Dataset Information

Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women's perspectives from slums of Addis Ababa, Ethiopia.

ABSTRACT:

Objective

The purpose of this study was to explore why some women who attend focused antenatal care (FANC) fail to deliver in health facilities from slums of Addis Ababa, Ethiopia.

Setting

Public health facilities (three health centres and one district hospital).

Study design

A qualitative exploratory and descriptive research design was used.

Study participants

Study participants comprised women of reproductive age (18-49 years) living in slum areas of Addis Ababa, Ethiopia. We used 20 in-depth audio-recorded interviews. Data were analysed concurrently with data collection. Thematic analysis was done for the study. A multilevel life-course framework of facility-based delivery in low-income and middle-income countries developed by Bohren et al was used to frame the current study and link the findings of the study to the body of knowledge.

Results

From the analysis of in-depth interview data, four themes emerged, namely, perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to healthcare facilities and inadequate (demand side) resources. These themes were identified as rich and detailed accounts of the perspectives of facility-based and home delivery among attendees of FANC in Addis Ababa, Ethiopia.

Conclusion

The findings of this qualitative study revealed that perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to healthcare facilities and inadequate (demand side) resources were related to low uptake of facility-based delivery services. Use of ANC visits to advise women about birth preparedness and complication readiness, the use of facility deliveries to reduce risks of home delivery to the mother and the newborn should be stressed.

SUBMITTER: Sendo EG

PROVIDER: S-EPMC7780505 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women's perspectives from slums of Addis Ababa, Ethiopia.

Sendo Endalew G EG Chauke M E ME Ganga-Limando M M

BMJ open 20201231 12

<h4>Objective</h4>The purpose of this study was to explore why some women who attend focused antenatal care (FANC) fail to deliver in health facilities from slums of Addis Ababa, Ethiopia.<h4>Setting</h4>Public health facilities (three health centres and one district hospital).<h4>Study design</h4>A qualitative exploratory and descriptive research design was used.<h4>Study participants</h4>Study participants comprised women of reproductive age (18-49 years) living in slum areas of Addis Ababa, E ...[more]

PMID: 33384387

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Project description:BackgroundIn developing countries, children under the age of five years who live in slums are highly vulnerable to diarrhea. However, there is a paucity of information on the relationship between sanitation facilities and hygienic conditions to acute diarrhea among under-five children in slum areas of Addis Ababa, Ethiopia. Therefore, this study examines the sanitation facilities and hygienic conditions in the slums of Addis Ababa and identifies the main factors significantly associated with acute diarrhea among children aged 0-50 months in those slums.MethodsA community-based cross-sectional household survey was carried out between September and November 2014, that then served as the baseline survey of a longitudinal study. For this survey, 697 children aged 0-50 months were recruited from two slum districts in Addis Ababa. A pre-tested structured questionnaire and an observational checklist were used for data collection. Multivariable logistic regression analysis was used to identify sanitation facilities and hygiene-related factors that were significantly associated with acute diarrhea by controlling potential confounding effects of selected socio-demographic factors. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to quantify the strength of association.Main findingsThe prevalence of acute diarrhea among children aged 0-50 months in the study area was 11.9% and 94.6% of the sanitation facilities were unimproved. Sharing of a sanitation facility by six or more households (AOR = 4.7; 95% CI: 2.4-9.4), proximity of sanitation facilities within 15 meters of homes (AOR = 6.6; 95% CI: 2.5-17.0), presence of feces (AOR = 3.9; 95% CI: 1.5-10.3) and flies (AOR = 2.5; 95% CI: 1.3-5.0) on the floor of and/or around sanitation facilities, and presence of uncollected garbage inside house compounds (AOR = 3.2; 95% CI: 1.2-8.4) were significantly associated with acute diarrhea.ConclusionThis study reveals the slum environment to be high risk for diarrhea due to close proximity of sanitation facilities to homes, sharing of sanitation facilities, and poor hygiene of the sanitation facilities and housing compounds. We recommend the development of a comprehensive diarrheal disease prevention program that focuses on improving the cleanliness of the sanitation facilities and housing compounds. Increasing the number of improved sanitation facilities at an appropriate distance from houses is also essential in order to reduce the number of households that share one latrine.

Project description:BackgroundGlobal strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited.ObjectiveThe study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility-delivery service among slums women, Addis Ababa, Ethiopia METHODS: Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18-49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge.ResultsThe FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

Project description:BackgroundMidwives are the primary source of care and support for mothers and newborns at the most vulnerable time in their lives.The Ethiopian National Reproductive Health Strategy targeted reduction of Maternal Mortality rate to 267/100,000 live births in the years 2006-2015. Midwives play a crucial role in the care of pregnant women, from the first antenatal visit right through to the delivery and the postpartum period.MethodologyInstitution based cross-sectional study was carried out from March 2015 to April 2015 in Addis Ababa city, Ethiopia to assess job satisfaction and its determinants among midwives working at government health facilities. A total of 234 midwives were involved from 84 health centers and 8 governmental hospitals proportional to the size of health centers and hospitals using simple random sampling method. A total of 175 and 59 midwives were taken from health centers and government hospitals respectively. Different variables like Socio demographic, Job related domain and Organizational domain were collected using pre structured questionnaire after getting written consent. Data entry and analysis were done using SPSS 21.00. Binary logistic regression was used to determine factors affecting job satisfaction. P-values less than 0.05 were considered statistically significant.ResultFrom 234 eligible respondents 221 midwives participated in this study which makes a response rate of 94.44%. The overall mean job satisfaction was 52.9%. Independent predictors of job satisfaction includes Sex [AOR = 4.07 (95%CI: 1.36-12.37)], working unit [AOR = 0.04 (95%CI:(0.001-0.45)], Educational status [AOR = 5.74(95%CI: 1.48-40.47)], Marital status [AOR = 3.48 [1.01-11.97)], supervision [AOR = 4.33 (95%CI: 1.53-20.22)], standard of care[AOR 4.80, (3.38-50.10)] and work load [AOR 8.94, (95%CI 2.37-22.65)]. Midwives were least satisfied from salary, extrinsic reward and professional opportunity subscales while they were most satisfied from coworker relation and the standard of care they provided to clients.ConclusionHalf of study subjects were satisfied with their job. Governmental and Nongovernmental organizations should consider the factors that contribute to job dissatisfaction in order to improve service provision.

Project description:BackgroundMother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programmes against HIV infection of newborn babies. This study aimed to investigate factors associated with the acceptability and utilization of PMTCT of HIV.MethodsAn institution based cross-sectional study was conducted in April 2010 using exit interviews with 843 pregnant women attending antenatal care (ANC) clinics of 10 health centers and two hospitals in Addis Ababa, Ethiopia. Trained nurses administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about MTCT, practice of HIV testing and satisfaction with the antenatal care services. Six focus group discussions among pregnant women and 22 in-depth interviews with service providers complemented the quantitative data.ResultsAbout 94% of the pregnant women visited the health facility for ANC check-up. Only 18% and 9% of respondents attended the facility for HIV counselling and testing (HCT) and receiving antiretroviral prophylaxis, respectively. About 90% knew that a mother with HIV can pass the virus to her child, and MTCT through breast milk was commonly cited by most women (72.4%) than transmission during pregnancy (49.7%) or delivery (49.5%). About 94% of them reported that they were tested for HIV in the current pregnancy and 60% replied that their partners were also tested for HIV. About 80% of the respondents reported adequacy of privacy and confidentiality during counseling (90.8% at hospitals and 78.6% at health centers), but 16% wished to have a different counselor. Absence of counselors, poor counselling, lack of awareness and knowledge about HCT, lack of interest and psychological unpreparedness were the main reasons cited for not undergoing HIV testing during the current pregnancy.ConclusionsHIV testing among ANC attendees and knowledge about MTCT of HIV was quite high. Efforts should be made to improve the quality and coverage of HCT services and mitigate the barriers preventing mothers from seeking HIV testing. Further research should be conducted to evaluate the uptake of antiretroviral prophylaxis among HIV-positive pregnant women attending ANC clinics.

Project description:BackgroundBlood film microscopy is the gold standard approach for malaria diagnosis, and preferred method for routine patient diagnosis in health facilities. However, the inability of laboratory professionals to correctly detect and identify malaria parasites microscopically leads to an inappropriate administration of anti-malarial drugs to the patients and incorrect findings in research areas. This study was carried out to evaluate the performance of laboratory professionals in malaria diagnosis in health facilities under the Defense Health Main Department in Addis Ababa and its surroundings, Ethiopia.MethodA cross sectional study was conducted from June to July 2015. Totally, 60 laboratory professionals out of the selected 16 health facilities were included in the study. Data were collected by distributing standardized pre-validated malaria slide-panels and self-administered questionnaires among professionals, onsite in each study facility. Sensitivity, specificity, and strength of agreement (with kappa score) in performance among the study participants against WHO-certified expert malaria microscopists were calculated.ResultOf the 60 study participants, 8.3% (5/60) correctly read all the distributed slides in terms of parasite detection, species identification and parasite counting; whereas, each of the remaining 55(91.7%) interpreted at least two slides incorrectly. The overall sensitivity and specificity of participants' performance in detection of malaria parasites were 65.7% and 100%, respectively. Overall, fair agreement (71.4%; Kappa: 0.4) in detection of malaria parasite was observed between the study subjects and expert readers. The overall sensitivity and specificity of participants in species identification of malaria parasites were respectively 41.3% and 100%. Overall, slight agreement (51.1%; kappa: 0.04) in identification of malaria species was observed. Generally, agreement was lower in parasite detection and species identification at low parasite density and mixed infection cases.ConclusionThe general agreement between the study participants and expert microscopists in malaria parasite detection and species identification was very low, particularly in the cases of low-parasite density and mixed infections. Therefore, regular external quality assessments and further refreshment trainings are crucial to enhance the skill of professionals in malaria microscopy; particularly for those in non-malarious areas where exposure to malaria diagnosis is low.

Project description:BackgroundThe problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa.MethodsA community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics.Main findingsDuring the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4-60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1-29.1) were independently associated with acute diarrhea.ConclusionWe conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City's water authority is able to deliver continuously available piped water supplies.

Project description:BackgroundProblems during pregnancy, childbirth and postpartum are the major contributors to maternal and perinatal morbidity and mortality. Focused antenatal care is an intervention set to provide basic services for pregnant women, to reduce morbidity and mortality related to pregnancy. In Ethiopia, there is a significant loss to follow up from antenatal care services between the first and fourth visits. The aim of this study is to explore the potential contributing barriers to loss to follow up of pregnant women from antenatal care services in villages around Addis Ababa, the capital city of the country.MethodsA qualitative research method was used, where 20 in-depth interviews (zonal, woreda and health center managers, midwives and health extension workers were the participants) and three focus group discussions (mothers who were lost to follow up, mothers who completed four sessions of antenatal care visits, and community volunteers were the participants) were conducted. A qualitative data analysis software, ATLAS.ti 8, was applied.ResultsInability to deliver essential antenatal care services which occurs primarily due to shortage of the required medical equipment, drugs, and other supplies is a major barrier for sustainable attendance of antenatal care services followed by poor care, respect, and receptiveness of service providers. Lack and cost of transport as well as partners' approval and support were also claimed to be part of the major barriers. Community culture and pervious maternal experiences as well as maternal sociodemographic factors like maternal age at time of pregnancy and educational status of mothers were also reported as barriers to seeking and completion of antenatal care services.ConclusionsBoth demand and supply side barriers play a significant role in the loss to follow up from antenatal care services. Availing essential antenatal care services, closer to the community by improving the infrastructure, health workforce and supply chain system is recommended.

Project description:BackgroundApproximately one-third of the global stillbirth burden occurs during intrapartum period. The ability to assess obstetric parameters including effacement, dilatation, uterine contraction, decent, rupture of the uterus, and moulding of the foetal head are among the essential competencies required by obstetric service providers admitting women for labour in health facilities. Misdiagnosis of these conditions could result in unnecessary obstetric interventions and unfavourable obstetric outcomes including intrapartum stillbirth. This study aimed to assess associations between missed diagnosis plus complication of labour on admission and intrapartum stillbirth.MethodsA case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and three public hospitals of Addis Ababa between 01 July 2010 and 30 June 2015 was conducted. Data were collected from charts of all cases meeting the inclusion criteria. Medical records of women with livebirths were randomly selected and reviewed from each public health facilities in two to one (2:1) control to case ratio. Accordingly, 728 cases of stillbirth out of 1,056 charts met the inclusion criteria whereas 1,551 controls out of 1,705 were also considered in the study.ResultsProportionally, more women in the stillbirth group (39.4%) than in the livebirth group (30.2%) experienced ruptured membrane on admission, with the difference being statistically significant (OR 1.7, 95% CI 1.37-2.03). Significantly higher proportion of women in the intrapartum stillbirth group experienced FRH lower than 110/min, a result suggestive of foetal distress on admission. Proportionally, more women in the intrapartum stillbirth group (14.5%) than in the livebirth group (4.5%) had breech foetal presentation on admission for labour, the difference being statistically significant (aOR 3.26 95% CI 1.93-5.50). Intrapartum stillbirth was slightly higher among women with cervical dilatation 4cm or more on admission (OR 1.2, 95% CI 1.00-1.45). This could be owing to delay in seeking obstetric care or misdiagnosis of the condition, a situation that seeks more rigorous study to determine the underlying causal links. Diagnosis of foetal member was missed among more cases than controls where the difference was statistically significant (aOR 1.51, CI 1.03-2.19).ConclusionLow FHR, non-vertex foetal presentations and ruptured cervical membrane were predictors of intrapartum stillbirth. Health facilities could avert unnecessary foetal loss by undertaking timely actions to manage obstetric emergencies on admission to labour.

Dataset Information

Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women's perspectives from slums of Addis Ababa, Ethiopia.

Objective

Setting

Study design

Study participants

Results

Conclusion

Publications

Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women's perspectives from slums of Addis Ababa, Ethiopia.

Similar Datasets

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