Individual and contextual factors associated with maternal healthcare utilisation in Mali: a cross-sectional study using Demographic and Health Survey data

Bain, Luchuo Engelbert; Aboagye, Richard Gyan; Malunga, Gift; Amu, Hubert; Dowou, Robert Kokou; Saah, Farrukh Ishaque; Kongnyuy, Eugene J

doi:10.1136/bmjopen-2021-057681

Cited by 10 publications

(6 citation statements)

References 85 publications

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“…Ever married women were more likely to partially and adequately utilize health services compared to never married women. This has been reported in other studies and the reason provided in this regard is that married women tend to enjoy financial support from their husbands [ 38 , 39 ]. Employment status is another factor which contributes significantly to health services utilization.…”

Section: Discussionsupporting

confidence: 69%

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

Adedokun

Uthman

Bisiriyu

2023

BMC Pregnancy Childbirth

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Background Access to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria. Methods This paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15–49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis. Results About 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility. Conclusions This study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors.

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Section: Discussionsupporting

confidence: 69%

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

Adedokun

Uthman

Bisiriyu

2023

BMC Pregnancy Childbirth

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“…Our results differ from previous studies, which found overall positive associations between ANC and PNC in Ethiopia, Nigeria, and Uganda [ 19 , 25 – 27 ]. However, prior studies have also demonstrated that rurality is negatively associated with PNC in sub-Saharan Africa [ 11 , 21 ]. Since 652 (44.7%) of our participants do not reside in Mbarara district, indicating they likely reside in rural settings, this could partially explain differences between our results and prior studies.…”

Section: Discussionmentioning

confidence: 99%

“…All regressions were adjusted for the following participant characteristics: (1) age, (2) marital status at time of delivery, (3) parity, (4) residence in Mbarara, (5) referral to MRRH for delivery, and (6) HIV serostatus. Covariates were selected a priori based upon their relationships with the exposure variable and outcome of interest [ 11 , 19 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

The interaction between antenatal care and abnormal temperature during delivery and its relationship with postpartum care: a prospective study of 1,538 women in semi-rural Uganda

Rahim

Ngonzi

Boatin

et al. 2022

BMC Pregnancy Childbirth

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Background Postnatal care (PNC) is an important tool for reducing maternal and neonatal morbidity and mortality. However, what predicts receipt and maintenance in PNC, particularly events during pregnancy and the peripartum period, is not well understood. We hypothesized that fever or hypothermia during delivery would engender greater health consciousness among those attending antenatal care, leading to greater PNC engagement after hospital discharge and our objective was to evaluate this relationship. Methods Women were prospectively enrolled immediately postpartum at Mbarara Regional Referral Hospital (MRRH). We collected postpartum vital signs and surveyed women by telephone about PNC receipt, fever, and infection at two and six weeks postpartum. Our outcome of interest was receipt of PNC post-discharge, defined as whether a participant visited a health facility and/or was hospitalized in the postpartum period. Our explanatory variables were whether a participant was ever febrile (> 38.0˚C) or hypothermic (< 36.0˚C) during delivery stay and whether a participant attended at least 4 antenatal care (ANC) visits. We used logistic regressions to estimate the association between ANC and fever/hypothermia with PNC, including an interaction term between ANC and fever/hypothermia to determine whether there was a modifying relationship between variables on PNC. Regression models were adjusted for age, marital status, parity, HIV serostatus, Mbarara residency, and whether the participant was referred to MRRH, Results Of the 1,541 women, 86 (5.6%) reported visiting a health facility and/or hospitalization and 186 (12.0%) had an abnormal temperature recorded during delivery stay. Of those who reported at least one visit, 59/86 (68.6%) delivered by cesarean, 37/86 (43.0%) reported post-discharge fever, and 44/86 (51.2%) reported post-discharge infection. Neither ANC attendance, abnormal temperature after delivery, nor their interaction term, were significantly associated with post-discharge PNC. The included covariates were not significantly associated with the outcome. Conclusions While the overall proportion of women reporting post-discharge PNC was low, those who reported visiting a health facility and/or hospitalization had high proportions of post-discharge fever, post-discharge infection, and cesarean delivery, which suggests that these visits may have been related to problem-focused care. No significant associations between ANC and PNC were observed in this cohort. Further research assessing ANC quality and PNC visit focus is needed to ensure ANC and PNC are optimized to reduce morbidity and mortality.

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“…The literature showed that monitoring inequalities are needed to address unfair disparities, identify vulnerable population subgroups left behind, and help inform equity-oriented policies that can narrow existing inequalities (3). Worldwide, evidence has accumulated on disparities in receiving competent maternal health care services by many dimensions of inequality, including wealth quintiles, location, education, maternal age, and women's empowerment (4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia

Shibre,

Mekonnen,

Haile Mariam

2024

Front. Public Health

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IntroductionAggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged.MethodsThe data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time.ResultsThere were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same.ConclusionSubstantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas.

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Individual and contextual factors associated with maternal healthcare utilisation in Mali: a cross-sectional study using Demographic and Health Survey data

Cited by 10 publications

References 85 publications

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

The interaction between antenatal care and abnormal temperature during delivery and its relationship with postpartum care: a prospective study of 1,538 women in semi-rural Uganda

Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia

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