Rethinking how to promote maternity care-seeking: factors associated with institutional delivery in Guinea.
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ABSTRACT:
SUBMITTER: Brazier E
PROVIDER: S-EPMC4160277 | biostudies-other | 2014
REPOSITORIES: biostudies-other
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Project description:BackgroundIn the past fifteen years, Afghanistan has made substantial progress in extending primary health care. However, coverage of essential health interventions proven to improve maternal and neonatal health outcomes, particularly skilled birth attendance, remains unacceptably low. This is especially true for those in the poorest quintile of the population. This cross-sectional quantitative and qualitative study assessed barriers associated with care-seeking for institutional delivery among rural Afghan women in three provinces.MethodsThe study was conducted from November to December 2016 in 12 districts across three provinces - Badghis, Bamyan, and Kandahar - which are predominately rural. Districts were used as the primary sampling unit with district-level sample sizes reflecting the ratio of that district's population to provincial population. Villages within these districts, the secondary sampling units, were randomly selected. A household survey was used to collect data on: demographics, socio-economic status, childbearing history, health transport and service costs, maternal health seeking behavior and barriers to service uptake. Data on barriers to facility delivery were compared across provinces using chi square tests.ResultsOf the 2479 women of child bearing age interviewed, one-third were from each province (33% n?=?813 Badghis, 34% n?=?840 Bamyan, 33% n?=?824 Kandahar). Among those respondents who had delivered none of their children in a health center, money to pay for services appeared to be most important barrier to accessing institutional delivery (56%, n?=?558). No transportation available was the second most widely cited reason (37%, n?=?368), followed by family restrictions (n?=?30%, n?=?302). Respondents in Badghis reported the highest levels of barriers compared to the other two provinces. Respondents in Badghis were more likely to report familial or cultural constraints as the most important barrier to institutional delivery (43%) compared to Bamyan (2%) and Kandahar (12%) (p?<?0.001).ConclusionsDespite the socio-demographic and geographic diversity of the three provinces under study, the top barriers to institutional delivery reported in all three areas are consistent with available evidence, namely, that distance, transport cost and transport availability are the main factors limiting institutional delivery. Proven and promising approaches to overcome these barriers to institutional delivery in Afghanistan should be explored and studied.
| S-EPMC6006744 | biostudies-literature
Project description:BACKGROUND:Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. METHOD:A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12?months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p?<?0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. RESULTS:Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR?=?7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR?=?4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR?=?2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR?=?3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. CONCLUSION:Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.
| S-EPMC6836405 | biostudies-literature
Project description:BackgroundBreast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed presentation among women with breast symptoms.MethodsAfter ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The "Delayed Presentation" questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting any health care facilities. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with the delayed presentation were analyzed using cross-tabulation and multiple logistic regression.ResultsThere were 106 respondents to the questionnaire, with a mean age of 34.0 (SD: 11.2) years, and 73.6% (n = 78) were < 39 years old. A total of 35.8% (n = 38) visited the local government clinic first and only 28.3% (n = 30) came to the BestARi clinic directly. The reasons for presentation were a palpable breast lump on breast self-examination (75.5%, n = 80), mastalgia (15.1%, n = 16), nipple discharge (5.7%, n = 6), skin changes (0.9%, n = 1), and others (2.8%, n = 3). Among the respondents, 10.4% (n = 11) had alternative treatments prior to presentation to a hospital. The mean presentation time was 98.9 (SD: 323.7) days. Most of the participants (61.3%, n = 65) presented to us within 1 month. The delayed presentation group accounted for 19.8% (n = 21) of the respondents. The factor that was significantly associated with delayed presentation was the participants' perception of symptoms as not dangerous (adjusted OR 3.05, 95% CI 1.11, 8.38).ConclusionsThe percentage of delayed presentations among our patients was lower than the percentage reported in a previous study. Interpretation of a symptom as harmless by the respondent was the only factor significantly associated with delayed presentation.
| S-EPMC9331147 | biostudies-literature
Project description: Not available
| S-EPMC7124722 | biostudies-literature
Project description:ObjectiveTo assess the availability of an institutional-level respectful maternity care (RMC) index, its components, and associated factors.MethodsA cross-sectional study design was applied to a 2016 census of 3804 health facilities in Ethiopia. The availability of an institutional-level RMC index was computed as the availability of all nine items identified as important aspects of institutional-level RMC during childbirth. Logistic regression analysis was used to identify factors associated with availability of the index.ResultsThree components of the institutional-level RMC index were identified: "RMC policy," "RMC experience," and "facility for provision of RMC." Overall, 28% of facilities (hospitals, 29.9%; health centers, 27.8%) reported availability of the institutional-level RMC index. Facility location urbanization (urban region), percentage of maternal and newborn health workers trained in basic emergency obstetric and newborn care, and availability of maternity waiting homes in health facilities were positively associated with availability of the institutional-level RMC index.ConclusionOnly one in three facilities reported availability of the institutional-level RMC index. The Ethiopian government should consider strengthening support mechanisms in different administrative regions (urban, pastoralist, and agrarian), implementing the provision training for health workers that incorporates RMC components, and increasing the availability of maternity waiting homes.
| S-EPMC8246788 | biostudies-literature
Project description:BackgroundHousehold surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually.MethodsThe EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies' characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group.ResultsA total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth.ConclusionsWomen who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.
| S-EPMC7869205 | biostudies-literature
Project description:ObjectiveThe aim of this study was to assess institutional delivery and its associated factors in Benishangul-Gumez region, North-West of Ethiopia. The data were obtained at community level in a single survey within 1 month and there is no continuation of this study or previously published part elsewhere.ResultsAmong the 428 eligible respondents recruited for this study, 427 of them responded completely to the interview, giving a response rate of 99.8%. Of the total (427) respondents, 51.1% women delivered the recent child at health facility in the 12 months preceding the survey. Among the common reasons for home delivery were, labour was urgent (25.8%), home birth was usual habit for them (23.9%) and distance to health center was too far. Age (AOR?=?3.4, 95% CI 1.46, 7.97), husband occupation (AOR?=?5.16, 95% CI 1.74, 15.31), frequency of antenatal care visit (AOR?=?3.34, 95% CI 1.88, 5.94) and maternal knowledge on danger signs of pregnancy and delivery (AOR?=?7.18, 95% CI 3.77, 13.66) were significantly associated factors with institutional delivery. Although, the prevalence of institutional delivery has improved when compared to previous reports, strategic modification is important to increase health facility delivery.
| S-EPMC5870376 | biostudies-literature
Project description:IntroductionInstitutional delivery has been considered as one of the important strategies to improve maternal and child health and significantly reduces birth-related complications. However, it is still low in developing countries though there are some improvements. Hence, the aim of this study was to assess the prevalence of institutional delivery and associated factors in the study area.MethodsA community-based cross-sectional study was conducted. A multistage systematic sampling technique was used to select 1,394 study participants. We collected data from 18-48 years old women by using a structured questionnaire. Binary logistic regression was performed to identify factors at 95% confidence level.ResultsThe mean age of respondents was 30 (±0.15). The wealth status of 33.48% respondents was poor and 33.33% rich. The prevalence of institutional delivery was 58.17% (95% CI: 55.57%, 60.77%). Multivariable logistic regression showed that demographic factors: women age (≥35years) (AOR = 1.43; 95% CI 1.04, 1.96), having a family size of less than five (AOR = 4.61; 95% CI 3.34, 6.34), having family discussion (AOR = 4.05; 95% CI 2.74, 5.97), distance from the nearby clinic (≤30min) (AOR = 2.92; 95% CI 1.53, 5.58) and decision power about place of delivery (AOR = 2.50; 95% CI 1.56, 4.01); socio-economic factors: husband's educational status of primary school (AOR = 1.64; 95% CI 1.19, 2.24), middle level household wealth index (AOR = 1.78; 95% CI 1.25, 2.54) and rich level household wealth index (AOR = 2.01; 95% CI 1.42, 2.86); and programmatic factors: antenatal care visit during their recent pregnancy (AOR = 1.86;95% CI 1.16, 2.97) were affects institutional delivery positively. Whereas bad behavior of health workers (AOR = 0.27; 95% CI 0.19, 0.39) negatively affects institutional delivery.ConclusionInstitutional delivery was low in the study area. This study implies that strengthening family discussion and up taking antenatal care services in regular ways are a few of the suggested recommendations.
| S-EPMC8297840 | biostudies-literature
Project description:BackgroundThere is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia.MethodsStudies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger's regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors.ResultTwenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I2 =?0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR)?=?2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR?=?3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR?=?3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR?=?2.91;95% 1.88,4.52) in 5 studies, availability of information source (AOR?=?1.80;95% CI 1.16,2.78) in 6 studies, ANC follow-up (AOR?=?2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR?=?4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR?=?3.04;95% CI 1.76,5.24) in 11 studies and place of birth of the elder child (AOR?=?8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization.ConclusionThis review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.
| S-EPMC7296650 | biostudies-literature
Project description:Objectiveto identify staff and institutional factors associated with substandard care by midwives managing postpartum hemorrhage (PPH).MethodsA multicenter vignette-based study was e-mailed to a random sample of midwives at 145 French maternity units that belonged to 15 randomly selected perinatal networks. Midwives were asked to describe how they would manage two case-vignettes about PPH and to complete a short questionnaire about their individual (e.g., age, experience, and full- vs. part-time practice) and institutional (private or public status and level of care) characteristics. These previously validated case-vignettes described two different scenarios: vignette 1, a typical immediate, severe PPH, and vignette 2, a severe but gradual hemorrhage. Experts consensually defined 14 criteria to judge adherence to guidelines. The number of errors (possible range: 0 to 14) for the 14 criteria quantified PPH guideline adherence, separately for each vignette.Results450 midwives from 87 maternity units provided complete responses. Perfect adherence (no error for any of the 14 criteria) was low: 25.1% for vignette 1 and 4.2% for vignette 2. After multivariate analysis, midwives' age remained significantly associated with a greater risk of error in guideline adherence in both vignettes (IRR 1.19 [1.09; 1.29] for vignette 1, and IRR 1.11 [1.05; 1.18] for vignette 2), and the practice of mortality and morbidity reviews in the unit with a lower risk (IRR 0.80 [0.64; 0.99], IRR 0.78 [0.66; 0.93] respectively). Risk-taking scores (IRR 1.41 [1.19; 1.67]) and full-time practice (IRR 0.83 [0.71; 0.97]) were significantly associated with adherence only in vignette 1.ConclusionsBoth staff and institutional factors may be associated with substandard care in midwives' PPH management.
| S-EPMC4806984 | biostudies-literature