Utilization Of Maternal Services Research Articles

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia

BackgroundSince 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households.ObjectivesTo determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023.MethodsA facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model.ResultThe median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504–2766) ETB. Monthly income of the family (β = 0.019), obstetrics complications (β = 0.033), distance from the health facility (β = 0.003), and mode of delivery (β = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (β = −0.041) was negatively associated with the outcome variable.ConclusionThis study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.

Accessibility andutilization of maternal and child health services among mothers in rural and urban communities of Oyo State

Background: Utilization of maternal and child health services has been linked to the characteristics of the health delivery system like the geographical and economic accessibility (cost) of these services. Low utilization of these services has been implicated in the explanation of high maternal and child mortality worldwide. Early and prompt utilization of maternal and child health care services would have averted most of these deaths. This study assessed the accessibility and utilization of maternal and child health services among mothers in rural and urban communities of Oyo state.Methods: This is a comparative cross-sectional study using a mixed method (quantitative and qualitative) of data collection. A pre-tested interviewer-administered questionnaire was used to collect data from 300 respondents that were recruited using a multistage sampling technique. The qualitative data was obtained through focus group discussions (FGD) with four groups selected using purposive sampling. Data was analyzed using IBM SPSS version 22 at 95% significance level with a p&lt;0.05.Results: This study showed that significant differences existed between the respondents' utilization of maternal and child health services among women of child bearing age in the rural and urban communities (p= 0.013). Few respondents in rural communities (72, 48.0%) have good utilization of maternal and child health services compared to the urban communities where more respondents (119,79.3%) have good utilization of maternal and child health services. Proximity of health facility and affordability of maternal and child health service were found to be statistically significant for respondents in the rural community. This finding is also similar to the FGD findings from the rural discussants.Conclusion: Overall good accessibility and good utilization of maternal and child health services were found to be more for respondents in the urban areas compared their counterparts in the rural communities. It is important for the government to initiate policies on health insurance to favour maternal and child health services especially in the rural communities.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs.

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

A study on utilization of ANC services and Psychological status of mothers during Covid–19 pandemic in five adopted villages of KSRDPR University, Gadag, Karnataka

Antenatal care is also known as prenatal care is a type of preventive and primitive health care during the period of whole pregnancy to ensure a better birthing outcome for mother and baby. Improving the utilization of maternal health care services is a global challenge for the health system in low and middle-income countries. The goal set by the United Nations, Millennium Developmental goals to reduce the maternal mortality ratio by three quarters during the period 1990-2015. WHO's new SMART guidelines approach, which includes the ANC Digital Adaptation Kit and WHO digital ANC module to support countries through the process of adapting and applying. With the emergence of the COVID - 19 outbreak, it is not impossible that access to quality antenatal care services in the region will be further compromised due to competition for limited health care services. COVID -19 pandemic affects routine service delivery, which may have an impact on antenatal care (ANC) utilization among pregnant women.To assess the utilization of Antenatal Check-ups before to and during the Covid -19 Pandemic period.After obtaining permission from the District Health Office and the appropriate officer in the health force, a community-based cross-sectional study was conducted. To select study participants who are both convenient and cooperative, the purposive sampling technique was used. A semi-structured questionnaire was used to collect data, information about mothers' socio-demographic details, Antenatal service utilization before and during the Covid - 19 pandemic, An interview schedule was developed in order to identify the Antenatal Care utilization Gap in the eyes of prospective pregnant mothers and the challenges faced by health workers in providing Antenatal services. The data was entered into an excel sheet, and the results were expressed as frequency, percentage.The study included 360 pregnant and delivered mothers aged 18 to 45 years. The majority of mothers (68.33 percent) are between the ages of 18 and 25. Half of the mothers are Primi (51.94%), a quarter of the mothers are Para 1 (33.61%), and more than one-fourth of the mothers are mildly anemic (38.06%). Few mothers have high blood pressure (8.89 percent), the majority of spouses supported their wives' Antenatal natal services visits (93.89 percent), and the majority of mothers received ANC services at no cost (99.44 percent).The current study discovered that due to the COVID - 19 pandemics, antenatal care utilization was lower than before the pandemic period.

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

Background: The promotion of respectful care during delivery is of utmost importance if the goals of attainment of quality health care and utilization of skilled birth attendants in our health facilities are to be achieved. This study sought to assess the prevalence, forms, and factors associated with Disrespect and Abuse (D&amp;A) of women during childbirth in Sokoto metropolis of Sokoto state.&#x0D; Method: A descriptive cross-sectional design was used to study 290 women who had facility-based delivery within the past eight weeks in Sokoto metropolis and were attending childhood immunization or family planning clinics. Data was collected using a set of structured questionnaire and was analyzed using IBM SPSS version 23 computer software. Level of statistical significance was set at p&lt;0.05 and approval for the study was obtained from the Research Ethics Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto while written informed consent was obtained from respondents after explaining the objectives of the study to them.&#x0D; Results: A total of 57 (19.7%) of the respondents had experienced at least one form of D &amp;A with bad attitude accounting for 75.4%, followed by Physical abuse (50.9%). Nurses and Midwives ranked highest (78.9%) among the perpetrators of D&amp;A. Emotional distress, injury and death of baby were some of the negative effects of D&amp;A.&#x0D; Conclusion: The incidents of D&amp;A have wider implications for the utilization of maternity services and maternal mortality. There is an urgent need for the training and re-training of health workers about respectful maternity care in Nigeria.

Factors associated with bypassing primary healthcare facilities for childbirth among women in Devchuli municipality of Nepal.

It is crucial to deliver a child at nearby primary healthcare facilities to prevent subsequent maternal or neonatal complications. In low-resource settings, such as Nepal, it is customary to forgo the neighboring primary healthcare facilities for child delivery. Reports are scanty about the extent and reasons for bypassing local health centers in Nepal. This study sought to determine the prevalence and contributing factors among women bypassing primary healthcare facilities for childbirth. A community-based cross-sectional study was carried out in the Devchuli municipality of Nawalparasi East district of Nepal. Utilizing an online data collection tool, structured interviews were conducted among 314 mothers having a child who is less than one year of age. This study showed that 58.9% of the respondents chose to bypass their nearest primary healthcare facility to deliver their babies in secondary or tertiary hospitals. Respondent's husband's employment status; informal employment (AOR: 4.2; 95% CI: 1.8-10.2) and formal employment (AOR: 3.2; 95% CI: 1.5-6.8), wealth quintile (AOR: 3.7; 95% CI: 1.7-7.7), parity (AOR): 3.0; 95% CI: 1.6-5.7], distance to nearest primary healthcare facility by the usual mode of transportation (AOR: 3.0; 95% CI: 1.5-5.6) and perceived service quality of primary healthcare facility (AOR: 3.759; 95% CI: 2.0-7.0) were associated with greater likelihood of bypassing primary healthcare facility. Enhancing the quality of care, and informing beneficiaries about the importance of delivering children at primary healthcare facilities are essential for improving maternal service utilization at local primary healthcare facilities.

Utilization of maternal health care services in a rural community of Nepal

Introduction: Nepal has made progress in declining maternal mortality; but not up to the target. One of the important aspects in this regard is to know about the base line maternal health care utilization among women and to develop intervention accordingly. This study aims to identify the utilization of maternal health care services among women of rural municipality of Nepal. Method: A cross sectional analytical study with purposive sampling among 323 married women having at least one child less than five years old was conducted in Bagnaskali rural municipality of Palpa district using face to face interview technique with self-developed structured interview schedule. Descriptive statistics frequency, percentage, mean and standard deviations were used and association between descriptive variables and utilization was done using Chi square and Fisher Exact test as applicable using Statistical Package for Social Sciences (SPSS) version 16. Result: The study showed 21.05% of respondents had completely utilized maternal health care services (four Antenatal Care (ANC) checkups, institutional delivery and three Postnatal Care (PNC) checkups), 78.94% of the respondents had partially utilized services. There was no significant difference in health care utilization between maternal age, education of both mothers and husbands, occupation, types of families and distance to nearest health facility as seen by Chi Square and Fisher Exact Test. Conclusion: Almost all the respondents had ANC checkup and institutional delivery. More than half of the respondents had PNC checkup and the demographic variables had no association with utilization of maternal health care services.

Exploring Antenatal Health Care Service Utilization in Nepal: A Comprehensive Analysis

The utilization of maternal health care is one of the important factors in reducing the incidence of maternal mortality. Studies in Nepal and in developing countries shows that various demographic, socio-economic and economic factors are associated with ANC service utilization. The main objective of this study is to identify and examine socio-demographic and economic factors affecting antenatal healthcare service utilization in Nepal. This study used data from the Nepal Demographic and Health Survey 2016 and analyzed the data using logistic regression analysis. This research analyzes ANC (antenatal care) concerning dependent variables: age, birth order, religion, ethnicity, educational attainment, province, residence, and wealth indices. Maternal health has been receiving increased attention in the global health, development, and human rights agenda, representing a priority area for accelerating progress on the SDGs and sustaining the gains of the MDGs. Bivariate analysis was conducted for all variables, and some of them were statistically significant at the 5 percent significance level (since p &lt; 0.05). The dichotomous use of modern maternal healthcare utilization, namely whether a woman utilized maternal health care or not, employed dichotomous logistic regression to determine which factors best explain and predict the outcome of maternal health care utilization during pregnancy. A positive estimated value indicates that the odds favor the event and the event is likely to occur, while a negative value indicates that the event is not likely to occur. ANC visits of women decrease with birth order. Based on empirical results, the major factors for ANC services were income, awareness, access to health care services, and birth order attended. The level of awareness among women about the utilization of maternal healthcare in the study area was low. Maternal healthcare service utilization differed across various components of maternity. It would be better to increase awareness about the utilization of modern maternal healthcare for mothers and improve access to healthcare services in their villages to minimize transportation costs and waiting times from the government's side, thus increasing the utilization of maternal health care services in Nepal.

The individual- and community-level women's empowerment and utilization of maternity care services in Afghanistan: a multilevel cross-validation study.

This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15-49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15-49 y.

Knowledge and Perception of Women of Reproductive Age on Utilization of Maternal Health Care Services in Akure South Local Government Area of Ondo State: A Quantitative Approach

Even though Maternal health care services utilization is very important for further improvement of maternal health, limited evidence exists on the utilization of Maternal health care services among women of reproductive age in Nigeria. This has resulted into high rate of maternal mortality. Thus, this study aims to assess the knowledge and perception of women of reproductive age on utilization of Maternal health care services in Akure south local government area of Ondo State, south western Nigeria using a qualitative research methodology. Data were primarily sourced from 384 women of child-bearing age who were purposively selected across the communities in Akure south local government area through a multi-purpose sampling technique. Secondary Data were obtained from journals, hospital, records, government’s publications, newspapers, and some internet materials that are relevant to this study. Analyses of Data were carried out with the aids of descriptive and inferential statistics. The findings revealed that majority of the respondents have good knowledge but poor perception of the Maternal health care services. Majority of the respondents opined that education and religion contributed to the utilization of Maternal health care services in the local government area. The study further revealed that there is a significant association between respondents knowledge and utilization of Maternal health care services (R= 12.29, p&lt; 0.000). There is also a significant association between respondents religion and the utilization of Maternal health care services ( R = 8.44, P &lt; 0.01). Significant association also exists between the respondent level of education and the use of maternal healthcare service (r =16.20, p&lt; 0.01). But here is no significant association between the perception of the respondent and utilization of maternal healthcare service ( R =10.25, p&gt;0.777) . The study, however, concluded that women of reproductive age in Akure South Local Government area have good knowledge and poor perception maternal healthcare service which utilization is influenced by their education especially in rural communities within the study areas and their religious affiliations. Against this background, the study recommends increased enlightenment among child- bearing women on the importance of maternal healthcare services, subsidization of cost of accessing healthcare services by the governments and NGOs, strengthening the National Health Insurance scheme to incorporate family planning into its benefit package, upgrade of the existing health facilities and establishment of more health centres in rural and semi-urban areas with explosive populations.

Child Marriage: Knowledge, Factors, Consequences and Utilization of Maternal Services among Early Married Women.

In 2020, UNFPA estimated additional 13 million child marriage cases in Nepal after a decade of lockdown due to COVID-19 wherein 2020, the data of child marriage before the age of 18 reached 5 million where marriage done before the age of 15 years was 1.3 million as per UNICEF. In Nepal, the legal age for marriage is 20 years. As per the National Criminal Code 2074, article 173 (1,2 and 3), one is imprisoned for three years with a penalty of Rs. 30,000, if found to violate the law: marrying before reaching the legal age. An analytical cross-sectional study was conducted. The sampling design used for the study was simple random sampling. Out of 9 municipalities in Sindhuli district, Dudhauli municipality was selected by using lottery method. 8 wards out of 14 wards in Dudhauli municipality were selected by using purposive sampling. 160 participants were early married women within the age of 15 to 24 years. Three key stakeholders were selected for Key Informant Interview from the local government level worker, non-Governmental organizations working within the municipality, and Dudhauli Health Post. One focused group discussion was conducted with 6 early married women. All the collected data were analyzed through simple descriptive statistics such as frequency, percentage, mean and inferential statics by using chi-square. For a qualitative study, the information collected from the key stakeholders was documented in narrative form. Seven out of 126 women suffered from miscarriage during their second delivery. There is a significant association between the age of marriage and the number of children (P-value 0.0520) and birth time after marriage (P-value 0.019). The majority, 32.6 percent believes that child marriage can be prevented by children's counseling Conclusions: Only 1.6 percent of early married women faced complications during delivery. Majority of physically active women engaged in agriculture sector (97.5%) did not face any difficulty during delivery. None of the early married women have ever suffered from obstetric fistula despite of early delivery.

Demand for Maternal Health Inputs in Eastern States of India

Using NFHS-4 data, this study explores the determinants of maternal health care programmes for eastern states of India, which include prenatal care and hospital delivery. To reduce unobserved heterogeneity in the analysis, we employed the Full Information Likelihood Method, also known as the Joint Estimation Technique, in conjunction with individual probit models. Like other studies, we found place of residence, wealth, caste, religion and level of education as significant contributor for demand for both services. But, unlike earlier studies, we found that women’s age increases the use of prenatal care and hospital delivery, and the child’s birth order influences getting prenatal care. To increase the utilisation of maternal health care services, we recommend investing in health infrastructure, increasing the Janani Suraksha Yojana (JSY) subsidy amount and coverage of the Janani Shishu Suraksha Karyakram (JSSK) scheme, and promoting awareness about various government programmes among women through the Accredited Social Health Activists (ASHAs). JEL Codes: I140, I150, I180, O150

User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.

Increasing free and skilled deliveryisa top priority in the global effortto reducematernal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors. A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching. The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC1 booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13). User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.

Utilization of Maternal Health Care Services in Himachal Pradesh: An Empirical Analysis

More than 500,000 maternal deaths during pregnancy, childbirth, or within a few weeks of delivery occur as a result of poor maternal health delivery in developing countries. Along with many other socioeconomic determinants, the persistent lack of accessibility and underuse of antenatal and other healthcare services continues to be a significant contributor to the high rates of maternal death. The main objective of the present study is to examine the utilization of maternal healthcare services, such as antenatal care (ANC), intranatal care (INC), and postnatal care (PNC), in Himachal Pradesh and what are the determinants which influence the utilization of maternal health care services. The cross-sectional design and multistage stratified random sample used in the study covered three administrative zones within Himachal Pradesh. 576 respondents participated in the study sample, and data were gathered using structured questionnaire. The result of the study showed that majority of the respondents had utilized at least one of the maternal healthcare services. A generous percentage of respondents chose public hospitals for ANC, with Mandi having the most significant consumption of ANC services. Normal delivery was predominant and most of the deliveries took place in public hospitals. The rate of PNC service utilization was relatively low. It was concluded from the study that the importance of education and income in improving maternal healthcare outcomes requires focused interventions to raise PNC service utilization.

Does Empowering Women Influence Maternal Healthcare Service Utilization?: Evidence from National Family Health Survey-5, India.

Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. DATA ANDMETHODS: The study uses data from the fifth round of the National Family Health Survey conducted in 2019-2021 and analyzed 26,552 (15-49 aged)currently married women who had a live birth in the last 5years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality.

Vaccination dropout and wealth related inequality among children aged 12-35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey.

Vaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12-35 months in remote and underserved areas of Ethiopia. This study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12-35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout. A total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24-10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15-2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21-2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87-40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24-2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38-2.52)]. Vaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout.

Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis

ABSTRACT Background Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda. Methods An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models. Results From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries. Conclusions In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries. Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.

Assessment of utilisation of government programmes and services by pregnant women in India.

Since the implementation of various maternal health programs, Maternal Mortality Ratio (MMR) has significantly declined in India through improvements in maternal health services. However, inequality persists at the regional and socio-economic levels. In light of this, the present study aims to assess the existing regional disparities in utilising various government initiatives for safe motherhood in India. National-level datasets such as National Family and Health Surveys (NFHS-3 (2005-06); NFHS-4 (2015-16) and NFHS-5(2019-21); Health Management Information System (HMIS), 2019-20; Sample Registrar System (SRS), 2001-2018) were used in the study. In addition, composite Index and inequality measures (Range, Ratio, and Gini) were calculated to examine inequality. At the same time, the Pearson correlation was used to investigate the correlation between various components of maternal health services and Maternal Mortality Rate (MMR). The composite index score (0.65) reflects that India is still far behind the targets of the utilisation of maternal health care services. Within the utilisation of services, the Gini coefficient reveals that the least inequality was recorded in skilled birth assistance deliveries (0.03) and institutional deliveries (0.04). In contrast, the highest inequality was recorded in receiving Iron and Folic Acid (IFA) Tablets for 100 days (0.19) and four Antenatal Care (ANC) visits (0.13) among selected states. Based on the composite score for maternal health utilisation, Kerala, Tamil Nadu, Andhra Pradesh, Odisha, and Delhi were amongst the best performers, whereas Bihar, Jharkhand, Uttar Pradesh, and Assam were amongst the worst performers. This indicates that the government's single-minded focus on enhancing institutional deliveries and skilled health-assisted deliveries has detracted from other essential interventions related to maternal health. Therefore, the states with the utilisation of maternal services need to initiate immediate action to increase the ANC and Post-natal Care (PNC utilisation with more attention towards better implementation of existing ANC programmes by the government.

Cost of maternal complications and its associated factors among mothers attending Hawassa public hospitals, Southern Ethiopia.

The cost of maternal complications is considered as an important factor hindering the utilization of maternal health care services. However, information of estimate of spending on maternal complication was lacking. This study was aimed to estimate the cost of maternal complications and associated factors among mother's attending Hawassa public hospitals, Sidama Regional state, Ethiopia. A cross-sectional study design was conducted among 348 randomly selected mothers attending public hospitals in Hawassa from November 15 to December 15, 2021. Data was coded and entered into Epi Data version 3.1 and exported to STATA version 16.0 for analysis. Simple and multiple linear regression analysis was done. Correlation coefficient along with 95% CI was used to present the finding and p < 0.05 was used to declare statistical significance. This study found that total median cost of maternal complications was 4895.5 (IQR = 3779) ETB. The total median direct medical cost was 1765.5 (IQR = 1649.5) ETB. Number of days absent [(R = 0.028; 95% CI: (0.023, 0.033)], distance from facility [(R = 0.001; 95% CI: (0.000, 0.002)], site of laboratory diagnosis [(R = 0.230; 95% CI: (0.140, 0.320)], number of laboratory test conducted [(R = 0.045; 95% CI: (0.021, 0.069)] were found to be significance predictors of maternal complications costs. Total median cost of maternal complications in current study was high. Respondents' site of diagnosis, number of days missed from work, number of laboratory tests, and distance from hospitals were independent predictors of maternal complications cost. Thus, we will recommend governments to introduce strategies that specifically help mothers with maternal complications.