follows-up (AOR = 3.5; 95% CI: 2.06-5.80), good knowledge of neonatal danger signs (AOR = 2.78; 95% CI: 1.63-4.73), decision-making power for taking sick neonates to health institution (AOR = 3.02, 95% CI: 1.61-5.67), mothers living with their partner (AOR = 3.00; 95% CI: 1.42-6.31), and health insurance (AOR = 1.82; 95% CI: 1.08-3.06) were significantly associated with having appropriate healthcare-seeking behavior. Healthcare-seeking behavior of the respondents' was low and indicated by nearly 2 out of 5 respondents' had appropriate health-seeking behavior for neonatal danger sign. Postnatal care follow-up, health insurance, good knowledge of neonatal danger signs, living with a partner, and decision-making power were predictors of appropriate healthcare-seeking behavior for neonatal danger signs. Emphasis should be given to creating awareness of neonatal danger signs, maintaining postnatal follow-up, and encouraging mothers/caregivers to make immediate decisions for seeking healthcare at healthcare institutions.

Maternal health care services in Nepal: A qualitative perspective based on the socio-ecological model

Nepal has a high Maternal Mortality Rates (MMR) in the South Asian region, partly due to the poor utilization of maternal and child healthcare services. The study aims to explore the influencing factors of maternal and child healthcare services among Nepalese women. Eighteen women, who had seven-days-old-children and those recently accessed maternal and child healthcare practices, were purposively selected. The face-to-face, In-depth-Interview (IDI) was applied to collect the information. The data were thematically analyzed, where Socio-Ecological Model (SEM) was applied as a theoretical framework. The study showed that the factors such as the knowledge of women, perception, and decision-making-autonomy at individual levels influenced maternal and child healthcare-seeking behaviors. Likewise, mothers-in-law and the role of husbands at intrapersonal levels, employment at institutional levels, peers and role of neighbors at community levels, and safe motherhood program at policy levels were significant factors for the utilization of maternal and child healthcare-seeking-behaviors. The negligence of women concerning pregnancy, inadequate health facilities, lack of specialist health workers with advanced equipment, and cultural taboos and beliefs were observed as score barriers for utilization of maternal and child health-seeking behaviors. The research strongly recommends that all women be aware of maternal and child healthcare and health-seeking behaviors at their initial ages.

Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities

BackgroundVaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa. MethodsWe analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination. ResultsOverall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake. ConclusionsContinued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.

Health care seeking behaviors regarding maternal care and the associated factors among married women in Naung Cho Township, Myanmar.

ABSTRACTThe aim of this study was to find associated factors with maternal health care seeking behaviors in a rural area in Myanmar. Married women who had delivered during the previous 12 months in Naung Cho Township were targeted and were sampled by three-stage sampling. Face-to-face interviews were performed using a structured questionnaire. The Poisson regression was used to find adjusted risk ratios (aRR) of each of two health care seeking behaviors for each of the investigated explanatory variables. Women whose husband had secondary education or above were at less risk of not having regular antenatal care (ANC) than those whose husband had only primary school level education (aRR=0.57, 95%CI: 0.34–0.95). Compared with primigravid women, aRR of not having regular ANC for those with two to four pregnancies was 1.52 (95% CI: 1.13–2.05) and 1.62 (95% CI: 1.11–2.35) for those with five or more pregnancies. Respondents who had secondary education or above and women who had married at age 20 or older showed a significantly lower risk of giving birth without skilled birth attendant (SBA) than those less educated and those who married at a younger age; aRR=0.54 (95% CI: 0.33–0.89) and aRR=0.72 (95% CI: 0.52–0.99), respectively. Own and husband’s education, the number of previous pregnancies, and marriage age were found as associated factors of maternal health seeking behaviors. Health education programs about the advantages of regular ANC and the importance of delivery with an SBA should be provided with married women, particularly targeting multigravida women, while improving access to and quality of maternal health care services.

Prelacteal feeding practice and its determinant factors among mothers having children less than 6 months of age in Bure district, Northwest Ethiopia: a community-based cross-sectional study

ObjectiveThe main aim of this study was to assess prelacteal feeding practice and its determinant factors among mothers having children less than 6 months of age in Bure district, Northwest...

Knowledge, attitudes and practices regarding neonatal jaundice among caregivers in a tertiary health facility in Ghana.

Neonatal jaundice is a major reason babies are frequently re-admitted after hospital discharge following delivery. One means of improving neonatal care and reducing potential mortality associated with neonatal jaundice in resource-limited settings is to create awareness among caregivers. Caregivers who tend to have higher knowledge and awareness, also have positive attitudes, and are not guided by outmoded socio-cultural beliefs and practices are more likely to seek early care and treatment for neonatal jaundice. This study investigated caregivers' knowledge, attitude and practices regarding neonatal jaundice in a tertiary health facility in the Volta region of Ghana. This was a descriptive cross-sectional study that employed a quantitative approach for data collection. A total of 202 caregivers from the Ho Teaching Hospital in the Volta region of Ghana were sampled using a systematic random sampling strategy where quantitative data was collected using a questionnaire and analyzed with STATA version 14.0. Ordered logistic regression was used to determine the factors that were associated with caregivers' knowledge regarding neonatal jaundice and attitude after controlling for relevant covariates. Less than half of the caregivers demonstrated good knowledge (45.5%) and attitude (47.5%) but 58.9% had good practices regarding neonatal jaundice. Caregivers who had prior awareness and education on neonatal jaundice were three times more likely to have good knowledge about jaundice than those without previous education [AOR = 3.02, (95%CI: 1.59-5.74), p = 0.001]. A caregiver employed in the public sector was two times more likely to have a good attitude about jaundice than those employed in the private sector [AOR = 2.08, (95%CI: 1.03-4.21), p = 0.042]. Less than two thirds of the caregivers demonstrated good practice with limited knowledge and poor attitude. Efforts to promote well informed and improved caregivers' attitude will advance positive maternal health-seeking behavior and reduce disabilities and death through early detection and intervention of infants with neonatal jaundice. Public awareness and education about neonatal jaundice especially among caregivers in the private sector should also be intensified.

Maternal Health-Seeking Behavior and Associated Factors in the Democratic Republic of the Congo.

Maternal health-seeking behavior (MHSB) is crucial for maternal health. However, little is known about MHSB in the Democratic Republic of the Congo (DRC). This study aims to evaluate the situation and socioeconomic associates of MHSB in the DRC. Based on the responses of 8,360 participants in a nationally representative survey, we adopted a K-modes cluster analysis algorithm to categorize women into three groups (i.e., infrequent service-users, partial service-users, and full service-users) according to their recent MHSB. Multinomial logistic regression was applied to identify the associated predictors of MHSB. The results show that most women (90.29%) did not receive integral maternal health services, including antenatal care, institutional delivery, and postnatal care. Compared with their counterparts, women who received higher maternal educational attainment, had good HIV-related knowledge, lived in urban regions, and lived in wealthier households were more likely to be partial service-users or full service-users. Women exposed to mass media at least once a week were more likely to be full service-users rather than infrequent service-users. The majority of participants who lived in Kasai and near provinces were infrequent service-users, indicating poor MHSB status in the region. Interventions to promote maternal health knowledge and awareness are highly recommended to improve MHSB in the DRC.

Household Hunger, Poverty, and Childcare in 5 States of Nigeria and Their Impacts on Nutritional Outcomes in Preschool Children.

This article presents findings from baseline surveys in 5 states of Nigeria to assess the nutritional outcomes on target groups on attaining the UN Sustainable Development Goal 2. The augmented regression technique was applied to analyze data from a sample of 1642 households with at least 1 child under the age of 5 years (U5) and their mothers or caregivers out of a total of 2500 households that were drawn from the 250 enumeration areas of the Nigeria Bureau of Statistics in the 5 states. The results support the growing evidence base that poverty and household hunger are pervasive. The incidence of poverty highlights inequalities among states. The combination of poverty and hunger was mirrored in the damning extent to which all forms of malnutrition coexisted in children U5, particularly during the second year of infancy and among poor households. Evidence from this study points to poor dietary quality of complementary food rather than other childcare practices as majorly responsible for child malnutrition. Child wellness was positively affected by maternal health-seeking behavior but negatively by the poverty probability index of the household. Notably, maternal health-seeking behavior played a more relevant role in child wellness than mothers' educational attainment.

Temporal relationship between Women\u2019s empowerment and utilization of antenatal care services: lessons from four National Surveys in sub-Saharan Africa

BackgroundIn November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women’s empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women’s empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women’s empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model.MethodsThe most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women’s empowerment captured in the DHS. The 30 variables on women’s empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results.ResultsThe proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women’s empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries.ConclusionThis study highlights the significant impact of women’s empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.

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.