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

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

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]

A community-Based Study on Utilisation in a Rural Zimbabwe

To estimate the degree and pattern of utilization of institutional maternity services in a rural area of Zimbabwe; a cross-sectional study was performed in Gutu district about 250 kilometers south of the capital Harare. In August; 1991; 12 out of 43 wards in the district were randomly selected and in each ward about 40 women (in total 520) who had delivered in the previous 12 months were randomly selected and interviewed. There was a high degree of utilization of institutional maternity services by the women (9679and 74) for antepartum; intrapartum and postpartum care respectively). Women sought this care from a multiplicity of sources depending on a variety of social; geographical and service factors. Very few women (17) had total pregnancy care at the rural health centre. There was a significant association between the actual place of delivery and nulliparity; whether the previous delivery took place at home; whether the family belonged to the Apostolic Faith sect; and whether the husband spent most time in urban area. For nulliparity; previous delivery at home and belonging to the Apostolic Faith sect the proportion of women delivering at home; at the rural health center/urban maternity clinic; and at hospital was statistically significant. The few maternity waiting shelters that were available lacked basic amenities and were unattractive to the mothers even though 65either used them or could have done so if they were available

Determinants of antenatal care attendance and preference of site of delivery in Addis Ababa

A community-based cross-sectional study was conducted in Gulele district; Addis Ababa to describe antenatal attendance; the women's characteristics and their reasons for choosing place of delivery. 441 women in their third trimester responded to a pretested questionnaire. Only 15.9 per cent of the respondents made their first visits during the first trimester; while 35.8 per cent attended in the second trimester; and 9.5 per cent in the beginning of the third trimester. A total of 38.8 per cent claimed they never attended antenatal clinics at all. In a multivariate analysis the risk of non-attendance was high for those pregnant women whose income was low (OR 1.77; 95 per cent CI: 1.44; 2.76); whose husband's or partner's attitude was negative or unknown; (OR 2.63; 95 per cent CI: 1.9; 3.64); who were first pregnant at the age 10 to 18 years (OR 1.85; 95 per cent CI: 1.20; 2.81); and low for nullipara (OR 0.52; 95 per cent CI: 0.33; 0.82). Three-quarters of the respondents preferred to deliver in health institutions and then rest at home. The most frequent reason for preference of place of delivery (40.8 per cent) was quality of service. The risk of choosing to deliver at home was high for those who were illiterate (OR 1.5; 95 per cent CI: 1.57; 2.00); for those whose partner's or husband's attitude toward antenatal care attendance was negative or unknown; (OR 2.19; 95 per cent CI: 1.34; 2.49) and for those who did not attend antenatal clinics (OR 2.19; 95 per cent CI: 1.69; 2.96). It was low for the nulliparae (OR 0.52; 95 per cent CI: 0.3; 0.9)