Skilled Birth Delivery Research Articles

Impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia: Implications for future pandemics.

Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia. A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level. Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (β: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (β: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (β: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (β: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (β: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (β: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia. Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services.

Mind the data gaps: Comparing the quality of data sources for maternal health services in Cameroon

BackgroundNumerous sources of routine data exist but there is limited information on how they relate or complement each other to improve data availability and the quality of data collected. This paper compares data coverage and completeness on selected maternal health service indicators between (1) a performance-based financing(PBF) database, (2) the national health information system, and (3) health facility registers in selected districts in Cameroon. MethodData on antenatal care, skilled birth delivery and family planning were collected from 2010 to 2020 in three purposively selected districts (Buea, Limbe and Tiko) in the southwest region of Cameroon. The coverage and completeness of data from the performance-based financing database, the district health information system (dhis2, a national system) and health facility registers were compared. Data sources for the performance-based financing database and the district health information system are based on data generated from health facilities. ResultsAmong the 90 health facilities in the three districts, 13 (14.5 %) facilities could not be accessed due to ongoing political conflict. Therefore, data were collected from 77 health facilities. Of the 77 facilities, half were public, a third private, and the remainder para-public (13 %) or confessional (5 %). Approximately seven registers at each health facility included data on maternal and child health. Problems of these data included incomplete coverage, misplacement of records, and incomplete data in the records identified. There was inconsistency across all sources. dhis2 collected antenatal care only for the first and fourth visits and PBF collected data for any antenatal care visits without specifying the visit number and health facility collected data for all antenatal care visits. ConclusionThe introduction of dhis2 and PBF programs has strengthened the availability of data in electronic format. Generally, we noted important gaps and heterogeneity in data reporting as well as incomplete data across health sectors and districts. There is need to transform the way data are collected at health facilities and there is also need for capacity building and better data governance to improve data quality and use. This will ensure that reliable, consistent, accurate, and actionable data are available to inform policy towards achieving Universal Health Coverage.

The Influence of Health Innovation Awareness on the Use of Skilled Birth Delivery Services: A Case Study of Kimilili SubCounty, Bungoma County, Kenya

The uptake of skilled birth delivery services (SBDs) is crucial for improving maternal and child health, as it significantly reduces maternal and child mortality rates (MCMR). Maternal morbidity and mortality profoundly impact mothers, babies, families, communities, and society at large. The World Health Organization (WHO) estimates that maternal and child deaths result in an annual loss of USD 15.5 billion in potential productivity globally. In Bungoma County, the rate of SBDs has risen to over 50% in the past eight years, except for 2017 when it dropped to 46% due to a prolonged health workers' strike. However, there has been uncertainty regarding the sustainability of these high SBD rates after the cessation of specific health programs.This study aimed to describe and analyze how awareness of health innovations influences the use of skilled birth delivery services in Kimilili Sub County, Bungoma County. Utilizing a cross-sectional descriptive quantitative analytical design, the study employed both probability and non-probability sampling techniques to select participants. Descriptive statistics, including means and percentages, were used to summarize the data, while multiple regression analysis assessed the relationship among various innovations in increasing skilled birth delivery uptake. Findings indicated that awareness of health innovations, particularly those addressing financial aspects of delivery, significantly influences the uptake of skilled birth delivery (p=0.000). The study concluded that health innovations providing financial support for medical bills and emotional support throughout pregnancy strongly affect skilled delivery rates in Kimilili Sub County.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review.

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Utilisation of growth monitoring and promotion services and associated factors among mothers of children younger than 2 years in Gondar Zuria District, northwest Ethiopia: a community-based, cross-sectional study

ObjectiveThe study aimed to assess the utilisation of growth monitoring and promotion services and the associated factors among mothers of children under 2 years old in Gondar Zuria District, northwest...

Factors associated with health facility delivery in Kitui County: a cross sectional study

Background High maternal mortality rate is a major public health concern in developing countries. Skilled birth delivery is key to reducing maternal mortality, yet health facility delivery (skilled birth delvery) remains low in Kitui County, Kenya. Our study estimated prevalence of unskilled delivery and identified factors associated with health facility delivery in Kitui County. Methods A cross-sectional study was conducted December 2017-February 2018. 245 women from five administrative wards were interviewed. A structured questionnaire was used to collect data. Variables that had p value ≤0.05 in bivariate analysis were included in multivariate regression model to assess for confounders. Variables with a p value of ≤0.05 in multivariate analysis were considered statistically significant at 95% CI. Results We interviewed 245 (240 analyzed) women from the five wards; the majority were 16-25 years age group (45.5%; 110/240). Mean age was 27±6.6 years. Prevalence of health facility delivery was 50.4%. Distance from a health facility, number of children in a household, occupation of the respondent’s partner, number of antenatal clinic (ANC) visits and means of transport were significant factors for not delivering in a health facility. On multivariate analysis, women who lived ≥5km from health facility were less likely to deliver in a health facility (AOR =0.36; 95% CI 0.15- 0.86). Women who attended ≥ 4 ANC visits were 4 times more likely to deliver in a health facility (95% CI 2.01-8.79). Conclusions More than half of the respondents delivered in a health facility. A long distance (over5kms radius) from the health facility is a hindrance to accessing ANC services. Inadequate ANC visits was associated with home delivery. Improving accessibility of health care services and health education on family planning would increase delivery at a health facility. We recommend Kitui County introduce five satellite clinics/ambulatory services so that expectant women can access maternal services easily.

Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.

How equitable is utilization of maternal health services in Uganda? Implications for achieving universal health coverage

BackgroundMaternal and neonatal mortality in Uganda remain persistently high. While utilisation of maternal health services has been shown to reduce the risk of maternal death, little is known about the inequalities in utilisation of maternal health services in Uganda. This study examined the inequalities in utilisation of maternal health services between 2006 and 2016 to draw implications for achieving universal health coverage.MethodsWe used the Uganda Demographic Health Survey 2006, 2011 and 2016 to analyse inequalities in utilisation of antenatal care (ANC4+), skilled birth attendance (SBA), postnatal care (PNC) and a package of maternal health services. Equity ratios, concentration curves, concentration indices and regression analysis were used in the estimations.ResultsInequalities in utilization of single and a package of maternal health services reduced between 2005 and 2016, but remained pro-rich. Inequalities in utilisation of package of maternal health services were greater than for a single service. Women from the richest quintile were 4 times more likely to receive a package of care compared to the poorest women, but were just 1.5 times more likely to receive ANC4 + than those in the poorest quintile. In 2006 women in urban areas were 2.6 times more likely to receive a package of all three maternal health services than their rural counterpart and they had a relative advantage of 23.4% to utilize skilled birth delivery than the poorest women. Each additional year of schooling and living in urban areas was associated with 1.2 and 1.6% point increase in utilisation of a package of care respectively. Wealth, education and living in urban areas were positively associated with utilisation of all maternal healthcare.ConclusionDeclining inequalities in utilisation of maternal healthcare reflect a move towards achieving universal health coverage in Uganda. Pro-rich, education and urban-biased inequalities, imply the need for targeted interventions for the poor, less educated and rural women. Targeted voucher schemes, free distribution of birth kits for poorer and rural women, community-level mobilization to improve uptake of postnatal care, and promoting women’s education and incomes are feasible interventions to improve utilisation of maternal health services and equity.

Exploring the Factors Influencing Home Delivery: A Cross Sectional Study among Rural Residents in Tamale Metropolis

Introduction: Maternal and child mortality continues as a disturbing public health problem facing Ghana and other low and middle-income countries. As such there are advocacy for skilled birth delivery. Despite the advocacy, in most rural communities, unskilled delivery still persists. It is against this background that this study aims to explore the factors influencing home delivery among women in rural areas of Tamale Metropolis.
 Methods: The study employed the descriptive cross-sectional design with the mixed method approach. The study recruited 200 women within reproductive age of 18-49 who had delivered at least once in the selected rural communities in the Tamale Metropolis. Questionnaire and interview guide were used to collect data for this study. The data was analyzed using SPSS version 26 and manual thematic content analysis for quantitative and qualitative data respectively.
 Results: The prevalence of home delivery was reported as (36.5%) among the respondents. More than quarter (35.5%) of the respondents rate their satisfaction of home delivery as good whereas more than half of the respondents rated TBAs’ attitude as good. Three (3) qualitative respondents indicated that most women chose to deliver at home in neglect of hospital because of better satisfaction gained from delivering at home. The qualitative data showed that the factors identified to influence home delivery were as followed: negative attitude of health workers, lack of trust in health workers competence, unnecessary expenses from hospitals, distance, and poor quality of services. Nearly 90.0% of the respondents were enrolled on the NHIS with a proof of active NHIS card. Majority of the respondents were aware of the free maternal health services and all respondents agreed that they had a CHPs compound in their communities, however, only 36.5% responded in the affirmative that these CHPs compound are resourced adequately.
 Conclusion: The study showed a substantive percentage of the respondents to be practicing home delivery with the support of unskilled birth attendants. Poor attitudes from health workers, better previous experience in delivering at home, unreliable means of transport to the hospital and additional informal delivery expenses were some of the factors found to be significant determinants of home delivery. It is recommended for the government and other stakeholders to provide rural ambulance services to aid in the transport of pregnant women in labor to the nearest health facility.

Performance-based financing, health sectors, and health seeking behavior of women attending antenatal care and skilled birth delivery: evidence from Cameroon

Performance-based financing, health sectors, and health seeking behavior of women attending antenatal care and skilled birth delivery: evidence from Cameroon

Prevalence and predictors of mother and newborn skin-to-skin contact at birth in Papua New Guinea

ObjectiveThis study examined the prevalence and predictors of maternal and newborn skin-to-skin contact at birth in Papua New Guinea.DesignData for the study was extracted from the 2016–18 Papua New Guinea...

Factors associated with health facility delivery in Kitui County: a cross sectional study

Background: High maternal mortality rate is a major public health concern in developing countries. Skilled birth delivery is central to reducing maternal mortality, yet health facility delivery remains low in Kitui County, Kenya. Our study estimated prevalence of unskilled delivery and identified factors associated with health facility delivery in Kitui County. Methods: A cross-sectional study was conducted December 2017-February 2018. 245 women from five administrative wards were interviewed. A structured questionnaire was used to collect data. Variables that had p value ≤0.05 in bivariate analysis were included in multivariable regression model to assess for confounders. Variables with a p value of ≤0.05 in multivariate analysis were considered statistically significant at 95% CI. Results: We interviewed 245 (240 analyzed) women from the five wards; the majority were 16-25 years age group (45.5%; 110/240). Mean age was 27±6.6 years. Prevalence of health facility delivery was 50.4%. Distance from a health facility, number of children in a household, occupation of the respondent’s partner, number of antenatal clinic (ANC) visits and means of transport were significant factors for not delivering in a health facility. On multivariate analysis, women who lived >5km from health facility were less likely to deliver in a health facility (AOR =0.36; 95% CI 0.15- 0.86). Women who attended ≥ 4 ANC visits were 4 times more likely to deliver in a health facility (95% CI 2.01-8.79). Conclusions: More than half of the respondents delivered in a health facility. A long distance from the health facility is a hindrance to accessing ANC services. Inadequate ANC visits was associated with home delivery. Improving accessibility of health care services and health education on family planning would increase delivery at a health facility. We recommend Kitui County introduce five satellite clinics/ambulatory services for expectant women to access ANC and maternal services.

A systematic review of home-based records in maternal and child health for improving informational continuity, health outcomes, and perceived usefulness in low and middle-income countries.

BackgroundEvidence shows that a gap in the documentation of patients’ past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care.MethodsThe protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria- studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively.ResultsIn total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited data on the usefulness of HBRs to providers and mothers/families. Home-based records were mostly available for providers during health care visits. However, the documentation in HBRs varied. The use of HBRs is likely to lead to improved antenatal visits and immunisation uptake, and skilled birth delivery in some settings. Mothers’ knowledge of breastfeeding practices and danger signs in pregnancy improved with the use of HBRs. One randomised trial found the use of HBRs reduced the risk of cognitive development delay in children and another reported on trial lessened the risk of underweight and stunted growth in children.ConclusionThere is limited literature from LMICs on the usefulness of HBRs and for improving information transfer across healthcare facilities, or their use by women at home. Current HBRs from LMICs are sub-optimally documented leading to poor informational availability that defeats the point of them as a source of information for future providers.

The effect of performance-based financing interventions on out-of-pocket expenses intended to improve access to and utilization of maternal health services in sub-Saharan Africa: protocol for a systematic review and meta-analysis

BackgroundOut-of-pocket expenses have been reported as a major barrier to accessing antenatal care and skilled birth delivery in most of sub-Saharan Africa. Performance-based financing (PBF) is one of several strategies introduced in lower- and middle-income countries to strengthen a weak health system. This review aims to synthesize evidence on the effectiveness of PBF interventions implemented with the objective of reducing out-of-pocket expenses and improving access to and utilization of ANC and skilled birth delivery and family planning in sub-Saharan Africa. It will consider evidence across health sectors and identify gaps in the evidence.Methods and analysisThis protocol is reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. The systematic review will apply a three-step strategy to search five databases (CINAHL, PubMed, Ovid Medline, EMBASE, Cochrane.) and grey literature with the help of a librarian. Two independent reviewers will conduct screening to determine eligibility and critical appraisal of selected studies using the risk of bias criteria developed by the Cochrane EPOC Group and the New Castle Ottawa Scale for observational studies. The certainty of evidence for the outcomes will be assessed using “Grades of Recommendation, Assessment, Development, and Evaluation” (GRADE) approach. This review will consider experimental and quasi-experimental study designs and observational studies. Studies published in English and French language(s) will be included. Studies published since the introduction of PBF in sub-Saharan Africa will be included. Data will be collected on each item that contributes to out-of-pocket expenses. This review will adopt the Multiple Dimensions of Access Framework to organize the findings.DiscussionThis systematic review will support evidence-informed data for the performance-based financing community and government by identifying, describing, and assessing the impact of performance-based financing interventions on out-of-pocket expenses in promoting access and utilization of ANC, skilled birth delivery, and family planning across health sectors.Systematic review registrationThis review has been registered with PROSPERO, Registration number CRD42020222893.

Factors affecting the initiation and continuation of maternal health service utilization among women who delivered in the past one year in Enemay district, East Gojjam, Ethiopia

BackgroundMaternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skilled birth attendant (SBA), and postnatal care (PNC) within 48 h of delivery. It is one of the essential strategies for reducing maternal and newborn morbidity and mortality. Therefore, this study aimed to assess the prevalence and factors affecting the initiation and continuation of maternal health service utilization among women who delivered in the past one year in Enemay district, East Gojjam zone, Ethiopia.MethodsA community-based cross-sectional study was conducted among six hundred twenty-one (621) women who gave birth in the last one year in Enemay district from February 25 to March 10, 2019. A simple random sampling technique was used to select the study participants. Data were collected by face-to-face interviewer-administered, pretested, and semi-structured questionnaire. Binary logistic regressions (bi-variable and multivariable) were fitted to identify statistically significant variables. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare statistically significant variables on the basis of p-value < 0.05 in the multivariable binary logistic regression.ResultsIn this study, around 61% of women had antenatal care follow-up. Out of those women having ante natal care follow-up, about 77.5% (95% CI 73, 81.7%) had continued to receiving skilled birth delivery service. Age (AOR = 1.7 95% CI: (1.0, 2.88)), marital status (AOR = 1.6, 95% CI: (1.01, 2.76)), women’s educational status (AOR = 2.9, 95% CI: (1.30, 6.72)), autonomy for health care decision-making (AOR = 3.71, 95%CI: (2.36, 6.02)), exposure to media (AOR = 2.8, 95% CI: (1.78, 4.6)), wanted pregnancy (AOR = 3.6 95% CI: (2.2, 5.95)), and parity (AOR = 0.34, 95%CI: (0.16, 0.71)) were statistically significant variables associated with initiation of antenatal care, whereas educational status of women (AOR = 4.65, 95% CI: (1.37, 15.7)), autonomy for health care decision making (AOR = 2.62, 95% CI:(1.0, 6.82)), and had counseled during antenatal care (AOR = 2.88 95% CI: (1.21, 6.83)) were statistically significant variables associated with the continuation of maternal health care services.ConclusionsThis study demonstrated that the initiation and continuity of maternal health care services are low in the study area. Age, marital status, residence, women’s educational status, health care decision-making autonomy, exposure to media, wanted pregnancy, and parity were factors significantly affecting the initiation of antenatal care. Whereas, women’s educational status, health care decision-making autonomy, and counseling during antenatal care were predictors influencing the continuation of maternal health care services (antenatal care to skilled birth delivery).

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

ObjectiveThe objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.DesignOur study was a cross-sectional study that used pooled data...

Factors influencing maternal health choices among women of reproductive age in Hausa communities in Ibadan, Nigeria: an exploratory study.

Introductiondecision making is a vital aspect of women's reproductive life. In an attempt to fulfil the desire to procreate, women's lives are lost especially in developing countries where medical care is still inadequate. The researchers sought to explore the Hausa people's culture as regards maternal health choices concerning modern family planning methods, delivery places and parity.Methodsa cross-sectional study using mixed methods was conducted among women of reproductive age (N=253) in three Hausa communities in Ibadan. Based on the objectives, semi-structured questionnaire and in-depth interview guide were used for data collection. Quantitative data were analysed using Chi-square and the level significance set at 0.05 while qualitative data were analysed thematically.Resultsover fifty percent respondents had more than 3 children and about one third (33.9%) preferred having more than 4 children. Nearly all participants (94%) were aware of modern family planning methods but only 49.0% used them. The most widely used methods are injectables (22.0%) and condoms (20.6%). Almost half of the study population (46.5%) delivered their babies at home with assistance from other residents with most preferring home delivery for various reasons.Conclusionalthough the level of awareness about family planning methods is quite satisfactory, however, the level of contraceptive uptake is still sub-optimal. Most Hausa women prefer home delivery which predisposes them to associated complications. Findings further identified various reasons for maternal health choices and provided insights on viable nursing interventions that can be adopted to promote skilled birth delivery to reduce maternal morbidity and mortality.

Barriers to and Opportunities for Male Partner Involvement in Antenatal Care in Efforts to Eliminate Mother-to-child Transmission of Human Immunodeficiency Virus in Kenya: Systematic Review

Introduction: Men’s involvement in antenatal care (ANC) is intended to encourage husbands to support women’s care and associated interventions, including prevention of mother-to-child transmission from pregnancy to delivery, and throughout the postnatal period. The present study aimed to systematically review the barriers and opportunities for male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus (HIV) in Kenya. Methods: A systematic search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID, and Google scholar. The reference list of included studies was manually searched for possible additional eligible articles. The searches were conducted from May 2019 to April 2020. Qualitative analysis was done and data were presented in thematic domains. Results: The search generated 2208 articles, of which only 19 met the inclusion criteria. The major findings were discussed under two thematic domains: 1) Barriers: Knowledge, Social-cultural/economic factors, Institutional factors, and Age. 2) Opportunities: Skilled Birth Attendant, Human Immunodeficiency virus-free infant and Human Immunodeficiency virus testing. Conclusion: The review notes that the main barriers to male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus in Kenya include; socio-cultural factors, the low maternal-child health education by the male partner, and institutional factors. It further provides insight on the opportunities associated with male partner involvement in antenatal care/prevention of mother-to-child transmission, which includes; having Human Immunodeficiency virus-free infants and increased, skilled birth deliveries. The review strongly calls out for sustainable initiatives to incorporate males into the antenatal care/prevention of mother to child transmission programs.

Evaluation of Implementation Level of Community Health Strategy and Its Influence on Uptake of Skilled Delivery in Lurambi Sub County-Kenya.

Background:Despite the widespread application of the community health strategy (CHS) in Kenya and evidence of its effectiveness in reducing health outcomes at the household level, data from Kakamega County, of which Lurambi sub-county is part of, still showed that skilled birth delivery was at 47% against the national estimateof 62% and a target of 90%. However, there was limited evidence on the level of CHS implementation and its association with the uptake of skilled delivery.Methods:The study employed a cross-sectional analytic design. A structured validated community unit (CU) scorecard and a household questionnaire were used to collect quantitative data from the CUs through Community Health Extension Workers (CHEWs) and at the household level through mothers with children below 1 year. A random sample of 436 mothers from all the 38 Community Units (CUs) was included. CU functionality was assessed using 17 binary indicators (scored as 1 for a positive response, 0 otherwise) and total scores were expressed as percentages. Fully functional CUs scored ≥80% and semi-functional CU scored >50 to <80%. No CU was non-functional (scored ≤50%). Data from the CUs were merged with data at the household level. Association between CU functionality and skilled delivery was assessed using multivariable binary logistic regression controlling for socio-demographic variables. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) are reported.Results:A total of 38 CUs were assessed and of these, 26(68.6%) were fully functional and 12(31.4%) were semi-functional, 18(47.4%) had both household registers (MOH 513) and service delivery logbooks (MOH 514). Overall, 387(80.0%) of mothers had skilled birth deliveries, 263(68%) were from functional CUs and 124(32%) were from semi-functional CUs. Pregnant women were more likely to have skilled deliveries in fully functional CUs than semi-functional CUs (OR=1.3; 95% CI=1.1-2.4; p-value<.001). Other factors significantly associated with uptake of skilled delivery included receiving health education(OR=2.9;95%CI =1.4-6.1, p=.005), being visited at least twice by Community Health Volunteers, CHVs(OR=1.9;95%CI=1.1-3.5, p=.045), attending antenatal care clinics, ANC (OR=3.4;95%CI=1.3-3.5, p=.012), receiving advice where to deliver (OR=4.1;95%CI=1.8-9.4, p=.001).Conclusion:2 out of 3 community units were fully functional, and functionality was associated with increased uptake of skilled delivery. In a fully functional CUs, Community Health Volunteers provided health education through regular visits and they were able to provide a referral to health facilities for the pregnant women. To achieve national targets for skilled deliveries and universal health coverage, there is a need to ensure CUs are fully functional

Prevalence and Factors Associated with Home Childbirth with Unskilled Birth Assistance in Dodoma-Tanzania: A Cross Sectional Study.

Background:Improving maternal health is one of the goals to be achieved under the Sustainable Development Goal (SDG) number 3. Worldwide, half a million of women die each year from pregnancy and childbirth related complications which can be prevented by skilled birth assistance. One of the determinants of maternal health is place of childbirth. Giving birth at home leads to a high risk of maternal and child mortality. The aim of the study was to determine the prevalence and factors associated with choice of home childbirth in Dodoma Municipality.Methods:A community based cross section study using multistage sampling was used to obtain the sample in which 2,523 women who gave birth within 3 years prior to the date of the study from different wards of Dodoma municipal were interviewed. The data obtained were entered and analysed using SPSS version 20. Binary logistic regression analysis was used to establish predictors of home childbirth with unskilled birth assistance.Results:A total of 1,174 (46.5%) women had home childbirth with unskilled birth assistance. After adjusted for the confounders, predictors of home childbirth with unskilled birth assistance among study respondents were level of education [primary education, AOR=0.69 at 95% CI=0.557-0.854, p<.001; secondary education, AOR=0.492 at 95% CI=0.358-0.676, p<.001 and above secondary education, AOR=0.35 at 95% CI=0.16-0.765;p<.01]; marital status [married women, AOR=0.686 at 95% CI=0.547-0.86, p<.001]; occupation of a mother [peasant, AOR=1.508 at 95% CI=1.214-1.874, p<.05]; parity [2 to 4 children, AOR=1.316 at 95% CI=1.028-1.684, p<.05; More than 4 children, AOR=2.006 at 95% CI=1.427-2.82, p<.001]; number of antenatal visits [4 or more antenatal visits, AOR=0.451 at 95% CI=0.204-0.997, p<.05] and walking distance [less than 5kilometres, AOR= 0.797 at 95% CI=0.674-0.943, p<.001]Conclusion:The findings of this study suggest a need for health education in the community on the importance of skilled birth delivery. There is also a need for the government to roll out the implementation of Primary Health Services Development Program (PHSDP-MMAM) which addresses the delivery of health services within 5 kilometres to ensure fair, equitable and quality health services to the community.