Utilization Of Maternal Health Services Research Articles

Impacts of inequalities in utilization of key maternal health service on fertility preference among high parity women in four selected regions of Ethiopia

BackgroundFertility is one of the three main components which determines the size, structure, and composition of a population, and fertility preferences are important measures for forecasting fertility levels of a population. Therefore, this study aims to assess the impacts of the inequalities in the utilization of key maternal health services on fertility preference among high parity women in four selected regions (i.e., Afar, Beninshangul-Gumuz, Gambella and Somali) of Ethiopia.MethodsThe study used data collected for the 2016 Ethiopian Demographic and Health Surveys (EDHS) survey. It includes a total of 977 high parity women (104 urban and 873 rural) residing in the four regions of the study. Bivariate logistic regression was used to select the potential variables by using a cut off p-value < 0.2 and then the multivariable logistic regression analyses were performed to assess the association between the selected explanatory variables (i.e., control and exposure variables) and the outcome variable (i.e. fertility preference). Further, the study employed a Population Attributable Fractions (PAFs) to examine the population level impacts of the inequalities in maternal and child health service variables on fertility preference.ResultsThe results showed that religion, household wealth index, place of delivery and contraceptive use were significantly associated with fertility preference. The results of the PAFs analysis indicated that contraceptive use had the biggest impact (80%), meaning that non-use of contraceptive increased fertility preference among women in the four regions. Similarly, out of health facility delivery increased fertility preference by 37%.ConclusionThe study findings underscore the critical factors influencing women’s fertility preferences in the studied regions. Low utilization of maternal health services had an impact on fertility preference, accounting for more than half of the observed variations in fertility preferences. To address this issue, targeted interventions are recommended: enhancing access to maternal health services, strengthening fertility control programs, promoting the benefits of using these services, and actively addressing inequalities.

Associations between maternal origin, breastfeeding and health service use: a mediation analysis

Abstract Background The influence of maternal health utilization on breastfeeding practices is well established. However, research shows that immigrant women tend to face challenges in accessing maternal health services. Our aim was to examine any variation in maternal and child health service utilization between immigrant and native-born mothers as well as to examine potential mediation roles of service utilization on the association between maternal origin and breastfeeding practices. Methods We used a nationwide FinChildren (2020) survey on parents with infants focusing on Somali (n = 29), Arabic (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508). We used Process Macro to conduct mediation analysis. Results Almost 25%/ of Somali-/Arabic-speaking mothers reported not taking their infants to routine child health clinic visits. The proportion was 0.4% for native-born mothers and 1.6% for Russian-speaking mothers (p &amp;lt; 0.001). Around 18% of Somali-/Arabic-speaking mothers and only 0.6% of the native-born mothers reported not utilizing child health clinic services in the past year (p &amp;lt; 0.001). Somali-/Arabic speaking mothers were more likely to receive breastfeeding support from maternity clinics and native-born mothers from maternity hospital or peer support groups. Russian-speaking mothers were most satisfied with the received child healthcare services while Somali/Arabic-speaking mothers were least satisfied with these services (p &amp;lt; 0.001). Only participating in breastfeeding peer support groups had mediation effects on association between maternal origin and breastfeeding practices. Conclusions This study shows that immigrants mothers, particularly Somali/Arabic speaking mothers use less the maternal health services particularly routine health visits. It is essential to encourage them to use the services to be able to monitor the health of both mother and the child. Key messages • Somali-/Arabic-speaking mothers are in a vulnerable position when it comes to utilizing healthcare services. • This study call for more research exploring factors contributing to this.

Effect of community – facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda

BackgroundImproving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the “Communities in which Mothers and Newborns Thrive (COMONETH) project” in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.MethodsWe used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.ResultsA total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07–1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06–4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20–1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80–1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93–1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06–1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27–1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03–1.14).ConclusionsThe findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

Armed conflict and maternal health service utilization in Ethiopia’s Tigray Region: a community-based survey

BackgroundEvidence generated on utilization of maternal health services during times of conflict can inform the development of targeted interventions. The deadly war in Tigray caused the health system to collapse. However, utilization of maternal health services is not well documented that might help in design effective interventions applicable during armed conflict. Thus, this study aimed to assess maternal health service utilization and bridge the gap in healthcare provision and support during conflict. .MethodsA community-based cross-sectional survey was conducted among mothers of children under the age of 1 year in six accessible zones of Tigray from August 4–20, 2021. The study participants were selected through a random sampling method. The study was conducted during the armed conflict where the access to health services was limited due to the damaged and looted health facilities. A descriptive study was used to characterize the study population and data were presented using proportions and percentages. A Chi-square test was used for categorical variables and a P-value of 0.05 was considered significant. .ResultsA total of 4,381 participants were included in the study. Modern contraceptives were used by 1002 (22.9%) of women, and injectable contraceptives were the most common method used by 472 (47.1%) women. Likewise, only 830 (36.5%),1956 (47.1%), and 623 (15.0%) respondents reported the use of optimal antenatal care (ANC), skilled delivery, and postnatal care (PNC) in the first 24 h by mothers, respectively. About 34% of women received comprehensive abortion care services. Most delivery services took place in hospitals. Residence has shown a significant difference in using maternal health services at p-value < 0.001.ConclusionThe conflict in Tigray has had a profound impact on maternal health services, resulting in a significant disruption that is disproportionately high in rural areas. Immediate action is required to provide access to lifesaving interventions for basic maternal health services. The timely initiation of these services is crucial in addressing the pressing needs of pregnant women and their infants. By implementing comprehensive and targeted interventions, we can mitigate the potential long-term consequences and ensure that maternal health services are effectively reinstated.

Regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria: A national population based cross-sectional study.

Globally, about 810 women die daily from pregnancy and childbirth complications, and the burden is highest in Africa. The United Nations sustainable development goal has a maternal mortality ratio (MMR) target of 70 per 100,000 live births by 2030. Nigeria, the largest country in Africa, has an MMR of 512 per 100,000 live births, thus there is need for intensified efforts to reduce maternal deaths in the country. Proper utilisation of maternal health services including health facilities for delivery is crucial to achieving this. This study assesses the regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria. This is a weighted secondary analysis of the Nigerian Demographic and Health Survey (NDHS). The sample included women who had a live birth in the preceding 5 years of the NDHS 2008, 2013 and 2018. Bivariate analysis and multilevel logistic regression were carried out to assess the determinants of health facility delivery. Trends analysis was done using bar graphs and spatial analysis showed the distribution of health facility delivery by State. Forty-one percent of women delivered their last child in a health facility. The proportion of women who delivered at a health facility increased from 2008 to 2018 for all regions, with exception of the South-south region. Determinants of facility-based delivery include; ethnicity, level of education, wealth index, exposure to mass media (AOR 1.34; 95% CI 1.20-1.50), number of childbirths, number of antenatal visits (AOR 4.03; 95% CI 3.51-4.62), getting a companion to go the health facility (AOR 0.84; 95% CI 0.72-0.98), community level poverty, community level of female education, community distance to health facility, and geographical region. There is an urgent need to deploy appropriate strategies and programme to improve health facility delivery in Nigeria.

Individual and community-level factors associated with adequate antenatal care service utilization in sub-Saharan Africa

BackgroundSub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.MethodWe used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.ResultsThe pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28–55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07–2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51–1.60), rich women AOR = 1.26, 95% CI 1.24–1.29), women 35–49 years of age (AOR = 1.36, 95% CI 1.32–1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11–1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78–0.82), not having mass media access (AOR = 0.74, 95% CI 0.72–0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68–0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.ConclusionThe sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.

Utilisation of maternal healthcare services and influencing factors in public health facilities in Addis Ababa, Ethiopia.

Ethiopian maternal mortality remains high, despite the implementation of extensive health programmes. This indicates that the full potential of maternal health services is not being effectively utilised. This study aimed to evaluate the utilisation and factors influencing maternal healthcare services in public health facilities in Addis Ababa. This study was conducted in five public hospitals and 10 public health centres of Addis Ababa city administration from 31st August 2023 to 13th October 2023. The study's design utilised a cross-sectional quantitative technique, which involved interviewing 354 women from each group who received visits throughout their pregnancy, delivery and postpartum period. The data were analysed using SPSS version 26. This study analysed maternal health service utilisation indicators, revealing a 70.8% overall utilisation of services, with antenatal care (ANC) at 85.5%, delivery at 71.58% and family planning services (PNC) at 55.4%. The study found that the length of time spent travelling to public health facilities significantly impacts the use of maternal health services. Pregnant women who travelled less than 30 min used services 2.29 times more than those over 2 h. The average client wait time also influenced service usage. Pregnant women with four or more prenatal care visits were more likely to use services. The study conducted in Addis Ababa's capital city revealed that the utilisation of maternity health care services is not optimal, despite the concentrated resources. The findings of the study could be beneficial for the Addis Ababa Health Bureau, Ministry of Health, legislators, and other stakeholders. It can help in the development of affordable intervention programmes, filling knowledge gaps and updating scientific understanding.

Impact of the COVID-19 pandemic on maternal, neonatal and child health service utilisation, delivery and health outcomes in Gauteng province, South Africa: an interrupted time series (ITS) analysis.

Gauteng was one of the provinces in South Africa most hit by COVID-19. However, there has been no assessment of the pandemic's impact on essential maternal, neonatal and child health (MNCH) services in Gauteng, for planning against future emergencies. This study sought to assess the impact of the COVID-19 pandemic on essential MNCH service utilisation, delivery and health outcomes in Gauteng province. We employed a quasi-experimental interrupted time series (ITS) study design, using the District Health Information System (DHIS) data set to evaluate the impact of COVID-19 on eight key MNCH indicators between March 2019 to February 2021. Using Stata V.17.0 and 5% alpha, a segmented linear regression (ITS) model quantified the trends of the indicators before COVID-19 (March 2019 to February 2020) (β1), the immediate change in level due to the March 2020 lockdown (β2), the post-lockdown (March 2020 to February 2021) trend (β4) and the change in gradient from before to after the lockdown (β3). COVID-19 lockdown exerted a significant decline in primary healthcare headcount<5 years (n) (β2= -60 106.9 (95% CI, -116 710.4; -3503.3), p=0.039); and postnatal care visits within 6 days (rate) (β2=-8.2 (95% CI, -12.4; -4.1), p=0.001). Antenatal care first visits before 20 weeks (rate) declined during COVID-19 (β3=-0.4 (95% CI, -0.7; -0.1), p=0.013) compared with the pre-COVID-19 period. COVID-19 adverse effects on service delivery (measles second dose coverage and fully immunised<1 year) and health outcomes (facility deaths 0-6 days, maternal mortality ratio and pneumonia case fatality<1 year) were insignificant. While some indicators post-lockdown attempted to recover, others deteriorated. In Gauteng province, the COVID-19 pandemic significantly disrupted essential MNCH service utilisation, particularly during the March 2020 lockdown. The mechanism of MNCH service disruption by COVID-19 was induced by both supply and demand services. It is imperative to strike a balance between maintaining routine healthcare services and managing an outbreak.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Health insurance, social safety net and maternal health service utilisation in Pakistan: a population based cross-sectional study

ObjectiveThe objective of the study is to examine the impact of health insurance and social safety net programmes on maternal health service utilisation (MHSU) in Pakistan.DesignCross-sectional.SettingsData were obtained from Pakistan...

Cyclone Freddy and its impact on maternal health service utilisation: Cross-sectional analysis of data from a national maternal surveillance platform in Malawi.

Climate change poses a significant threat to women's health in sub-Saharan Africa, yet the impact of climate change on maternal health is rarely reported in the region. Using an existing Maternal Surveillance Platform (MATSurvey), we estimated the immediate impact of Cyclone Freddy on maternal health care service indicators in Malawi. We analysed facility-level data for pregnant women up to 42 weeks post-partum using the national MATSurvey database. We compared incidences of service utilisation before (1 January to 19 February 2023) and after (20 February to 30 March 2023) the cyclone using a negative binomial regression approach. Between 1 January and 30 March 2023, a total of 37,445 live births, 50,048 antenatal clinic attendances, 23,250 postnatal clinic attendances, 84 maternal deaths, and 1,166 neonatal deaths were recorded by 33 facilities in the MatSurvey database. There was an immediate reduction in service utilisation in the post-cyclone period, including the postnatal attendance per week (pre-cyclone median: 355.0 [IQR 279.0-552.0], post-cyclone median: 261.0 [IQR 154.3-305.5], RR 0.56 [95% CI 0.44-0.71, p <0.001]) and the antenatal attendance per week (pre-cyclone median: 860.0 [IQR 756.5-1060.0], post-cyclone median: 656.5 [IQR 486.5-803.3], RR 0.66 [95% CI 0.55-0.78, p <0.001]). Stratified analyses by geographical zones revealed a stronger reduction in postnatal clinic attendance in the Southwest (RR 0.50 [95% CI 0.29-0.85, p = 0.010]) and the North (RR 0.29 [95% CI 0.15-0.56, p <0.001]). Cyclone Freddy resulted in an immediate decline in utilisation of maternal health services in cyclone-affected regions in Malawi. We observe evidence of catastrophic climate events impacting on the healthcare of women and their babies. Policymakers, researchers, and health systems need to ensure that essential women's health services are maintained during these events and improve measures to support service resilience in the face of climate change.

Spatial distribution and determinants of exclusive breastfeeding practice among mothers of children under 24 months of age in Ethiopia: spatial and multilevel analysis

BackgroundBreast milk is the first, highly valuable, and solely natural food recommended for infants in their first six months of life, which is critical for children's overall growth and development. Evidence suggests that exclusive breastfeeding differs by geographic area in Ethiopia. However, little is known regarding the geographic distribution of exclusive breastfeeding practice. Hence, this study aimed to assess exclusive breastfeeding practice, its geographic variation and associated factors among Ethiopian mothers.MethodThe study used the 2019 Ethiopian mini demographic and health survey data. All living children born 0–23 months before the survey were included. Global Moran’s I statistics on Arc-GIS and Getis Ord Gi* statistics was used to visualize the spatial pattern and hotspot and cold spot areas, respectively. Kulldorff SaTScan was used to show purely significant spatial clusters. The associated factors were identified using a multilevel mixed-effects logistic regression model. Statistically significant factors were reported using the AOR with a 95% CI and a p-value of < 5%.ResultThe coverage of exclusive breastfeeding practice in Ethiopia was 56.05% (95% CI: 53.95%, 58.10%). The spatial pattern was non-random across the country’s regions. Somalia, Gambela, Benshangul Gumuz, Dire Dawa, and Harari regions had low clustering of exclusive breastfeeding practices, whereas Amhara, Eastern SNNPR, and Central and Northern Oromia regions had high clustering. Children born through caesarean delivery [AOR = 0.36; 95% CI: 0.21, 0.63], initiated breastfeeding within the first 1 h [AOR = 0.55; 95% CI: 0.34, 0.90], after 1–24 h of delivery [AOR = 0.36; 95% CI: 0.24, 0.54], after a day [AOR = 0.04; 95% CI: 0.02, 0.08], and women residing in the pastoralist region [AOR = 0.22; 95% CI: 0.12, 0.39] or city administrations [AOR = 0.49; 95% CI: 0.27, 0.89] had lower odds of exclusive breastfeeding practice.ConclusionExclusive breastfeeding practice in Ethiopia remained low. The practice had a spatial variation across the country. Caesarean section delivery, late breastfeeding initiation, and region were statistically significant variables. Therefore, promoting timely initiation of breastfeeding and improving the utilization of maternal health services and designing special intervention strategy for women residing in city administrations and pastoralist regions of the country may increase the coverage of exclusive breastfeeding practice.

Enhancing maternal health service utilization among highly vulnerable pregnant women through a human-centered design process: Study protocol for a quasi-experimental study in Oromia, Ethiopia

Background Disproportionate uptake of and access to maternal and child health services remain significant challenges across and within countries. Differing geographic, economic, environmental, and social factors contribute to varying degrees of vulnerabilities among individuals, which manifest as disparities in maternal and newborn health outcomes. Designing solutions according to need is vital to improve maternal and child health outcomes. In this paper, we describe our study protocol on evaluating the effectiveness of an intervention package developed through a human-centered design (HCD) process in improving maternal health service uptake among vulnerable pregnant women in rural areas of Ethiopia. Methods The study has two distinct phases. For both phases, solutions will be developed leveraging HCD approaches to improve institutional delivery and antenatal care uptake among vulnerable pregnant women. Final solutions will be implemented in collaboration with community health workers and health officers. A community-based, quasi-experimental, mixed-method study design is used to assess differences between intervention and control arms. A panel sample will be enrolled after screening for pregnancy and vulnerability level and surveyed at baseline and midline in Phase 1. In Phase 2, a post-only study will be conducted in the same intervention and control sites. Pregnant women will receive refined solutions for six months, which will be evaluated using end-line assessment. Qualitative interviews will be conducted among vulnerable pregnant women and healthcare providers. Conclusions and Implications Our sequential approach to evaluating initial solutions, which in turn will be used to inform the enhancement of solutions, will provide practical insights into how solutions are accepted among vulnerable women and how they can be better integrated into women’s lives and health systems. Our findings on program effectiveness and implementation research will be disseminated to the Ethiopian Ministry of Health and its partners to inform large-scale implementation at the national level.

How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso.

Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whether the gratuité maintained high service use under such changing circumstances. Our study aimed to assess the effects of gratuité on the utilization of facility-based delivery and curative care of children under 5 years in light of this changing context. We employed a controlled interrupted time series analysis using data from the Health Management Information System and annual statistical reports of 2560 primary health facilities from January 2013 to December 2021. We focused on facility-based deliveries and curative care for children under 5 years, with antenatal care and curative care for children over 5 years as non-equivalent controls. We employed segmented regression with the generalized least square model, accounting for autocorrelation and monthly seasonality. The monthly utilization rate among children under 5 years compared to those above 5 years (controls) immediately increased by 111.19 visits per 1000 children (95% CI: 91.12, 131.26) due to the gratuité. This immediate effect declined afterwards with a monthly change of 0.93 per 1000 children (95% CI: -1.57, -0.29). We found no significant effects, both immediate and long-term, on the use of maternal care services attributable to the gratuité. Our findings suggest that free healthcare policies can be instrumental in improving healthcare, yet more comprehensive strategies are needed to maintain healthcare utilization. Our findings reflect the overall situation in the country, while localized research is needed to understand the effect of insecurity and the pandemic at the local level and the effects of gratuité across geographies and socioeconomic statuses.

Discontinued Maternal Health Care Utilization in Bhojpur District, Nepal

Why all pregnant women did not receive all care at antenatal period; those who did not even utilize any ANC visit may also prefer to utilize facility-based delivery or postnatal care related queries are rarely available in several rounds of NDHS data set. A study conducted in Tarai region of Nepal, analysis of Nepal demographic and health surveys of several rounds, Annual Health Report 2077/78 published by the Department of health services, Ministry of health and population were taken into study. A qualitative study designed in 2014-15 from the women of reproductive health having children of 2-23 months were asked their discontinuation, if any. Maternal health service utilization through national and the district level data were analysed to study about the discontinuation in utilization.Several factors are identified as the cause for discontinuation in the Tarai region of Nepal. Data revealed by department of health services for the fiscal year 2077-78 show discontinued maternal health service utilization (MHSU) in Bhojpur district. The NDHS 2022 report still found some level of discontinuation in national level. Therefore, urgent need of qualitative study is a most for Bhojpur district which has low level of utilization. In the new administrative set-up according to constitution of Nepal, effective functional policy adopted by municipal region may solve several issues of maternal health. Hilly regions could have different response than Tarai region of Nepal. Therefore, local bodies of hilly regions should bring maternal health policy and program to achieve continuum of maternal health care which will ultimately help Nepal to achieve SDG related goal and target.

Adolescent maternal health services utilization and associated barriers in Sub-Saharan Africa: A comprehensive systematic review and meta-analysis before and during the sustainable development goals

IntroductionEffective and adequate maternal health service utilization is critical for improving maternal and newborn health, reducing maternal and perinatal mortality, and important to achieve global sustainable development goals (SDGs). The purpose of this systematic review was to assess adolescent maternal health service utilization and its barriers before and during SDG era in Sub-Saharan Africa (SSA). MethodsSystematic review of published articles, sourced from multiple electronic databases such as Medline, PubMed, Scopus, Embase, CINAHL, PsycINFO, Web of Science, African Journal Online (AJOL) and Google Scholar were conducted up to January 2024. Assessment of risk of bias in the individual studies were undertaken using the Johanna Briggs Institute (JBI) quality assessment tool. The maternal health service utilization of adolescent women was compared before and after adoption of SDGs. Barriers of maternal health service utilization was synthesized using Andersen's health-seeking model. Meta-analysis was carried out using the STATA version 17 software. ResultsThirty-eight studies from 15 SSA countries were included in the review. Before adoption of SDGs, 38.2 % (95 % CI: 28.5 %, 47.9 %) adolescents utilized full antenatal care (ANC) and 44.9 % (95%CI: 26.2, 63.6 %) were attended by skilled birth attendants (SBA). During SDGs, 42.6 % (95 % CI: 32.4 %, 52.8 %) of adolescents utilized full ANC and 53.0 % (95 % CI: 40.6 %, 65.5 %) were attended by SBAs. Furthermore, this review found that adolescent women's utilization of maternal health services is influenced by various barriers, including predisposing, enabling, need, and contextual factors. ConclusionsThere was a modest rise in the utilization of ANC services and SBA from the pre-SDG era to the SDG era. However, the level of maternal health service utilization by adolescent women remains low, with significant disparities across SSA regions and multiple barriers to access services. These findings indicate the importance of developing context-specific interventions that target adolescent women to achieve SDG3 by the year 2030.

Animal source food consumption and its determinants among children aged 6 to 23 months in sub-Saharan African countries: a multilevel analysis of demographic and health survey

IntroductionChild undernutrition is a major public health problem in sub-Saharan Africa. Children who eat animal-based foods have higher intakes of various nutrients that are important for optimal linear growth. However, the prevalence of animal-source food consumption was low across many countries. Therefore, this study aimed to determine the prevalence of good consumption of animal-source foods and its determinants among children aged 6 to 23 months in sub-Saharan African countries.MethodsA cross-sectional pooled dataset using recent demographic and health surveys from 19 sub-Saharan African countries was employed. A total weighted sample of 65,742 children aged 6 to 23 months was included in the study. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Descriptive analysis was carried out to present both individual and community-level variables using frequencies and percentages. A multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Finally, variables with a p-value less than 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.ResultsIn this study, 43.1% (95% CI: 42.7–43.5%) of children aged 6 to 23 months consumed animal-source foods. Factors like maternal education [AOR = 1.36; 95% CI (1.28, 1.44)], maternal occupation [AOR = 1.24; 95% CI (1.18, 1.31)], exposure to media [AOR = 1.30; 95% CI (1.24, 1.36)], wealth index [AOR = 1.16; 95% CI (1.10, 1.23)] & [AOR = 1.28; 95% CI (1.21, 1.36)], owned a mobile telephone [AOR = 1.23; 95% CI (1.17, 1.29)], ANC visits [AOR = 1.20; 95% CI (1.15, 1.25)], place of delivery [AOR = 1.09; 95% CI (1.04, 1.14)], PNC checkup [AOR = 1.34; 95% CI (1.28, 1.39)], the current age of the child [AOR = 1.99; 95% CI (1.85, 2.14)], [AOR = 3.34; 95% CI (3.14, 3.56)], & [AOR = 4.3; 95% CI (4.10, 4.66)], birth interval [AOR = 0.92; 95% CI (0.87, 0.97)], residence [AOR = 1.43; 95% CI (1.35, 1.50)], community illiteracy [AOR = 0.91; 95% CI (0.86, 0.96)], and community poverty [AOR = 1.07; 95% CI (1.01, 1.14)] were significantly associated with consumption of animal-source foods.ConclusionLess than half of children aged 6 to 23 months consumed any type of animal-source foods in sub-Saharan African countries. Higher educational level, non-agricultural work, exposure to media, high economic status, having a mobile telephone, attending 4 + ANC visits, health facility delivery, PNC checkups, older children, a birth interval of 24 months, urban residency, community literacy, and low community poverty were determinates of good consumption of animal source foods. Women empowerment, dissemination of nutrition-related information through mass media, promotion of health facility delivery, and improving utilization of maternal health services are recommended to improve infant and child feeding practices.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions

BackgroundOver the last 20 years, global healthcare has placed a major focus on improving the survival rates of mothers and children, recognizing the potential to prevent a significant number of deaths resulting from pregnancy and childbirth. Nevertheless, there remains an ongoing obstacle to the insufficient utilization of critical obstetric services to achieve optimal health outcomes for pregnant women. This study aimed to assess the magnitude and determinants of maternal healthcare use in the Jimma Zone, Ethiopia.MethodsData were obtained from a household survey as part of the baseline assessment of a cluster randomized controlled trial. The study participants comprised 588 women in early pregnancy, specifically those with a gestational age of less than 20 weeks. Logistic regression analysis was employed to identify factors associated with the use of maternal health services. Adjusted odds ratios (AORs) were used to assess the strength of the associations, with significance level set at a p-value ≤ 0.05.ResultsThe overall prevalence of maternal health service utilization was 87.9% (CI: 85.1, 90.4) for antenatal care, 74.7% (CI: 73.2, 79.9) for health facility delivery, and 60.4% (CI: 56.4, 64.3) for postnatal care. Multivariable logistic analysis revealed that maternal health service use was significantly influenced by access to health facilities (AOR: 6.6; 95% CI: 2.39, 18.16), financial hardship (AOR: 3; 95% CI: 1.97, 4.61), perceived respectful care (AOR: 2.3; 95% CI: 1.07, 5.11), perceived privacy of service provisions (AOR: 2.4; 95% CI: 1.47, 4.06), and attitudes toward maternal service use (AOR: 2.2; 95% CI: 1.48, 3.24).ConclusionsThe study revealed slightly higher rates of antenatal care, facility delivery, and postpartum care utilization. However, there was a low proportion of early antenatal care initiation, and high rates of antenatal care dropout. Mobile phone-based messaging intervention may enhance maternal health service use by addressing factors such as lack of access, economic challenges, disrespectful care, no privacy of procedures, and unfavorable attitudes.