Proportion Of Institutional Deliveries Research Articles

Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial

IntroductionMaternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia.MethodsWe conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables.ResultsThe study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar’s Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4).ConclusionThe study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings.Trial registration: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.

Delivery site preferences and associated factors among married women of Panauti Municipality, Kavrepalanchok district, Nepal

Introduction: Maternal mortality is a top global developmental agenda. The main cause of being underutilization of available delivery services especially in a developing country like Nepal. Various socio-demographic, socio-cultural and health service-related factors affect the utilization of these services. Thus, the study aims to identify the delivery site preferences and its associated factors among the married women of Panauti municipality of Kavrepalanchok district.&#x0D; Method: A cross-sectional study was conducted among the married women between the ages of 15-49 y residing in Panauti municipality. The face-to-face interviews were conducted using semi-structured questionnaires. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.&#x0D; Result: A total of 106 women of 15-49 y were included in the study. The proportion of institutional delivery among the participants was 68%. 90.6% of total participants would prefer health facility for their future deliveries; 7.5% were not sure about their preferences and very few (1.9%) preferred to deliver at home. The factors like knowledge regarding safe-motherhood program and age at marriage were found to be significantly associated with their delivery site preference (p&lt;0.05).&#x0D; Conclusion: In a country like Nepal, home delivery is still in practice and pregnancy and childbirth are regarded as normal life events. Thus, efforts should be made to change that perception, increasing utilization of available services and improving maternal and child health. This in turn will help to achieve the Sustainable Development Goal target in reducing the Maternal Mortality Rate.

Factors associated with institutional delivery among mothers who gave birth within 1 year prior to the study at Gilgelbelles town, Northwest Ethiopia: a mixed-methods study

ObjectivesThis study aimed to assess factors associated with institutional delivery among mothers who had delivered within 1 year prior to the study at Gilgelbelles town, Northwest, Ethiopia.DesignA community-based mixed-methods study...

Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighborhood in Delhi, India.

ObjectiveTo estimate utilization of maternal, perinatal healthcare services after the lockdown was implemented in response to the COVID-19 pandemic compared to the period before.MethodsThis study conducted in Dakshinpuri, an urban neighborhood in Delhi, reports data over a 13-month period which includes the period “before lockdown” i.e., October 1, 2019 to March 21, 2020 and “after lockdown” i.e., March 22 to November 5, 2020. The period “after lockdown” included the lockdown phase (March 22 to May 31, 2020) and unlock phase (June 1 to November 5, 2020). Mothers delivered during this period in the study area were interviewed using semi-structured questionnaires. In-depth interviews (IDIs) were conducted in a subsample to understand the experiences, challenges, and factors for underutilization of healthcare services.FindingsThe survey covered a total population of 21,025 in 4,762 households; 199 eligible mothers (mean age 27.4 years) were interviewed. In women who delivered after lockdown against before lockdown, adjusted odds of having >2 antenatal care visits in the third trimester was 80% lower (aOR 0.2, 95% CI 0.1–0.5); proportion of institutional deliveries was lower (93 vs. 97%); exclusive breastfeeding during first 6 months of birth (64.5 vs. 75.7%) and health worker home visitation within 6 weeks of birth (median, 1 vs. 3 visits) were substantially lower. Fear of contracting COVID-19, poor quality of services, lack of transportation and financial constraints were key issues faced by mothers in accessing health care. More than three-fourth (81%) of the mothers reported feeling down, depressed or hopeless after lockdown. The major factors for stress during lockdown was financial reasons (70%), followed by health-related concerns.ConclusionCOVID-19 pandemic-related lockdown substantially affected maternal and perinatal healthcare utilization and service delivery.

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

BackgroundThe Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery.MethodsWe used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother’s locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women’s characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country.ResultsEquipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (β = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (β = − 0.130, 95% CI -0.23, − 0.03) more than in the comparison group.ConclusionsResults indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities’ capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Are the labour rooms of primary healthcare facilities capable of providing basic delivery and newborn services? A cross-sectional study.

Objectives:The study aimed to assess the functionality of labour rooms by evaluating the labour room infrastructure with reference to the standard guidelines, the status of the availability of human resources, the availability of essential equipment and consumables in the labour room and by documenting the knowledge of the healthcare provider in terms of labour room practices. The study also explored the facility parameters associated with its delivery load taking the facility as a unit of analysis.Design:A cross-sectional analytical study.Setting:India has realised the importance of improving the quality of care in public health facilities, and steps are being taken to make healthcare more responsive to women's needs. With an increase in the proportion of institutional deliveries in India, the outcome of the delivery process can be improved by optimising the health facility components.Participants:The study was conducted in 52 health facilities and healthcare providers involved in the delivery process in the selected facilities.Results:The infrastructure of the facilities was found to be the best for medical college followed by district hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs) and subcentres. Similar findings were observed in terms of the availability of equipment and consumables. Lack of healthcare providers was observed as only 20% of the posts for health personnel were fulfilled in CHCs followed by PHCs, subcentres and district hospitals where 43, 50 and 79% of the available vacancies were fulfilled. The level of knowledge of healthcare providers in terms of partograph, active management of the third stage of labour and post-partum haemorrhage ranged as per their designation. The specialists were the most knowledgeable while the Auxiliary Nurse Midwife (AMNs) were the least. All the components of structural capacity, i.e. infrastructure (r2 = 0.377, P value < 0.001), equipment and consumable (r2 = 0.606, P value < 0.001) and knowledge of healthcare providers (r2 = 0.456, P value < 0.001) along with the overall facility score were positively correlated with the average delivery load of the health facility. The results from multivariate linear regression depict significant relation between the delivery load and availability of equipment and consumables (t = 4.015, P < 0.01) and with the knowledge of healthcare providers (t = 2.129, P = 0.039).Conclusions:The higher facilities were better equipped to provide delivery and newborn care. A higher delivery load was found at high-level facilities which can be attributed to better infrastructure, adequate supply of equipment and consumables and availability of trained human resources.

Institutional deliveries and stillbirth and neonatal mortality in the Global Network's Maternal and Newborn Health Registry

BackgroundFew studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality.ObjectivesThe study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth.MethodsWe analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between institutional delivery and mortality rates.ResultsFrom 2010 to 2018, a total of 413,377 deliveries in 80 clusters across 6 sites in 5 countries were included in these analyses. An increase in the proportion of institutional deliveries occurred in all sites, with a range in 2018 from 57.7 to 99.8%. In 2010, the stillbirth rates ranged from 19.3 per 1000 births in the Kenyan site to 46.2 per 1000 births in the Pakistani site and by 2018, ranged from 9.7 per 1000 births in the Belagavi, India site to 40.8 per 1000 births in the Pakistani site. The 2010 neonatal mortality rates ranged from 19.0 per 1000 live births in the Kenyan site to 51.3 per 1000 live births in the Pakistani site with the 2018 neonatal mortality rates ranging from 9.2 per 1000 live births in the Zambian site to 50.2 per 1000 live births in the Pakistani site. In multivariate modeling, in some but not all sites, the reductions in stillbirth and neonatal death were significantly associated with an increase in the institutional deliveries.ConclusionsThere was an increase in institutional delivery rates in all sites and a reduction in stillbirth and neonatal mortality rates in some of the GN sites over the past decade. The relationship between institutional delivery and a decrease in mortality was significant in some but not all sites. However, the stillbirth and neonatal mortality rates remain at high levels. Understanding the relationship between institutional delivery and stillbirth and neonatal deaths in resource-limited environments will enable development of targeted interventions for reducing the mortality burden.Trial registrationThe study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.

Magnitude and Associated Factors of Institutional Delivery Among Reproductive Age Women in Southwest Ethiopia.

BackgroundDespite the global maternal mortality ratio (MMR) fallen by nearly 44% from 1990 to 2015, however, maternal mortality remains a global problem. Reducing maternal morbidity and mortality is a global priority, which is particularly relevant for developing countries like Ethiopia. A good strategy for reducing maternal morbidity and mortality is increasing institutional delivery service utilization. This study aimed to assess the magnitude and associated factors of institutional delivery among reproductive-age women in southwest Ethiopia.MethodsA community-based cross-sectional study was conducted among 526 women at Mizan-Aman town from January 1 to 30, 2019. The data were collected through face-to-face interviews, and a structured questionnaire was used to assess the prevalence and associated factors of institutional delivery among reproductive-age women who delivered in the past one year. The collected data were entered into the Epi Data manager and analyzed using SPSS version 21. Binary logistic regression was done to determine the association between dependent and expected independent variables. Statistical significance was declared at p < 0.05 in the multivariable logistic regression analysis.ResultsOf the 526 mothers interviewed, the proportion of institutional delivery was 76%, 95% CI (72.4%-79.7%). The study also found maternal age 25–34 years (AOR=1.89, 95% CI [1.42–3.26]) and 35 years and above (AOR=3.51, 95% CI [1.52–7.85]), monthly income ≥36 USD (AOR=2.22, 95% CI [1.12–4.13]), being multiparity (AOR=1.98, 95% CI [1.08–3.62]), having ANC visit (AOR=10.5, 95% CI [6.76–28.3]), knowledge of pregnancy danger signs (AOR=5.51, 95% CI [3.46–10.2]) and experience of pregnancy danger signs (AOR=3.86, 95% CI [2.67–7.29]) were significantly associated with institutional delivery.ConclusionThe utilization of institutional delivery service among mothers in the study area was good. But, more effort is needed to increase service utilization to 100%. The provision of the continuous house to house health education regarding institutional delivery is an important segment of intervention that can be done through health extension workers. Besides, counseling mothers on the importance of institutional delivery by health professionals at each ANC follow-up visit plays paramount importance.

Institutional Delivery Among Young Women in Ethiopia: Further Analysis of Trends and Determinants, from the Four Consecutive Ethiopia Demographic and Health Survey.

PurposeAlthough young people have a right to sexual and reproductive health, they are facing inadequate access to information and services. The Ethiopian government has started implementing policies and strategies to eliminate inequalities in reproductive health service use. However, there are huge disparities in institutional delivery utilization between different age groups. Therefore, this study aimed to explore trends and factors associated with institutional childbirth among young women in Ethiopia.MethodsEthiopian demographic and health survey data (EDHS) from 2000 to 2016 surveys were used. Data on the most recent births to women aged 15–24 years that occurred in the 5 years preceding the survey period were extracted. All the four EDHS data were used to examine trends of institutional delivery, whereas determinants for institutional delivery were analyzed from a 2016 dataset by using multivariable logistic regression analysis.FindingsBetween 2000 and 2016, the proportion of institutional delivery among young women increased from 6% (95% CI=3.7–6.5%) to 40.1% (95% CI=30.6–44.3%). The odds of institutional delivery increased for young women who had attended secondary and above education (AOR=2.68; 95% CI=1.559–4.607), started ANC visits early (AOR=1.518; 95% CI=1.095–2.105) and received four or more ANC visits (AOR=1.87; 95% CI=1.370–2.561). However, the odds were lower among young women who had two (AOR=0.31; 95% CI=0.185–0.514), and three or more children (AOR=0.62; 95% CI=0.452–0.849).ConclusionThere is an increase in trend of institutional delivery among young women during the 2000 to 2016 EDHS. Having higher educational levels, early ANC booking, and attending four or more ANC visits were positively associated with institutional delivery. Increased number of children is negatively associated with institutional delivery. Strengthening strategies for improving girls’ education and addressing their socioeconomic and demographic vulnerabilities, and strengthening strategies being implemented for encouraging early and recommended ANC visits is crucial.

Institutional births analysis from labour room registries in North Indian hilly state

Background: India is the second most populous country in the world contributing to one fifth of global deaths among under 5-year-old children. Of these under 5 deaths, Infant mortality contributes to more than 89% and neonatal mortality is responsible for 70% of IMR. Of the many proximal determinants of neonatal mortality, inadequate utilization of health services and poor skills of health care providers contribute significantly. The lack of data constrains targeted interventions for these. This study is an attempt to analyze the existing data quality along with gaps in the reporting system to initiate timely course correction for improved programmatic outcomes.Methods: The labour room birth registries from 12 District hospitals and two Government Medical Colleges in the state of Himachal Pradesh (India) were analyzed. The data was extracted from archives in the State Child health Nodal Officer for the year 2017-2018 and 2018-2019.Results: Over these two years the proportion of institutional delivery has improved. The number of newborns resuscitated remained constant at 4.5%. There was an improved coverage of birth dose immunization. Improvement in Antenatal Corticosteroids coverage among preterm laboring mothers was also observed.Conclusions: Continuous data analysis for improving its quality to take evidence informed decisions is needed. Hands on skill improvement for staff is need of the hour to ensure timely and maximum returns on investment in reproductive and Child Health program.

Quality of maternity care provided by private sector healthcare facilities in three states of India: a situational analysis

BackgroundBetter quality of care around the time of childbirth can significantly improve maternal and newborn survival. In countries like India, where the private sector contributes to a considerable proportion of institutional deliveries, it is important to assess the quality of maternity care offered by private sector healthcare facilities. This study seeks to fill that information gap by analysing baseline assessments conducted for the Manyata program, which aims to improve the quality of maternity care at private facilities.MethodsAn observation checklist based on 16 clinical standards endorsed by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) was used to assess 201 private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh. Data on facility characteristics came from profiles completed when facilities enrolled in Manyata. Differences in the mean number of standards met were analysed by facility characteristics and the availability of essential supplies.ResultsAround half (47.1%) of all nursing staff engaged in maternity care services at these private healthcare facilities were under qualified. The mean number of clinical standards met by facilities was 3.2 (SD 2.4). Facilities with a monthly delivery load between 20 and 50 met a significantly higher number of standards, as did facilities that had more than 70% of essential supplies available. Both these factors were also significant in a multiple linear regression analysis.ConclusionsThe overall quality of maternity care in private healthcare facilities is poor in all three states, especially for clinical standards related to management of complications.

Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

BackgroundOver the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health system. The result has been a definite but unequal increase in the proportion of institutional deliveries, across geographical areas and social groups. Tribal (indigenous) communities are one such group in which the proportion of institutional deliveries is low. The persistence of these inequities indicates that a different approach is required to address the maternal health challenges in these communities.MethodsThis paper describes an exploratory study in Rayagada District of Odisha which aimed to understand tribal women’s experiences with pregnancy and childbirth and their interactions with the formal health system. Methods included in-depth interviews with women, traditional healers and formal health care providers and outreach workers, observations in the community and health facilities.ResultsThe exploration of traditional practices shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring external intervention. There is a well-established practice of birthing in the community which also recognizes the need for health system interventions in case of high-risk births or complications. However, there has been no effort by the health system to build on this traditional understanding of safety of woman and child. Instead, the system continues to rely on incentives and disincentives to motivate women. Traditional health providers who are important stakeholders have not been integrated into the health system. Despite the immense difficulties that women face, however, they do access health facilities, but barriers of distance, language, cultural inappropriateness of services, and experiences of gross violations have further compounded their distrust.ConclusionsThe results of the study suggest a re-examining of the very approach to addressing maternal health in this community. The study calls for reorienting maternal health services, to be responsive to the requirements of tribal women, cater to their cultural needs, provide support to domiciliary deliveries, invest in building trust with the community, and preserve beneficial traditional practices.

Place and type of delivery along with assistance during delivery among women residing in a village in South Delhi: Low performance pocket within a high performing state

Background: Various initiatives have been taken under the National Health Mission to improve coverage of institutional deliveries. Yet there are disparities in the proportion of institutional deliveries between states. A high proportion of non-institutional deliveries was noted in a village under PHC Fatehpur Beri in South Delhi. Aims and Objectives: To study the place, assistance and type of deliveries in this village during the years 2007 to 2016 which is the period when several initiatives were taken up to promote institutional deliveries. Material &amp; Methods: A community based cross-sectional study was conducted in Kharak village under PHC, Fatehpur Beri in which data on place and year of delivery, assistance during delivery, type and outcome of deliveries in the period 2007 to 2016 were collected. In analysis, the data for two five year periods were compared using Fishers exact test and odds ratio was calculated with 95% confidence intervals. Trends were assessed by using Mantel-Haenszel test. Changes in the delivery characteristics of two consecutive deliveries were assessed. Results: Of the 312 deliveries, 106 (34%) were institutional deliveries out of which 98 (92%) were in public hospitals. A total of 113 (36%) were assisted by doctors and nurses 44 (14%) were caesarean section deliveries. The proportion of institutional deliveries had increased significantly from 23% in the years 2007-2012 to 42 % in the period 2012 to 2016. [X2=11.76, df=1, p=0.001, OR=2.37(1.44-3.91)]. The proportion of women assisted by trained health professionals during the deliveries also showed a significant rise from 26% to 44% between these time periods. [X2=11.39, df =1, p=0.001, OR=2.3(1.41-3.75)] There was no significant difference in the proportion of caesarean section deliveries between the two study periods. [X2=0.167, df=1, p=0.683, OR=0.87(0.46-1.66)]. There was a significant increase in the proportion of institutional deliveries over the ten year period from 23% to 56% [X2=17.84, df=1, p=0.00]. Conclusion: There are pockets of poor performance on institutional deliveries within high performing states. There is increasing trend in institutional deliveries and assistance by trained health professional in the village but there is huge scope to improve the coverage to match the state and national figures. There is a need to identify the challenges and customize interventions to address them in such pockets

Determinants of Safe Delivery Service Utilization Among Women of Childbearing Age in Egela Sub-Woreda, Tigray, Northern Ethiopia

Maternal mortality and morbidity in Ethiopia is among the highest in the world. Community based studies about factors affecting safe delivery service utilization are scanty only few studies done showed that professional assisted delivery is low in the country; particularly in Tigray region where the study was conducted. Community based cross-sectional survey was conducted in subworeda Egela, Tigray Central Zone, Northern Ethiopia on assessment of safe delivery service utilization and associated factors in mothers of childbearing age from March 05, 2011- July 05, 2011. The data was collected using interviewer administered questionnaire on a sample of 380 mothers residing in the Sub-woreda. The data were entered and analyzed using SPSS 16.0. Possible associations and statistical significance was measured using Odds ratio at 95% CI, and P-value of &lt;0.05. Multivariate regression analysis was carried out to identify predictors of safe delivery services utilization. The study revealed that 25% of the urban and 6.3% of the rural women deliver at health institutions. The socio-demographic variables such as age during interview, residency, marital status, educational status of the women, levels of education attended, monthly income, family size, husband occupation, distance of health institution and obstetric factors found to have statistically significant association with institutional delivery. The monthly income and women higher educational level were independent predictors for safe delivery service utilization. In conclusion, this study revealed that the proportion of institutional delivery was unsatisfactory. The monthly income and mothers’ educational status were determinant factors. Therefore, empowering women, providing health education & establishing centers for emergency obstetric care in accessible areas are used to tackle the problem.

Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants

BackgroundEstimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.DesignWe used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.ResultsDue to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.ConclusionsHigh in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

Options for Optimal Coverage of Free C-Section Services for Poor Mothers in Indian State of Gujarat: Location Allocation Analysis Using GIS.

BackgroundGujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called “Chiranjeevi Yojana” (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology.MethodologySupply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012–13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses.ResultsCurrently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that about 80–96% of the population can be covered for free C-section services with addition of 4–6 centres in critical but underserved regions. It was also suggested that upgrading of public sector facilities with minimal investment can improve the services.ConclusionThis study highlights utility of Geographic Information System technology for planning service centres to optimize access to vital lifesaving procedure such as C-section. Although the location allocation methodology has been available for decades, it has been used sparsely by public health professionals. This paper makes an important contribution to the literature for use of the method for planning in resource limited settings.

Trends in Choosing Place of Delivery and Assistance during Delivery in Nanded District, Maharashtra, India

Delivery in a medical institution promotes child survival and reduces the risk of maternal mortality. Many initiatives under the National Rural Health Mission (NRHM) focus on increasing the institutional deliveries. This study describes the trends in choosing place of delivery in Nanded district at the end of the first phase of the mission. Key informants were interviewed to document the initiatives under NRHM implemented in the district. A cross-sectional descriptive study was conducted in 30 villages selected using one stage cluster-sampling method. A house-to-house survey was conducted in June 2009. A set of structured open-ended questionnaire was used for interviewing all women who had delivered during January 2004-May 2009. The outcomes studied were place of delivery and assistance during delivery. Analysis was done by calculating chi-square test and odds ratio. Interventions to improve the quality of health services and healthcare-seeking behaviour were implemented successfully in the district. The proportion of institutional deliveries increased from 42% in 2004 to 69% in 2009. A significant increase was observed in the proportion of institutional deliveries [60% vs 45%; chi2 = 173.85, p < 0.05, odds ratio (OR) = 1.8 (95% confidence interval (CI) 1.65-1.97)] in the NRHM period compared to the pre-NRHM period. The deliveries in government institutions and in private institutions also showed a significant rise. The proportion of deliveries assisted by health personnel increased significantly during the NRHM period [62% vs 49%; chi2 = 149.39; p < 0.05, OR = 1.73, 95% CI 1.58-1.89]. However, less than 10% of the deliveries in the home (range 2-9%) were assisted by health personnel throughout the study period. There was a wide geographic variation in place of delivery among the study villages. The results showed a significant increase in the proportion of institutional deliveries and deliveries assisted by health personnel in the NRHM period. Since a less proportion of deliveries in the home is conducted by health personnel, the focus should be on increasing the institutional deliveries. Special and innovative interventions should be implemented in the villages with a less proportion of institutional deliveries.

Maternal Health: A Case Study of Rajasthan

This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan's maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed.