Skilled Attendance Research Articles

Lessons from the field: progress towards the sustainable development goals in Nepal in federal transition of the state

In Nepal, despite the decade-long internal conflict and unstable governments during the Millennium Development Goal (MDG) period, the progress in reducing maternal and child deaths has been praiseworthy. The under-five...

Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh?

BackgroundIn Sunamganj there are fewer than four skilled providers per 10,000 population and just 27% of births are assisted by a skilled attendant. We evaluate a private community skilled birth attendant (P-CSBA) model, developed through the GSK-CARE Frontline Health Worker Programme, designed to address this gap and report on changes in service utilization and health outcomes from baseline to three years post-baseline.MethodsThis analysis presents the results of a pre-post cross sectional design. A baseline survey (n = 1800) was conducted using a multistage cluster sampling approach. Three years post-baseline a second cross-sectional survey (n = 1755) was conducted across the same project area. To describe demographic characteristics of the study participants descriptive statistical techniques were used as appropriate. Logistic and multiple logistic regression, controlling for a comprehensive set of covariates, were used to assess odds ratios for key maternal health behaviors and outcomes.ResultsBirth planning and the use of key maternal health services improved from baseline to follow-up. There was a dramatic increase in the proportion of respondents reporting skilled attendance at birth (aOR: 2.18, p = .001). Women also reported significantly fewer complications during the prenatal (aOR: .30, p<.001), labor and delivery (aOR: 0.41, p<.0001) and postnatal periods (aOR: 0.32, p<.0001).ConclusionPrivate-sector approaches, when coupled with robust efforts to strengthen and collaborate with the public sector, can work successfully to deliver services in underserved communities. The success of this model lends credence to the growing appreciation that reaching our development targets will require governments to work in partnership with private sector actors and highlights the potential of private-public partnerships as we drive towards universal health coverage.

Assessing the Uptake of Supervised Delivery in the Akuapem South District in the Eastern Region of Ghana

Introduction: In spite of the national target of achieving at least an 80% skilled delivery, skilled health providers attended to just 56.2% of deliveries in 2016 according to the Ghana Health Service annual report. The highest proportion of ANC registrants in the Akuapem South District in the Eastern Region of Ghana who sought skilled attendance at birth for the past 3 years has been about 36% as recorded in 2017. The fundamental factors responsible for this low skilled delivery in the district are poorly understood. The aim of this study, however, was to explore the factors that contribute to the uptake of skilled delivery in the Akuapem South District. Methodology: This cross-sectional study involved 371 women in the reproductive ages (15 - 49 years) who had delivered within the last 12 months preceding January 2019, and have been residents in the research communities during the period of pregnancy. A convenient sampling technique was used to select all 371 respondents from 15 communities. Structured questionnaires were used for the interviews by trained staff. Results: The prevalence of skilled delivery among respondents in this district as revealed by this study was 65.77% despite the 97.04% reported ANC attendance for at least once. Significant influencers of the uptake of skilled delivery were; maternal age, mother and partner’s educational level, partner’s occupation, the attitude of health staff/midwives, distance to the nearest health facility, transportation fare, and availability of medical equipment in the nearest health facility. Conclusion: Even though the overall ANC attendance was high, including women who made more than three visits, uptake of supervised delivery is a major challenge. There is, therefore, the need for the Akuapem South District Health Directorate to fully strengthen the adopted WHO’s goal that focuses on ANC at the individual facility levels.

Health providers´ knowledge on maternal and newborn care: implications on health systems strengthening in Vihiga County, Kenya.

Introductionpregnant women need access to skilled attendance at birth and emergency obstetric care (EmOC) to avert maternal deaths. While poor EmOC services may explain the high maternal mortality, inadequate knowledge of providers is also part of the problem. This forms the basis of this paper, in a setting where 50.2% of women deliver in a health facility but maternal mortality remains high at 531/100,000 live births, compared to the national average of 362/100,000 in Kenya.Methodsa facility based cross-sectional survey was conducted in 2018 with a set of knowledge questions extracted from the averting maternal death and disability toolkit. Providers knowledge for maternal and newborn health (MNH) was assessed by interviewing nurses on duty in the maternity units. Data were entered in Ms Access and exported to R version 3.6.2 for descriptive and logistic regression analysis. Ethical clearance was obtained from Kenya Medical Research Unit.Resultsa total of 55 nurses were interviewed. Majority (71%) of the respondents were diploma nurses. The overall knowledge score for MNH among the providers was adequate with a score of (64%). Generally, the midwives and higher diploma nurses consistently scored higher than diploma nurses in all the topic areas of MNH. In the mixed linear regression, determinants of knowledge score were seen in provider-level variables.Conclusionoverall, the providers scores were higher on intrapartum and newborn care compared to scores on care for complications. We conclude that in-service training on EmOC to providers is critical to reduction of maternal mortality.

Healthcare workers\u2019 clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment

BackgroundImproving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers’ knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge.MethodsThis study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score.ResultsA total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants.ConclusionWith regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.

Implementing the skilled birth attendance strategy in Uganda: a policy analysis

BackgroundUganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda’s skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care.MethodsThis is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis.ResultsThe skilled birth attendance policy was an important priority on Uganda’s maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional.ConclusionUganda’s skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

Maternal near-miss and death among women with rupture of the gravid uterus: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

To investigate the burden of maternal near-miss and death due to rupture of the gravid uterus, the indicators of quality of care, and avoidable factors associated with care deficiencies for ruptured uterus in Nigerian tertiary hospitals. Secondary analysis of a nationwide cross-sectional study. Forty-two tertiary hospitals. Women admitted for pregnancy, childbirth or puerperal complications. Cases of severe maternal outcome [SMO: maternal near-miss (MNM) or maternal death (MD)] following uterine rupture were prospectively identified over 1year. Incidence of SMO, indicators of quality of care, and avoidable factors associated with deficiencies in care. There were 91724 live births and 3285 women with SMO during the study period. SMO due to uterine rupture occurred in 392 women: 305MNM and 87 MD. Uterine rupture accounted for 11.9, 13.3, and 8.7% of all SMO, MNM, and MD, respectively. SMO, MNM, and intra-hospital maternal mortality ratios due to uterine rupture were 4.3/1000 live births, 3.3/1000 live births, and 94.8/100000 live births, respectively. Mortality index (% of MD/SMO) was 22.2%, and MNM:MD ratio was 3.5. Avoidable factors contributing to deaths were related to patient-orientated problems, especially late hospital presentation and lack of insurance to cover life-saving interventions. Medical personnel problems contributed to care deficiencies in one-third of women who died. Uterine rupture significantly contributes to SMO in Nigerian tertiary hospitals. Strategies to improve maternal survival should address avoidable institutional factors and include community-based interventions to encourage skilled attendance at birth and early referral of complications. Uterine rupture remains an important cause of maternal death in Nigerian tertiary hospitals.

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

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

Investigating pathways linking women's status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach.

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women’s empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method–structural equation modeling (SEM)–to investigate the complex and multidimensional pathways through which women’s empowerment affects SBA use. The results show that women’s education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.

Status and determinants of birth preparedness and complication readiness in a rural block of Haryana.

Introduction:Pregnancy and motherhood is a physiological phenomenon. However, approximately 830 women die from preventable causes related to pregnancy and childbirth every day. Birth preparedness and complication readiness (BPACR) improves preventive behavior and improves knowledge of mothers about danger signs.Objective:The objective of the study is to assess the status and sociodemographic determinants of BPACR among the women who have experienced motherhood recently.Materials and Methods:The study was carried out among 200 women in a rural block of Haryana over a period of 6 months. The tool used to collect data was adapted from survey tools of Johns Hopkins Program for International Education in Gynaecology and Obstetrics/Maternal and Neonatal Health Program.Results:BPACR index came out to be 66.93 and 58.5% women were well prepared for BPACR. Education and occupation of participants, education of participant's husband, socioeconomic status, and caste were found to be significantly associated with BPACR.Conclusion:BPACR is a comprehensive strategy to ensure safer pregnancy and motherhood. Providing educational and skill acquisition opportunities for rural women for their empowerment and increasing their role in decision-making are imperative in order to improve BPACR and promote utilization of skilled attendants at every delivery.

Integration of traditional birth attendants (TBAs) into the health sector for improving maternal health in Nigeria: a systematic review

This work tries to look at how the integration of traditional birth attendants (TBAs) into the health sector in Nigeria can be a strategy for reducing maternal deaths. Skilled birth attendance in Nigeria is below 40% and most deliveries are with unskilled personnel like the TBAs. In the light of current evidence that training of TBAs can have some positive effect on neonatal outcome and with inconclusive evidence on their role in maternal health, this “birthing workforce” can be harnessed by the Nigerian government by re-defining their roles as health promoters with the overall aim of improving skilled attendance at deliveries and the reduction of maternal morbidity and mortality.

Perceptions of Home Delivery Risk and Associated Factors among Pregnant Mothers in North Achefer District, Amhara Region of Ethiopia: The Health Belief Model Perspective

Background: Women continue to experience various problems utilizing skilled attendants help at delivery. The clinical causes of maternal deaths, the characteristics of women who die and the causes inherent to the health care system are well known in Ethiopia and elsewhere. Less is known about the perception of risk that may contribute to women’s deaths during pregnancy and childbirth. Methods: A community based cross-sectional study was undertaken on 610 pregnant women who were in their third trimester in January 2015. Systematic random sampling technique was applied. Data were collected using a modified version of the Champion’s Health Belief Model Constructs Instrument to assess the perception of risk of home delivery among pregnant women. Result: Among women with a last live birth delivered anytime within two years prior to the survey, 55.6% (95% CI: 1.07-1.47) had been assisted by Non-skilled birth attendants. It was shown that home delivery was significantly associated with perceived susceptibility (AOR=4.93, 95% CI: 2.94-8.20), perceived barrier (AOR=5.00 95% CI: 3.05-8.20) and perceived severity (AOR=1.62, 95% CI: 1.04-2.54). The largest variance of intention to give birth at home was explained by Perceived Seriousness (46.2%) and followed by Perceive Susceptibility (32.2%) and perceived barrier (26.4%) among pregnant mothers. Conclusion: Given the perceived susceptibility, perceived severity and perceived barriers roles in home delivery prediction, it is recommended to consider these structures in designing educational interventions in order to promote institutional delivery in the research area.

Health System Factors Influencing Practice of Neonatal Resuscitation among Nurses in Machakos Level 5 Hospital

The first minute after birth is usually referred to as the golden minute, and the new born baby should be able to initiate spontaneous breathing, failure to which a condition called birth asphyxia ensues. Globally, approximately 5 per cent to10 per cent of newborns in facilities require resuscitation after delivery. In sub-Saharan Africa where over one third of all intrapartum related neonatal deaths occur, the rates of skilled attendance at birth are very low. In Kenya neonatal mortality remains at 22/100,000 live births, majority associated with poor resuscitation. This study sought to assess neonatal resuscitation practice among nurses in Machakos Level 5 Hospital, in Machakos County, Kenya. Specifically the study sought to assess health system factors that influence practice of neonatal resuscitation among nurses. The study adopted a descriptive cross-sectional study design. The study population included a sample of 201 nurses working in Machakos level 5 hospitals in Machakos County. Quantitative data was collected using semi-structured questionnaires from selected nurses through systematic random sampling at a predetermined interval of 2. Qualitative data was collected using key informant interview schedules with 6 selected Key Informants. Key informants were purposively selected for inclusion in the study. Descriptive statistics were analyzed using Statistical Package for Social Sciences (spss) version 24.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analyzed using thematic analysis and results triangulated with quantitative data as narrations. To test the association between study variables, Chi-Square tests done was at 95% confidence interval (p&lt;0.05) were used. The study results revealed that 41 per cent of respondents fully practiced neonatal resuscitation. Health system factors that significantly influenced neonatal resuscitation included; availability of resuscitation equipment (p=0.001), place of keeping resuscitation equipment (p=0.021) and reference to guidelines (p=0.001). The study recommends increased rates of continuous medical education of nurses coupled with strict supervision to increase achievement rates of practicing neonatal resuscitation according to the guidelines. The Ministry of Health and Machakos County should create awareness to the policy makers on training methods to improve on the level of skill and knowledge on newborn resuscitation among nurses deployed in the country’s medical institutions thus reducing rates of neonatal mortality.

Women’s childbearing location preferences in South Ethiopia: a qualitative study

Maternal mortality is unacceptably high in developing countries, and maternal health care service utilization is associated with improved maternal outcomes. We shed light on conditions that influence women’s preferences for childbirth location. Based on a qualitative descriptive design, 25 interviews were conducted with women of childbearing age in Southern Ethiopia in 2015. Previous experience of complications was the most common reason for using skilled attendants at the next childbirth. In addition, women’s limited decision-making authority and knowledge, as well as the quality of health care services and infrastructure, influenced childbirth location preferences. Home birth is still the norm, but there is growing interest in using health facilities and skilled attendants.

Mothers’ Awareness and Level of Knowledge on Skilled Delivery and Its Utilization in Yendi Municipality, Ghana

Background: Skilled delivery is one of the services rendered as part of safe motherhood campaign to prevent maternal and infant deaths. Majority of pregnant women in the Yendi Municipality received antenatal care, but a substantial number do not receive skilled delivery services. The main objective of the study was to find out the awareness and level of knowledge of mothers' on skilled delivery and its utilization in the Yendi Municipality.Methods: The research was a descriptive cross-sectional survey study among 450 respondents who were selected through the simple random sampling technique in thirty (30) communities to form the sample for the study. Structured questionnaire was used to collect data from 04/7/2016 – 18/7/2016 for the study. SPSS software package version 21 was used to analyze the data. Chi-square test and Cross-tabulation were the main statistical processes used in analyzing the relationships between the study variables. Results: Majority (87%) of respondents was aware of the importance of skilled delivery and 69% was also aware of risks associated with home delivery. Most of the respondents (72%) also had confidence in skilled attendants. Findings showed statistically significance between respondents' parity and importance of skilled delivery (P=0.005). However, more than half of the respondents (51%) were assisted by TBAs to deliver while 46% of the respondents indicated that they gave birth in the health facility. Most (53.1%) respondents also said they fear caesarean section. Conclusion: Skilled delivery status (46%) is lower than the WHO 90% target set since 2004 while TBAs assisted delivery (51%) is rather high. Thus urgent and appropriate training should be organized for TBAs to sharpen their skills on safe delivery practices in their various communities.

A road to obstetric fistula in Malawi: capturing women's perspectives through a framework of three delays.

IntroductionObstetric fistula (OF) is a devastating birth injury, which leaves a woman with leaking urine and/or feces accompanied by bad smell, a situation that has been likened to death itself. The condition is caused by neglected obstructed labor. Many factors underlie fistula formation, most of which are preventable. The main purpose of this study was to explore labor and childbirth experiences of women who developed OF with a focus on accessibility of care in the central region of Malawi.MethodsWe conducted semi-structured interviews with 25 women with OF at Bwaila Fistula Care Center in Lilongwe and in its surrounding districts. We interviewed 20 women at Bwaila Fistula Care Center; additional five women were identified through snowball sampling and were interviewed in their homes. Data were categorized using Nvivo 11 and were analyzed using thematic analysis. The three delays model by Thaddeus and Maine was used for data analysis.FindingsThe majority of women in our study suffered from OF with their subsequent pregnancies. All women experienced delays in one form or another consistent with the three-phase delays described by Thaddeus and Maine. Most of the participants (16) experienced two delays and 15 experienced second-phase delay, which was always coupled with the other; nine participants experienced delay while at the hospital. None of the participants experienced all three delays. Most decisions to seek health care when labor was complicated were made by mothers-in-law and traditional birth attendants. All but two delivered stillborn babies.ConclusionTestimonies by women in our study suggest the complexity of the journey to developing fistula. Poverty, illiteracy, inaccessible health facilities, negligence, lack of male involvement in childbirth issues, and shortage of staff together conspire to fistula formation. To prevent new cases of OF in Malawi, the above mentioned issues need to be addressed, more importantly, increasing access to skilled attendance at birth and emergency obstetric care and promoting girls’ education to increase their financial autonomy and decision-making power about their reproductive lives. Also men need to be educated and be involved in maternal and women’s reproductive health issues to help them make informed decisions when their spouses end up with a complicated labor or delivery.

Opting for home birth in rural Bangladesh: An assessment of the current status and reasons.

In Bangladesh, over half of women give birth at home, generally without the support of a skilled birth attendant. In this article, we examined the decision-making around birthplace and explored the reported reasons of preferring home birth over facility birth in a rural district of Bangladesh. A cross-sectional household survey with 1367 women was conducted in Brahmanbaria district. Choice of birthplace and actual place of birth were the main outcomes of interest. Associations between the outcomes of interest and background characteristics were analyzed through binary logistic regression. Effects of the covariates and confounders were adjusted through multiple logistic regression. Sixty-four percent of women planned to give birth at home, and 62% gave birth at home. Planning to give birth at home was significantly associated with eventually giving birth at home (AOR [CI]: 4.93 [3.79-6.43]). Multiparous women and women from larger households were significantly more likely to give birth at home, whereas more educated and wealthier women and those attending antenatal care were significantly less likely to give birth at home. The main reported reasons for home birth were perceived lack of importance of facility birth, financial reasons, fear of cesarean section, and not being permitted by a husband of other family member to seek facility birth. Home is the preferred birthplace and main actual place of birth in rural Bangladesh. The maternal health program of Bangladesh should look critically at the preferences of women and reasons for those preferences for further promotion of skilled attendance at birth in rural settings.

Husbands\u2019 involvement in antenatal care and its association with women\u2019s utilization of skilled birth attendants in Sidama zone, Ethiopia: a prospective cohort study

BackgroundThere is limited evidence about husbands’ roles on women’s utilization of skilled maternity care in Ethiopia, a country with low utilization coverage of skilled birth attendants and high maternal mortality. This study examined the association between husbands’ involvement in antenatal care and women’s use of skilled birth attendants in Sidama zone, Southern Ethiopia.MethodsUsing a cohort study design, we followed a random sample of 709 antenatal women until delivery from June 01 to November 30, 2015. Main exposure variable was husband’s involvement in at least one antenatal care visit, and outcome variable was women’s use of skilled attendants during birth. Data were analysed using SPSS software-version20. We computed univariate and bivariate analyses to describe characteristics of the study subjects. A chi-square test with p-value < 0.05 level of significance and logistic regression analyses with odds ratio and 95% confidence interval were computed to test homogeneity of the two groups’ baseline characteristics and examine the association between husbands’ involvement in antenatal care and women’s use of skilled attendants during birth. Model assessment of the regression equation was checked using a likelihood ratio test, score test, and Hosmer-Lemeshow goodness-of-fit test.ResultsWomen who reported at least one antenatal care visit in which their husbands accompanied them were 6.27 times (95% Confidence interval: 4.2, 9.3) more likely to use skilled birth attendants compared to women attended antenatal care alone.ConclusionThere was a strong statistically significant association between husbands’ involvement during antenatal care and women’s use of skilled attendants during birth. This implies that woman’s utilization of skilled attendants during birth can be improved by involving their husbands in at least one antenatal care visit.

"Childbirth is not a Sickness; A Woman Should Struggle to Give Birth": Exploring Continuing Popularity of Home Births in Western Kenya.

More than 95% of Kenyan women receive antenatal care (ANC) and only 62% access skilled delivery. To explore women's opinion on delivery location, 20 focus group discussions were conducted at an urban and rural setting in western Kenya. Participants included health care workers, traditional birth attendants (TBAs), and women who attended at least four ANC visits and delivered. Six in-depth interviews were also conducted with a combination of women who gave birth in a facility and at home. Discussions were digitally recorded and transcribed for analysis. Data was subjected to content analysis for deductive and inductive codes. Emergent themes were logically organized to address the study topic. Findings revealed that delivery services were sought from both skilled attendants and TBAs. TBAs remain popular despite lack of acknowledgement from mainstream health care. Choice of delivery is influenced by financial access, availability and quality of skilled delivery services, physical access, culture, ignorance about childbirth processes, easy access to familiar TBAs, fear of hospitals and hospital procedures, and social stigma. Appreciation of TBA referral role, quality maternity service, and reproductive health education can encourage facility deliveries. Formal and informal health workers should cooperate in innovative ways and ensure safe motherhood in Kenya.

Uptake of skilled attendance along the continuum of care in rural Western Kenya: selected analysis from Global Health initiative survey-2012

BackgroundExamining skilled attendance throughout pregnancy, delivery and immediate postnatal period is proxy indicator on the progress towards reduction of maternal and neonatal mortality in developing countries.MethodsWe conducted a cross-sectional baseline survey of households of mothers with at least 1 child under-5 years in 2012 within the KEMRI/CDC health and demographic surveillance system (HDSS) area in rural western Kenya.ResultsOut of 8260 mother-child pairs, data on antenatal care (ANC) in the most recent pregnancy was obtained for 89% (n = 8260); 97% (n = 7387) reported attendance. Data on number of ANC visits was available for 89% (n = 7140); 52% (n = 6335) of mothers reported ≥4 ANC visits. Data on gestation month at first ANC was available for 94% (n = 7140) of mothers; 14% (n = 6690) reported first visit was in1sttrimester (0-12 weeks), 73% in 2nd trimester (14-28 weeks) and remaining 13% in third trimester. Forty nine percent (n = 8259) of mothers delivered in a Health Facility (HF), 48% at home and 3% en route to HF. Forty percent (n = 7140) and 63% (n = 4028) of mothers reporting ANC attendance and HF delivery respectively also reported receiving postnatal care (PNC). About 36% (n = 8259) of mothers reported newborn assessment (NBA). Sixty eight percent (n = 3966) of mothers that delivered at home reported taking newborn for HF check-up, with only 5% (n = 2693) doing so within 48 h of delivery. Being ≤34 years (OR 1.8; 95% CI 1.4-2.4) and at least primary education (OR 5.3; 95% CI 1.8-15.3) were significantly associated with ANC attendance. Being ≤34 years (OR 1.7; 95% CI 1.5-2.0), post-secondary vs primary education (OR 10; 95% CI 4.4-23.4), ANC attendance (OR 4.5; 95% CI 3.2-6.1), completing ≥4 ANC visits (OR 2.0; 95% CI 1.8-2.2), were strongly associated with HF delivery. The continuum of care was such that 97% (n = 7387) mothers reported ANC attendance, 49% reported both ANC and HF delivery attendance, 34% reported ANC, HF delivery and PNC attendance and only 18% reported ANC, HF delivery, PNC and NBA attendance.ConclusionUptake of services drastically declined from antenatal to postnatal period, along the continuum of care. Age and education were key determinants of uptake.