Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey.

BACKGROUND: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. METHODS: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. RESULTS: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10-74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47-6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34-5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19-5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68-133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99-6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43-350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88-14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77-3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35-21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). CONCLUSION: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.

Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community.

Community-Based Health Education Led by Women's Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial.

OBJECTIVE: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. METHODS: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. RESULTS: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). CONCLUSION: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. TRIAL REGISTRATION NUMBER: NCT05865873.

Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis.

BACKGROUND: Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. OBJECTIVES: This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. DESIGN: A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. METHODS: Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. RESULTS: Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). CONCLUSION: Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.

Antenatal care utilization and its associated factors in Somalia: a cross-sectional study.

BACKGROUND: WHO recommends attending minimum four ANC consultations during pregnancy to ensure early detection of complications. The objective of this study was to quantify ANC attendance and factors associated with it. METHODS: Participants were randomly selected using the WHO Cluster survey methodology in Southern and Central Somalia. A paper-print questionnaire was used to collect all data. Outcomes of interest were: access to at least one ANC consultation, completion of at least four ANC consultations, initiation of breastfeeding and place of delivery, while exposures included factors related to the latest pregnancy and demographic characteristics. Associations were assessed through logistic regression. RESULTS: Seven hundred ninety-two women answered the questionnaire; 85% attended at least one and 23% at least four ANC consultations, 95% started breastfeeding and 51% had an institutional delivery. Encouragement to attend ANC increased the odds of attending at least one consultation (aOR = 8.22, 95%CI 4.36-15.49), while negative attitude of husband or family decreased the odds (aOR = 0.33, 95%CI 0.16-0.69). Knowing there is a midwife increased the odds of at least four visits (aOR = 1.87, 95%CI 1.03-3.41). Attending at least four consultations increased the odds of delivering in a health structure (aOR = 1.50, 95%CI 1.01-2.24), and attending at least one consultation was associated with higher odds of initiating breastfeeding (aOR = 2.69, 95%CI 1.07-6.74). CONCLUSIONS: Family has a strong influence in women's ANC attendance, which increases the likelihood of institutional delivery and initiating breastfeeding. Women and families need to have access to information about benefits and availability of services; potential solutions can include health education and outreach interventions.

Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching.

Background: Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. Methods: We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. Result: After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. Conclusion and recommendation: This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.

Health facility delivery service utilization and its associated factors among women in the pastoralist regions of Ethiopia: A systematic review and meta-analysis.

Background and Aims: Utilizing health facility delivery services is one of the pillars of lowering maternal mortality. However, the coverage of health facility delivery service utilization continues to be uneven around the world. In Ethiopia, particularly among pastoralist regions, health facility delivery service utilization is less common. Therefore, the purpose of this study was to determine the pooled prevalence of health facility delivery service utilization and identify the associated factors among women in the pastoralist regions of Ethiopia. Methods: A comprehensive systematic search was carried out in PubMed/MEDLINE, Hinary, Cochrane Library, Google Scholar, Google, and Ethiopian online university repositories. Studies were appraised using the JBI appraisal checklist. The analysis was done using STATA version 16. The pooled analysis was conducted using DerSimonian and Laird random-effects model. I 2 test and Eggers & Begg's tests were used to assess the heterogeneity and publication bias, respectively. p < 0.05 was set to determine the statistical significance of all the tests. Results: The pooled prevalence of health facility delivery service utilization was 23.09% (95% CI: 18.05%-28.12%). Have ANC visit during pregnancy (OR = 3.75, [95% CI: 1.84-7.63]), have information regarding maternal health service fee exemption (OR = 9.51, [95% CI: 1.41-64.26]), have a nearby health facility (OR = 3.49, [95% CI: 1.48-8.20]), and women attend secondary and above education (OR = 3.06, [95% CI: 1.77-5.29]) were found to be significant associated factors. Conclusions: Health facility delivery service utilization is very low in pastoralist regions of Ethiopia, and ANC follow-up, distance from the health facility, women's educational status, and information regarding maternal health service fees were identified as significant associated factors. Consequently, strengthening ANC services, introducing free health services to the community, and constructing health facilities for the nearby residents are recommended to improve the practice.

Is there a link between the autonomy of women and maternal healthcare utilization in Nigeria? A cross-sectional survey.

BACKGROUND: Despite legislation and intervention programmes, the rates of maternal and child mortality in Nigeria remain high. Sustainable development goals on mother and child mortality would be a mirage if this continues. The study investigated the autonomy of women (women's decision-making autonomy) and the use of maternal health-care services in Nigeria. METHODS: Secondary data obtained from the Nigeria Demographic and Health Survey, 2018 were used in this investigation. Women who indicated they gave birth in the five-year before the surveys were considered in the study. The association between autonomy of women and maternal health-care utilization was studied using binary logistic regression models. RESULTS: In total, about one-fifth of the women (19.6%) indicated they had at least eight ANC visits for their most recent birth. Overall, 40.5% of the women gave birth in a health institution, and 20.1% went for postnatal checkups. The use of health-care services was significantly related to the autonomy of women. Women's and husbands/partners' educational levels, residency and ethnicity were socio-demographic characteristics that influenced women's healthcare service consumption. CONCLUSIONS: For most recent childbirth, most women did not utilise the health-care services in Nigeria. To enhance the autonomy of women and, as a result, maternal health-care services use in Nigeria, effective interventions, policies, and programmes are required.

The effect of health facility births on newborn mortality in Malawi.

We examine the effect of health facility delivery on newborn mortality in Malawi using data from a survey of mothers in the Chimutu district, Malawi. The study exploits labour contraction time as an instrumental variable to overcome endogeneity of health facility delivery. The results show that health facility delivery does not reduce 7-day and 28-day mortality rates. In a low-income country like Malawi where the healthcare quality is severely compromised, we conclude that encouraging health facility delivery may not guarantee positive health outcomes for newborn births.

Determinants of health facility delivery among young mothers aged 15 - 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey.

BACKGROUND: Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS: A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS: Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION: Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis.

BACKGROUND: Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD: Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS: Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS: Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.

Trends and factors contributing to health facility delivery among adolescent women in Ethiopia: multivariate decomposition analysis.

BACKGROUND: Although an increase in health facility delivery in Ethiopia over time, adolescent women giving birth at health facilities is still low. Health facility delivery is crucial to improving the health of women and their newborns' health by providing safe delivery services. We aimed to examine the trend change and identify factors contributing to health facility delivery in Ethiopia. METHODS: We analyzed the data on adolescent women obtained from three Ethiopian Demographic and Health Surveys. A total of weighted samples were 575 in 2005, 492 in 2011, and 378 in 2016. Data management and further statistical analysis were done using STATA 14. Trends and multivariate decomposition analysis were used to examine the trends in health facility delivery over time and the factors contributing to the change in health facility delivery. RESULTS: This study showed that the prevalence of health facility delivery among adolescent women in Ethiopia increased significantly from 4.6% (95% CI 3.2-6.7) in 2005 to 38.7% (95% CI 33.9-43.7) in 2016. Decomposition analysis revealed that around 78.4% of the total change in health facility delivery over time was due to the changes in the composition of adolescent women and approximately 21.6% was due to the changes in their behavior. In this study, maternal age, place of residency, wealth index, maternal education, frequency of ANC visits, number of living children, and region were significant factors contributing to an increase in health facility delivery over the study periods. CONCLUSION: The prevalence of health facility delivery for adolescent women in Ethiopia has increased significantly over time. Approximately 78.4% increase in health facility delivery was due to adolescent women's compositional changes. Public health interventions targeting rural residents and uneducated women would help to increase the prevalence of health facility delivery.

Factors associated with health facility delivery among reproductive age women in Nepal: an analysis of Nepal multiple indicator cluster survey 2019.

BACKGROUND: Despite existing efforts to improve maternal health in Nepal, delivery in a health facility with skilled providers is still a major health concern in Nepal. This study aimed to examine the factors associated with delivery in a health facility with skilled providers among women aged 15-49 years in Nepal. METHODS: This study used data from Nepal Multiple Indicator Cluster Survey 2019, a nationally representative cross-sectional survey. This survey was a two-stage, stratified cluster sampling. A total of 1,950 married women aged 15-49 years who had at least one live birth in the last two years preceding the survey were included in the analysis. Bivariate and multivariate logistic regression analyses were performed in this study. RESULTS: Seventy-five percent of women are delivered in a health facility with skilled providers. Women from urban areas (AOR = 1.74, p < 0.01), women residing in Sudurpaschim province (AOR = 5.64, p < 0.001), women with first parity (AOR = 2.82, p < 0.001), and women from rich household status (AOR = 4.60, p < 0.001) and women who attained at least four ANC visits (AOR = 10.81, p < 0.001) were associated with higher odds of delivering in a health facility. Women who were more educated and used the internet were more likely to deliver in a health facility by a skilled provider. CONCLUSION: Place of residence, household wealth status, and ANC visits appear to be the strongest predictors of health facility delivery with skilled providers in Nepal. Disparities in delivery in a health facility with skilled providers persist among provinces and caste/ethnicity.

National and subnational variations in gender relations and the utilization of maternal healthcare services in Nigeria.

Introduction: poor maternal health outcomes remain a major public health issue in Nigeria. These have been shown to be affected by the low level of utilization of maternal healthcare services. This study investigates the levels of gender relations (GR) among Nigerian women and how these influence their utilization of maternal healthcare services. The relations are conceptualized as feminine (FGR), masculine (MGR) and egalitarian. Methods: data on household decision-making, antenatal care (ANC) visits, health facility delivery, and associated sociodemographic variables, were extracted from the 2018 Nigeria Demographic and Health Survey for 29,992 parous women aged 15-49 for a cross-sectional study. Associations were investigated using Chi-Square and regression analyses. Results: women with FGR constituted 5.7% of the population at the national level, while subnational variations ranged from 1.8% in the North-East to 12.8% in the South-South regions. The prevalence rates of the recommended minimum ANC visits (RMANC) and health facility delivery were 42.1% and 30.0% at the national level and were lowest in the northern regions. At both the unadjusted and adjusted levels, FGR was not significantly associated with RMANC and health facility delivery at the national level and in all the regions except the South-West. MGR was however significantly associated with increased odds of RMANC (OR: 2.235, CI: 2.043-2.444) and health facility delivery (OR: 2.571, CI: 2.369-2.791) at national level. Significant subnational variations in the association between gender relations and the utilization of maternal healthcare services were also recorded. Conclusion: sub-national variations in GR and their varying impacts on the utilization of maternal healthcare services in Nigeria suggest that gender-related policies to improve maternal health outcomes should be location-specific, rather than general. As FGR did not affect maternal healthcare services utilization, educating men on the benefits of supporting their wives to scale-up utilization is recommended.

Determinants of health facility delivery among young mothers in Ghana; insights from the 2014 Ghana Demographic and Health Survey.

BACKGROUND: Globally, young women deliver at home, often under unhygienic conditions and without skilled birth attendants. This study identified the determinants of health facility delivery among young mothers in Ghana. METHODS: We analysed secondary data from the 2014 Ghana Demographic and Health Survey, which collected data across the former ten administrative regions of Ghana. This study analysed data from the 'women file' by adjusting for the sample weight. STATA/SE version 16 was employed to analyse the data by computing descriptive statistics, Chi-square, and Binary Logistic Regression. RESULTS: Seven in ten young mothers gave birth in a health facility. Young mothers who had secondary school education were over three-fold more likely to deliver in a health facility (AOR = 3.5, 95% CI: 1.33-9.23) compared with young mothers with no formal education. Young mothers who resided in rural areas had lower odds (73%) of delivering in a health facility (AOR = 0.27; 95% CI: 0.14-0.514) compared with those in urban areas. Young mothers within the richest wealth quintile also had higher odds (8 times) of delivering in a health facility (AOR = 8.24; 95% CI: 0.95-71.77) compared with those within the poorest wealth quintile. Young mothers who obtained four to seven antenatal visits (AOR = 0.53; 95% CI: 0.27-1.03) had lower odds of delivering in a health facility compared with those who obtained eight or more antenatal visits. CONCLUSION: The majority of young mothers in Ghana gave birth in a health facility. The likelihood of delivering in a health facility was influenced by socio-demographic factors, economic factors and utilization of antenatal care services. Therefore, interventions aimed at increasing utilization of skilled delivery among young women should focus on promoting girl child education, economic status and antenatal care visits.

Factors Associated with Health Facility Delivery in the 12th District of Kandahar City, Kandahar, Afghanistan: A community-Based Cross-Sectional Study.

Background: Maternal mortality and morbidity are increasing public health concerns in Afghanistan. Even more worrying is maternal death due to causes that can be prevented through maternal healthcare services utilization during pregnancy and delivery. Objectives: We sought to investigate the magnitude of women giving birth in a health facility and its associated factors in the 12th district of Kandahar city, Kandahar province, Afghanistan. Materials and Methods: A community-based cross-sectional study of women who gave birth in the last 2 years in the 12th district of Kandahar city was conducted in early 2021. We used a systematic random sampling method to enroll 850 women. We collected data on sociodemographics, reproductive characteristics, and delivery practices of respondents. Factors associated with health facility delivery were identified using a multivariable logistic regression model. Results: The proportion of women who gave birth at health facilities was 71.8% (confidence interval [CI]; 68.61%-74.77%). In this study, health facility delivery was associated with husbands' education (adjusted odds ratio [AOR] = 3.07, 95% CI: 1.50-6.31), antenatal care (ANC) services utilization (AOR = 17.84, 95% CI: 11.86-26.8), and history of complications in previous births (AOR = 3.65, 95% CI: 2.32-5.74). Conclusion: In this study, the utilization of a health facility for delivery was slightly lower than reported on the national level. Our study found potential factors such as ANC visits, husbands' education, and history of complications in previous births, for which interventions aimed at enhancing the proportion of health facility deliveries.

Maternal social support and health facility delivery in Southwest Ethiopia.

BACKGROUND: Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia. METHODS: A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level. RESULT: Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. CONCLUSIONS: Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.

Do Predictors of Health Facility Delivery Among Reproductive-Age Women Differ by Health Insurance Enrollment? A Multi-Level Analysis of Nigeria's Data.

This study aims to compare determinants of health facility delivery for women under a health insurance scheme and those not under a health insurance scheme. Secondary data drawn from the National Demographic and Health Survey was used for the analysis. The characteristics of the women were presented with simple proportions. Binary multilevel logistic regression was used to examine the determinants of health facilities for women who enrolled in health insurance and those who did not. All statistical analyses were set at 5% level of significant level (p = 0.24). The result showed that 2.1% of the women were under a health insurance scheme. Disparity exists in health insurance ownership as a higher proportion of those enrolled in health insurance were those with higher education attainment, in urban parts of the country, and those situated on higher wealth quintiles. There is a significant difference between those with and those without health insurance. It implies that a higher proportion of women who enrolled in health insurance delivered in health facility delivery compared to those who do not. The unique determinants of health facility delivery for women under health insurance were parity and birth order, while unique determinants of health facility delivery for women not enrolled in health schemes were employment status, marriage type, and geopolitical zones. Uniform predictors of health facility delivery for both groups of women were maternal education, household wealth quintiles, autonomy on healthcare, number of antenatal contacts, residential status, community-level poverty, community-level media use, and community-level literacy. Intervention programs designed to improve health facility delivery should expand educational opportunities for women, improve household socioeconomic conditions, target rural women, and encourage women to undertake a minimum of four antenatal contacts.

Identifying Programmatic Factors that Increase Likelihood of Health Facility Delivery: Results from a Community Health Worker Program in Zanzibar.

INTRODUCTION: Community health worker (CHW) interventions have been utilized to address barriers that prevent pregnant women from delivering in health facilities in low- and middle-income countries (LMICs). The objective of this research was to assess the programmatic factors that increase the likelihood of health facility delivery within a large digital health-supported CHW program in Zanzibar, Tanzania. METHODS: This study included 36,693 women who were enrolled in the Safer Deliveries program with a live birth between January 1, 2017 and July 31, 2019. We assessed whether long-term enrollment, recency of CHW pregnancy visit prior to delivery, and number of routine home pregnancy visits were associated with an increased likelihood of health facility delivery compared to home delivery. We used Chi-squared tests to assess bivariate relationships and performed logistic regression analyses to assess the association between each programmatic variable and health facility delivery, adjusting for relevant confounders. RESULTS: We found that long-term enrollment was significantly associated with increased likelihood of health facility delivery, with the strongest relationship among women with a previous home delivery (OR = 1.4, 95%CI [1.0,1.7]). Among first-time mothers, two or more pregnancy visits by a CHW was positively associated with health facility delivery (OR = 1.8, 95%CI [1.2, 2.7]). Recent pregnancy visit by a CHW was positively associated with health facility delivery, but was not significant at the α = 0.05 level. DISCUSSION: In this program, we found evidence that at least two routine home pregnancy visits, longer length of enrollment in the program, and recency of home visit to the delivery date were strategies to increase health facility delivery rates among enrolled mothers. Maternal and child health programs should undertake similar evaluations to improve program delivery.

Effects of antenatal care visits and health facility delivery on women's choice to circumcise their daughters in sub-Saharan Africa: evidence from demographic and health surveys.

BACKGROUND: This study examines the association between maternal healthcare service utilisation and circumcision of daughters in sub-Saharan Africa (SSA). METHODS: This study is based on a cross-sectional study design that draws on analysis of pooled data from current demographic and health surveys conducted between 2010 and 2019 in 12 countries in SSA. Both bivariate and multivariable binary logistic regression models were employed. RESULTS: Mothers who had four or more antenatal care visits were less likely to circumcise their daughters compared with those who had zero to three visits. Mothers who delivered at a health facility were less likely to circumcise their daughters than those who delivered at home. With the covariates, circumcision of daughters increased with increasing maternal age but decreased with increasing wealth quintile and level of education. Girls born to married women and women who had been circumcised were more likely to be circumcised. CONCLUSIONS: This study established an association between maternal healthcare service utilisation and circumcision of girls from birth to age 14 y in SSA. The findings highlight the need to strengthen policies that promote maternal healthcare service utilisation (antenatal care and health facility delivery) by integrating female genital mutilation (FGM) information and education in countries studied.

Women's perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study.

BACKGROUND: Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited. OBJECTIVE: The study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility-delivery service among slums women, Addis Ababa, Ethiopia METHODS: Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18-49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge. RESULTS: The FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

Global strategies for targeting high maternal mortality levels are based on ensuring eligible delivery attendance along with access to obstetric emergency care. Research examining strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is minimal. The study aimed to examine women's perspectives on measures needed to improve the use of health facility-based delivery services.A qualitative research design, both exploratory and descriptive, was used. Women in the reproductive age group (18­49 years of age) living in the slum areas of Addis Ababa, Ethiopia, participated in the study. The study used a purposeful sampling method. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants. In FGDs, the number of participants was between 6 and 10 women. Data were analyzed in conjunction with data collection. For the research, thematic analysis was performed.Two issues arose from the review of data from focus group interviews, namely quality care provision, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were identified as a detailed and comprehensive account of the views and suggestions of focused antenatal care [FANC] participants on steps needed to enhance the use of health facility-based delivery services. According to the results of the focus groups, among FANC participants in the slum residents of Addis Ababa, women who took part in this study identified steps needed to increase the use of health facility-based delivery services. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.