scholarly journals Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Suresh Mehata ◽  
Yuba Raj Paudel ◽  
Maureen Dariang ◽  
Krishna Kumar Aryal ◽  
Bibek Kumar Lal ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Concentration Index ◽  
Maternal Education ◽  
Institutional Delivery ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Demographic And Health Surveys ◽  
Cross Sectional ◽  
Remote Areas

Background. Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. Methods. Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. Findings. The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76 (95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful. Conclusion. To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas.

scholarly journals Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001–2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vishnu Prasad Sapkota ◽  
Umesh Prasad Bhusal ◽  
Kiran Acharya
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Concentration Index ◽  
Institutional Delivery ◽  
National Level ◽  
Wealth Index ◽  
Maternal Health Services ◽  
Demographic And Health Surveys ◽  
Cesarean Section Delivery ◽  
The Government

Abstract Background Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services. Methods The study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis. Results The study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016. Conclusion Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.

scholarly journals The association between male involvement in institutional delivery and women’s use of institutional delivery in Debre Tabor town, North West Ethiopia: Community based survey

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249917
Author(s):  
Kassanesh Melese Tessema ◽  
Kebadnew Mulatu Mihirete ◽  
Endalkachew Worku Mengesha ◽  
Azezu Asres Nigussie ◽  
Awoke Giletew Wondie
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Institutional Delivery ◽  
Male Involvement ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Male Partners ◽  
Community Based ◽  
Cross Sectional ◽  
The Impact

Background Maternal deaths remain high in Ethiopia mainly due to poor maternal health service utilization. Despite men are the chief decision-makers and economically dominant in Ethiopia, the impact of their involvement on maternal health services utilization is not clear. This study aimed to assess the association between male involvement and women’s use of institutional delivery, and factors influencing male partners’ involvement in institutional delivery. Methods A community based cross-sectional study was conducted between March and May, 2019. A total of 477 married men who have children less than one year of age were interviewed. Face-to-face interviews using a pre-tested and structured questionnaire were used for data collection. Bivariate and multiple logistic regressions were carried out. SPSS version 23 was used for data analysis. Results Overall 181 (37.9%) husbands/partners were involved in institutional delivery for the most recent child birth. Male partners involvement in institutional delivery was strongly associated with an increased odds of attending institutional delivery by spouse [AOR: 66.2, 95% CI: 24.8, 177.0]. Education [AOR: 0.33, 95% CI: 0.18–0.59], knowledge on maternal health [AOR: 1.67, 95% CI: 1.11–2.50], favourable attitude towards institutional delivery [AOR: 1.83, 95% CI: 1.23–2.71], and no fear while supporting spouse [AOR: 2.65, 95% CI: 1.28–5.50] were positively associated with male partners involvement in institutional delivery. Conclusion Male partner’s involvement in institutional delivery was inadequate. This study reported a significant beneficial impact of male involvement on maternal health through improved utilisation of institutional delivery. Therefore, maternal health interventions should target husbands as consumers of maternal health services, and healthcare/government policies that isolate or discourage men from having active engagement in maternal health should be improved.

scholarly journals Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1061
Author(s):  
Sathirakorn Pongpanich ◽  
Abdul Ghaffar ◽  
Najma Ghaffar ◽  
Hafiz Abdul Majid
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Postnatal Care ◽  
Health Surveys ◽  
Newborn Care ◽  
Wealth Index ◽  
Maternal Health Services ◽  
Care Utilization ◽  
Demographic And Health Surveys ◽  
Cross Sectional

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

scholarly journals A cross-sectional study on utilization of maternal health services and its determinants among rural population of district Sitapur, Uttar Pradesh

2021 ◽  
Vol 8 (8) ◽  
pp. 3999
Author(s):  
Arslan Neyaz ◽  
Jaideep K. Chaubey ◽  
Malik S. Ahmed ◽  
Virendra Kumar ◽  
Kripashankar Nayak
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Institutional Delivery ◽  
Maternal Health Services ◽  
Cross Sectional Study ◽  
Maternal Health Service ◽  
Sectional Study ◽  
Cross Sectional

Background: In India, despite substantial improvements in maternal health over the last decade or so, still condition is even poor in rural areas. As per National health policy 2017, target is to reduce MMR to 100 by 2020 and sustaining antenatal coverage at 100%, institutional delivery 80% and skilled attendance of birth 100% by 2025.The study is conducted with the objective to assess the pattern of maternal health service utilization and to identify the factors affecting it.Methods: A community based cross-sectional study was conducted at field practice area of Rural Health Training Centre, Hind Institute Of Medical Sciences, Sitapur with a sample of 208 women selected using systematic random sampling. SPSS Statistics 20.0 was used for data entry and calculation of statistical tests.Results: ANC utilization was found to be 70.7% whereas minimum recommended ANC visits were 50%. Only 54.8% deliveries were found to be institutional whereas 59.1% women received at least one postnatal check-up in our study. Most common reason for not utilizing ANC, Institutional delivery and PNC services was found to be tradition, availability of trained person and no need respectively. A highly significant association was found between maternal health service utilization and woman’s education, partner’s education, partner’s occupation, birth order and standard of living index (p<0.05).Conclusions: This study established that educating the population, empowering women, promoting maternal health service utilization in multipara’s and improving the socio-economic status of the family would yield greater results in increasing the use of maternal health services. 

scholarly journals Factors Associated with Use of Maternal Health Services in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey

2019 ◽  
Vol 17 (3) ◽  
pp. 301-307
Author(s):  
Prithutam Bhattarai
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Survey ◽  
Institutional Delivery ◽  
Maternal Health Services ◽  
Demographic And Health Survey ◽  
Maternal Health Service ◽  
Health Institution ◽  
Delivery Services

Background: Timely access and use of health services are critical for improving maternal health services. The objective of present study is to identify key factors related to antenatal care and institutional delivery services in Nepal.Methods: Data from the Nepal Demographic Health Survey 2016 was analyzed. Women who have taken four or more antenatal checkup (ANC4+), and who delivered at a health Institution were considered outcome variables. Logistic regression analysis was used to compute odds ratio. Women (15-49) having most recent birth in 5 years preceding the survey were included in the study.Results: 69.4% women had taken four or more ANC and 60.6 % had given delivery at a health institution. Age of mother at birth of child, birth order, residence, and ethnicity were significantly associated with use of maternal health service. Educated were 3.79(CI2.83-5.08) times likely to take ANC4+ and 2.71 (CI 2.05-3.57) times likely to give birth at health institution. Richest women were 2.25(CI2.83-5.08) times likely to utilize the ANC4+ service and 9.48(CI6.46-13.91) times likely to give birth at health institution. Women in Province 7 were 3.16(CI2.14-4.67) times likely to utilize ANC4+ service and 2.71(CI 1.83-4.05) times likely to give delivery in health institution compared to women in Province 6.Conclusions: Higher educated and richest women were using antenatal care and institutional delivery compared to less educated. The finding reinforces importance of empowering women with education and improving economic situation.Keywords: Antenatal care; demographic and health survey; institutional delivery; maternal health; Nepal.

scholarly journals Disparity in Maternal Health Services Among the Different Geopolitical Zones in Nigeria

2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Abubakar Sadiq Umar ◽  
Chinaro Kennedy ◽  
Hebatullah Tawfik ◽  
Daniel M. N. Okenu
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Secondary Data ◽  
Maternal Health Services ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Health Delivery ◽  
Delivery Services ◽  
The Difference ◽  
Antenatal Visits

Although the use of antenatal and other skilled maternal health delivery services in Nigeria was reported to be on the increase, this research explored whether geopolitical zone of residence and place of domicile are associated with the number of antenatal visits and place of delivery. A quantitative cross-sectional study based on secondary data from the Demographic and Health Survey was used to examine the relationship between women’s geopolitical zone of residence, place of domicile (rural/urban), and the number of antenatal visits (categorized as fewer than four or four or more) and delivery (home or health facility). A total of 33,385 women aged 15–49 years were recruited from 888 clusters spread across all the 36 states and the federal capital territory of Nigeria using a stratified two stage proportionate to size cluster design. A higher proportion of women from the South West and North Central zones had made four or more antenatal care visits compared to the other geopolitical zones. The difference was statistically significant even after controlling for differences in education, income, ethnicity, religion, autonomy, and place of domicile (adjusted odd ratio = 2.062; 95% confidence interval [1.897, 2.241]; <em>p </em>< .05). Healthcare policy makers should consider the potential impact of geopolitical zones and place of domicile to enable the development of an all-inclusive strategy to robustly address maternal health services in Nigeria.

scholarly journals Persistence of the inverse care law in maternal health service utilization: An examination of antenatal care and hospital delivery in Ghana

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Coretta M.P. Jonah
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Know How ◽  
The Past ◽  
Inverse Care Law ◽  
Maternal Health Outcomes

The gap in maternal health outcomes, access and utilization between the haves and have-nots continues to be a challenge globally despite improvements over the past decade. Though Ghana has experienced steady gains in maternal health access and utilization over the years, maternal outcomes, on the other hand, remain poor. In this regard, it is essential to know how various groups in the population achieved improvements and whether some women continue to be disproportionately disadvantaged. The paper performs an analysis of cross-sectional data from the 2017 Ghana maternal health survey to examine the existence of the inverse care law in maternal health services in Ghana. Using descriptive techniques and multivariate logistic regression models the study reveals a pro-rich and pro-urban gradient in the use of hospital facilities for delivery and antenatal care attendance — also, regions known for their high levels of poverty feature significantly lower rates of hospital deliveries. The paper concludes by stressing that unless policies are changed to accommodate these groups, overall gains in maternal health will continue to be incremental.

scholarly journals Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036211
Author(s):  
Clara C Natai ◽  
Neema Gervas ◽  
Frybert M Sikira ◽  
Beatrice J Leyaro ◽  
Juma Mfanga ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Male Involvement ◽  
Maternal Health Services ◽  
Cross Sectional Study ◽  
Growth Monitoring ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mwanza City

BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services.ObjectivesTo determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania.DesignA cross-sectional study conducted from June to July 2019.SettingThis study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City.ParticipantsIncluded 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care).Outcome measures4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery.MethodsInterviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS.ResultsThe mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with SBA use or PNC utilisation.ConclusionMale involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.

scholarly journals Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027822 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Ibukun-Oluwa Omolade Abejirinde ◽  
Oluwasola Banke-Thomas ◽  
Adamu Maikano ◽  
Charles Anawo Ameh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Economic Evaluations ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

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