Perceived barriers to utilization of maternal health services in rural Cambodia

Matsuoka, Sadatoshi; Aiga, Hirotsugu; Rasmey, Lon Chan; Rathavy, Tung; Okitsu, Akiko

doi:10.1016/j.healthpol.2009.12.011

Cited by 88 publications

(113 citation statements)

References 21 publications

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“…Young women may also be likely to be educated than older women. This finding concur with another study, in which older women view pregnancy as a normal event rather than a medical condition requiring professional monitoring and supervision [23]. Contrary to our finding, Pell et al reported that adolescents and unmarried younger women tend to hide their pregnancies and delayed ANC to avoid the potential social implications of pregnancy: exclusion from school, expulsion from their natal home, partner abandonment, stigmatization and gossip [24].…”

Section: Discussionsupporting

confidence: 89%

“…Pell, et al, argue that unaccustomed to the experience of pregnancy, the associated signs and symptoms, some primagravidae were more likely to seek advice and assistance and initiate ANC earlier [23,24]. Matsuoka, et al also found that multiparous women who had experienced one or more healthy pregnancies view pregnancy as a normal event [23].…”

Section: Discussionmentioning

confidence: 99%

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Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9

Ouma¹,

Asweto²

2017

AJPHR

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Background: ANC provides the opportunity to detect and treat anomalies of pregnancy and access to preventive maternal and child healthcare. However, detailed information about the actual quality and content of ANC in practice is scanty, especially in developing countries. We analyzed the pattern and content of antenatal care service in Kenya in order to assess the quality of ANC. Methods: We used data from the 2008/9 KDHS, a nationally representative survey of women aged 15-49 years in Kenya. Proportion was used for description purpose while association was determined by bivariate and multivariate analysis in which odds ratio with a 95% confidence interval values were calculated. Results: About 50.9% of women sought ANC services either in health centers or dispensaries but these lower level health facilities had more content gaps. Multivariate analysis indicated that maternal age, regional residence, urban residence, wealth index, education and the media influenced ANC initiation and at least 4 ANC visits. There was a coverage gap existing in terms of iron-folate supplementation (66.1%), tetanus toxoid (66.5%), presumptive/preventive treatment for malaria with SP (38.7%) and education on pregnancy complication (44.3%). Nearly a third of women missed the screening for complication during pregnancy. Conclusion: Disparities exist in provision of ANC components, by type of facility attended, rural-urban and low versus higher income biases. Consequently vulnerable women attending ANC miss important care including screening for complication during pregnancy and labor. Efforts should be designed to improve on supplies to government health centers and dispensaries. Well stocked outreach village clinics with the requirements of a comprehensive antenatal care resource allocation should be used to eliminate service disparities. Government policy should help to increase media penetration amongst the masses and sensitize mothers on the importance of ANC.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9

Ouma¹,

Asweto²

2017

AJPHR

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“…Husbands may become upset when their wives are asked to undergo testing for HIV, since it is associated with immoral behavior [24]. Similarly to our study findings, other studies have reported that female patients tend to receive less support from their families and often face financial, physical and social barriers in accessing health services [25,26]. Our results show that stigma and anticipated social consequences are factors that cause delays in seeking a diagnosis.…”

Section: Discussionsupporting

confidence: 78%

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

Yellapa

Devadasan

Krumeich

et al. 2017

Global Health Action

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Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services.

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“…Similarly, curative care utilization of health facilities has generally increased in most settings but not always resulted in an increase in promotive care, such as MCH provision (10). However, community perspectives on reasons of underlying improvement or lack of improvements in facility utilization have not been explored qualitatively in as much depth as in quantitative surveys (2,13). This study endeavored to explore perceived barriers for utilizing MNH services, in contracted out versus noncontracted primary healthcare facilities among mothers and their spouses residing in catchment areas of these facilities.…”

Section: Key Messagesmentioning

confidence: 99%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong communitybased behavior change strategies. Implications for policy makers• Contracting out public health facilities can be an effective strategy to improve service delivery for Maternal and Neonatal Health (MNH), however, not sufficient to improve the service utilization. • With poor physical and financial access to health facilities in rural settings, transportation and financial safety nets need to be established. • Cultural and customary trends strongly influence decision-making for MNH services utilization. Therefore, community-based behavior change strategies targeting mothers, spouses and mother-in-laws seem crucial.

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Perceived barriers to utilization of maternal health services in rural Cambodia

Cited by 88 publications

References 21 publications

Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9

Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

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