Factors influencing women's choice for place of child birth in rural Ethiopia: a cross-sectional study

Background: Pregnancy and childbirth complications are foremost cause of deaths and incapacity among women of the reproductive age in developing countries. In Ethiopia, nearly a third to a fourth of births occur without the help of a trained birth assistant. Objectives: The aim of this study was to assess the prevalence of institutional delivery and the determinants for choice of place of delivery. Methodology: A cross-sectional study design was employed from June to August 2018 and systematic sampling method used to select eligible respondents. From a total number of 5,398 pregnant women of whom 85% had visted ANC facilities, thestudy recruited 402 mothers aged 25-34 years. These mothers had given birth one year prior to data collection in the Wondo Genet District of Ethiopia. Data was cleansed, coded, entered into Epi Data 3.1 and analyzed using SPSS version 20. Logistic regression was used to identify statistically significant variables for the choice of place for delivery. Results: More than half 216 (53.7%) of the respondents were rural residents and more than onethird 147 (36.6%) were not able to read nor write. From every 10 women, 4 were housewives thus 249 (61.9%). More than 75% of them had access to the media (majorly television and radio) Factors that were statistically significant for the choice place of delivery were primary and above educational status of women, (AOR=0.14, CI, 0.03-0.68), income greater than 3000 ETB (AOR=8.35 CI, 3.6-19.4), four or more ANC frequency (AOR=4.14 CI, 2.0-8.6) and previous planned pregnancy (AOR=4.14 CI, 2.0- 8.6). Conclusion: Prevalence of institutional delivery was 61.2%. This calls for the District Health Committee to work on myth and misconception surrounding institutional delivery. Appropriate information, education, and communication will be a vital strategy in helping women to take the initiative of visiting health facilities. Educational status and monthly income were statistically important factors in disseminating health information to enhance knowledge of the women

Fistules urogenitales: etude epidemiologique et clinique dans deux hopitaux generaux du district de la Tshopo; Kisangani-RDC

Introduction : Les fistules vesico-vaginales et recto-vaginales; veritable humiliation pour la femme; constituent un probleme majeur de Sante Publique de par sa forte prevalence principalement pour les pays pauvres (Afrique sub-saharienne et Asie du Sud-est). Dans cette etude; notre objectif a ete d'evaluer l'ampleur des fistules genito-urinaire et rectales a Kisangani et ses environs et d'en ressortir les causes ainsi que les caracteristiques des fistuleuses. Materiel et methodes : Une etude descriptive transversale retrospective basee sur l'analyse documentaire a ete menee dans les Hopitaux Generaux de Reference de Makiso-Kisangani (a Kisangani) et de Banalia (a Banalia) du 29 Aout au 08 Novembre 2013; apres sensibilisation des femmes par l'UNFPA. Resultats : La frequence des fistules genitourinaires et rectales a ete de 0;005 dans la ville de Kisangani et de 0;012 a Banalia soit une frequence globale de 0;008 soit 8 cas pour 1000 femmes survenant chez les femmes agees de 20 a 34 ans(45;61) avec des extremes d'age de 5 a 75 ans. 54;38 d'entr'elles etaient Mariees; 63;16 menageres; 80;71 de bas niveau d'instruction. Les femmes habitant les milieux peripheriques ou eloignes des centres hospitaliers ont ete les plus nombreuses soit 69;6 pour Kisangani et 67;6 pour Banalia. Les fistules souvent obstetricales (85;91) lors des accouchements a domiciles (50;8) etaient le plus souvent de type simple (57;89); a leur premiere reparation (52;63) et evoluant depuis de 2 mois a 55 ans. Les fistules traumatiques dues au viol a represente 1 ;75. La prise en charge a ete chirurgicale essentiellement basse dans 84;21 de cas avec un taux de succes de 82;46. Conclusion : La lutte contre les accouchements a domicile et les conflits armes et l'organisation des campagnes de prise en charge des fistuleuses constituent des strategies majeures de riposte contre les fistules vaginale

Home Births and Postnatal Practices in Madagali; North-Eastern Nigeria

Background: Home births are common in resource poor countries and postnatal practices vary from one community to the other. Objective: To determine the proportion of home births; reasons for home delivery; and evaluate postnatal practices in Madagali; north-eastern Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 400 women of reproductive age; who had put to birth in the past 1 year. The study was carried out over a period of 8 weeks from April to June 2010. The multistage method of sampling was used to select respondents. In the first stage; four of the five health districts were chosen randomly; namely; Gulak; Madagali; Sukur; and Duhu. The questionnaires were evenly distributed among the four health districts. In the second stage; from each district; two villages were chosen by simple random sample. In the third stage; two wards were selected in each village by simple random sampling. Result: Of the 400 respondents interviewed; 289 (72.2) were aged between 20 and 39 years; and most; 374 (93.5) were married. Only 14 (3.5) had tertiary education. Most respondents; 224 (56.0) were farmers and grandmultiparae; 187 (46.7). A total of 196 (49.0) women delivered at home; whereas 204 (51.0) delivered at the hospital. Of the 196 respondents who delivered at home; the bedroom 142 (72.4); was the preferred place of birth. The most common reason for home birth was short duration of labor in 71 (36.3) cases. Delivery was conducted by untrained persons in 50; (25.4); whereas 99 (50.8) and 31 (15.5) deliveries were supervised by Traditional Birth Attendants (TBAs) and Midwives/Nurses; respectively. Postpartum; the majority; 235 (58.7) respondents used sanitary pads to stanch lochia; whereas 140 (35) used rags. Conclusion: A significant number of births take place in the home and supervised by unskilled persons. Against the backdrop of poor education and low socio-economic status of respondents; perineal hygiene can be adjudged satisfactory. There is the need to increase on the number of hospital birth and also trained TBA who conduct most of home deliveries

Factors Contributing to Home Delivery in Kongwa District; Dodoma - September 2008

Objectives To determine factors contributing to home delivery in Kongwa District. Methods: A community-based cross-sectional study was conducted in September 2009 in which women of child-bearing age were interviewed. The variables mainly included: accessibility of maternal health care; practicing TBA's; existence of beliefs; traditional practices and reasons for home delivery. Results: Of the 400 respondents; majority (92.5) had information about the presence of a Government heath facility that provides maternal health care including delivery services. Two thirds of the respondents were found living more than 5 km away from the health facilities. Carts; bicycle and walking were the means of transport used by about 89of the Pregnant Women in the District. Only a minority(9.5) never attended the health facility for maternal health care. TBA's were known to almost 90of respondents. 65of the respondents had once delivered at home from where 62were assisted by TBA`s; 34by mothers; and 4by husbands. The main reasons for home delivery included natural habits (57.7) and unsatisfactory maternal health care (53.8). Conclusion: The proportion of women delivering at home in Kongwa district is high refl ecting an inevitable high maternal mortalityratio. Natural Habits; traditional practices and unsatisfactory maternal health care are the main factors contributing to the problem. Deliberate initiatives focusing on community based maternal health education and improving the quality of maternal care in health facilities are needed to counteract these factors in order to scale up health facility deliveries and reduce maternal death

Prevention of postpartum hemorrhage: options for home births in rural Ethiopia

This paper sought to determine the safety and feasibility of home-based prophylaxis of postpartum hemorrhage (PPH) with misoprostol, including assessment of the need for referrals and additional interventions. In rural Tigray, Ethiopia, traditional birth attendants (TBAs) in intervention areas were trained to administer 600mcg of oral misoprostol. In non-intervention areas women were referred to the nearest health facility. Of the 966 vaginal deliveries attended by TBAs, only 8.9% of those who took misoprostol prophylactically (n=485) needed additional intervention due to excessive bleeding compared to 18.9% of those who did not take misoprostol (n=481).The experience of symptoms among those who used misoprostol can be considered of minor relevance and self-contained. This study found that prophylactic use of misoprostol in home births is a safe and feasible intervention. Community health care workers trained in its use can correctly and effectively administer misoprostol and be a champion in reducing PPH morbidity and mortality (Afr J Reprod Health 2009; 13[2]:87-95)

Accouchement a domicile ; un risque pour la mere et l'enfant

"Cette etude analyse les complications maternelles et foetales des accouchements a domicile hospitalises pour une prise a charge du post-partum immediat aux Cliniques Universitaires de Kisangani de 1982 a 1992. L'accouchement a domicile comporte donc un grand risque de morbidite et de mortalite maternelle et foetale. Pour reduire ces complications; l'auteur insiste sur la mise en oeuvre du programme de ""maternite sans risque"" tel que recommande par la Conference de Nairobi (Kenya) en 1987; et de Niamey (Niger) en 1988"

Guide de l'accoucheuse pour une maternite sans risque

Ce manuel; oeuvre du Comite Technique du Projet Sante pour Tous-Kinshasa; est le fruit de la pratique de terrain. Il se veut etre un guide de l'accoucheuse pour une maternite sans risque. Il est divise en cinq parties. La premiere partie donne les indications sur l'environnement de la prise en charge de la femme; avant; pendant et apres l'accouchement. Les deux parties qui suivent instruisent l'accoucheuse sur les mecanismes et procedures a suivre pendant la grossesse (2eme partie) ainsi que pendant et apres l'accouchement (3eme partie). La quatrieme partie n'est qu'une reference rappelant a l'accoucheuse quelques techniques obstetricales importantes. La derniere partie concerne les soins a donner au nouveau-ne par l'accoucheuse et par la mere