Women autonomy and demand for maternal health services in Nigeria: Evidence from the Nigeria Demographic and Health Survey

mproving women autonomy can be vital in determining the uptake of healthcare services, especially in a patriarchal society with gender rights concerns. Using the 2013 Nigeria Demographic and Health Survey and employing Zero Inflated Negative Binomial regression, the effect of household decision-making power with considerations to women autonomy on the demand for maternal health services in Nigeria was examined. The result of the analysis suggests that women autonomy in deciding expenditures on household healthcare services, and autonomy in deciding their income expenditures significantly increases the likelihood of demand for maternal healthcare services. On the other hand, when the husband/partner makes sole decision, as well as joint decision making concerning expenditure on household healthcare services and expenditure of woman's income reduces the likelihood of demand for maternal healthcare services in the country. This reduction was however much more when husband alone takes the decision than when decisions were taken jointly. Other socioeconomic variables like higher maternal education, and household wealth, also increased the demand for maternal healthcare services. We recommend that government should put in place policies that will help increase women's participation in household decision-making through the sensitization and capacity building initiatives such as improved educational quality for women. (Afr J Reprod Health 2022; 26[4]: 65-74).

Compliance to maternal care guidelines is high in patients with complications compared to patients without complications. The tip of an iceberg? A retrospective case-control study

BACKGROUND: Rwanda achieved Millennium Development Goal Five (MDG5) and continues to register improvements in maternal health. Maternal death audit revealed that a great number of deaths were due to preventable causes in hospitals.OBJECTIVE: To identify preventable causes of severe maternal outcomes linked to poor guideline utilization in hospitals.METHODS: A retrospective case-control study was conducted. Data were collected for 196 controls (discharged without complications) and 100 cases with severe maternal outcomes (dead or discharged after complications) between 2016 to 2018 at Ruhengeri Referral Hospital in Musanze, Northern Province, Rwanda. Medical case files were reviewed, and outcomes were compared.RESULTS: Guideline utilization in diagnosis during ward rounds was 59% and 54% respectively. Correct guideline utilization [76% vs. 51%, OR: 3.21; 95% CI: 1.69-6.28)], noting of vital signs [65% vs. 22%, OR: 6.50, 95% CI: 3.55-11.96), lab results [76% vs. 48%, OR: 3.59, 95% CI: 2.09-6.21)] and regular ward rounds [76% vs. 39%, OR: 4.81 95% CI: 2.64-8.89)] were statistically different between the two groups.CONCLUSION: Guideline utilization was noted in complicated cases compared to patients without complications, post discharge mortality of 59% could be improved by putting guidelines in place, and attention to the details. There is a need for nationwide medical record review and implementation of a standardized guideline

Midwives' knowledge and use of partographs at Juba Teaching Hospital, South Sudan

Background:Evidence shows that good knowledge of partographs and proper application of this knowledge results in a remarkable reduction in prolonged and obstructed labour and reduces maternal mortality. Obstructed labour can be prevented by a simple and cost-effective health intervention tool, the partograph. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. This provides an opportunity for early identification of deviation from normal progress. Early detection of prolonged labour greatly contributes to prevention of obstructed labour and related complications.Objective:To assess midwives' knowledge and use of partographs in the maternity ward of Juba Teaching Hospital, South Sudan.Methods:A cross-sectional descriptive study was conducted to assess utilisation of partographs among healthcare providers in Juba Teaching Hospital. All providers working at the time of the study were included. An interviewer administered questionnaire prepared in English was used to assess socio-demographic and other related variables of respondents as well as knowledge and practice. Ethical procedures were followed at every step. Results:Only 20% of the 30 respondents were registered midwives, 67% knew the components -of a partograph, and 93% could differentiate between normal and abnormal labour with the use of a partograph. The factors affecting the use of partographs included; shortage of partographs in the ward, lack of protocols on partograph use, understanding semantics of the English language, absence of refresher training, late reporting of mothers to the ward, and a shortage of staff. Conclusions: Despite good knowledge of the partograph, about half of the providers do not use them. We recommend training and recruitment of more qualified midwives, a continuous supply of partographs to improve use of partographs continuous supportive supervision, mentoring of staff and motivation schemes

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancy related morbidities and mortalities. This mixed-methods study quantitatively assessed women's satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available

Maternal health service disparities across incomes and implications on prevention of mother-to-child transmission service coverage: current context in Sub-Saharan Africa

About 69% of people living with HIV globally and over 90% of the children who acquired HIV infection are in Sub-Saharan Africa. Despite this, promising results have been observed, especially over the last decade ­ for example, a 25% decline in new HIV infections as compared to 2001 and a 38% decline in the number of children newly infected by HIV in 2012 as compared to 2009. However, the Global Plan and the Global Fast-Track Commitments of eliminating new HIV infections among children require addressing impediments to service expansion. In this regard, this paper attempts to draw attention to the extent to which disparities across income in using antenatal care (ANC) services may constrain the prevention of mother-to-child transmission (PMTCT) service expansion in Sub-Saharan Africa. The analysis is based on ANC service coverage data from Demographic and Health Surveys conducted between 2008 and 2015 in 31 Sub-Saharan African countries; and PMTCT coverage data from UNAIDS datasets released in 2016. Our analysis found that women in the highest wealth quintile are about three times more likely to frequently use ANC services (at least four visits) as compared to those in the lowest wealth quintile (95%CI: 1.7-5.7, P<0.0001). A regression analysis shows that one-quarter of the PMTCT service coverage can be explained by the disparity in ANC use associated with income; and the higher the disparity in ANC use, the lower the PMTCT service (P<0.05). The findings suggest that achieving the ambitious plan of zero new HIV infections among children while keeping their mothers alive will require on-going PMTCT/ANC service integration and ensuring that programs reach women who are most in need; specifically those in the poorest income categories

Association between Intimate Partner Violence and Utilisation of Maternal Health Services in Nigeria

This study examines the relationship between intimate partner violence and utilisation of maternal healthcare services. Data was extracted from the 2008 Nigeria Demographic and Health Survey. Data were analysed using the STATA. Results show that: 15.6 of the women have ever of the women have ever experienced at least one type of sexual violence; and 22.4experienced at least one type of physical violence; 4.1 of the women have ever experienced at least one type of emotional violence. The logistic regression show that women who have ever experienced emotional violence were: 24.2 less likely to utilise skilled antenatal care (OR=0.7578;p0.001); 36.0 less likely to have facility delivery (OR

The JC Coetzee Memorial Lecture : Maternal Health in Primary Care: are we Providing Safe Maternity Units?

The Service Level Agreement of the Minister of Health provides; as one of its aims; to reduce the number of deaths of pregnant women and their babies. Over 60 of the births in South Africa; one third of all maternal deaths; and 62 of the perinatal deaths; occur at the prilevel of care. The numbers are far too high for a service which is supposed to cater to low-risk maternity cases. The Lives Saved Tool is a programme which can model the potential number of lives that can be saved depending on the pattern of disease; interventions used and coverage of these interventions. This tool has been used to select which interventions would be most effective in reducing maternal and perinatal mortality. If the effects of human immunodeficiency virus are excluded; the intervention that would save the most lives would be that of improving maternal and neonatal emergency care. A survey was conducted on the ability of healthcare facilities in 12 districts to provide essential emergency care services to pregnant women and their babies. It was found that the vast majority of the community healthcare facilities could not provide the seven lifesaving services needed for basic emergency obstetric care; and less than half of the district hospitals could provide the nine life-saving services required for comprehensive emergency obstetric care. Lack of knowledgeable and skilled staff; inadequate equipment and human resources; as well as poor emergency transport services at the sites are the main reasons for these unsafe maternity units. Realignment of the services might improve the ability of the districts to provide a safe maternity service

Barriers to Utilisation of Maternal Health Services in a Semi-urban Community in Northern Nigeria: The Clients' Perspective

Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. Materials and Methods: A cross-sectional study of 150 mothers; selected through multistage technique; was conducted. Data were collected using a structured interviewer-administered questionnaire; and analysed using SPSS statistics 17.0. Results: Only 2.7 utilised preconception service; 98.7 antenatal care service (ANC); 24.0 delivery; 35.3 postnatal care and 14.0 utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57 (CI = 47.4-66.1)) and negative provider attitude (23.7(CI = 16.4-32.7)). For non-utilisation of postnatal care; the major reasons were also not having a postnatal complication in the past (60.8 (CI = 50.4-70.4)) and negative provider attitude (27.8 (CI = 19.4-38.0)). As for non-utilisation of family planning service; the major reason was desire to have more children (32.6 (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0) were aware of preconception care in the first place and only 2 (1.3) were aware of preconception care in the first place and only 2 (1.3) were not using ANC. Conclusion: Despite living near a health facility; most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services; bring it closer to the mothers and make it more affordable; there is a more pressing need to improve its quality; especially through the alleviation of negative attitude of health care providers

Barriers to Utilization of Maternal Health Care Facilities among Pregnant and Non-Pregnant Women of Child Bearing Age in Maiduguri Metropolitan Council (Mmc) and Jere Lgas of Borno State

Women's utilization of maternal health care facility is an important health issue with regard to the wellbeing and survival of both the mother and her child during childbirth which has implications on thematernal and child mortality rate in human society. However; in most third world countries and Nigeria in particular there are certain factors that inhibit pregnant and women in patronizing maternal health facilities during childbirth. It is these factors that this paper investigated among pregnant women in the two Local Government Areas of Borno State. The methods of data collection adopted in the study were the survey methods: Seventy eight (78) questionnaires were administered; six (6) in-depth interviews and four sessions of focus-group discussion (three sessions in each of the 2 LG Areas) were conducted

Factors Affecting the Utilization of Antenatal Care Services in Ibadan; Nigeria

BACKGROUND: Antenatal care utilization is still low in Nigeria. This underutilization varies from region to region and from state to state. This study assesses the factors that determine the utilization of antenatal care service in Ibadan. METHODS: A cross-sectional study was carried out in two randomly selected local government council area in Ibadan. A pretested questionnaire was administered to 400 women. Information was obtained from the women on their attendance at antenatal clinic and the reasons for not attending the antenatal clinics RESULTS: Majority (76.8) of the respondents attended ANC clinic. Women in urban areas were more than 2 times likely to attend antenatal clinic than women in urban areas [(OR=2.177; 95CI; 1.081-4.382)].Women who were Muslims or other religions were more than 2 times likely to attend ANC clinic than women who were Christians [(OR=2.398; 95CI; 1.264-4.557)]. Also; Women who were 25 years and older were more than 2 times more likely to utilize antenatalthan women who were 25 years or younger (OR=2.236; 95CI;1.106- 4.107]. CONCLUSION: Efforts towards ensuring the utilization should be targeted towards rural areas; the importance of modern antenatal care should be emphasized even in the religious settings and younger women should be encouraged to utilize antenatal care services

Utilization of antenatal care services among teenagers in Ethiopia: a cross sectional study

Background: Teenaged women suffer from a disproportionate share of reproductive health problem. The purpose of this study was to estimate the utilization of antenatal care (ANC) services among teenagers (13-19 years) during delivery in Ethiopia. Methodology: Raw data collected from all part of the country on child bearing aged women using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 was used. From the large dataset of women; a total of 994 teenage women at the time of their most recent childbirth five years prior to the survey was selected and analyzed. Both bivariate and multivariate analyses were performed to determine the differentials of ANC by explanatory variables. Result: Most (60) of the subjects were in the age group between 18 and 19 years. The vast majority (90) was from the rural settings and most (87) were in marital union. Almost three out of four (72.4) of those who had given birth has no any form of formal education. Over a quarter (27.3) of most recent childbirths had at least one ANC service; of this; 21had started their first antenatal visit in the first trimester of pregnancy. The majority (80.4) of the women who attended ANC delivered at home without being assisted. The major deriving factors for the utilization of ANC service were education level of women and their male partners; better wealth index and urban residence. Conclusion: Education of partners; rich wealth index and urban residence seemed to encourage teenagers to utilize ANC. Appropriate interventions targeting teenaged women with poor socioeconomic status is recommended with more emphasis on the rural underserved segment of population. [Ethiop. J. Health Dev. 2010;24(3):221-225]

Previous Utilization of Service does not Improve Timely Booking in Antenatal Care: Cross Sectional Study on Timing of Ababa

Background: Antenatal care is more beneficial in preventing adverse pregnancy outcomes when it is sought early in pregnancy. However; existing evidence from developing countries including Ethiopia indicate that few women seek antenatal care at early stage of their pregnancy. Objective: The objective of this study was to assess the timing of ANC booking and impact of previous antenatal care utilization on timing of first antenatal care booking in Addis Ababa governmental health institutions. Methods: A cross sectional study was conducted to collect data from 630 pregnant women who were attending antenatal care service at 10 governmental health centers in Addis Ababa from March 1 to 30; 2008. Results: Past experience on antenatal care service utilization did not come out as a predictor for timely booking of antenatal care (OR=1.40; 95CI: 0.91; 2.15). Multivariate analysis revealed that respondents who received advice on recommended time of booking; their pregnancy was planned and first pregnancy; were more likely to book timely compared to others (AOR=10.10; 95CI: 4.54; 22.40; AOR=1.87; 95CI:1.11; 3.23; (AOR= 1.86; 95CI: 1.01; 3.44) respectively. Conclusions: Past utilization of antenatal care service did not come as a predictor for timely booking of the service; provided that advice on timely booking is the main factor. In order to improve the situation; strengthening of focused antenatal care; availing of clear service delivery guidelines and training of service providers are important. [Ethiop. J. Health Dev. 2010;24(3):226-233]

Integrating maternal health services into a health insurance scheme: effect on healthcare delivery

Healthcare delivery is a foremost important basic social services.This study reviews the influence of the integration of maternal health services into the Anambra State of Nigeria government-community health care financing scheme on health service delivery at primary health care level in Igboukwu; Aguata Local Government Area of Anambra State; Nigeria.A descriptive; cross-sectional study with an intervention component; conducted amongst 120 women of reproductive age group at Obiuno health centre; Igboukwu.Mean age of respondents was 30.5 +/- 6.0 years with majority; 44 (36.7); in the age range of 26-30 years. Almost half; forty eight (40); of the participants are of post secondary educational status; 60 (50) are civil servants. Utilization of maternal health servicesantenatal and delivery services; were significantly better at the late intervention period when compared to the early intervention period. Quality of service from clients' perspective also showed significant improvement at the late intervention period. There was an overall greater availability of maternal health service equipments; drugs and consumables; and medical records in the health facility later during the scheme.Community based health insurance schemes that focus on maternal health services ensure the provision of adequate funds for maternal health services that cover a great proportion of the rural communities

Knowledge and utilization of the partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary; secondary and tertiary level care. 719 respondents comprising of CHEWS - 110 (15.3); Auxiliary Nurses - 148 (20.6); Nurse/Midwives - 365 (50.6); Physicians - 96 (13.4) were selected from primary (38.2); secondary (39.1) and tertiary levels (22.7). Only 32.3used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4vs. 19.3; X2 = 214.6; p 0.0001). Only 37.3of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1; p 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable; the partograph is commonly not used to monitor the Nigerian woman in labour

Mothers' Access to Supportive Hospital Services after the Loss of a Baby through Stillbirth or Neonatal Death

Every year; 3-5 of pregnant mothers in South Africa lose their babies to a stillbirth or neonatal death. These mothers need adequate services to prevent complications in their grieving process. Most of these babies are lost in hospital settings; so the treatment medical staff provide is vital. This study examined mothers' experiences of accessing hospital; religious; formal and social services after a stillbirth or neonatal death. An exploratory research design was used to conduct applied research. A semi-structured interview schedule was used with a sample of 15 mothers who had lost a baby in the last 5 years. The findings were analysed quantitatively and qualitatively. The primary focus of this article is the quantitative findings relating to hospital services. The sample was small and these results cannot be generalised; but some conclusions are reached and recommendations are made to service providers in hospitals working with mothers who have lost babies. Mothers generally experienced the support services from hospitals as inadequate; compared to what hospitals could offer. Mothers that receive support after the loss of a baby generally cope better. This support thus assists them in the grieving process. Hospital staff can be trained to provide these services

Mandatory HIV Testing and Uptake of Ante-Natal Services in a Primary Health Care Centre in South-South Nigeria

Background: The Nigeria's national policy on HIV/AIDS did not allow for mandatory HIV testing. But several health institutions in Nigeria insist on an HIV test before certain services are given. Fears have been expressed that such mandatory HIV testing might lead to poorer uptake of associated services. Aim: To assess the impact of mandatory HIV testing on the uptake of ante-natal services in a primary health centre located in Obrikom - a semi-urban community in south-south Nigeria. Method: A cross-sectional study was carried out; using the ante-natal records of the primary health centre. The HIV testing procedure of the health centre was clearly established using in-depth interview of staff; and exit interview of women attending the ante-natal clinic. A four-year (October; 2002 to September; 2006) review of the ante-natal records of the health center was then carried out to coincide with the period; two years before; and two years after the introduction of Mandatory HIV testing in the health centre. Results: The health centre had a total of 281 new antenatal registrations during the study period; out of which; only 75 (26.69) were registered two years after the introduction of the policy. This is a significant reduction (p-value 0.001); when compared to the number that registered before the introduction of the policy. There is also a significant decrease in the number of antenatal visits (p-value 0.05); the number of visits decreased from a total of 840 visits; and an average quarterly visits of 105 (s.d 19.94) before the implementation of the policy; to 394 visits and an average quarterly visits of 44.75 (s.d 15.1). Conclusion: Mandatory HIV testing can lead to a significant decrease in the uptake of associated health care services. Efforts should be made to discourage it

Health Care Attendance Patterns By Pregnant Women In Durban; South Africa

"Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance; or attendance late in pregnancy; for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners; but do not attend antenatal care in the public sector. The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban; South Africa.Methods This was a descriptive study. Participants were recruited and categorised into ""early booker""; ""late booker"" and ""unbooked in labour"" groups. All the participants were interviewed individually using a structured questionnaire. Results: The majority of participants presented for formal ""booking"" late in pregnancy; 47.9""booked"" at a gestationalage of six months after the last menstrual period. Among the ""early bookers""; the majority (94.4) had confirmed their pregnancy by four months of amenorrhoea; and 60.6of these confirmed their pregnancies within the public health sector. All the ""early bookers"" began antenatal care prior to the 20th week of gestation.A total of 66.9of the ""late bookers"" and 66.7of the ""unbooked"" women also had their pregnancies confirmed at four months amenorrhoea; but 49.0of the ""late bookers"" and 59.8of the ""unbooked"" women confirmed their pregnancies in the private health sector. The ""late bookers"" also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study; 49visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0if only the ""late bookers"" and the ""unbooked"" were analysed. Further; 35.3visited a GP more than once; either for antenatal care or because of ill health. ConclusionIt is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately."

Utilization of maternal health services by rural Hausa women in Zaria environs; northern Nigeria: has primary health care made a difference?

Background: Expanding coverage; strengthening of; and increasing access and utilization of maternal health services is one of the key components of Nigeria's Primary Health Care (PHC) efforts ; which was started in 1986. A descriptive study was undertaken to document the level and pattern of utilization of selected maternal health services among rural Hausa women in order to assess progress in PHC implementation. Methods: A cross-sectional descriptive; quantitative study using structured interviewer-administered questionnaire was used to collect data on family planning; antenatal; post natal and delivery services utilization pattern from a total population of 655 currently married women in the reproductive age group in two predominantly Hausa villages in north-western Nigeria. The findings were compared with the baseline data obtained in the local government area at the start of PHC in 1986. Results: About two-thirds of the women had heard of family planning. There were statistically significant associations between age (P0.001); education (p0.05); occupation (p 0.001) and level of knowledge of contraceptive methods. However; utilization of modern contraceptives was very low; only 1.8 had ever used a method while 0.9 was using a method at the time of the study. Only 25.9 of the women had modern antenatal care during their last full term pregnancies with the mean age at booking of 6.6 months and an average of 5.4 visits throughout the pregnancy. There was a significant association between education and antenatal care uptake (p 0.05). Only 9 of their last deliveries took place in hospital while skilled attendants attended to 11 of the deliveries. The data showed a decline in most of the rates compared to the baseline data obtained for the local government at the inception of PHC. Conclusion: Utilization of orthodox maternal health services among the rural Hausa women is abysmally low and PHC implementation has not made any appreciable impact on their maternal health services uptake