Skilled Delivery Service Utilization Research Articles

Pregnancy Risk Perception, Knowledge of Obstetric Danger Signs and Attitude Towards Skilled Delivery Service Utilization Among Pregnant Mothers in a Rural Setting in South Ethiopia: A Community-Based Cross-Sectional Study.

Poor pregnancy risk perception, ignorance of obstetric risk symptoms, and attitudes toward institutional delivery services are factors that prevent pregnant women from choosing to receive emergency obstetric treatment. To assess pregnancy risk perception, attitude towards skilled delivery service, and knowledge of obstetric danger signs and associated factors among pregnant mothers. A cross-sectional community-based study design was used. The 668 pregnant women who participated in this study were chosen using a multi-stage sampling methodology. Data were gathered using a pretested questionnaire that was presented by an interviewer. To find independent factors, logistic regression analysis was used. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated. Pregnancy risk perception was shown to have a lower mean score (23) overall. Only 40.9% of the study participants had high pregnancy risk perception. Over 50% (337) of respondents had a positive attitude towards skilled delivery service utilization. In all categories of obstetric danger signs, only 153 respondents (or 22.9%) knew what the obstetric danger signs were. Maternal age (AOR = 1.966, CI: 1.185-3.261), maternal education (AOR = 1.965, 1.002-3.854), and parity (AOR = 0.534, CI: 0.305-0.933) were factors affecting knowledge of obstetric danger signs. Pregnancy risk Perception (AOR = 14.7, CI: 9.849-22.235) and parity (AOR = 2.27, CI: 1.381-3.733) were significantly associated with attitudes on the use of skilled delivery services. This study found that pregnant women in rural locations had poor levels of knowledge of obstetric danger sign, attitude toward using skilled delivery services, and perception of pregnancy risk. The knowledge of obstetric danger indicators among pregnant women was considerably affected by the mother's age, education, and parity. The perception of pregnancy risk and parity were found to be substantially associated with attitudes towards skilled delivery services.

Assessment of Knowledge, Attitude, and Practice of Skilled Assistance Seeking Maternal Healthcare Services and Associated Factors among Women in West Shoa Zone, Oromia Region, Ethiopia.

Background This study aimed to assess women's knowledge, attitude, and practice towards skilled assistance seeking maternal healthcare services in West Shoa Zone, Oromia Region, Ethiopia. Methods Cross-sectional survey design was conducted from 1 February to 23 March 2018 in West Shoa Zone, Oromia, Ethiopia. A simple random sampling technique was used to select the participants. The data were collected using a pretested and structured questionnaire. Data were entered using EpiData version 3.1, and descriptive analysis and bivariate and multivariate logistic regression analyses were carried out using SPSS version 20 statistical software package. Results The study revealed that the knowledge, attitude, and practice towards skilled maternal health services were found such that 473.3 (72.4%) of the study participants had good knowledge, 180.7 (27.6%) had poor knowledge, and 400 (61.3%) had positive attitude, 254 (38.84%) had negative attitude, 460.3 (70.4%) had good practice, and 193.7 (29.6%) had poor practice towards skilled maternal health services. Factors that had a significant association with antenatal care utilization were planned pregnancy (AOR = 8.2, 95% CI = 3.39-19.78-0.87) and access to transport (AOR = 3.1, 95% CI = 1.46–6.61). Attending ANC at least once (AOR = 3.1, 95% CI = 1.13–8.41), women's education (AOR = 3.0, 95% CI = 1.18–7.84), and unplanned pregnancy (AOR = 0.3, 95% CI = 0.21–0.75) were factors associated with skilled delivery service utilization. Attending ANC at least once (AOR = 2.1, 95% CI = 1.1–4.2), birth complications (AOR = 2.2, 95% CI = 1.35–3.66), unplanned pregnancies (AOR = 0.3, 95% CI = 0.22–0.68), and awareness about skilled obstetric care (AOR = 3.7, 95% CI = 1.68–12.79) were factors associated with postnatal care utilization. Conclusions This study found that the knowledge, attitude, and practice of skilled maternal health services among the study participants are low, showing less than three-quarters of the total sample size. Therefore, this study implied that interventions are required to improve women's knowledge, attitude, and practice of skilled maternal health services in the study area. Furthermore, women's education is significantly associated with skilled delivery service utilization. Accordingly, this study recommends that improving equity among the marginalized population is needed to increase maternal health service coverage.

Perceived physical accessibility, mother's perception of quality of care, and utilization of skilled delivery service in rural Ethiopia.

Objective:Despite the concerted effort to improve skilled delivery service utilization in Ethiopia, a considerable proportion of births still occur at home by traditional birth attendants, notably in a rural setting. Hence, the aim of this study was to investigate whether mother’s perceived service quality and physical accessibility affect skilled delivery service utilization.Methods:A community-based cross-sectional study was conducted from 1 July 2019 to 30 August 2019, among mothers who gave birth in the last 12 months before the study, in selected five districts of Kaffa Zone, Ethiopia.Result:In this study, 262 (70.1%) of mothers utilized skilled delivery service in their recent childbirth. Mothers regarding the nearby health facility’s physical environment as “Good” (adjusted odds ratio = 2.48, 95% confidence interval = 1.44, 4.25), mothers mentioning time to reach to the nearby health facility “<1 h” (adjusted odds ratio = 1.92, 95% confidence interval = 1.11, 3.34), and mothers regarding prompt transport service from home to the nearby health facility “Available” (adjusted odds ratio = 2.01, 95% confidence interval = 1.11, 3.63) were positively associated with skilled delivery services’ utilization. Furthermore, completing secondary education and above, attending three and more antenatal care visits, and having good knowledge of danger signs during pregnancy showed a significant association.Conclusion:Although the study evidenced statistically significant association between perceived physical accessibility and perceived service quality, further study is recommended to investigate the relationship between actual physical accessibility and actual service quality. Targeted health education program intended to improve skilled delivery service utilization should give due emphasis on enhancing antenatal care service uptake, and raising mothers’ awareness on danger signs during pregnancy, with particular focus on those mothers with low schooling.

Prevalence and Determinants of Rural-Urban Utilization of Skilled Delivery Services in Northern Ghana.

Background There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR = 1.59; CI: 1. 07–2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.

Skilled delivery service utilization and its association with the establishment of Women\u2019s Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis

BackgroundBecause of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as “Women’s Health Development Army” (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known.MethodsA community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service.ResultsAbout 45% of women have received skilled delivery care. A significant heterogeneity was observed between “Women’s Health Development Teams (clusters)” for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization.ConclusionsIn this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (− 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.

An evaluation of economic and education determinants on utilization of skilled delivery services by Maasai Women in Kiekonyokie sub location of Kajiado County in Kenya

Background: Maternal health is one of the eight Millennium Development Goals,is central to poverty reduction and overall development efforts and it increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries. This research paper aimed to study economic and education determinants on the utilization of skilled delivery services by Maasai women, the study population belonging to a community of nomadic life style in North of Kajiado County in Kenya.Methods: The study design was a cross sectional descriptive study adopting both quantitative and qualitative methodologies. Results: Utilization of skilled delivery was higher among women who had a source of income (34%) compared to women who had no source of income (19%) indicating a statistical significance p=0.003. Women who had higher level of education were more likely to use skilled delivery 50% compared to 22% who had no education at all hence p=0.002. Education level had a statistical significance, (p-0.002). 69% of those who delivered in the hospital paid &gt; 500 shillings compared to 8% of those who paid &lt; 500 shillings. The amount paid for skilled delivery had a statistical significance, (p&lt;0.001). 97.7% of the Maasai women in the Kajiado North study takes more than 1hour to reach to the nearest health facility while less than (1%) of them in this study takes less than 30minutes to reach to the health facility. Conclusions: In conclusion this study shows that high level of illiteracy, low economic status, distance away, cost to pay for skilled delivery hindered skilled delivery service utilization among the Maasai women.

Prevalence and Determinants of Institutional Delivery Service Uptake among Women in Farta District, Northwest Ethiopia

Background: Although institutional delivery is the corner stone to reduce maternal death and improve child health, institutional delivery in Ethiopia is the lower in the world where only 26% of women attained skilled delivery. This study aimed to identify factors determininging the utilization of delivery services among women in Farta District. Method: A community based cross sectional study design was conducted from March 1-30, 2017. Multistage sampling was used to select women. Data were collected from a sample of 779 women using structured questionnaire, entered in to EPI-info version 7.2, and analysed by SPSS Version 23. Frequencies, percentages and summary statistics were computed to describe the study population. Logistic regression was computed to identify the associated predictors with skilled delivery service utilization. Statistical level of significance was declared at p<0.05. Results: The prevalence of institutional delivery was 64.4% (95% CI=61, 67.4). A multivariable logistic regression model indicated that family size, availability of transport, planned pregnancy, information about place of delivery, participation of women monthly health conference (PWMHC), information about exempted service, and having antenatal care (ANC) follow up during their last pregnancy were found to be significantly associated with institutional delivery service utilization. Conclusion: The attendance of women for institutional delivery care is good but below the national plan. Maternal care information, women monthly conference and behavioural change for planning pregnancy should be taken due attention to mobilize mothers towards skilled birth attendance. Allocation of more resource to the program and increasing availability of transportation during labor is also commendable. Improving mother’s ANC follow up attendance in resource limited regions is warmly suggested.

An analysis of health seeking behaviour on utilizationof skilled delivery services by Maasai womenin kiekonyokie sub location of kajiado county in Kenya

Introduction: Maternal health is one of the eight Millennium Development Goals, is central to poverty reduction and overall development,and it increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries. In Kenya, 44 percent of births are delivered under the supervision of a health professional, mainly a nurse or midwife. Traditional birth attendants continue to play a vital role in delivery, assisting with 28 percent of births. Objectives: This research paper aimed to analyse the role of Health Seeking Behaviour onthe utilization of skilled delivery services by Maasai women, the study population belonging to a community of nomadic life style in North of Kajiado County inKenya. Methodology: The study design was a cross sectional descriptive study adopting both quantitative and qualitative methodologies. The sample size was 264 women of reproductive age obtained by using formula given by Fisher et al., when the population is more than 10,000.The quantitative data has been analyzed using (SPSS) version 17.0 while the qualitative data was analyzed by summarizing of the themes. Results: Results show that 57.2% Maasai women go to the health facility in case of illnesses, while 7.6% consulted their mother in law., husbands make most of the decisions (40.2%) on the place of delivery of the expectant mothers whereas as the relatives make the least decisions 5.7%. Preparation of the expectant mother for delivery did not have a statistical significant p-0.046. The traditional rite of passage practices had no statistical significance p-0.190. 72% of womencould mention at least one correct danger sign for pregnancy out of the posssible four. 97.7% of the Maasai women take more than 1hour to reach to the nearest health facility and less than 1% of them take less than 30minutes to reach to the health facility , 56.1%, of the women had delivered at home while 11.4% were assisted by health personnel at the facility, 69% of those who delivered in the hospital paid > 500 shillings compared to 8% of those who paid < 500 shillings. A mount paid for skilled delivery had a statistical significance, (p<0.001).

The effect of Kenya’s free maternal health care policy on the utilization of skilled delivery services and maternal and neonatal mortality rates in public health facilities

Background: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting skilled delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of the free maternal health care policy’s effect on skilled delivery service utilization and maternal and neonatal mortality rates in Kenyan public health facilities. Methods: Interrupted time series analysis of skilled delivery services utilization, maternal and neonatal mortality rates two years before and after the policy intervention was carried out in 77 Kenyan public health facilities. Results: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the rates of maternal mortality and neonatal mortality. Conclusions: The findings suggest that cost is a deterrent to skilled delivery service utilization in Kenya and thus free delivery services are an important strategy in the effort to promote the utilization of skilled delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related deaths when addressing maternal and neonatal mortality rates.

Distance from health facility and mothers&amp;rsquo; perception of quality related to skilled delivery service utilization in northern Ethiopia

BackgroundPoor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia.Subjects and methodsA community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization.ConclusionImplementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.

Prevalence and Associated Factors of Home Delivery in Arbaminch Zuria District, Southern Ethiopia: Community Based Cross Sectional Study

Background፡ Maternal morbidity and mortality is a global health challenge and developing countries contribute about 99% of maternal death. In Ethiopia about 30% of all women death is related to pregnancy related causes and current maternal mortality ratio is 676 per 100,000 live births. However, a large proportion of these maternal deaths could be prevented through timely and appropriate interventions including the presence of skilled delivery service utilization at each birth. Therefore the aim of this study was to assess prevalence and associated factors of home delivery at Arbaminch zuria district. Method: A community based cross-sectional study design was applied from July 1st to July 30 2012 to collect data from reproductive age women who gave birth in the last 2 years in Arbaminch zuria district who was sampled by systematic random sampling method. A single population proportion formula was used to estimate the sample size by using statistical software EPI info 3.5.4 by considering the assumption that the prevalence of home delivery 81.8%, 95% confidence interval, 5% of absolute precision, design effect 2 then adding non response rate of 5% a total sample size of 481 mother who gave birth in the last two years. The data was entered into EPI info version 3.5.4 and exported into SPSS then analysis was made by using SPSS version 16. Descriptive statistics to describe the study population in relation to relevant variables and multivariate analysis was used to assess the presence and degree of association between home delivery and independent variables. Result: Of the total respondents 157(36%) of the women was age in between 25-29 years, with mean age of 31.4±6.2 years and majority was married and illiterate 396(90.8%) and 234(53.6%)respectively. 346(79.4%) was gave birth at home with unskilled attendants 328(75.2%).Mothers educational status(p< 0.001), parity of the women(p<0.001),and travel time to health facility(p<0.001) was statistically significant association with home delivery. Conclusion: As revealed by this study home delivery attended by un trained personnel was high (75.2%) and the predominant factors associated with home delivery identified by this study were educational status of the women, parity of the women and travel time to health institution.

Skilled Delivery Service Utilization and Associated Factors among Mothers Who Gave Birth in the Last Two Years in Northwest Ethiopia.

Giving birth in a medical institution, under the care and supervision of trained health-care providers, reduces the risk of maternal mortality and promotes child survival. Despite this, most mothers in Ethiopia are giving birth at home. Thus, this study was conducted to assess the level of skilled delivery service use and associated factors among mothers in Enarje Enawga District, Northwest Ethiopia. A community-based cross-sectional study design was employed to recruit a total of 777 mothers who gave birth in the last two years. Data were collected using structured questionnaire. Bi-variable and multivariable logistic regression analyses were employed to assess factors associated with skilled delivery service use. Odds ratios with 95% confidence intervals were computed. Only 156 (20.1%) of the mothers had utilized skilled delivery service in the last two years. Mothers aged 15-24 years (AOR = 5.57), residing in urban areas (AOR = 1.80), and residing within a walking time of 16-30 minutes from health facility (AOR = 3.52) were more likely to use skilled delivery practice. Additionaly, mothers who had four and more antenatal care (ANC) visits (AOR = 4.94) and mothers who received health education (AOR = 5.04) were more likely to use skilled delivery service. The level of skilled delivery service use among mothers was low. Age, residence, distance from health facility, number of ANC visits and health education were found to be associated with skilled delivery service use. Community-based health education programs regarding the risks of home delivery is necessary with a special focus on younger mothers residing in rural area.