世界経済・社会統計 = World development indicators

Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.

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Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

Introduction : Utilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average Methods : We analysed the 2013 Nigeria DHS to determine factors associated with utilization of these  health MCH indicators by employing both bivariate and multivariate logistic regressions Results : Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births Factors that consistently predict the utilization of the  three MCH services are maternal and husband's level education, place of residence, wealth level and parity Antenatal care strongly predicts both health facility delivery (OR=216, 95%CI: 199-234) and postnatal care utilization (OR=467, 95%CI: 395-554); while health facility delivery equally predicting  postnatal care (OR=284, 95%CI: 220-280) Conclusion : Improving utilization of these three MCH indicators will require targeting women in the rural  areas and those with low level of education as well as creating demand for health facility delivery Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization Key words: ANC, institutional delivery, postnatal, Nigeria, DHS, 2013

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Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria

Objectives To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa. Design Systematic review. Data sources Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science. Eligibility criteria Primary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018. Data extraction and synthesis A data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings. Results 74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband’s support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits. Conclusion A variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.

https://bmjopen.bmj.com/content/bmjopen/9/10/e031890.full.pdf

Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review.

In Nigeria, over one third of pregnant women do not attend Antenatal Care (ANC) service during pregnancy. This study evaluated barriers to the use of ANC services in Nigeria from the perspective of non-users. Records of the 2199 (34.9%) respondents who did not use ANC among the 6299 women of childbearing age who had at least one child within five years preceding the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus II), were used for this analysis. The barriers reported for not visiting any ANC provider were assessed vis-a-vis respondents’ social demographic characteristics, using multiple response data analysis techniques and Pearson chi-square test at 5% significance level. Of the mothers who did not use ANC during five years preceding the survey, rural dwellers were the majority (82.5%) and 57.3% had no formal education. Most non-users (96.5%) were employed while 93.0% were currently married. North East with 51.5% was the geographical zone with highest number of non-users compared with 14.3% from the South East. Some respondents with higher education (2.0%) and also in the wealthiest quintiles (4.2%) did not use ANC. The reasons for non-use of ANC varied significantly with respondents’ wealth status, educational attainment, residence, geographical locations, age and marital status. Over half (56.4%) of the non-users reported having a problem with getting money to use ANC services while 44.1% claimed they did not attend ANC due to unavailability of transport facilities. The three leading problems: “getting money to go”, “Farness of ANC service providers” and “unavailability of transport” constituted 44.3% of all barriers. Elimination of these three problems could increase ANC coverage in Nigeria by over 15%. Non-use of ANC was commonest among the poor, rural, currently married, less educated respondents from Northern Nigeria especially the North East zone. Affordability, availability and accessibility of ANC providers are the hurdles to ANC utilization in Nigeria. Addressing financial and other barriers to ANC use, quality improvement of ANC services to increase women’s satisfaction and utilization and ensuring maximal contacts among women, society, and ANC providers are surest ways to increasing ANC coverage in Nigeria.

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Barriers to antenatal care use in Nigeria: evidences from non-users and implications for maternal health programming

The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the rural areas and in some of the regions. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for the rural dwellers.

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Wealth and antenatal care use: implications for maternal health care utilisation in Ghana

The study examines the effect of health expenditure on health outcomes in sub-Sahara African (SSA) countries. These countries have made significant efforts in increasing health expenditure over the years, with the aim of improving health outcomes. Despite this, health outcomes have only responded marginally, raising concerns on the significance of health expenditure in improving health outcomes. The data for the study were sourced from the 2014 World Bank's World Development Indicators for a sample of 40 SSA countries. The study was based on the Grossman Human Capital Model on the demand for health and the fixed effect was used in the empirical analysis. The findings indicate that health expenditure has a significant but inelastic effect on health outcomes in SSA, reducing mortality rates and improving life expectancy at birth. Reductions in mortality rates were significantly influenced by public health expenditure, whereas improvements in life expectancy at birth were significantly influenced by private health expenditure. There is, however, a strong complementary relationship between public and private health expenditures in SSA, despite the dominance of the former over the latter. Given the significant but inelastic effect of health expenditure on health outcomes, the study recommends that SSA countries should make efforts to increase health expenditure in order to improve health outcomes. In particular, there should be deliberate efforts to increase public health expenditure with a view to reducing the burden of private health spending on individuals. This perhaps can be achieved through effective health insurance schemes, which will enable people to save against financial crisis that may arise due to ill health, thereby reducing out-of-pocket health expenditure.

The Effects of Health Expenditure on Health Outcomes in Sub‐Saharan Africa (SSA)

Purpose – The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.Design/methodology/approach – The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.Findings – The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the ...

Determinants of utilization of antenatal care services in developing countries: Recent evidence from Ghana

Though fertility in Ghana has declined from an average of 8 children per woman over the past three decades to 4 per woman in recent times the current rate of population growth is still unmatched by the requisite economic growth. Recent evidence suggests that the use of contraceptives have increased marginally despite the considerable decline in fertility rate. This paper revisits the determinants of contraceptive use among Ghanaian women aged 15-49 using the 2008 GDHS. Empirically the logistic and multinomial logistic regressions are used. Our results indicate that wealth status level of education ownership of health insurance number of surviving children marital status location and geographical area of residence religion and women autonomy are significant correlates of contraceptive use in Ghana. The finding reveals that women who take health decisions jointly with their partners are more likely to use modern contraceptives as compared to women who take health decisions alone.

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Correlates of Contraceptive use among Ghanaian women of Reproductive Age (15-49 Years)

Early initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana. Cross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey. The results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child’s health. Additionally, factors such as the wealth of the household, mother’s education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana. The findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.

https://www.econstor.eu/bitstream/10419/150472/1/82671806X.pdf

Eric Arthur

Papers

Wealth and antenatal care use: implications for maternal health care utilisation in Ghana

The Effects of Health Expenditure on Health Outcomes in Sub‐Saharan Africa (SSA)

Determinants of utilization of antenatal care services in developing countries: Recent evidence from Ghana

Correlates of Contraceptive use among Ghanaian women of Reproductive Age (15-49 Years)

Effect of timely initiation of breastfeeding on child health in Ghana