Skilled Birth Attendants Research Articles

A CROSS-SECTIONAL STUDY TO ASSESS THE KNOWLEDGE OF SKILLED BIRTH ATTENDANTS IN INDORE DISTRICT OF MADHYA PRADESH

Objective: The objective of the study is to assess the knowledge of skilled birth attendants (SBAs) in providing antenatal care, intranatal care, management of complications, and postnatal care. Methods: A cross-sectional study was done at primary and secondary level of health-care delivery centers of Indore district in Madhya Pradesh. Health centers were selected by simple random sampling. SBA-trained health personnel were selected from the study health centers and their knowledge was assessed through pre-designed, semistructured questionnaire prepared from “Trainers manual for training of SBA” of MOHFW. Result: A total of 80 trained SBAs were selected from the study health centers. Knowledge regarding postnatal care was highest (88.5%) followed by knowledge regarding antenatal care (86.8) and intranatal care (82.3%). Knowledge regarding the management of complications was lowest (75.8%). Overall, average % of knowledge regarding various subtopics among Medical Officer/AYUSH Medical Officer was 88.5%, followed by staff nurse (SN) was 85.5, lady health visitor (LHV) was 83.4%, and auxiliary nurse midwife (ANM) was 76.1%. Average % in the management of complications was lowest among LHVs (61.9%) and ANM (66.3%). A significant difference was observed between SNs and ANM with regard to intranatal care (p=0.011) and management of complications (p<0.001). Conclusion: Knowledge of SBA was highest in postnatal care followed by antenatal and intranatal care and lowest in management of complications. Among the different categories of SBA, knowledge with regard to intranatal care and management of complications was better in SNs than ANMs.

Do current maternal health staffing and bed occupancy benchmarks work in practice? Results from a simulation model

IntroductionThe WHO has issued the global target of reducing maternal mortality rates by two-thirds of 2010 baseline levels by 2030. In low-income settings, high birth rates and a relative lack...

State of the maternal healthcare continuum in Guinea, awaiting the next Demographic and Health Survey: the case of the five communes of Conakry in 2022.

The continuum of maternal health care ensures consistency in the delivery of care from pregnancy to the postnatal period. It recommends a minimum of 4 antenatal visits, skilled birth attendance, and 42 days of postnatal care. This approach helps reduce maternal deaths. The aim of this study was to estimate the proportion of women who had completed the different stages of the continuum of maternal health care (four antenatal visits, given birth under the care of qualified personnel, and received postnatal care within 42 days of delivery). This was a cross-sectional analytical study conducted in the five communes of Conakry, using a two-stage cluster sampling for data collection. Results were described using medians and percentages. The proportions of women in the continuum of care, and at the different stages of this continuum, have been weighted. Multivariate logistic regression was used to identify the factors associated with non-completion of the different stages of the maternal health care continuum among the women included in this study. We found that 26.9% of women had completed all stages of the maternal health care continuum, while 73.1% had not. While 56.7% received four antenatal visits, only 29.5% delivered under the care of a qualified healthcare professional. Key factors associated with discontinuity were not attending school (AOR 1.825: 1.594-2.089), unemployment (AOR 4.588: 3.983-5.285), having two or more living children (AOR 1.890: 1.016-1.296), and not receiving a free Long-Lasting Insecticidal Net at the first Antenatal Care. Maternal care discontinuity is a major issue in Guinea. The country's Health Development Plan had set an expected level for maternal care which has not been met as of 2022. The completeness of care is influenced by various factors, including individual socio-demographic characteristics and factors related to the organization, availability, and quality of health services. To reduce maternal and child mortality rates, it is essential to improve interpersonal communication during antenatal care, ensure the availability of quality health services, and conduct a national study on maternal health service quality and maternal satisfaction. This will help establish a proper continuum of care for mothers and children.

Disrespect and abuse of women during childbirth in selected health facilities in Sokoto metropolis, Nigeria

Background: The promotion of respectful care during delivery is of utmost importance if the goals of attainment of quality health care and utilization of skilled birth attendants in our health facilities are to be achieved. This study sought to assess the prevalence, forms, and factors associated with Disrespect and Abuse (D&A) of women during childbirth in Sokoto metropolis of Sokoto state.
 Method: A descriptive cross-sectional design was used to study 290 women who had facility-based delivery within the past eight weeks in Sokoto metropolis and were attending childhood immunization or family planning clinics. Data was collected using a set of structured questionnaire and was analyzed using IBM SPSS version 23 computer software. Level of statistical significance was set at p<0.05 and approval for the study was obtained from the Research Ethics Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto while written informed consent was obtained from respondents after explaining the objectives of the study to them.
 Results: A total of 57 (19.7%) of the respondents had experienced at least one form of D &A with bad attitude accounting for 75.4%, followed by Physical abuse (50.9%). Nurses and Midwives ranked highest (78.9%) among the perpetrators of D&A. Emotional distress, injury and death of baby were some of the negative effects of D&A.
 Conclusion: The incidents of D&A have wider implications for the utilization of maternity services and maternal mortality. There is an urgent need for the training and re-training of health workers about respectful maternity care in Nigeria.

Prevalence of Exclusive Breastfeeding among Nursing Mothers in Afijio Local Government Area, Southwest, Nigeria: A Cross-sectional Study

Background: Exclusive breastfeeding is public health intervention strategy for child health development and growth from birth to weaning period. It is recommended for nursing mothers during Health promotion sessions by Health Educators according to WHO AND UNICEF guidelines at various health facilities. Nigeria recorded 17.5% prevalence rate of exclusive breastfeeding despite regional variations. This is relatively low to WHO recommendations. Hitherto no study has been conducted in Afijio Local Government, South west of Nigeria for prevalence of exclusive breastfeeding. Hence the aim of this study is to evaluate Knowledge, Altitude and Practice of exclusive breastfeeding by distribution of questionnaires to nursing mothers in Afijio Local Government areas. Methodology: a cross sectional study of randomly selected 172 nursing mothers from Ilora, Awe, Jobele/ Akinmoorin and Fiditi of Afijio Local Government Area. Data analysis was employed by frequency, relative frequency and simple percentage. Results: A total number of 172 nursing mothers were interviewed with mean age of 33 ± 4.0 years. The literacy level is 97%. The employment rate is 65%. Formal education received on knowledge of exclusive breast feeding by respondents (Prevalence) is 89.0 %. The altitude of the participants on benefits of exclusive breastfeeding is 78.5%. Finally, practice of breastfeeding especially within first hours of birth is 84%. Conclusion: There is need for more support from local government’s health authority on exclusive breast feeding in Afijio Local Government Areas. Thus training courses should be provided to skilled birth attendants for skilled support to breastfeeding mothers.

Intra-urban Differences in Maternal Health Care Service Utilization in Nepal: Results from 2016 Nepal DHS

After restructure of local bodies in Nepal, some rural settings before 2015 fall under urban set tings. It is advantageous to understand the situation of maternal health care utilization among poor and non-poor in the new urban structure. Officially, one-fifth of the total population is poor in the country. The objective of this study is to explore the differentials in utilization of all the care designed during the course of reproduction from the notice of pregnancy to postnatal care within two days of delivery among urban poor and non-poor in Nepal. Differentials and roles in utilization of all care, utilization of full maternal health care service for the healthy pregnancy and childbirth are explored among the two economic groups living in urban setting of Nepal. This study has utilized Nepal demographic and health survey 2016 women’s data file. The data used for the analysis came from the 2016 Nepal Demographic and Health Survey (NDHS). This survey is nationally representative population-based household surveys that collected information on fertility, family planning, maternal and child health etc among other data. Details about the survey designs and sampling procedures of this survey are explained in publicly available final report. Using wealth index used as a proxy for household economic status, the lowest wealth quintile is taken as poor and the remaining as non-poor. Result shows that nearly 10 percentage point differences have been observed in utilizing recommended months of antenatal care visits as well as full antenatal care among poor and non-poor. Such differences remained three times more extensive in receiving de livery care from skilled birth attendants and the postnatal care within two days of delivery among those groups. Even, urban poor women are less likely to receive all components of maternal health care. Results of logistic regression confirm the lower chance of receiving full maternal health care by urban poor. The study concludes that urban setting, as local body of Nepal, needs to address the urban poor especially in utilization of maternal health care in protecting and saving health of mother and the newborn.

Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey.

Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.

Perspectives of Healthcare Providers in Maternal and Child Health Services in BokeoProvince, Lao People’s Democratic Republic: A Qualitative Study

In Bokeo province, Lao People’s Democratic Republic, the high rates of poverty and poor health outcomes are striking. According to data collected from the Lao government, the area has a high mortality rate among mothers and children under five years old. Consequently, there is an urgent need for significant enhancements in maternal and child health (MCH) services. This study aims to investigate the perspectives of healthcare providers on the MCH situation, difficulties, challenges, and potential solutions for the growth and implementation of MCH services. We conducted in-depth interviews with 45 healthcare providers from varying healthcare system levels using qualitative methods. The key findings are as follows: Healthcare providers demonstrate a strong understanding of MCH policies, acknowledgment of national objectives, and dedication to personal growth. However, significant obstacles exist, including access barriers for ethnic minorities, transportation complications, inadequate healthcare personnel, and insufficient equipment and infrastructure. Healthcare providers have also indicated a need for more training and opportunities for professional development to improve MCH outcomes. To enhance MCH outcomes in Bokeo province, addressing these challenges and supporting healthcare providers in their quest for self-improvementis essential. The findings of our study can aid in creating targeted interventions and policies to improve MCH outcomes in Bokeo province and similar regions. By focusing on critical areas such as antenatal care, skilled birth attendance, postnatal care, immunizations, nutrition, family planning, health education, and access to healthcare, we can strive towards improved health outcomes and reduced mortality rates.

Assessing the impact of COVID-19 pandemic on maternal healthcare usage: evidence from routine health data in Kenya and Ethiopia

ObjectivesLockdowns and fear of COVID-19 may have reduced access to antenatal care (ANC) and skilled birth attendance (SBA) in sub-Saharan Africa, which could undermine progress towards maternal and child survival...

Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study

BackgroundObstetric fistula is a preventable devastating condition that is mostly caused by obstructed labour. About 22% of obstructed labor is complicated by obstetric fistula. Skilled birth attendants during delivery are essential for the prevention of obstetric fistula. However, little is known about the status of the knowledge and practice of obstetric fistula prevention in the Gamo zone.ObjectiveWe aimed to assess the knowledge, practice, and associated factors of obstetric caregivers on the prevention of obstetric fistula in public health facilities of the Gamo zone in southwest Ethiopia 2023.MethodA cross-sectional study was employed among 372 obstetric caregivers in selected public health facilities of the Gamo zone in southwest Ethiopia from 1 December 2022 to 30 January 2023. Study participants were selected by a simple random sampling technique, and data were collected by using a pre-tested and self-administered questionnaire. The collected data were coded and entered into Epi-Data version 4.6 computer software and exported to SPSS version 27 for analysis purposes. Bivariable and Multivariable Logistic analyses were applied. The level of significance was declared at aP-value ≤0.05 and a 95% confidence interval.ResultsAbout 57% [95% CI (53.00–62.00)] of participants had good knowledge, and about 55.4% [95% CI (50.00–60.00)] of obstetric caregivers showed good practice for obstetric fistula prevention. The factors significantly associated with knowledge were service year [AOR = 2.50, 95% CI = (1.12–6.73)], types of a health facility [AOR = 1.99, 95% CI = (1.01–3.92)], age [AOR = 2.38, 95% CI = (1.03–5.49)], and in-service training [AOR = 4.61, 95% CI = (2.35–9.05)]. In-service training [AOR = 14.86, 95% CI = (12.75–18.73)], service year [AOR = 3.58, 95% CI = (1.24–10.29)], and knowledge [AOR: 13.24, 95% CI = (6.18–14.34)] were factors which were significantly associated with the practice of obstetric caregivers towards obstetric fistula prevention.ConclusionThe knowledge and practice of obstetric caregivers on the prevention of obstetric fistula was low in public health facilities of the Gamo zone. In this study, practicing at a hospital was a factor significantly associated with the knowledge of obstetric caregivers. Having in-service training, advanced service year, and age were factors significantly associated with the knowledge and practice of obstetric caregivers. Regular in-service training of health professionals can enhance their knowledge and practice of obstetric fistula prevention.

A multilevel analysis of social determinants of skilled birth attendant utilisation among married and cohabiting women of Madagascar.

Maternal mortality ratio (MMR) in Madagascar is 392 deaths per 100000 live births, and this is a major public health concern. One of the strategies for reducing MMR and achieving target 3.1 of the Sustainable Development Goals (i.e. reducing the global MMR below 70 per 100000 live births) is the utilisation of skilled birth attendants (SBAs). This analysis examined the prevalence and social determinants of SBA utilisation among married and cohabiting women of Madagascar. Data from the 2021 Madagascar Demographic and Health Surveys was analysed on a weighted sample of 6997 married and cohabiting women. A multilevel regression was carried out to determine the social determinants of utilising SBAs. The results are presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and a p-value <0.05 to determine the significant associations. The prevalence of SBAs among married and cohabiting women of Madagascar was 64.4% (95% CI 0.62 to 0.68). In model 3 of the multilevel regression, women 35-39y of age (adjusted OR [aOR] 1.86 [95% CI 1.30 to 2.60]), women with secondary/higher education (aOR 1.67 [95% CI 1.32 to 2.10]), women whose partners had secondary/higher education (aOR 1.58 [95% CI 1.25 to 1.99]), cohabiting women (aOR 1.33 [95% CI 1.07 to 1.65]), women who had four or more antenatal care visits (aOR 2.05 [95% CI 1.79 to 2.35]), female household head (aOR 1.44 [95% CI 1.06 to 1.95]), Muslims (aOR 1.58 [95% CI 0.71 to 3.53]), those of the richest wealth index (aOR 4.32 [95% CI 2.93 to 6.36]) and women who lived in communities with high literacy levels (aOR 2.17 [95% CI 1.57 to 3.00]) had higher odds of utilisation of SBA. This current analysis revealed low SBA utilisation among married and cohabiting women in Madagascar. The analysis points to the fact that understaffing and inaccessibility of health facilities remain major contributors to the low utilisation of SBAs. The findings call on the government and stakeholders in Madagascar to consider implementing programs that will empower women and focus on disadvantaged groups. These programs could include providing free maternal healthcare services to all pregnant women and intensifying health education programs that target women and their partners with no formal education.

Barriers experienced by community midwives to provide basic emergency obstetric and newborn care in rural Pakistan

BackgroundConsidering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied.MethodsThis was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan.ResultsThe majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant.ConclusionFinancial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.

Factors associated with maternal health services utilization in Pakistan: Evidence from Pakistan maternal mortality survey, 2019.

This study investigates the factors associated with maternal health services utilization in Pakistan using two outcome indicators, ideal antenatal care (IANC), defined as the pregnant woman receiving all the essential services included in standard antenatal care, and skilled birth attendance (SBA). This study used the Pakistan Maternal Mortality Survey 2019 data. The study utilized binary logistic regression models to investigate the adjusted association between the outcome variables, separately for IANC and SBA, and the independent variables, education, wealth, parity, and residence. Wealth showed a positive association with utilization of IANC (adjusted odds ratio [AOR] = 11.48, 95% CI = 7.76, 16.99) and SBA (AOR = 4.37, 95% CI = 3.30,5. 80). Maternal age was associated only with IANC for women aged 35 or more years (AOR = 1.31, 95% CI = 1.06, 1.62). Increased likelihood of utilization of IANC and SBA services was also observed for women with formal education. Women who had 3-5 previous live births had higher odds of using IANC and SBA than women who had 1-2 or more than five previous live births. Urban residency was not correlated with either IANC or SBA. When compared to the wealthy and educated quintile, women in the lower wealth quintile and those without any formal education were less likely to utilize ANC and SBA services. A comprehensive and multipronged approach from the health and education sectors is needed to improve maternal health in Pakistan.

Experiences of mothers and health workers with MomCare and SafeCare bundles in Kenya and Tanzania: A qualitative evaluation.

Between 2019 and 2022, the digital dividend project (DDP), a technology-based intervention that combined care (MomCare) and quality improvement (SafeCare) bundles to empower mothers to access quality care during pregnancy, labor, and delivery, and postnatally, was implemented in Kenya and Tanzania aiming to improve maternal and newborn health outcomes. We describe the experiences of the mothers in accessing and utilizing health services under the bundles, and the experiences of the health workers in providing the services. Between November and December 2022, we conducted a qualitative evaluation across health facilities in Kenya and Tanzania. We held Interviews with mothers (pregnant and postpartum women who had benefited from the care bundles) and health workers (physicians, nurses, and midwives who provided the care bundles, including health facility In-Charges) at the antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) service delivery points. We performed content analysis. Findings are reported using themes and quotes from the participants. We included 127 mothers (Kenya = 76, Tanzania = 51) and 119 health workers. Findings revealed that among mothers, the care bundles eased access to health services, ensured easy access and optimal ANC use, provision of respectful care, removed financial constraints, and led to the receipt of sufficient health education. Health workers reported that the care bundles offered them a new opportunity to provide quality maternal and newborn care and to adhere to the standard of care besides experiencing a positive and fulfilling practice. Health systems improvements included prompt emergency response and continual care, infrastructural developments, medical supplies and logistics, staffing, and increased documentation. Overall, the care bundles led to the strengthening of the healthcare system (staffing, service delivery, financing, supplies/logistics, and information management) in order to deliver quality maternal and child health services. The bundles should be replicated in settings with similar maternal and child health challenges.

“God Has Commanded Me”: A Spiritual Code of a Traditional Birth Attendance (TBA)

Abstract Many studies have demonstrated the significant involvement of Traditional Birth Attendants (TBAs) during pregnancy and delivery. In several countries, including Indonesia, the role of the TBA cannot be easily replaced by Skilled Birth Attendants (SBAs), reducing the capacity of the health sector to reduce the maternal mortality rate. The TBA has a religious and social connection with the community in her area which is often undervalued by the medically-trained SBA; this disconnect interferes with the provision of quality care. In this paper, with the use of a narrative approach, a TBA reveals her reflection and perspective as rooted in the community where she lives. This ethnography provides living evidence that the point of view of modern health professionals often fails when faced with the world view of the community. TBAs have social power that cannot be separated from the social context where they live. Therefore, an analysis of the religious aspects of a TBA’s practice should enrich the effort to decrease the maternal mortality rate. The religiosity of a community is closely connected with the community’s perspective on health.

Effect of women’s literacy status on maternal healthcare services utilisation in Ethiopia: a stratified analysis of the 2019 mini Ethiopian Demographic and Health Survey

ObjectivesMaternal mortality remains unacceptably high in sub-Saharan Africa with 533 maternal deaths per 100 000 live births, accounting for 68% of all maternal deaths worldwide. Most maternal deaths could be...

Perception and utilization of traditional birth attendants among women attending primary healthcare centres in Ilishan-Remo, Ogun State, Nigeria

Despite the introduction of modern health facilities and safe motherhood initiative programs, some women still patronize TBAs, especially in developing countries which has caused a lot of havoc on the health of the mother and the child. This has triggered the interest of the researchers to assess the perception and level of utilization of traditional birth attendants among women in Ilishan Remo, Ogun State, Nigeria. This study adopted a descriptive survey design, 126 women were selected using a simple random sampling technique. Two (2) research questions and two (2) hypotheses were formed for the study. The hypotheses were analyzed using PPMC and Chi-square respectively. The findings revealed a negative perception and a low utilization among women towards Traditional Birth Attendants services. The study further showed a positive insignificant relationship between utilization and perception of women (r = 0.130.; p=0.147&gt; 0.05), also showed a positive significant relationship between the level of education and the utilization of traditional birth attendant with a p-value &lt;0.05 (21, X2=.132.195, r=0.594). In conclusion, antenatal health education should be effective in raising awareness of issues surrounding the well-being of women and unborn children and the need to constantly make use of approved healthcare centers and skilled birth attendants for delivery. Based on these findings, the researchers recommend that this study be replicated in other communities in Ogun State and even other parts of the country and that the federal government subsidize the price of maternity care to all pregnant women irrespective of their religion, age or economic status.

Audit of obstructed labour cases managed in a rural specialist hospital in Enugu, south-east, Nigeria

Background: Labour is a physiological process through which the fetus and placenta are expelled from the vagina at term. It is a challenging and painful process that ends with the joy of a newborn. On many occasions, the process is complicated by obstruction arising from disproportion between the baby and the maternal pelvis. Such conditions if not detected on time, will lead to significant feto-maternal morbidities and mortality. This experience in the developing nations of the world is a recurrent one even though it is almost eliminated in the developed world due to their advancement in antenatal and intrapartum care. The condition is even more prevalent in the rural areas of the developing countries where scarcity of skilled birth attendants is the order of the day, hence, this 5-year review in a rural hospital. Aim: The aim of this study was to determine the prevalence, outcome and socio-demographic determinants of obstructed labour in a private rural hospital Methodology: This was a 5-year retrospective review of all cases of all cases of obstructed labour managed in a rural specialist hospital. The data was collected from delivery registers, theatre registers and patients’ case files using a specialized proforma. The data was analyzed using the Statistical Product and Service Solutions (SPSS) version 25.0 for windows. Results were presented using tables, frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P Result: From the data collected, records of 1,487 births in the centre over the 5-year period were reviewed. Out of these 123 were cases of obstructed labour giving a prevalence of 8.27%. The age distribution of the cases showed that majority of them (30.9%) were aged 30-35 years and the least were over 40 years (6.5%). In all, 75.6% were married and 22.8% were single; majority of them were in a monogamous relationship (65.9%). Those with primary education topped the list (42.3%) followed by those with secondary education (37.4%) while the least had tertiary education (1.6%). Forty eight percent of them were unemployed, followed by 46.3% who were petty traders and only 5.7% were civil servants. Almost all of them were Christians (83.7%) and 45.5% of their partners were artisans. Majority of them (60.2%) were para 3 or above and 64.2% were delivered at gestational ages of between 37 to 40 weeks whereas 32.8% were above 40 weeks. Fifty two percent were verbally referred to the centre and 1.6% had a written referral. Most of them 73.2% were referred from a Traditional Birth Attendant (TBA). They were all labouring outside of the facility and 69.9% were referred from a TBA homes. One hundred and seventeen (95.1%) had severe pain, 95.1% were dehydrated, 81% had edematous vulva, 24.4% presented in shock and 18.7% had vaginal bleeding. It also showed that 98.4% had significant moulding and caput, 84.6% fetal distress and 13.8% intrauterine fetal death. Many presented with a combination of these features. Almost all the parturients (98.4%) were rehydrated with intravenous fluids, 94.3% had analgesia, 92.7% had emergency caesarean delivery, 86.2% were transfused, 4.9% had destructive procedures, 5.7% were delivered vaginally, and 6.5% had hysterectomy. Majority of them (61.8%) had surgical site infections, 33.3% had PPH and 72.4% of the babies had birth asphyxia. In all, marital status, conjugal relationship and educational level had a significant relationship with obstructed labour with p-values less than 0.05. Conclusion: Obstructed labour was an important occurrence in the centre and all of them were referred cases. Marital status, type of conjugal relationship and educational qualification had significant influence on the condition and majority of the babies were asphyxiated at birth. Therefore, we recommend registration, training and retraining of TBAs in rural areas to recognize early signs of obstruction and make timely referrals. Secondly, policies to enhance girl child education and women empowerment should be encouraged. Finally, provision of health facilities to make Essential Obstetric Care available and affordable to the rural populace should be a priority of all regional governments

Women's autonomy and completion of continuum of care in maternal healthcare

Abstract Background In low- and middle-income countries, interventions to improve maternal health services throughout pregnancy, during labor, and after delivery are often targeted independently. For health optimization, it is important to adopt a more comprehensive approach and identify factors that hinder women's continuum of care (CoC) in maternal health services. This study aimed to assess the association between women's autonomy and completion of CoC in maternal health services in India. Methods Using the fifth National Family Health Survey, 25,515 women aged 15-49 years who had births in the past five years were analyzed. Women's autonomy was determined based on their control over decision-making (either by themselves or jointly with husband/partner) about healthcare utilization, large purchases, visits to family/relatives, and spending of money. Women were considered as having completed CoC in maternal health services if they received at least eight antenatal care visits, gave birth in health facility with skilled birth attendants, and received postnatal care within 24 hours of birth. Multivariable-adjusted logistic regression analysis was performed. Results Overall, 64.55% of women were identified as having autonomy and 13.68% had completed CoC in maternal health services. Women's autonomy was associated with significantly increased odds of completing CoC in maternal health services (AORs: 1.19, 95% CI: 1.05-1.36), after adjusting for demographic and socioeconomic covariates. Conclusions Despite substantial progress made on maternal health services, completion of CoC remains low in India. Fostering a social climate to promote women's autonomy should be considered in comprehensive interventions to ensure completion of CoC for healthy pregnancy. Key messages • In India, the percentage of women who received full completion of care (CoC) in maternal healthcare services remained low. • Women's autonomy was significantly associated with higher CoC in maternal health services, highlighting the significance of women's participation in the household decision-making process.

Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen’s behaviour model

BackgroundPapua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG.MethodsThe study was conducted using the 2016–2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05.ResultsThe prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women’s employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors.ConclusionsThis study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women’s education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.