Assessing individual factors associated with choice of place of delivery among postnatal women in Marsabit County, Kenya.

Background: Globally, about 295,000 maternal deaths occurred in 2017 with Sub-Saharan Africa and Asia accounting for 86%. Sub-Saharan Africa alone accounted for nearly two-thirds. The rate of skilled birth attendant in Sub-African region stood at 59%. Three quarters of neonatal and maternal deaths occur outside hospital settings. Currently, the rate of maternal mortality in Kenya stands at 362 per 100,000 live births. Despite the deliberate government interventions to increase hospital deliveries, still a significant number of women deliver at home. The objective of this study was to assess the individual actors associated with choice of place of delivery among postnatal women in Marsabit County, Kenya. Methods: This was a cross-sectional descriptive study adopting both quantitative and qualitative data collection methods. A total of 416 postnatal women were systematically sampled from households at a predetermined interval of four. Key informants interviews and focused group discussions provided additional qualitative data.Results: Approximately 56.7% of postnatal women in Marsabit County delivered in health facilities. Most individual factors such as decision maker (p=0.031), myths and misconceptions (p=0.025), reduction of complications (p=0.001), hospital delivery time consuming (p=0.023) and possession of medical insurance (p=0.001) were significantly associated with choice of place of delivery. Conclusions: Approximately 6 out 10 deliveries occur at health facilities in Marsabit County. Individual factors significantly influenced choice of place of delivery. There is need for the ministry of health, County Government of Marsabit and relevant stakeholders to demystify myths and misconceptions about hospital deliveries, scale up awareness on availability of Linda Mama medical cover for pregnant women to ensure easy access of hospital delivery services.

Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

Background Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. Methods and findings We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths (p-value < 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study’s limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. Conclusions Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality.

The disparities in health insurance ownership of hospital-based birth deliveries in eastern Indonesia

Background Development in Eastern Indonesia tends to be left behind compared to other Indonesian regions, including development in the health sector. The study aimed at analyzing the health insurance ownership disparities in hospital delivery in Eastern Indonesia. Methods The study draws on secondary data from the 2017 Indonesia Demographic and Health Survey. The study population was women aged 15–49 years who had given birth in the last five years in Eastern Indonesia. The study analyzes a weighted sample size of 2299 respondents. The study employed hospital-based birth delivery as a dependent variable. Apart from health insurance ownership, other variables analyzed as independent variables are province, residence type, age group, marital status, education level, employment status, parity, and wealth status. The final stage analysis used binary logistic regression. Results The results showed that insured women were 1.426 times more likely than uninsured women to undergo hospital delivery (AOR 1.426; 95% CI 1.426–1.427). This analysis indicates that having health insurance is a protective factor for women in Eastern Indonesia for hospital delivery. There is still a disparity between insured and uninsured women in hospital-based birth deliveries in eastern Indonesia. Insured women are nearly one and a half times more likely than uninsured women to give birth in a hospital. Conclusion The study concludes that there are health insurance ownership disparities for hospital delivery in eastern Indonesia. Insured women have a better chance than uninsured women for hospital delivery.

Effect of the COVID-19 pandemic on health facility delivery in Ethiopia; results from PMA Ethiopia’s longitudinal panel

Objectives To examine the effect of COVID-19 on health facility delivery in Ethiopia. Design We used longitudinal data with a pre-post exposure to the pandemic to assess change in facility delivery patterns nationally and by urban and rural strata. We conducted design-based multivariable multinomial logistic regression comparing home, lower-level facility, and hospital delivery with date of birth as a spline term, with a knot indicating births before and on/after April 8, 2020. Setting Six regions in Ethiopia, covering 91% of the population. Participants Women were eligible to participate if they were currently pregnant or less than six weeks postpartum and were recontacted at six weeks, six months, and one year postpartum. 2,889 women were eligible and 2,855 enrolled. Data used in this paper come from the six-week interview, with a follow-up rate of 88.9% (2,537 women). Results In urban areas, women who delivered during the COVID-19 pandemic had a 77% reduced relative risk of delivering in a hospital relative to women who delivered prior to the pandemic (aRRR: 0.23, 95% CI: 0.07–0.71). There were no significant differences between the pre- and COVID-19 periods within rural strata where the majority of women deliver at home (55.6%). Overall, the effect was non-significant at a national level. Among women who delivered during the COVID-19 pandemic, 20.0% of urban women said COVID-19 affected where they delivered relative to 8.7% of rural women (p-value = 0.01). Conclusion We found that delivery patterns in urban areas changed during the early months of the COVID-19 pandemic, but there was no evidence of large-scale declines of hospital delivery at the national level. Concerns about COVID-19 transmission in health facilities and ensuring lower-level facilities are equipped to address obstetric emergencies are critical to address. COVID-19 will likely slow progress towards increasing rates of institutional delivery in urban areas in Ethiopia.

The Scope of the Right to Give Birth at Home as Reproductive Self-determination In the Legislation of Georgia and the Practice of the European Court of Human Rights

This article discusses the scope of the right to give birth at home as reproductive self-de- termination in the context of Georgian law and the case-law of the European Court. Georgia, like many other member states of the Council of Europe, unconditionally prefers the model of hospital delivery to protect maternal and fetal life and health. It is true that under Georgian law, home birth is not prohibited as such, however except for emergencies, medical staff is authorized to provide medical care only in a licensed medical premise. That equates to a restriction of the right. Despite the legitimate interest in restricting the right to give birth at home, scientific studies have confirmed the similarity between the consequences of home birth and hospital delivery in the case of low-risk pregnancies. The blanket ban on the right to give birth at home became the object of debate in the European Court in 2010. The court explained that the right to respect for private life enshrined in the Convention includes not only a person’s decision to become or not to become a parent, but also the choice of conditions. According to the court, childbirth is a unique and delicate moment in a woman’s life, and the determination of the place of childbirth is fundamentally related to a woman’s personal life. The European Court has discussed the availability and foreseeability of national legislation in the context of restricting the right to give birth at home. The Court has ruled that national authorities must ensure the clarity (if any) of the responsibility for providing obstetric services at home. However, the Court has still left open the issue of the need to restrict the right to give birth at home on the grounds of a lack of consensus among the member states of the Council of Europe and the complex socio-economic aspects of the issue.

ASSESSMENT OF CHILD MORTALITY IN CHILDREN UNDER FIVE YEARS AT THE COAST GENRAL TEACHING AND REFERRAL HOSPITAL, KENYA

According to World Health Organization, children in Sub-Saharan Africa are more affected where the cases of deaths are 15 times more than the children in high income countries (WHO 2019). The carried out an assessment of child mortality at the Coast General teaching and Referral Hospital by looking at the prevalence, risk factors associated and utilization of Maternal Child Health services at the hospital. The study used a cross sectional study design where the target populations were children delivered as well as those seeking health services at the hospital. The study recruited a sample size of 384 participants. Structured questionnaire was used to collect quantitative data and interview for qualitative data then data was analyzed using SPSS version 20. The study results were presented using tables and pie charts. The study findings show that child mortality rate stands at 31%, 54.9% of the mothers had given birth to children with more than 2.5kg and 50.8% developed pregnancy or delivery complication. Bivariate analysis finding show that age during the first birth (p=0.036), placenta and umbilical cord complication (p=0.007), hospital delivery (p=0.000) to be statistically significant to child mortality. KEY WORDS: child mortality, hospital delivery, maternal and health care

Time Trends and Regional Disparities of Maternal Mortality Ratio: Evidences From China, 1990-2018.

Introduction China is one of the few countries to achieve Millennium Development Goal 4 and 5. This study aimed to access the levels and trends of maternal mortality ratio (MMR) in China from 1990 to 2018. Methods Using descriptive epidemiology, we collected the data from the China Health Statistics Yearbooks and the China Statistical Yearbooks to describe changes in MMRs, hospital delivery rate, per capita GDP, policies, health expenditure indictors and per capita annual income by region from 1990 to 2018. Spearman correlation analysis was used to assess the relevance between MMR and health expenditure indicators. Results The MMR decreased by 79.4% from 1990 to 2018 in China, and the MMR was remarkably lower in the eastern China than that in the western China. In the context of the widening gap between urban and rural wealth from 1990 to 2018, the urban-rural MMR gap narrowed. The MMR in China has always been higher in rural areas than in urban areas. After the implementation of the Two-Child policy in 2015, the urban MMR continued to decline in 2015-2018, and the rural MMR rebounded in 2017. The hospital delivery rate in China has been on the rise, with almost all pregnant women giving birth in hospital by 2018. The MMR was negatively correlated with the percentage of government health expenditure in the total health expenditure. Obstetric hemorrhage has always been the leading cause of maternal death from 1990 to 2018 in urban and rural areas. Conclusions China has made remarkable progress in maternal survival, despite regional differences still exist. The implementation of the Two-Child policy slowed down the decline of MMR in rural areas. Chinese government should focus on the maternal health in western provinces, rural areas, and the floating population in urban areas.

Knowledge, Practice and Problems of Exclusive Breastfeeding among Mothers Attending the Outpatient Clinic of a Baby Friendly Hospital Initiative Designated Hospital in Port Harcourt, Nigeria

Background: Exclusive breastfeeding (EBF) provides all an infant requires for optimal growth and development in the first six months of life. Although most babies are breastfed in Nigeria, only 23% are exclusively breastfed. This study was carried out to ascertain the knowledge, practice and problems associated with EBF amongst mothers attending the Rivers State University Teaching Hospital (RSUTH). Methods: A 5-month cross sectional study was carried out in the Paediatric outpatient clinic (POPC) of RSUTH. A total of 343 mothers were randomly recruited and a pre-tested structured questionnaire administered after obtaining informed consent. Results: Ninety eight percent of the mothers had heard of EBF, 88% knew of its content and 80.2% knew that the duration of EBF was for 6 months. Only 46.4% exclusively breastfed their babies for 6 months and about 66% of participants knew of its benefits to both mother and child. Breastfeeding was commenced within 1 hour of delivery by 40.8% of mothers and pre-lacteal feeds given by 34.1% of mothers. Tertiary education, attending antenatal clinic and hospital delivery were significantly associated with good knowledge of EBF, while hospital delivery and multiparous women with at least 4 pregnancies were significantly associated with good EBF practice. Common challenges to EBF were perception that breast milk was insufficient for the babies (17.5%) and the need for mothers to return to work (9.3%). Conclusion: Knowledge of EBF was high among mothers attending the POPC in RSUTH but the EBF rate was suboptimal. Increased health education on the importance of EBF, the provision of creches at work places and the extension of maternity leave is advocated.