scholarly journals Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Augustine Tanle ◽  
Kwaku Kissah-Korsah ◽  
Joshua Amo-Adjei
Keyword(s):  
Decision Making ◽  
Women’S Health ◽  
Women's Health ◽  
Health Facility ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Wealth Status ◽  
Health Decision Making ◽  
Birth Attendance ◽  
Health Decision

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery.

Worry and Bother: Factors in Rural Women’s Health Decision Making

2015 ◽  
Vol 27 (3) ◽  
pp. 251-265 ◽  
Author(s):  
B. Jan McCulloch ◽  
Melanie N. G. Jackson ◽  
Sara L. Lassig
Keyword(s):  
Decision Making ◽  
Women’S Health ◽  
Women's Health ◽  
Health Decision Making ◽  
Health Decision

scholarly journals Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242325
Author(s):  
Mohammad Habibullah Pulok ◽  
Gowokani Chijere Chirwa ◽  
Jacob Novignon ◽  
Toshiaki Aizawa ◽  
Marshall Makate
Keyword(s):  
Health Facility ◽  
Socioeconomic Inequality ◽  
Care Service ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Facility Delivery ◽  
Delivery Care ◽  
Health Facility Delivery ◽  
Care Services ◽  
Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

scholarly journals Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Achamyeleh Birhanu Teshale ◽  
Zemenu Tadesse Tessema
Keyword(s):  
East Africa ◽  
Health Facility ◽  
Media Exposure ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
East African ◽  
African Countries ◽  
Wealth Status ◽  
Under Five ◽  
Size At Birth

Abstract Background In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa. Methods A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children’s survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality. Results Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1–3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24–48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality. Conclusion Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn’t have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.

scholarly journals “If there are no female nurses to attend to me, I will just go and deliver at home”: a qualitative study in Garissa, Kenya

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Coralie N’Gbichi ◽  
Abdhalah Kasiira Ziraba ◽  
David Wainaina Wambui ◽  
Pauline Bakibinga ◽  
Isaac Kisiangani ◽  
...  
Keyword(s):  
Health Facility ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Facility Delivery ◽  
Maternal And Newborn Health ◽  
Health Facility Delivery ◽  
Community Members ◽  
Birth Attendance ◽  
Female Nurses ◽  
Maternal And Newborn

Abstract Background The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. Methods The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. Results Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. Conclusion To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.

Is Decision-Making For Health Care Related To Health Facility Delivery Among Married Women In Uganda? Analysis From DHS 2016

2021 ◽  
Author(s):  
Harriet Akello
Keyword(s):  
Decision Making ◽  
Older Women ◽  
Health Facility ◽  
Odds Ratio ◽  
Wealth Index ◽  
Married Women ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Factors Associated ◽  
The Relationship

Abstract Background Most maternal and neonatal deaths occur in low and middle incomes, and more than half takes place within the first day of birth. These deaths could be prevented if delivery was attended to by skilled health professionals in the health facilities. Empirical studies have reported several factors associated with low facility-based delivery. Limited literature is available on the relationship between women autonomy and health facility delivery in Uganda. This study aims to establish the relationship between decision-making for health care and health facility delivery among married women in Uganda. Method: The data used for the cross-sectional study was from the Uganda Demographic Health Survey 2016. The study used a sample of 1541 women who gave birth within five years before the survey. Proportions, odds ratio and 95% confidence interval were used to estimate the health facility delivery for each independent variable using the level of significance of p < 0.05. Binary logistics regression was used to calculate the odds ratio for the different variables. Results: 49% of the women could decide by themselves to seek care. Although 94% of the women attended ANC during the last pregnancy, only 75% of the married women delivered their most recent child in the hospital/health facility. There was regional variation for facility-based delivery (Western AOR 0.441, CI 0.285-0.684; Eastern 0.568, CI 0.395-0.816; Central 0.587, CI 0.361-0.952). Older women are less likely to deliver in a health facility compared to younger ones (25-29years AOR 0.559, CI 0.356-0.877; 30-34years AOR 0.530, CI 0.342-0.823, 35-39years AOR 0.406, CI 0.252-0.652; 40-44year AOR 0 .569, CI 0.345-0.938; 45-49years AOR 0.485, CI 0.288-0.814). Women who were aged 20-29years were more likely to deliver in a health facility (AOR 1.55 CI 1.141-2.109). Women in the middle, richer and richest wealth index have higher odds of delivering in the hospital compared to women in the poorest wealth index (Middle AOR 1.544, CI 1.053-2.264; richer AOR 1.863, CI 1.211-2.866; Richest AOR 4.104, CI 2.051-8.213). Women who do not have problems with transport are more likely to deliver in the hospital (AOR 1.503, CI 1.168-1.935). Conclusion: Decision-making for health has no association with health facility delivery. The factors associated with health facility delivery among married women were the current age of the woman, age of the woman at the birth of the first child, distance to the facility, wealth, region and place of residence. The government needed to develop strategies that will improve health facility distribution per capita, invest in infrastructure that will reduce the distance to the health facility, invest in projects that will improve wealth index and carry out health promotion targeting older women and considers geographical variations.

scholarly journals The NCCMT’s dynamic model for evidence-informed public health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Clark ◽  
S Neil-Sztramko ◽  
M Dobbins
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Research Evidence ◽  
Decision Makers ◽  
Local Data ◽  
Public Health Decision ◽  
Health Decision Making ◽  
Political Preferences ◽  
Health Decision ◽  
Structured Approach

Abstract Issue It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making. Description of the problem As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making. Results The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated. Lessons Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges. Key messages Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.

scholarly journals Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Dharel ◽  
A Bhattarai ◽  
Y R Paudel ◽  
P Acharya ◽  
K Acharya
Keyword(s):  
Health Facility ◽  
Newborn Care ◽  
Facility Delivery ◽  
Early Initiation ◽  
Health Facility Delivery ◽  
Essential Newborn Care ◽  
Place Of Delivery ◽  
Early Initiation Of Breastfeeding ◽  
Nationally Representative ◽  
Initiation Of Breastfeeding

Abstract Background Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal. Methods We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates. Results The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods. Conclusions Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery. Key messages The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

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