A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda

Kananura, Rornald Muhumuza; Wamala, Robert; Ekirapa-Kiracho, Elizabeth; Tetui, Moses; Kiwanuka, Suzanne N; Waiswa, Peter; Atuhaire, Leonard

doi:10.1186/s12884-017-1289-5

Cited by 23 publications

(22 citation statements)

References 37 publications

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“…Secondly, we performed a bivariate analysis using ulogit STATA command in order to attain the likelihood of the predictors of timely ANC, health facility delivery and timely PNC. Thirdly, we used a generalized structural equation modeling with binomial logistic link function since the study had more than one endogenous variable (30,31). Only variables that had a relatively small probability value of 0.1 or less were considered for inclusion in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

Atuhaire¹

2019

Preprint

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Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

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Section: Discussionmentioning

confidence: 99%

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

Atuhaire¹

2019

Preprint

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“…The prevalence of LBW appears to be a major public health issue in India and reported to be the highest among South-Asian countries. The LBW appears to be related to higher risks of several important chronic conditions (Christian 2009;Demelash et al 2015;Kananura et al 2017;Mahumud et al 2017). Thus, the determining factors that influence intrauterine growth and birth weight may have a serious effect on health outcomes many years later in life.…”

Section: Discussionmentioning

confidence: 99%

“…Birth weight of newborns is considered being a common proxy measure of intrauterine growth, influenced by socio-economic status, nutrition, environment, lifestyle factors and maternal health services during the gestation period (Christian 2009;Ludwig and Currie 2010;Sen et al 2010;Yigwan et al 2012;Amose and Degun 2014;Demelash et al 2015;Kananura et al 2017;Mahumud et al 2017). Low birth weight (LBW) has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 gm.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of LBW is positively associated with different short and long-term adverse consequences apparent with fetal development and neonatal mortality and morbidity, inhibiting several significant physical growth and congenital development risk and causing chronic diseases in later life (UNICEF 2004;Sen et al 2010;Adane et al 2014;Demelash et al 2015;Dahlui et al 2016;Mahumud et al 2017). The LBW is considered being public health issues in many of the developing countries including India (Bisai et al 2007;Badshah et al 2008;Bisai 2010;Sen et al 2010;Bharati et al 2011;Yilgwan et al 2012;Adane et al 2014;Bhaskar et al 2015;Demelash et al 2015;Dahlui et al 2016;Saini et al 2016;Kananura et al 2017;Mahumud et al 2017;Sudha et al 2017;Kavle and Landry 2018).…”

Section: Introductionmentioning

confidence: 99%

“…They have important roles in determining newborns birth weight and determining future health. Several studies have reported that LBW is affected by maternal nutrition or weight gain during pregnancy (Sen et al 2010;Ludwig and Currie 2010;Yilgwan et al 2012;Bhaskar et al 2015;Demelash et al 2015;Dahlui et al 2016;Mahumud et al 2017;Soltani et al 2017;Kavle and Landry 2018), socio-economic status (Sen et al 2010;Demelash et al 2015;Mahumud et al 2017;Budree et al 2017;Sudha et al 2017) and physical factors, maternal environment, physical activity and healthcare services (Li and Chang 2005;Elshibly and Schmalisch 2008;Demelash et al 2015;Budree et al 2017;Kananura et al 2017;Wang et al 2017). Maternal factors such as maternal age and pregnancy order are important determinants of birth weight.…”

Section: Introductionmentioning

confidence: 99%

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A Comparative Study of Food Consumption and Nutritional Status of Women in West Bengal

2018

JLS

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Birth weight of newborns is a common proxy measure of intrauterine growth, which is influenced by nutrition, environment, socio-economic status and lifestyle factors during the gestation period. The objectives of the present investigation were to understand the influences of maternal age, pregnancy order and seasonal variation in newborn low birth weight (LBW). Data of 13,423 newborn birth weight during the period from July 2007 to June 2010 were recorded from the Siliguri District Hospital of Darjeeling, West Bengal India. The information collected comprised of birth weight, type of pregnancy, maternal age, pregnancy order, month (season) of delivery and residential addresses. The overall mean (±SD) and prevalence of LBW were 2.71±0.41 kg and 19.19 percent (n=2576), respectively. The binary logistic regression analysis showed higher odds values (p<0.01) of LBW with mother's age < 20 years (Odds: 1.416) and 1 st pregnancy order (Odds: 1.636). However, births during spring season exhibited lower odds of LBW (Odds: 0.798) (p<0.01). The maternal age =<20 years and =<1 st pregnancy order was associated with LBW (p<0.05). The ROC-AUC analysis showed that pregnancy order (AUC=0.553) was better surrogate associate measure than maternal age (AUC=0.544) for determination of LBW (p<0.05). Early detection in newborns can attain appropriate weight gain and this can be achieved through regular checkup effective implementation of ongoing intervention programmes and appropriate healthcare facilities to prevent intrauterine growth retardation.

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Disentangling the link between social determinants of health and child survival in Nigeria during the Sustainable Development Goals era: a hierarchical path analysis of time-to-event outcome

Adeyinka,

Muhajarine

2023

J. Biosoc. Sci.

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While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child’s sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.

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A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda

Cited by 23 publications

References 37 publications

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

A Comparative Study of Food Consumption and Nutritional Status of Women in West Bengal

Disentangling the link between social determinants of health and child survival in Nigeria during the Sustainable Development Goals era: a hierarchical path analysis of time-to-event outcome

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