Non-institutional Deliveries Research Articles

Impact evaluation of invisible intimate partner violence on maternal healthcare utilization in Pakistan

IntroductionExisting research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan.MethodsWe analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012–2013 and 2017–2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women’s last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples.ResultsExposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups.ConclusionsPregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.

Analysing Determinants of Institutional Delivery in NFHS-5: A Comprehensive Study in India with a Focus on Caste Dynamics

The benefit of institutional delivery not only impacts maternal health but also reduces newborn mortality and increases overall well-being. This study focused on differences in the determinants of delivering at institution settings in India, with specific importance given to mothers within different caste groups. This is one area that was given less importance in the existing literature, particularly in studies that focused on the determinants of institutional delivery in India. Using data from the National Family Health Survey 5 (NFHS-5), the research explores factors influencing the choice between institutional and non-institutional delivery. Using logistic regression, and after removing influential and large residual observations (outliers), the analysis reveals that sociocultural determinants, including caste, religion, economic status and maternal education, significantly impact delivery preferences. Mothers from Scheduled Castes and Other Caste categories exhibit a higher likelihood of opting for institutional delivery. Economic factors, partner support, family size, maternal education, health-seeking behaviours, age, perceived distance to health facilities and media engagement also play crucial roles. Comparative analyses across caste groups emphasize the influence of wealth and education on institutional delivery choices. The findings underscore the need for having targeted interventions addressing diverse sociocultural contexts to improve maternal healthcare outcomes and reduce health disparities in India. Efforts should focus on awareness campaigns and overcoming challenges to promote the benefits of institutional delivery.

Correlates of non-institutional delivery to delayed initiation of breastfeeding in Nigeria: logit-decomposition and subnational analysis of population-based survey

BackgroundStudies have connected newborn delivery settings and modality to optimal breastfeeding, but how it influences untimely initiation, mostly prevalent in sub-Saharan Africa is unknown. Hence, the role of home delivery on delay initiation of breastfeeding (DIBF) in Nigeria was investigated to inform evidence-based strategy for improved breastfeeding practice.MethodologyThis is a secondary analysis of births (11,469 home and 7632 facility delivery) by 19,101 reproductive age women in the 2018 NDHS. DIBF is the outcome, home birth is the exposure, and explanatory variables were classified as: socio-demographics, obstetrics and economic factors. Descriptive statistics (frequencies and percentages) were reported, and bivariate (chi-square) analysis was carried out at 20% (p < 0.20) cutoff point. Multivariable logistic regression assessed the probability and significance of the outcome per place of birth. Multivariate decomposition further evaluated the endowment and coefficient effect contribution by independent factors to the outcome. Analysis was carried out at p < 0.05 (95% confidence level) on Stata.Results56.6% of mothers DIBF, with 37.1% and 19.5% from home and facility delivery, respectively. Home delivery (AOR = 1.34, 95% CI 1.17–1.52) increase the chance of DIBF by 34%, while DIBF probability reduces by 26% in facility delivery (AOR = 0.74, 95% CI 0.65–0.85). DIBF is 5 times more likely in caesarian section delivery (AOR = 5.10, 95% CI 4.08–6.38) compared to virginal birth in facility delivery. Skilled antenatal provider, parity and wealth are negatively associated with DIBF in home birth, while undesired pregnancy, rural residency, partial/no skin-to-skin contact and large child size positively influence DIBF in both home and facility delivery. Skilled antenatal provider (C = − 66.3%, p < 0.01) and skin-to-skin contact (C = − 60.6%, p < 0.001) contributed most to reducing the negative DIBF effect with 69% and 31% overall characteristics and coefficient effect component, respectively. DIBF is more likely in Bauchi and Sokoto but less likely in Bayelsa.ConclusionsHigh DIBF prevalent in Nigeria was largely due to elevated rate of home birth, positively associated with DIBF. Caesarian section delivery though heightens the chance of DIBF in facility delivery. Strengthening utilization of skilled provider and skin-to-skin contact can eliminate two-third of the adverse DIBF effect and improve early initiation rate. Adopting this strategy will bridge home-facility delivery gap to achieve optimal breastfeeding practice.

Determinants of non-institutional childbirth: Evidence from the Peruvian demographic and health survey

ObjectiveWe aimed to evaluate the determinants of non-institutional delivery among women of childbearing age in Peru. MethodsWe conducted a secondary analysis of data from the Peru 2019 Demographic and Family Health Survey (ENDES). This multi-stage survey sampling is representative at the urban-rural, regional, and national levels. The outcome variable was place of delivery, collected by self-reporting. Binary logistic regression models were used to assess the factors associated with non-institutionalized delivery. Thus, we estimated crude and adjusted odd ratios (aOR). For the multivariable model, the manual forward selection method and the Wald test were used to obtain a final parsimonious model. ResultsThe final sample included 14,061 women of reproductive age between the ages of 15 and 49. The prevalence of non-institutional delivery was 7.8 %. Multivariate regression analysis found that having a secondary education (aOR:0.48; 95 % confidence interval [CI]:0.39–0.58) or higher (aOR:0.57; 95 %CI:0.42–0.78); belonging to the second (aOR:0.26; 95 %CI:0.20–0.33), third (aOR:0.28; 95 %CI:0.21–0.38), fourth (aOR:0.21; 95 %CI:0.13–0.33), or fifth wealth quintile (aOR:0.15; 95 %CI:0.09–0.27); and suffering intimate partner violence (aOR:0.76; 95 %CI:0.64–0.91) were associated with lower odds of non-institutional delivery, while not having some type of health insurance (aOR:3.12; 95 %CI:2.47–3.95), living in a rural area (aOR:1.93; 95 %CI:1.54–2.42), and having had three or more deliveries (aOR:1.36; 95 %CI:1.07–1.72), were associated with higher odds of non-institutional delivery. ConclusionsWe found that not having health insurance, residing in a rural area, and having had three or more deliveries were factors associated with non-institutional delivery in women of childbearing age. We propose that should focus public health strategies towards providing education to women about maternal health, and likewise, facilitating access to specialized health centers for rural populations.

Practice of non-institutional delivery and its associated factors among women who gave birth in Southern Ethiopia, 2022

BackgroundNon-institutional delivery is one of the major reasons that results in high mortality rates for a mother and her neonate. The World Health Organization estimates that only 43% of mothers have access to skilled delivery services. A recent Ethiopian Mini Demographic Survey indicated that more than half of Ethiopian women have given birth non-institutionally. This shows that maternal health remains a major public health challenge in Ethiopia, irrespective of the government’s measures for institutional delivery. So, the aim of this study was to assess the practice of non-institutional delivery and its associated factors among women who gave birth in the study area.MethodsA community-based cross-sectional study was carried out on 260 study participants from June 1 to July 1, 2022, in Boloso Bombe Woreda. Data collection was done using a structured questionnaire, and systematic sampling techniques were used to select the study subjects. The data was entered into the EPI data version 3.1 and analyzed using SPSS version 25. The adjusted odds ratio, along with 95% confidence intervals, was used, and the level of statistical significance was declared at a P-value of 0.05.ResultOut of 260 women interviewed, 252 (97%) pregnant women participated in the interview. The prevalence of non-institutional delivery among study participants was 68.7% (95% CI: 63.1–72.9). Mothers who were a daily laborer [AOR = 6.6;95%CI(3.6(1.2–11.2), last pregnancy planned [AOR = 0.4; 95%CI (0.4(0.2–0.8)), an absence of antenatal care contacting history [AOR = 3.3; 95%CI (1.3–8.6)], respondents’ knowledge on the labor complication [AOR = 3; (95%CI); 3.5(2.2–6.1)], and place of first delivery [AOR = 8.7 95%CI(3.2–23)] were factors that significantly associated with practice of non-institutional delivery.ConclusionThis study indicated that the majority of study participants practiced non-institutional delivery in this study area. Thus, we strongly recommend that all responsible bodies take immediate action, such as community health education on pregnancy-related complications, encouraging ANC visits, and raising awareness of the advantages of preventing non-institutional delivery in order to reduce non-institutional pregnancy practices and improve the factors identified.

Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women’s knowledge of severity of illness

BackgroundLittle is known whether women’s knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap.MethodsData were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used.ResultsData were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women’s knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54–2.05), 2.28(1.99–2.61), and 2.78 (2.34–3.32) on knowledge of 1, 2, and 3–5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12–2.90), 2.22(1.42–3.48), and 3.33(2.00–5.54), respectively. In women with institutional deliveries, it was 1.49(1.32–1.68), 2.02(1.78–2.28), and 2.34(1.95–2.79), respectively. Other strong predictors were women’s education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor.ConclusionOur findings suggest that pregnant women’s healthcare seeking behaviour is influenced by women’s knowledge of danger signs and symptoms during pregnancy, women’s education, socioeconomic status, access to media, husband’s, in-laws’ and relatives’ decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women’s knowledge, education, and social status.

Effect of goal-oriented prenatal education on birth preparedness, complication readiness and institutional delivery among semi-urban pregnant women in Nigeria: A quasi-experimental study.

High maternal mortality has been associated with inadequate Birth preparedness and Complication Readiness (BPCR) and non-institutional delivery in developing countries. Therefore, there is a need for proven interventions that will improve BPCR and institutional delivery to reduce maternal mortality. Therefore, this study evaluated the effects of Goal-Oriented Prenatal Education (GOPE) on pregnant women's BPCR and institutional delivery. The study adopted a quasi-experimental two-group pre and post-test design. Two Local Government Areas (LGAs) were randomly selected from the six semi-urban LGAs in Ibadan. These LGAs were randomized into an intervention and control group. Two Primary Healthcare Centres (PHCs) were randomly selected from each LGA, and 400 pregnant women who registered for antenatal care in the selected PHCs, and met the inclusion criteria were purposively selected to participate in the study. A validated questionnaire and checklist were adapted for data collection at baseline and post-intervention. The pregnant women in the intervention group received GOPE focusing on knowledge and attitude to BPCR. Participants' place of birth was documented at delivery. Data were analyzed using descriptive statistics, and the Mann-Whitney U test at α0.05. Good knowledge of BPCR was found in 65.5% of pregnant women at baseline and 91.8% post-intervention. Good BPCR practice was found in 95.3% and 73.1% of women in the intervention and control groups respectively. At delivery, 93.5% and 53.5% had institutional delivery in the intervention and control groups respectively. A significant difference (p<0.001) was observed in BPCR knowledge and attitude post-intervention, as well as in BPCR practice and institutional delivery between women in the intervention and control group. Goal-oriented prenatal education improved birth preparedness and complication readiness as well as institutional delivery among pregnant women. This should be integrated into routine prenatal education in Nigeria.

Practice of Non-Institutional Delivery and Its Associated Factors Among Women Who Gave Birth in Southern Ethiopia, 2022.

Since 2000, the Ethiopian ministries of health and other stakeholders have taken some measures to enhance institutional delivery. However, the Ethiopian Demographic Health Survey 2019 report indicated that more than 50% of Ethiopian reproductive-age women gave birth outside health facilities. Therefore, the purpose of this study was to assess the practice of noninstitutional delivery among women who gave birth at Boloso Bombe Woreda (district) in southern Ethiopia. A community-based cross-sectional study was carried out on 252 study participants from June to July 2022 in Boloso Bombe Woreda. Data collection was done using a structured questionnaire and systematic sampling techniques were used to select the study subjects. Data were entered into the EPI data, version 3.1, and analyzed using SPSS, version 25. Adjusted odds ratios (AORs), along with 95% confidence intervals (CIs), were used and the level of statistical significance was declared at a p-value of 0.05. In this study, 252 participants completed the survey, with a 97% response rate. The prevalence of noninstitutional delivery among study participants was 68.7% (95% CI: 63.1-72.9). In this study, mother's occupation, such as working as a daily laborer (AOR = 3.6; 95% CI [1.2-11.2]); absence of antenatal care history (AOR = 3.3; 95% CI [1.3-8.6]); poor knowledge of labor complications (AOR = 3.5; 95% CI [2.2-6.1]); and place of first delivery (AOR = 8.7; 95% CI [3.2-23]) were factors that were positively and significantly associated with the practice of noninstitutional delivery. However, last pregnancy planned was negatively associated with the practice of noninstitutional delivery (AOR = 0.4; 95% CI [0.2-0.8]). This study indicated that the majority of study participants practiced noninstitutional delivery in this study area. Therefore, we strongly recommend that all responsible bodies should take immediate action to reduce the practice of noninstitutional delivery and improve those identified factors.

Birth Preparedness Plans and Status Disclosure Among Pregnant Women Living with HIV Who are Receiving Antiretroviral Therapy in Ibadan, Southwest, Nigeria.

Promoting the maternal health of pregnant women who are living with human immunodeficiency virus (HIV; [PWLH]) is key to reducing maternal mortality and morbidity. Thus, inadequate birth preparedness plans, non-institutional delivery, and status concealment among PWLH contribute to the spread of HIV infection and threaten the prevention of mother-to-child transmission (PMTCT). Therefore, this study aimed to assess the birth preparedness plan and status disclosure among PWLH, as well as the prevalence of HIV infection among pregnant women. The study adopted a descriptive cross-sectional research design; a quantitative approach was used for data collection. Three healthcare facilities that represented the three levels of healthcare institutions and referral centers for the care of PWLH in the Ibadan metropolis were selected for the recruitment process. A validated questionnaire was used to collect data from 77 participants within the targeted population. Ethical approval was obtained prior to the commencement of data collection. The prevalence rate of HIV infection among the participants was 3.7%. Only 37.1% of the participants had a birth preparedness plan. A total of 40% of the participants tested for HIV, because testing was compulsory for antenatal registration. Only 7.1% of the participants had their status disclosed to their partners. Although 90% of the participants proposed delivering their babies in a hospital, only 80% of these participants had their status known in their proposed place of birth. The prevalence of HIV infection among pregnant women is very low, which is an indication of improved maternal health. However, the level of birth preparedness plan and status disclosure to partners are equally low, and these factors can hinder PMTCT. Institutional delivery should be encouraged among all PWLH, and their HIV status must be disclosed at their place of birth.

Trends and patterns of maternal deaths from 2015 to 2019, associated factors and pregnancy outcomes in rural Lagos, Nigeria: a cross-sectional study.

maternal mortality is still a problem attracting global attention, with an estimate of 289,000 maternal deaths annually. Over half of these deaths occur in sub-Saharan Africa, with Nigeria accounting for 14% of the global maternal deaths. This study assessed the trends and patterns of maternal deaths, associated factors, and pregnancy outcomes in a rural area in Lagos, Nigeria. this study adopted a cross-sectional descriptive research design. A retrospective assessment of all maternal deaths that occurred at Epe Local Government Area (LGA) from 2015 to 2019 was done. A validated checklist was used to retrieve information from the records of 96 deceased. Ethical approval was obtained for the study. Data collected were analyzed using SPSS version 20.0. Analyses were done using descriptive and inferential statistics at a significance level of 0.05. highest number of maternal deaths 24 (23%) were recorded in the year 2015. The maternal mortality ratio was 1,645 per 100,000 live births. The highest direct cause of maternal death was eclampsia (27.1%), while the highest indirect cause was anemia (5.2%). Chances of maternal death increased with nonregistered pregnancy (71.9%), and non-institutional delivery (79.2%). Poor pregnancy outcomes include; stillbirth (60.4%), and preterm babies (62.5%). Statistical associations were found between maternal deaths and parity (p = 0.004). the maternal mortality ratio in rural areas is still very high and far from the proposed global target of 70 per 100,000. These maternal deaths are linked to direct and indirect causes. Maternal deaths could result in poor pregnancy outcomes.

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

BackgroundDespite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions.MethodsThis study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes.ResultsAmong 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference.ConclusionsPreterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.Trial registrationThe trial is registered with ClinicalTrials.gov, number NCT01824940.

Individual and community-level factors associated with non-institutional delivery of women of childbearing-age in Nigeria

Maternal health is a major concern in Africa especially due to high level of maternal mortality in the region. A significant cause of high mortality is the unavailability of health facilities and preference for home-based delivery often carried out by unskilled health attendants. Reports reveal that 69% of young women in Nigeria opt for home-based delivery in Nigeria and some of these mothers lose their lives as a result of childbirth complications that are not properly attended to. This trend calls for urgent concern in the nation’s health system. Against this backdrop, this study examined the determinants of non-institutional delivery among women of reproductive age in Nigeria using the country’s National Demographic Health Survey [NDHS] (2018. Demographic health survey data. NPC and ICF, Abuja, Nigeria and Rockville. MD, USA) The data for this study include 12,567 of women of childbearing-age contained in the NDHS data. To analyse the data, the multilevel binary logistic regression was used to examine the determinants of non-institutional delivery among the women of childbearing-age. The results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The result revealed that 56.8% of women preferred to have their children outside health institutions. The findings further revealed that educated women including urban dwellers, women with some level of formal education, high exposure to news media, high level of income and women with significant level of autonomy were less likely to deliver their babies outside health institutions. Based on the findings of the study, that there is the need to expand educational opportunities for Nigerian women, enhance and strengthen advocacy, and utilise focused group discussions, family outreach programmes and peer education to educate mothers on the benefits of using healthcare facilities during childbirth.

Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.

Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. The prevalence of adverse birth outcomes was: miscarriage: 5.0%[95% confidence interval (CI), 4.4, 5.7]; stillbirth:2.3% (95% CI 1.9, 2.7);preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); andneonatal mortality:31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthenedmanagement of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.

Negative Incentives for Noninstitutional Births Are Associated With a Higher Rate of Facility-Based Births in the Eastern Visaya Region, Philippines.

In the Philippines, the "no home-birthing policy" implemented in 2008 has encouraged local governments to endorse ordinances that prohibit noninstitutional deliveries (NIDs). The Philippines' social insurance scheme has also enabled them to provide incentive payments to women who deliver at birthing facilities (BFs). This study evaluated whether these positive and/or negative incentives were associated with an increased facility-based delivery (FBD) rate and examined challenges in implementing those incentive measures in the Eastern Visaya Region of the Philippines. Cross-sectional data were collected regarding delivery locations during 2017, and barangay-level data were collected regarding positive and negative incentives and the characteristics of 4,371 barangays in the region. Multivariate logistic regression analysis, using "ordinance with nonmonetary sanction" as the reference category, indicated that no ordinance to prohibit NIDs was significantly associated with a lower FBD rate (odds ratio [OR]: 0.90, P=.013), and ordinance with low cash penalty (OR: 1.37, P<.001) and high cash penalty (OR: 2.52, P<.001) had higher FBD rates. Positive incentives were not associated with FBD rates (OR: 1.02, P=.563). The FBD rate was also significantly associated with urban barangay status (OR: 1.45, P<.001), availability of a vehicle (OR: 3.19, P<.001), availability of public transportation to a government BF (OR: 1.25, P<.001), and distance to the most accessible government BF (OR: 0.89, P<.001). Substantial proportions of barangays had no vehicles available for transportation (34.1%) or no available vehicles and no public transportation to a government BF (5.5%). Although negative incentives for NIDs could motivate pregnant women to seek FBD, local governments in the Philippines should be aware of barriers that limit access to government BFs in underserved barangays before introducing those negative incentives. Above all, barangay-level investments in making a vehicle for transporting pregnant women might help address these barriers and increase the FBD rate.

Prevalence and correlates of neurodevelopmental disorders among children in India: a narrative review

Neurodevelopmental disorders (NDD) are seen disproportionately affecting the low-income communities. Paucity of consistent and large-scale studies in India and variations in assessment and diagnostic tools reduce the scope for generalization of prevalence estimates to national level. This review tried to consolidate the existing community-based evidence of the prevalence of NDDs, risk factors and comorbidities among children in India. We searched studies related to the review objectives on search engines PubMed and Google Scholar. The community or school-based studies in India, published in English language were included. The prevalence of each of these NDDs differed in different locations and age groups. The prevalence appeared to be increasing with increase in age. Non-institutional delivery, perinatal asphyxia or delayed crying, low birth weight or prematurity, neonatal illness or neurological infections were significantly associated with the NDDs. Most of the significant risk factors are modifiable with the help of effective programs to improve maternal and child healthcare and nutrition. Further large-scale, good-quality epidemiological studies in community settings are needed to develop and prioritize the delivery of the prevention and rehabilitation interventions.

Factors Associated with Non-Institutional Delivery among Pregnant Women in Nepal

Delivery location may influence maternal morbidity and mortality, especially in developing countries such as Nepal. The aim of this study was to determine factors associated with place of delivery among pregnant women in Nepal in order to inform health policy makers attempting to improve mother and child health. Data from the Multiple Indicator Cluster Survey, conducted in 2014, were retrospectively reviewed. In the survey, women aged 15-49 years were interviewed face-to-face using a structured questionnaire. Study subjects were women who had giving birth within the previous two years. A total of 2,086 women (48.9%) had non-institutional delivery (46.5% at home). Logistic regression models were used to identify significant factors influencing non-institutional delivery. Results showed that increasing educational level and wealth quintile index corresponded to a decreasing percentage of non-institutional delivery. More than half (55.5%) of women from rural areas had a non-institutional delivery. Multiparous women (57.2%) and those having less than 4 antenatal care visits (66.8%) had relatively higher rates of non-institutional delivery. In conclusion, there is a need to intensify education for pregnant women, especially those who have had previous childbirth experience. It is also crucial to target women from poor households, to increase their awareness, and promote institutional delivery.

Neonatal Death with Relation to Institutional Delivery in North-Eastern States of India

Background: Millennium development goal sets target to achieve goal of reducing child mortality for all countries. However decline in neonatal mortality for developing countries was very slow. In India reduction in neonatal mortality was led by institutional delivery along with several other factors. As government of India has implemented various policies to promote institutional delivery. Objectives: This study provides information regarding impact of institutional delivery on neonatal death. Also explains underlying factors which affect institutional delivery. Methods: Present study analyse data from National Family Health Survey, 2015-16 (NFHS-IV). A total of 179752 births (last birth) and 3774 neonatal death were recorded in last 1 Year in Northeastern states of India. A Logistic regression is attempted to understand the correlates of Institutional delivery. Logistic regression model was used to assess the factors responsible for neonatal death in North-Eastern states of India. Results: In Sikkim almost all deliveries taken place at institutions whereas Nagaland is having the highest cases of non-institutional delivery. Highest neonatal death prevails in the state of Assam, Whereas Mizoram and Arunachal Pradesh is having few neonatal death. Conclusion: This study clearly indicates the roll of different socio-economic factors on institutional delivery as a part of to promote neonatal survival. And found that influence of institutional delivery is not much on neonatal death. This may be because there are several variables which affect the pattern of neonatal death of an area. But from the study it is found that delivery at home is still higher in some of the states like Nagaland. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The institutional review board of IIPS Mumbai has given ethical approval.

Mismatch between antenatal care attendance and institutional delivery in south Ethiopia: A multilevel analysis

ObjectivesUptake of maternal health services remains suboptimal in Ethiopia. Significant proportions of antenatal care attendees give birth at home. This study was conducted to identify the predictors of non-institutional delivery...

Efforts to alter the trajectory of neonatal mortality in Malawi: evaluating relative effects of access to maternal care services and birth history risk factors.

BackgroundThe neonatal mortality rate (NMR) in Malawi has remained stagnant at around 27 per 1000 live births over the last 15 years, despite an increase in the uptake of targeted health care interventions. We used the nationally representative 2015/16 Demographic Health Survey data set to evaluate the effect of two types of maternal exposures, namely, lack of access to maternal or intra-partum care services and birth history factors, on the risk of neonatal mortality.MethodsA causal inference approach was used to estimate a population attributable risk parameter for each exposure, adjusting for co-exposures and household, maternal and child-specific covariates. The maternal exposures evaluated were unmet family planning needs, less than 4+ antenatal care visits, lack of institutional delivery or skilled birth attendance, having prior neonatal mortality, short (8-24 months) birth interval preceding the index birth, first pregnancy, and two or more pregnancy outcomes within the preceding five years of the survey interview.ResultsWe included 9553 women and their most recent live birth within 3 years of the survey. The sample’s overall neonatal mortality rate was 18.5 per 1000 live births. The adjusted population attributable risk for first pregnancies was 3.9/1000 (P < 0.001), while non-institutional deliveries and the shortest preceding birth interval (8-24 months) each had an attributable risk of 1.3/1000 (Ps = 0.01). Having 2 or more pregnancy outcomes within the last 5 years had an attributable risk of 3/1000 (P = 0.006). Attending less than 4 ANC visits had, a relatively large attributable risk (2.1/1,000), and it was not statistically significant at alpha level 0.05.ConclusionsOur analysis addresses the gap in the literature on evaluating the effect of these exposures on neonatal mortality in Malawi. It also helps inform programs and current efforts such as the Every Newborn Action 2020 Plan. Increasing access to maternal care interventions has an important role to play in changing the trajectory of neonatal mortality, and women who are at an increased risk may not be receiving adequate care. Recent studies indicate an urgent need to assess gaps in service readiness and quality of care at the antenatal and obstetric care facilities.

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BackgroundNeurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.Methods and findingsWe assessed 3,964 children (with almost equal number of boys and girls distributed in 2–<6 and 6–9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6–9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2–<6 year olds ranged from 2.9% (95% CI 1.6–5.5) to 18.7% (95% CI 14.7–23.6), and for any of nine NDDs in the 6–9-year-old children, from 6.5% (95% CI 4.6–9.1) to 18.5% (95% CI 15.3–22.3). Two or more NDDs were present in 0.4% (95% CI 0.1–1.7) to 4.3% (95% CI 2.2–8.2) in the younger age category and 0.7% (95% CI 0.2–2.0) to 5.3% (95% CI 3.3–8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5–11.2) and 13.6% (95% CI 11.3–16.2) in children of 2–<6 and 6–9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6–9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.ConclusionsThe study identifies NDDs in children aged 2–9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.