Journal Article•
Determinants of place of delivery among women in a semi-urban settlement in Zaria, northern Nigeria
01 Jan 2006-Annals of African Medicine (Usmanu Danfodiyo University Teaching Hospital)-Vol. 5, Iss: 2, pp 68-72
TL;DR: Low maternal education, unemployment among fathers, first pregnancies at less than 18 years of age increase the likelihood of home delivery in Sabuwar Unguwa, Magume district of Zaria, Nigeria.
Abstract: Background/Objective: Majority of the maternal deaths that occur especially in developing countries are avoidable or preventable. Studies have shown that the health, reproductive behaviour and socio economic status of women are among the important determinants of maternal mortality. This study was aimed at assessing the role of some health, socio-economic and demographic factors in determining the place of delivery among women in a semi-urban settlement in Zaria, north-western Nigeria. Method: The study design was a cross sectional descriptive study conducted in Sabuwar Unguwa, Magume district Zaria Local Government Area Kaduna State Nigeria in June, 2003. A total of 496 women who had delivered at least once were interviewed using a pre-tested interviewer administered questionnaire. Results: The study revealed both high rates of home deliveries and deliveries not supervised by skilled attendants of 70% and 78% respectively. Mother's educational level, husband's occupation and age at first pregnancy were the main determinants of place of delivery. Statistically significant associations between non- formal education and home delivery, (X 2 = 6.7 df = 1 P 2 =18.7 df = 1 P 2 = 0.59 df = 1 P>0.05). Conclusion: Low maternal education, unemployment among fathers, first pregnancies at less than 18 years of age increase the likelihood of home delivery in Sabuwar Unguwa, Magume district of Zaria. Girl child education, income generating activities and training of TBAs could reduce the high rate of home deliveries and its consequences in the study area. Keywords: Delivery, place, determinants Annals of African Medicine Vol. 5(2) 2006: 68-72
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TL;DR: Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD.
Abstract: While the most important factors associated with facility-based delivery (FBD) have been explored within individual countries in Africa, no systematic review has explored the factors associated with FBD across sub-Saharan Africa. A systematic search of the peer-reviewed literature was conducted to identify articles published in English from 1/1995-12/2011 that reported on original research conducted entirely or in part in sub-Saharan Africa and included a primary outcome variable of FBD, delivery location, or skilled birth attendance (SBA). Out of 1,168 citations identified, 65 met inclusion criteria. 62 of 65 were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorized as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied. This may be a result of the overwhelming reliance on household survey data – where maternal sociodemographic factors are likely to be well-represented and non-maternal factors may be less consistently and accurately represented. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. Research to date has been dominated by analysis of cross-sectional household survey data. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.
270 citations
Cites background from "Determinants of place of delivery a..."
...Maternal age Botswana; Burkina-Faso; Ghana; Ivory Coast; Kenya; Malawi; Nigeria; Tanzania; 21 countries in Africa Younger women more likely to deliver in a facility, except if very young (<18 years of age); inconsistently found significant [14-22]...
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...Husband's occupation Kenya; Nigeria Non-farmers have higher rates of FBD [18,59]...
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...Maternal education Botswana; Burkina Faso; Eritrea; Ethiopia; Ghana; Ivory Coast; Kenya; Malawi; Namibia; Nigeria; Tanzania; Uganda; multiple lowincome, developing or African nations Greater education is linked to higher levels of facility based delivery and skilled birth attendance [14,16-21,23-47]...
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TL;DR: Despite similarities in Obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned and more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women.
Abstract: Since 2000, the United Nations’ Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms ‘obstetric care’, ‘access’, ‘barriers’, ‘developing countries’ and ‘sub-Saharan Africa’ were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women’s self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users’ residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. PROSPERO 2014 CRD42014015549
202 citations
Cites background from "Determinants of place of delivery a..."
...Only a few studies reported lower maternal age or teenage motherhood as a barrier [46, 82, 143]....
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...Women or their partners who were unemployed [82, 143] or employed in agricultural occupations or whose husbands/partners worked in agriculture were also reported to make less use of maternity care services [94, 134]....
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TL;DR: 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.
Abstract: 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
199 citations
Cites background from "Determinants of place of delivery a..."
...While there are several studies documenting factors related to utilization of antenatal care and institutional delivery/skilled attendance at delivery in Nigeria [12-25] studies exploring utilization of postnatal care are scarce and fragmentary despite its role promoting maternal and neonatal health....
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TL;DR: Institutional delivery service utilization was found to be low in the study area and secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery.
Abstract: Background
Reducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors.
148 citations
TL;DR: In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery and intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery Service utilization.
Abstract: High maternal mortality is a continued challenge for the achievement of the fifth millennium development goal in Sub-Saharan African countries including Ethiopia. Although institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality, interventions at the community and/or institutions were unsatisfactorily reduced maternal mortality. Institutional delivery service utilization is affected by the interaction of personal, socio-cultural, behavioral and institutional factors. Therefore this study was designed to assess factors associated with institutional delivery service use among mothers in Bahir Dar city administration. A community based cross sectional study was conducted in Bahir Dar City administration Northwest of Addis Ababa, Ethiopia. Four hundred eighty four mothers were included in the study. Data were collected by trained female data collectors. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios (OR) with 95% confidence intervals. In this study, 78.8% of women gave birth to their current child at health institution. The multivariable logistic regression showed that, attending primary education (AOR = 4.7[95% CI:1.3-16.7], secondary education (AOR = 3.5[95% CI:1.1-10.7]), age at first marriage; first time marriage at 15–19 years (AOR = 5.4[95% CI:2.0-15.0]) and first time marriage at 20–24 years (AOR = 5.0[95% CI:1.5-16.8] and gestational age at first ANC visit (first trimester) (AOR = 5.3[1.3-22.2]) and second trimester (AOR = 2.8[95% CI:0.7-11.]) were independent factors affecting institutional delivery service utilization. In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery. This study indicated that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Hence, intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery service utilization.
100 citations
Cites background or result from "Determinants of place of delivery a..."
...For example, 42.0% of women in Malawi [12], 69% in Nepal [13], 70% in Zaria (Northern Nigeria) [14], 74% in Pakistan [15] and 87.6% in Eastern Burma [16] gave birth at home....
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...The prevalence of home delivery in this study was less compared with findings from other developing countries like Malawi [12], Nepal [13], Zaria, Northern Nigeria [14], Pakistan [15], and Eastern Burma [16]....
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...Not only maternal variables, husbands’ personal, socio-demographic and wealth related variable were associated with delivery service use [12-14,20,21]....
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...0% of women in Malawi [12], 69% in Nepal [13], 70% in Zaria (Northern Nigeria) [14], 74% in Pakistan [15] and 87....
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References
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TL;DR: A conceptual scheme is offered that clarifies the confusion and overlap existing among the definitions of "access" "quality of care" and "medical barriers" as these terms apply to family planning (FP) programs.
Abstract: This article offers a conceptual scheme that clarifies the confusion and overlap existing among the definitions of "access" "quality of care" and "medical barriers" as these terms apply to family planning (FP) programs. After an introduction the article explains that these concepts are characteristics of the supply environment and apply to any type of service delivery point. The article also bases its framework on a distinction between what happens "inside" and "outside" of the service delivery point. The article then defines the terms and discusses related issues and concerns. The next sections explore the linkages among the terms and set forth the following research priorities: 1) developing methods of "scoring" various elements of quality 2) improving methods of measuring clients perspectives of access and quality 3) verifying the population-based effects of variations among the components of the concepts and 4) validating the presumed linkages among these concepts. Finally the article enumerates the policy implications of its attempt to clarify these concepts as follows: 1) access involves more than simply geographic availability of services points 2) access and quality must be enhanced concurrently 3) quality promotion should employ a humanitarian and a demographic rationale 4) expansion of FP services to include reproductive health services will require careful consideration of medical barriers as well as monitoring of levels of quality of care and 5) that it is important to have a balanced approach.
212 citations
"Determinants of place of delivery a..." refers background in this paper
...Several factors have been identified as barriers to access to skilled care by women especially in developing countries; these include unavailability of the services, inadequate number of skilled personnel, geographical inaccessibility and poor quality of care.(4) In developing countries, most women deliver at home for some reasons....
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TL;DR: Data from a household survey was used to analyse the distribution of newborn deliveries in a rural area of Kenya and found that 52% of deliveries occurred at home or with traditional birth attendants.
Abstract: Data from a household survey were used to analyse the distribution of newborn deliveries in a rural area of Kenya. It was found that 52% of deliveries occurred at home or with traditional birth attendants. Using regression techniques, the most significant predictors of choosing an informal delivery setting are the household's distance from the nearest maternity bed and whether a household member has insurance. The results suggest that travel time is an important barrier to access. Therefore, quality improvements at existing facilities may not result in greater use of modern sector delivery, particularly if improvements are partially offset by user fees.
107 citations
TL;DR: Factors found to be most consistently associated with the use of health institutions for delivery were maternal education and occupation, religion, and occupation of the husband.
Abstract: The pattern and determinants of maternal service utilization were studied in a rural Nigerian community. The study sample consisted of 488 randomly selected women who had a childbirth or an abortion between May 1987 and September 1989. Although 93% registered for prenatal care in a health care institution, only 51% delivered in a health institution while 49% delivered at home mainly under the care of traditional birth attendants. Factors found to be most consistently associated with the use of health institutions for delivery were maternal education and occupation, religion, and occupation of the husband. Maternal age, parity and marital status and place of the residence were not significantly associated with the choice between home and institutional delivery. Logistic regression analysis was used to determine the odds ratio and to quantify the weight of these independent variables found to be significantly associated with the place of delivery as the outcome variable.
101 citations
TL;DR: In Ghana, the Accra Prevention of Maternal Mortality (PMM) team one of 12 multidisciplinary teams in the international PMM Network implemented a number of interventions to reduce maternal mortality due to obstructed labor as discussed by the authors.
83 citations
TL;DR: It is concluded that provision of relatively accessible services does not guarantee their use and that other social and cultural considerations must be taken into account.
Abstract: Pregnancy is a time when women's health is placed at risk by a host of factors; however, professionals providing antenatal care can reduce that risk by monitoring women's health regularly and offering preventive services. Hygienic delivery services by a qualified attendant also help to reduce risks associated with childbearing. We explored these considerations in a rural Nigerian town by following 60 Yoruba women through pregnancy to childbirth. Although a functioning government maternity center in the community offered a full range of antenatal and delivery services, most of the women did not register for antenatal care until their sixth month of pregnancy or later, and 65% delivered at home. This behavior is explained in terms of (a) fees for delivery services, (b) level of income, (c) cultural beliefs, and (d) education. We conclude that provision of relatively accessible services does not guarantee their use and that other social and cultural considerations must be taken into account.
34 citations