Skilled Birth Delivery Research Articles

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.

Assessment of Effect of COVID 19 Pandemic on the Utilization of Maternal Newborn Child Health and Nutrition Services in Somali Region of Ethiopia

Background: Somali Region of Ethiopia recorded the first confirmed case of SARS-CoV-2 (COVID 19) pandemic on 26th April 2020. The study aimed to assess the effect of the pandemic on the utilization of maternal new-born and child health services. Subjects and Method: This was a retrospective chart review of monthly DHIS database of health facilities in Farfan zone of Somali Region and test of association using t test was used to compare the mean reduction in utilization of maternal and child health services three months before (January – March 2020) and three months during the pandemic (April 2020 to June 2020) at p value set at significant level of 5%. The outcome measure was the utilization of maternal and child health services. Results: The mean reductions in OPD per capita for children under five, children who received first dose of pentavalent vaccines and pregnant women who received first ANC before and during the pandemic was 14.26%, t=1.07; 95% CI= 283.17 to 725.17; p= 0.325); 12.51%, t=0.74; 95% CI= 1439.33 to 2697.31; p= 0.489) and 14.43%, t=0.49; 95% CI= 2363.33 to 3543.41; p= 0.642) respectively, while the mean reduction in skilled birth deliveries conducted at the health facilities was 21.4%, t= 0.97; 95% CI= 319.26 to 736.16 ; p= 0.371). Conclusion: The study provided early effects of COVID 19 on health and health services and the need for policy development on health system strengthening and resilience to withstand future outbreaks. This study indicated that indirect health service effects are substantial and highlights the importance of maintaining routine essential health and nutrition service delivery and the need to explore innovative ways of delivering both preventive and curative essential service. Keywords: COVID 19, pandemic, maternal newborn and child health, utilization, essential services Correspondence: Olusola Oladeji. UNICEF Somali Field Office, Ethiopia. Email: ooladeji@unicef.org. Journal of Epidemiology and Public Health (2020), 05(04): 458-469 https://doi.org/10.26911/jepublichealth.2020.05.04.08

\u201cIf there are no female nurses to attend to me, I will just go and deliver at home\u201d: a qualitative study in Garissa, Kenya

BackgroundThe North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community.MethodsThe study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes.ResultsUsing health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted.ConclusionTo increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.

Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?

The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12,273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period.

Perspectives of beneficiaries, health service providers, and community members on a maternal and child health conditional cash transfer pilot programme in Nigeria.

Our paper presents experiences and perceptions of beneficiaries, health service providers, and community members about a conditional cash transfer (CCT) programme piloted in Nigeria from April 2013 to May 2015 to boost demand for maternal, newborn, and child health services. We conducted a descriptive cross-sectional retrospective study using both qualitative and quantitative methods. Personal interviews and focus group discussions (FGDs) were conducted between June and July 2015 for 314 CCT beneficiaries, 72 ward development committee (WDC) members, and 60 service providers (midwives, community health extension workers [CHEWs], and village health workers [VHWs]) including 29 officers-in-charge as key informants. Content analysis was applied to qualitative findings and grouped into themes of attitude, practices, CCT operations, payout, and perceived impact. Over 97% of beneficiaries affirmed that the cash incentive was very helpful and almost 70% opined that the free supply-side services were the real benefit. Majority of service providers applauded the programme though, with complaints about the increased workload. Community members applauded the scheme, with mixed feelings over some operational processes. Beneficiaries, service providers, and community members expressed deep satisfaction with the CCT programme and opined that antenatal care (ANC) and skilled birth delivery service utilization increased. Insights into some programmatic challenges are provided to enrich future CCT design and implementation.

Uptake of skilled birth deliveries in women of reproductive age: Results of a cross-sectional survey following implementation of free maternal services in Nyatike Sub-County, Kenya

Uptake of skilled birth deliveries in women of reproductive age: Results of a cross-sectional survey following implementation of free maternal services in Nyatike Sub-County, Kenya

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria Ms. Iboro Nelson Abstract The global community has adopted Prevention of Mother-To- Child Transmission (PMTCT) of HIV as the first entry point of care to eliminating new pediatric infections. In the absence of any intervention, the possibility of HIV transmission often runs between 15 - 45% and can be reduced to below 5% with effective PMTCT intervention. However, not much attention is given to analyze the human resource requirements to scale up PMTCT services. Meanwhile, WHO‘s Alma Ata Declaration states that ―primary health care shall rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community‖. Over the years, this has been neglected and the results have been continued shortage of needed manpower to deliver health services to the people where it matters most. Using disaggregated data of frontline healthcare workers, TBAs‘ distribution as well as service utilization data across the State of Akwa Ibom of Nigeria between 2010-2015, the paper seeks to demonstrate the effectiveness of integration of traditional birth attendants (TBAs) into healthcare service delivery. Key findings from the analysis show that while ANC attendance has increased over the period under review, facility deliveries within the same period dwindled while non-facility deliveries on the otherhand increased. Secondly, with a nurse to population ratio of 1:2,067 compared with TBAs to population ratio of 1:1,883, there is a great shortage of manpower to meet the universal professional and skilled birth delivery targets especially in the face of dwindling resources for health in developing countries including Nigeria. Thus, engaging TBAs is achievable and effective in improving MNCH services and increasing PMTCT uptake. Full Text: PDF DOI: 10.15640/jeds.v6n2a5

A Pilot Trial of Applying Geographic Information System Technology to Health System Strengthening in the Upper East Region of Ghana

Despite widespread use of Geographic Information System (GIS) technology to strengthening health systems, the application of GIS to health systems strengthening in resource-poor Sub-Saharan Africa remains rare. Over the June 2012 to December 2013 period, the Ghana Health Service (GHS) conducted a pilot application of GIS to health systems development in one rural impoverished district of the Upper East Region (UER). Workers were deployed to gather coordinates of health care facilities throughout the UER. Coordinates were linked to routine health information data, and utilized to generate maps for guiding task prioritization. For example, geocoded Community-based Management of Severe Acute Malnutrition (CMAM) program data were used to target services in communities where the prevalence of childhood acute malnutrition was relatively high. GIS was pivotal in tracking and responding to infectious disease morbidity from causes such as diarrheal diseases and tuberculosis. UER Regional Health Administration (RHA) authorities are currently utilizing GIS to map antenatal care coverage, skilled birth deliveries, neonatal mortality, still births, family planning service caseloads as well as for targeting programmatic action. Experience emerging from this trial attests to the value of GIS in contributing to efforts to strengthen health systems in rural impoverished regions of Africa.

Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study

BackgroundThe growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia’s strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia’s aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization.MethodsWe used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers.ResultsIn 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03–1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01–1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents’ village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation.ConclusionsPoor women with Jamkesmas membership had a modest increase in HFD and SBD. These findings are consistent with economic theory that health insurance coverage can reduce financial barriers to care and increase service uptake. However, factors such as socio-cultural beliefs, accessibility, and quality of care are important elements that need to be addressed as part of the national UHC agenda to improve maternal health services in Indonesia.

Implications of the SURE-P MCH National Village Health Worker Experience in Northern Nigeria for the Road Map for Village Health Workers in Nigeria

Background: Community Health Workers (CHWs) can facilitate access to primary health care services among isolated rural communities. This study examines how Nigeria’s Subsidy Reinvestment and Empowerment Program on Maternal and Child Health (SURE-P MCH) Village Health Worker (VHW) programme provides a model for the Nigerian Road Map for VHWs. Methods: We used pre-post with comparison model design, comparing two successive VHW cohorts, recruited in 2013 (n=109) and in 2014 (n=147) in Jigawa, Katsina and Zamfara states, northern Nigeria. We collected performance statistics and conducted interviews with the VHWs, and focus group discussions with the VHWs, their CHEW mentors, the in-charges at the facilities, and the village health/ ward development committees overseeing the recruitment and support of the VHWs. Significant differences between the 2013 and 2014 cohort were assessed using bi-variate statistics. Results: All VHWs were female. The VHWs worked 20.8 hours/week, and averaged 34.3 home visits/month. After their training, 90% were comfortable with their primary tasks of encouraging antenatal care (ANC) visits and teaching about a healthy pregnancy. They identified 11.7 newly pregnant women per month, of whom 9.0 went to ANC. The pictorial guides were the most useful tools for encouraging ANC and facility deliveries. Compared to before the VHWs began work, clinics recorded 84.8% more women making 4+ ANC visits and 119.9% more skilled birth deliveries. Clinical consultations at the PHC referral sites for the VHWs increased significantly after the introduction of the VHWs and again from 2013 to 2014 (p < 0.010). Qualitative feedback identified the following factors supporting their effectiveness: linkage to support systems within and in the peripheral health facility, pictorial materials and a thank-you stipend for services. Conclusion: The SURE-P MCH VHWs were associated with significant increases in maternal health service uptake at the rural PHCs to which they were affiliated. The factors associated with their effectiveness should be incorporated into the Nigerian Road Map for VHWs: training in coaching health promotion topics, pictorial guides to assist in coaching, mentoring and support from the CHEWs and the community, and a nominal stipend.

Conceptual Model for M-Health Utilization: A Nigerian Adaptation

Background: Compliance with Antenatal Care (ANC) and Postnatal Care (PNC) regimen is a known determinant of pregnancy outcomes. In most developing countries, access to Skilled Birth Delivery (SBD) and Childhood Immunization (CIm), socio-cultural beliefs, physical and financial barriers significantly influence perinatal health outcome. Mobile health (M-Health) is an emerging strategy for improving healthcare utilization and compliance but the extent to which it may influence uptake of available maternal and infant welfare services in Nigeria is not documented in literature. Nurses are the fulcrum for maternal healthcare but their knowledge and roles in the use of M-Health are not known in Nigeria.

Increasing health equity and access to skilled birth delivery services for the poor through community-based health-care interventions: evidence from northern Nigeria

Background The Partnership for Transforming Health Systems Phase 2 (PATHS2) project introduced and supports community based interventions such as safe motherhood initiative demand side (SMID) and an emergency transport scheme within northern Nigeria. This study evaluates the effect of PATHS2’s community based interventions in addressing transportation as a barrier to accessing skilled birth delivery services in health facilities.

ASSESSMENT OF SKILLED BIRTH ATTENDANTS REGARDING HELPING BABIES BREATH INTERVENTION TO IMPROVE NEWBORN CARE IN RURAL DISTRICT OF SINDH

Background: Globally, 3.1 million newborn deaths occur every year out of these estimated 400,000 neonatal deaths occur in Pakistan. All neonatal deaths 99% take place in poorest region and countries of the world, usually within hours of birth; mostly the cause of neonatal deaths is hypoxia. To access knowledge and practice of SBAs regarding HBB and to access the availability of equipments required for HBB. Methods: Descriptive Cross-Sectional Study on SBAs as trained in HBB. All 46 SBAs trained on HBB working in Labour room eight rural Health centers, four Taluka, One district Head Quarter Health Facilities and thirteen Mlbcs of the district, were included in the sample for study. All 41 SBAs were trained on HBB participated in the study. Results: Mean age of 30 years. Out of total 41 participants 25 were working in B-EmoNC (61%), 3in C-EmoNC (7.3%) and 13 in mid wife laid birth Centre (MLBC) or birth station (31.7%). About 92.7% of participants said that main purpose of HBB training is to decrease the NMR by improving newborn care. Drying of newborn is 82.7%, hand washing is 95.12% and 85.3% of the study participants said that they gave 30-40 breaths per minutes. Cord clamp and pair of ties was accessible to 85% of participants versus 14.3% who reported it's not accessible. Almost one quarter (34.1%) participants have low knowledge and practice. Knowledge and training had significant effect on the overall practices of the skilled birth attendants for skilled birth deliveries and reduce the neonatal deaths (P &lt;0.001). Conclusion: Tools play a vital role for the implication of the knowledge into practices and tools were available almost to every participant. Although few barriers also identified for the less application of the helping hand babies trainings in the community.