Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review.

INTRODUCTION: In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas. METHODS: Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools. RESULTS: Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals. CONCLUSIONS: Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.

Health-seeking behaviour of Ethiopian caregivers when infants are unwell: a descriptive qualitative study.

OBJECTIVES: To explore the health-seeking behaviour of Ethiopian caregivers when infants are unwell. DESIGN: A qualitative descriptive approach was employed using in-depth interviews and focus group discussions. Data were collected using semistructured interview guides. SETTING: The study was conducted in East Gojjam zone, Amhara region, northwest Ethiopia. PARTICIPANTS: Participants were selected using a maximum variation purposive sampling technique across the different study groups: caregivers, community members and healthcare providers. A total of 35 respondents, 27 individuals in the focus group discussions and 8 individuals in the in-depth interviews participated in the study. METHOD: In this study, a qualitative descriptive approach was employed to explore the health-seeking behaviour of caregivers. The data were collected from July to September 2019 and conventional content analysis was applied. RESULTS: The decision to take a sick child to healthcare facilities is part of a complex care-seeking process that involves many people. Some of the critical steps in the process are caregivers recognising that the child is ill, recognising the severity of the illness and deciding to take the child to a health institution based on the recognised symptoms and illness. In Ethiopia, a significant proportion of caregivers do not seek healthcare for childhood illness, and most caregivers do not know where and when to seek care for their child. This study points out that the health-seeking behaviour of caregivers can be influenced by different contextual factors such as caregivers' disease understanding, access to health services and family pressures to seek care. CONCLUSIONS: Healthcare-seeking practice plays an important role in reducing the impact of childhood illnesses and mortality. In Ethiopia, home-based treatment practice and traditional healing methods are widely accepted. Therefore, contextual understanding of the caregivers' health-seeking is important to design contextual healthcare interventions in the study area.

Optimum maternal healthcare service utilization and infant mortality in Ethiopia.

BACKGROUND: Ethiopia has one of the highest rates of infant mortality in the world. Utilization of maternal healthcare during pregnancy, at delivery, and after delivery is critical to reducing the risk of infant mortality. Studies in Ethiopia have shown how infant survival is affected by utilization of maternal healthcare services, however, no studies to date have investigated the relationship between optimum utilization of maternal healthcare services utilization and infant mortality. Therefore, this study examined the effect of optimum utilization of maternal healthcare service on infant mortality in Ethiopia based on the World Health Organization (WHO, 2010) guidelines. METHODS: We used nationally representative cross-sectional data from the Ethiopian Demographic and Health Survey (EDHS). Sampling weights were applied to adjust for the non-proportional allocation of the sample to the nine regions and two city administrations as well as the sample difference across urban and rural areas. A total of 7193 most recent births from mothers who had provided complete information on infant mortality, ANC visits, tetanus injections, place of delivery and skilled birth attendance during pregnancy were included. The EDHS was conducted from January to June 2016. We applied a multivariate logistic regression analysis to estimate the relationship between optimum maternal healthcare service utilization and infant mortality in Ethiopia. RESULTS: The findings from this study showed that optimum maternal healthcare service utilization had a significant association with infant mortality after adjusting for other socioeconomic characteristics. This implies that increased maternal healthcare service utilization decreases the rate of infant mortality in Ethiopia. The main finding from this study indicated that infant mortality was reduced by approximately 66% among mothers who had high utilization of maternal healthcare services compared to mothers who had not utilized maternal healthcare services (AOR = 0.34; 95%CI: 0.16-0.75; p-value = 0.007). Furthermore, infant mortality was reduced by approximately 46% among mothers who had low utilization of maternal healthcare services compared to mothers who had not utilized any maternal healthcare services (AOR = 0.54; 95%CI: 0.31-0.97; p-value = 0.040). CONCLUSIONS: From this study, we concluded that optimum utilization of maternal healthcare services during pregnancy, at delivery and after delivery might reduce the rate of infant mortality in Ethiopia.

Individual-, household- and community-level determinants of infant mortality in Ethiopia.

INTRODUCTION: People living in the same area share similar determinants of infant mortality, such as access to healthcare. The community's prevailing norms and attitudes about health behaviours could also influence the health care decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and family characteristics alone, but also due to differences in the socioeconomic characteristics of the community where the child lives. While individual level characteristics have been examined to some extent, almost all studies into infant mortality conducted in Ethiopia have failed to consider the impact of community-level characteristics. Therefore, this study aims to identify individual and community level determinants of infant mortality in Ethiopia. METHOD: Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A total of 10641 live births were included in this analysis. A multi-level logistic regression analysis was used to examine both individual and community level determinants while accounting for the hierarchal structure of the data. RESULTS: Individual-level characteristics such as infant sex have a statistically significant association with infant mortality. The odds of infant death before one year was 50% higher for males than females (AOR = 1.66; 95% CI: 1.25-2.20; p-value <0.001). At the community level, infants from pastoralist areas (Somali and Afar regions) were 1.4 more likely die compared with infants living in the Agrarian area such as Amhara, Tigray, and Oromia regions; AOR = 1.44; 95% CI; 1.02-2.06; p-value = 0.039). CONCLUSION: Individual, household and community level characteristics have a statistically significant association with infant mortality. In addition to the individual based interventions already in place, household and community-based interventions such as focusing on socially and economically disadvantaged regions in Ethiopia could help to reduce infant mortality.

The effects of health expenditure on infant mortality in sub-Saharan Africa: evidence from panel data analysis.

INTRODUCTION: Although health expenditure in sub-Saharan African countries is the lowest compared with other regions in the world, most African countries have improved their budget allocations to health care over the past 15 years. The majority of health care sources in sub-Saharan Africa are private and largely involve out-of-pocket expenditure, which may prevent healthcare access. Access to healthcare is a known predictor of infant mortality. Therefore the objective of this study is to determine the impact of health care expenditure on infant mortality in sub-Saharan Africa. METHODS: The study used panel data from World Bank Development Indictors (WDI) from 2000 to 2015 covering 46 countries in sub-Saharan Africa. The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of health care expenditure on infant and neonatal mortality. RESULTS: Both public and external health care spending showed a significant negative association with infant and neonatal mortality. However, private health expenditure was not significantly associated with either infant or neonatal mortality. In this study, private expenditure includes funds from households, corporations and non-profit organizations. Public expenditure include domestic revenue as internal transfers and grants, transfers, subsidies to voluntary health insurance beneficiaries, non-profit institutions serving households or enterprise financing schemes as well as compulsory prepayment and social health insurance contributions. External health expenditure is composed of direct foreign transfers and foreign transfers distributed by government encompassing all financial inflows into the national health system from outside the country. CONCLUSION: Health care expenditure remains a crucial component of reducing infant and neonatal mortality in sub-Saharan African countries. In the region, where health infrastructure is largely underdeveloped, increasing health expenditure will contribute to progress towards reducing infant and neonatal mortality during the Sustainable Development Goals (SDGs) era. Therefore, governments in the region need to increase amounts allocated to health care service delivery in order to reduce infant mortality.

The effect of maternal education on infant mortality in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Some studies in developing countries have shown that infant mortality is highly associated with maternal education, implying that maternal education might play an important role in the reduction of infant mortality. However, other research has shown that lower levels of maternal education does not have any significant contribution to infant survival. In this systematic review, we focus on the effect of different levels of maternal education on infant mortality in Ethiopia. METHODS: MEDLINE, EMBASE, CINAHL, Scopus, and Maternity and Infant Care databases were searched between November 15, 2017 and February 20, 2018. All articles published until February 20, 2018 were included in the study. The data extraction was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA 2009) guidelines. An I2 test was used to assess heterogeneity and a funnel plot was used to check publication bias. FINDINGS: We retrieved 441 records after removing duplications. During screening, 31 articles were fully accessed for data extraction. Finally, five articles were included for analysis. The overall pooled estimate indicated that attending primary education was associated with a 28% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.72 (95% CI = 0.66, 0.78). Another pooled estimate indicated that attending secondary education and above was associated with a 45% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.55 (95% CI = 0.47, 0.64). CONCLUSION: From this study, understanding the long-term impact of maternal education may contribute to reduce infant mortality. Therefore, policy makers should give more attention in promoting the role of women through removing institutional and cultural barriers, which hinder women from access to education in order to reduce infant mortality in Ethiopia.