Use Of Maternal Health Services Research Articles

Predictors of health facility childbirth among unmarried and married youth in Uganda.

Uganda has a high maternal mortality rate combined with poor use of health facilities at childbirth among youth. Improved use of maternal health services by the youth would help reduce maternal deaths in the country. Predictors of use of health facilities at childbirth among unmarried compared to married youth aged 15-24 years in Uganda between 2006 and 2016 are examined. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey. This analysis was among a sample of 764 unmarried, compared to 5,176 married youth aged 15-24 years. Overall, unmarried youth were more likely to have a childbirth within the health facilities (79.3%) compared to married youth (67.6%). Higher odds of use of health facilities at childbirth were observed among youth with at least secondary education (OR = 2.915, 95%CI = 1.747-4.865 for unmarried vs OR = 1.633, 95%CI = 1.348-1.979 for married) and frequent antenatal care of at least four visits (OR = 1.758, 95%CI = 1.153-2.681 for unmarried vs OR = 1.792, 95%CI = 1.573-2.042 for married). Results further showed that youth with parity two or more, those that resided in rural areas and those who were engaged in agriculture had reduced odds of the use of health facilities at childbirth. In addition, among married youth, the odds of using health facilities at childbirth were higher among those with at least middle wealth index, and those with frequent access to the newspapers (OR = 1.699, 95%CI = 1.162-2.486), radio (OR = 1.290, 95%CI = 1.091-1.525) and television (OR = 1.568, 95%CI = 1.149-2.138) compared to those with no access to each of the media, yet these were not significant among unmarried youth. Frequent use of antenatal care and higher education attainment were associated with increased chances of use of health facilities while higher parity, rural residence and being employed in the agriculture sector were negatively associated with use of health facilities at childbirth among both unmarried and married youth. To enhance use of health facilities among youth, there is a need to encourage frequent antenatal care use, especially for higher parity births and for rural residents, and design policies that will improve access to mass media, youth's education level and their economic status.

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

BackgroundSeveral studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.MethodsThis study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.ResultsOverall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].ConclusionDecomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

Use of and barriers to maternal health services in southeast Chad: results of a population-based survey 2019

ObjectivesChad reports the second highest maternal mortality worldwide. We conducted a survey in Sila region in southeast Chad to estimate the use of maternal health services (MHS) and to identify...

Level of Knowledge and Awareness of Pregnant Women about the Coronavirus Pandemic (COVID-19): An Assessment from a Developing Country

Pregnant women may experience psychological difficulties during the pregnancy experience. Being pregnant during the Covid-19 pandemic process carries pregnancy experiences to a different dimension. Pregnancy is among the vulnerable groups against respiratory tract infections. Health systems support services should be provided to women of reproductive age and pregnant women during the COVID-19 pandemic. This study aims to determine the information needs of pregnant women during the COVID-19 epidemic and to contribute to increasing the quality of health care services to be provided.The sample of this study consisted of 254 pregnant from Trakya University Medical Faculty Obstetrics Clinic in Turkey. The study was conducted from December 2019 to October 2021. Two scales were used in our study. Participants were first evaluated with a personal information form. The scales we used in our study, Perceived Stress Scale-10 (PSS-10), Beck Anxiety Inventory (BAI) were used.In our study; concerns of pregnant women for their own health, their unborn baby (children) and the postpartum period were significantly higher during the COVID-19 pandemic. In addition, the COVID-19 pandemic has demonstrated the need for optimal community use of maternal and child health services. As the time of birth approached, the feeling of pregnant women was increasing.Developing countries may be the weakest part of the chain to stop the spread of current and future epidemics.It is necessary to carry out a well-planned, high-quality and structured training program in order to increase the level of social awareness and contribute to better process management in pregnant women.

The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa.

ABSTRACT.Facility births and antenatal care (ANC) are key to improving maternal health. This study evaluates the relationship between physician and nurse/midwife densities and the use of key maternal health services in sub-Saharan Africa (SSA). We matched individual-level maternal health service indicators from Demographic and Health Surveys between 2008 and 2017, to country-level physician and nurse/midwife per-capita densities, across 35 SSA countries. We performed univariate and multivariate probit regression analyses to evaluate the association between healthcare worker (HCW) densities and facility births as our primary outcome and additional ANC services as secondary outcomes. We controlled for established maternal health predictors, including literacy, child marriage, reported problems accessing healthcare, GDP per capita, political instability, and government effectiveness scores. HCW density across SSA was low at 0.13 physicians and 0.91 nurses/midwives per 1,000 people, compared with 2010 worldwide mean densities of 1.33 and 3.07, respectively. The probability of facility birth increased by 9.8% (95% CI: 2.1–17.5%) for every additional physician per 1,000 people and 8.9% (95% CI: 7.1–9.7%) for every additional nurse/midwife per 1,000 people. HCW densities were also associated with increased likelihood of ANC by the respective provider type, and with antenatal testing for preeclampsia (urine and blood pressure checks). Other ANC services demonstrated variable relationships with HCW densities based on provider type. In 35 SSA countries, HCW density was positively associated with many key measures of maternal health service utilization including facility birth and ANC testing for preeclampsia.

Disrespect and abuse during focused antenatal care and associated factors among pregnant women who visited public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia.

Maternal disrespect and abuse are the top significant barriers to the use of maternal health services. However, poor attention has been given to the hospitality and suitability of care provided to women in the facilities where they have been moved to utilize health services. This study is aimed to assess the prevalence of maternal disrespect and abuse during focused antenatal care and its associated factors among pregnant women who visit public health facilities in Awsi Rasu of Afar Region Northeast Ethiopia. Institution-based cross-sectional study design was employed from March 1 to 30, 2022 in selected health facilities of the Awsi Rasu of Afar Region, Northeast Ethiopia. A total of 1278 mothers were included using consecutive sampling techniques. The data were entered into Epi-data version 3.1 and exported to SPSS version 23.0 for statistical analysis. Statistical significance is declared using adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI). The overall prevalence of disrespect and the abusive experience was 56.7% (95% CI: 54-59.3%). A low average monthly income of less than or equal to 3000 Ethiopian birrs (AOR = 0.72; 95% CI: 0.55-0.94), Age (20-25) years (AOR = 2.33; 95% CI 1.72-3.2), having no formal education (AOR = 2.01; 95% CI: 1.35-3.15), and having unplanned pregnancy (AOR = 1.6; 95% CI: 1.21-2.01) were significantly associated with disrespect and abuse during focused antenatal care. The prevalence of disrespect and abusive experience during antenatal care in the study area was high relative to other studies. In the multivariable logistic regression model age of the mother (20-25 years), no formal education, low family income, and unplanned pregnancy are the predictors of disrespect and abusive care. Providing respectful health care during antenatal care with a suitable approach for all mothers irrespective of their age, unplanned pregnancies, and educational status is the most substantial to encourage maternal service use.

Antenatal care service utilization among women of recent delivery: Analysis of the determinants of quality of care in selected health facilities in Burayu Town, Oromia

In Ethiopia, although the use of maternal health services, including antenatal care has improved, most of the mothers do not attend and use a minimum number of four visits and the six-core set of items of ANC services respectively recommended by the World Health Organization (WHO). Therefore, the objective of the study was to investigate determinants and quality of ANC in the Burayu Healthcare center, Ethiopia. A cross-sectional study was conducted on 420 mothers who gave birth within the past six months as of March to June 2021 at Burayu Healthcare center, Ethiopia. Data were entered into Epi data version 3.1 and exported to STATA version 14 software. Multivariable logistic and Negative Binomial regression models were used to determine the determinants of the two outcome variables. Among the 420 mothers included in this study, the majority of the mothers (68.6%) attended 4+ ANC visits and a very small proportion (1.9%) of mothers received all the six selected elements of ANC services. In multivariable logistic regression analysis of the determinants of frequency of ANC visits, women who were from urban, early starters of ANC visit, those with inter-pregnancy of less than or equal to 24 months and who had pregnancy-related acute illness had higher odds of receiving at least 4+ visits compared to their respective reference categories. Similarly in multivariate negative binomial regression analysis, married mothers, mothers with morbidity history, pregnancy-related acute illness, and who spent less than 30 minutes to reach health facilities were more likely to receive the WHO recommended items/contents of ANC services than their counterparts. Their respective odds ratios were marital statuses (AOR =1.05; 95%CI: 1.01-1.09), mothers with no morbidity history (AOR = 1.03, 95% CI: 1.02–1.06), and the mothers who live at a distance greater than one hour from health facilities (AOR = 1.88; 95% CI: 1.85–1.91). Moderate and extremely low levels of compliance with the WHO minimum recommended ANC visit (4+ visits) and core contents or items of the ANC respectively have been observed in Burayu town. Health promotion programs targeting mothers are vital to increase their awareness about the importance of antenatal services and to improve the coverage and contents of ANC services in Burayu.

Effects of a four-year health systems intervention on the use of maternal and infant health services: results from a programme evaluation in two districts of rural Chad

BackgroundAttendance of maternal and infant care services in rural Chad are consistently low. Our study aimed to assess the use of antenatal (ANC) and postnatal care (PNC) services, health facility delivery and infant health services after 4 years of a health systems intervention for improving the infrastructure, supplies, training and sensitization for maternal and infant health in two districts of rural Chad.MethodsData from a repeated cross-sectional household survey conducted in Yao and Danamadji in 2015 and in 2018 were analyzed. A stratified two-stage cluster sampling methodology was applied to achieve a representative sample of the rural settled and mobile population groups in the study area. A generalized linear model was applied to determine the health care utilization rates. Multivariate regression models were used to assess the association between the programme intervention and utilization outcomes of selected maternal and infant health services.ResultsComplete datasets were available for 1284 households at baseline. The endline analysis included 1175 households with complete survey data. The use of at least one ANC amongst pregnant women increased in both settled communities (from 80% in 2015 to 90% in 2018) and amongst mobile pastoralist communities (from 48% in 2015 to 56% in 2018). The rate of home delivery among settled communities and mobile pastoralists changed little between baseline and endline and remained high for both population groups. Individuals that were covered by the health systems intervention were however significantly more likely to attend ANC and less likely to give birth at home. PNC services only showed improvements amongst the settled communities (of 30%). Infants’ reported health outcomes and vaccination coverage considerably improved; the latter especially among mobile pastoralist (from 15% in 2015 to 84% in 2018).ConclusionA combination of health systems strengthening interventions was associated with an increased use of certain maternal and infant health services. However, to facilitate equitable access to and use of health care services in particular in times of increased vulnerability and by certain population groups in hard-to-reach areas, reinforced health education and culturally adapted communication strategies, including gender-specific messaging will be needed over a sustained period.

Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study

BackgroundDisparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal.MethodsThe study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05.ResultsThe results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group.ConclusionThe IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.

Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya.

Background: Community perceptions of quality of maternal healthcare services—including Person-centered maternity care (PCMC)—influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors.Materials and Methods: We used data from a survey on community perceptions of PCMC in Migori County, Kenya conducted in August 2016. Community members were relatives or friends of women aged 15 to 49 years who gave birth in the 9 wk preceding the survey (N = 198). PCMC was measured using a 30-item scale with three sub-scales for dignity and respect, communication and autonomy, and supportive care. PCMC scores were standardized to range from 0 to 100, with higher scores indicative of higher PCMC. Descriptive, bivariate, and multivariate analyses were performed in STATA (version 14).Results: The average total PCMC score was 62 (SD = 15.7), with scores of 74, 63, and 53 for dignity and respect, supportive care, and communication and autonomy, respectively. Controlling for other factors, respondents who were employed and literate had higher PCMC perception scores than those who were less literate and unemployed. Respondents who rated their health as very good had higher PCMC perception scores than those who rated their health as poor. Female respondents who previously gave birth at a health facility had lower perceptions of dignity and respect than those with no prior facility birth.Conclusion: The findings imply that community perceptions of PCMC, particularly related to communication and autonomy, are poor. Given the effects of these perceptions on use of maternal health services, there is a need to improve PCMC.

Traditional practices influencing the use of maternal health care services in Indonesia.

BackgroundMaternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia.MethodsWe used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates.ResultsTraditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services.DiscussionNot all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

Women’s autonomy and maternal health service utilization among the women’s having less than two years age children in Rautahat district, Nepal

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Despite various attempts and schemes made by government. maternal mortality remains as one of the biggest public health challenges in Nepal. The aim of the study was to assess the association of women autonomy with maternal health service utilization among the women having 2 years children in Paroha municipality ward no. 3 and 4, Rautahat, Nepal.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Cross sectional study was conducted. Simple random sampling was used to select respondents. Data were collected through face to face interview. Data were entered in Epi data and analyzed using SPSS. Chi square test was applied to test the significance of association at 95% confidence interval. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority (76.8%) of the respondents had antenatal care visit and more than half of them had four or more antenatal care visits. similarly, overwhelming majority (88.4%) of the birth were institutional delivery. Almost (91%) of the women had postnatal care visit for their last child. The study indicates that almost (95.5%) of the decisions were made without the involvement of the women. Most of women had medium level autonomy in all aspect (score= 17-32). Autonomy was positively associated with use of maternal health services i.e.; ANC visit (p=0.000), place of delivery (p=0.036), PNC visit (p=0.045).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Findings of the study show that if women autonomy will be higher, there will be increase in maternal service utilization. Whereas autonomy has link with better education and employment opportunity of the women.&lt;/p&gt;

A cross-sectional study on utilization of maternal health services and its determinants among rural population of district Sitapur, Uttar Pradesh

Background: In India, despite substantial improvements in maternal health over the last decade or so, still condition is even poor in rural areas. As per National health policy 2017, target is to reduce MMR to 100 by 2020 and sustaining antenatal coverage at 100%, institutional delivery 80% and skilled attendance of birth 100% by 2025.The study is conducted with the objective to assess the pattern of maternal health service utilization and to identify the factors affecting it.Methods: A community based cross-sectional study was conducted at field practice area of Rural Health Training Centre, Hind Institute Of Medical Sciences, Sitapur with a sample of 208 women selected using systematic random sampling. SPSS Statistics 20.0 was used for data entry and calculation of statistical tests.Results: ANC utilization was found to be 70.7% whereas minimum recommended ANC visits were 50%. Only 54.8% deliveries were found to be institutional whereas 59.1% women received at least one postnatal check-up in our study. Most common reason for not utilizing ANC, Institutional delivery and PNC services was found to be tradition, availability of trained person and no need respectively. A highly significant association was found between maternal health service utilization and woman’s education, partner’s education, partner’s occupation, birth order and standard of living index (p&lt;0.05).Conclusions: This study established that educating the population, empowering women, promoting maternal health service utilization in multipara’s and improving the socio-economic status of the family would yield greater results in increasing the use of maternal health services.

Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia-An Analysis of Demographic Health Surveys.

Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined associations between household availability of improved drinking water and sanitation, respectively, and use of maternal and child health (MCH) services in South Asian countries. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0–36 months (n = 145,262). Types of households’ water source and sanitation facilities were categorized based on the World Health Organization and UNICEF’s definitions of “improved” and “unimproved”. We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, and reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water source was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. Approaches addressing water/sanitation and MCH services across sectors could be a suggested public health strategy.

The Tasmanian Conception to Community (C2C) Study Database 2008-09 to 2013-14: Using linked health administrative data to address each piece in the puzzle

BackgroundTasmania, Australia has a small widely dispersed regional and rural population. The Conception to Community (C2C) Study Database was established as a research platform to inform service planning and policy development and improve health outcomes for Tasmanian mothers and children. The aims of this study were to establish by maternal socio-demographic characteristics: 1) the distribution of births in Tasmania; 2) hospital utilisation for children from birth to 5-years; and 3) the association between child and maternal emergency department (ED) presentation rates. MethodsPerinatal and public hospital ED and admitted patient data were linked for every child born in Tasmania between 2008-09 to 2013-14, and their mothers. Individualised rates of ED presentations and hospital admissions were calculated from birth to 5-years. Frequent presenters to ED were defined as having at least four presentations per annum. Ratios of ED presentation and hospital admission rates by sociodemographic characteristics (region (north, north-west, south), rurality, maternal age, and area socioeconomic disadvantage) were estimated using mixed-effects negative binomial models, with random intercepts for each child and family. ResultsThe C2C Database is comprised of records for 37,041 children and 27,532 mothers. One-in-ten Tasmanian babies lived in a remote area. The mean yearly rate of ED presentations per child varied by sex, age, region and rurality. Frequent presenters were more likely to reside in the north-west or north, in urban areas, have mothers under 20- years, be male, and live in more disadvantaged areas, with 2.3% of children frequent presenters in their first year of life. The odds of a child being a frequent presenter during their first-year was 6.1- times higher if the mother was a frequent presenter during this period. ConclusionAssociations between maternal and child health service use and combined effects of regionality and rurality highlight opportunities for targeted intervention and service innovations.

Impact of the COVID-19 pandemic and response on the utilisation of health services in public facilities during the first wave in Kinshasa, the Democratic Republic of the Congo

IntroductionHealth service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the...

Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis

BackgroundPersisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia.MethodsCross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women’s proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality.ResultsSignificant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women’s decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale.ConclusionsSpatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations.

The maternal health study: Study design update for a prospective cohort of first-time mothers and their firstborn children from birth to age ten.

Maternal health is critical to the health and well-being of children and families, but is rarely the primary focus of pregnancy and birth cohort studies. Globally, poor maternal health and the exposure of women and children to family violence contribute to the perpetuation and persistence of intergenerational health inequalities. The Maternal Health Study was designed to investigate the contribution of social and obstetric risk factors to common maternal physical and psychological morbidities. Over time, our focus has expanded to include mother-child pairs and investigation of intergenerational trauma and family violence. A total of 1507 first-time mothers were recruited in early pregnancy from six public hospitals in Melbourne, Australia, in 2003-2005. Women completed questionnaires or telephone interviews in early pregnancy (≤24weeks); at 32weeks' gestation; at three, six, nine, 12 and 18months postpartum; and at four and ten years. At ten years, women and children were invited to participate in face-to-face interviews, which included direct assessment of children's cognitive and language development. A wide range of obstetric, social and contextual factors have been measured, including exposure to intimate partner violence (IPV) (1-year, 4-year and 10-year follow-up). 1507 eligible women were recruited at a mean gestation of 15weeks. At one year, four years and ten years postpartum, 90.0%, 73.1% and 63.2% of the original cohort took part in follow-up. One in three women in the study (34.5%) reported exposure to IPV in the first ten years of motherhood: 19% in the first 12months postpartum, 20% in the year prior to four-year follow-up and 18.3% in the year prior to ten-year follow-up. The study affords a unique opportunity to examine patterns of maternal and child health and health service use associated with exposure to IPV.

Analyzing the Impact of Lady Health Worker Program on Utilization of Maternal Health Services in Community With A Lady Health Worker in Sindh Province

The study aims to analyze impact of Lady Health Worker program on use of maternal health services in community with a lady health worker. The main focus was the rural districts of Sindh for this case study. The maternal health service is determined by at least four Antenatal care (ANC) visits provided to mother and receipt of at least two Tetanus Toxoid (TT) injections to mother during pregnancy. These have direct impact on maternal mortality rate and infant mortality rate. Secondary data pertaining to all districts of Sind for three years (2017-2019) was collected from the Sindh Lady Health Worker program office Hyderabad for analysis purpose. Further secondary data of Pakistan Demographic and Health Survey (2017-18) was also used to see the impact of intervention of LHW program implemented by Ministry of Health Pakistan in 1994 and then devolved to provinces after the implementation of 18th Constitutional Amendment in 2010. The study found that the services provided by the lady health workers in communities in these districts has positively influenced the uptake of maternal health services as determined by the variables like antenatal visits by pregnant mothers to nearest health facilities and receipt of Tetanus Toxoid injection during pregnancy.

Maternal Healthcare Utilization among Mothers Aged 15-24 Years in Indonesia: a Literature Review

Introduction: The use of health care services in mothers was a very important concern in developing countries because it was very beneficial in terms of declining maternal mortality rate, but the use of maternal health services in mothers aged 15-24 years In Indonesia was still not maximized. The purpose of this review was to analyze best practices in the use of maternal health services in mothers aged 15-24 years.Method: The systematic review of this search was done by the publication range was five years ago. Article criteria were articles reviewed by Bestari Partners, government documents and research locations in developing countries. Acquired 10 references that meet predefined criteria.Results: The analysis obtained was the use of maternal health services in mothers aged 15-24 years needs to be increased by looking at the factors that influence among them were seeing from the socio-demography of mothers and husbands, household factors, access to health services and regional factors.Conclusion: These recommendations are aimed at governments, health professionals and families that efforts to increase not only can be done by a single community line, but the whole must also be able to cooperate by the role in the efforts to increase the use of Health care services.