Factors associated with the choices of home deliveries in Myanmar: A secondary data analysis of the Demographic Health Survey in Myanmar in 2015-2016 / 国際保健医療

Objectives  Maternal and neonatal mortality remains high in Myanmar. Whilst the proportion of deliveries assisted by a skilled birth attendant (SBA) is moderate, the proportion of institutional deliveries is low in Myanmar. Home births have life-threatening risks for mothers and their newborn due to the limited emergency care available at home. This study explores the socio-cultural and maternal health factors, which were associated with mothers’ place of delivery using secondary data.Methods  This study used nationally representative data from the Myanmar Demographic Health Survey (DHS) conducted in 2015-16. The data was obtained from mothers aged 15-49 years with their most recent births in five years preceding the survey (n=3856). A multivariable logistic regression analysis was undertaken, and the adjusted Odds Ratio (aOR) and 95% Confidence Interval (CI) of home deliveries were provided. Results  The study shows that 62% of women in Myanmar delivered at home. The aOR of home deliveries was 6.18 (95% CI: 4.17-9.16) for women with no antenatal care (ANC) compared to those with four or more ANC visits, 4.46 (3.19-6.22) for the lowest wealth quintile in comparison with the highest wealth quintile, and 2.94 (2.28-3.80) for women having four or five children relative to women with only one child. The place of residence, women’s educational attainment, women’s and their husbands’ occupations were also associated with the place of delivery. On the other hand, maternal age, husbands’ education levels, women’s media exposure levels and women’s decision-making power were not associated with home deliveries. Conclusion  This study has identified populations which service providers should target to attend for institutional deliveries in Myanmar. It appears necessary to improve accessibility of health services, including ANC, to promote institutional deliveries and have better health outcomes among mothers and their newborn.

Nutritional Risk of the Elderly Receiving a Home-Delivered Meal Service Program and the Factors for Nutritional Risk / 대한지역사회영양학회지

OBJECTIVES: This study examined the characteristics and nutritional risk of the elderly who receive home delivery services. We then analyzed the effects of the characteristics of the elderly who receive the home-delivery meal service on their nutritional risk. METHODS: A total of 220 respondents who receive home-delivery meal service in Seoul participated in the survey. The survey consisted of the characteristics of the elderly (health status, tooth condition, physical activity, social participation activity, depression and relationship with neighbors), nutritional risk assessment and other general matters. The data was analyzed by using the SPSS program. Cross-tabulation analysis, t-test, correlation analysis and regression analysis were all conducted. RESULTS: 47.0% of the subjects were under 80 years old and 53.0% were over 80 years old, The nutritional risk score, as evaluated by a Nutrition Screening Initiative (NSI) checklist was 10.7 points, and the high nutrition risk group was 91.5% of the subjects. The subjective self-health status score was 2.24 points (out of a total of 5 points) and the tooth status score was 3.30 points. The physical activity level was 2.17 points for the under 80 years old group and 1.76 points for the over 80 years old, and there was a significant difference according to age (p<0.01), The higher the health status, tooth condition, physical activity and social participation activity level, the lower was the nutritional risk. Further, the higher the degree of depression, the higher was the nutritional risk. CONCLUSIONS: For the healthy life of the elderly in the community, various welfare policies should be planned to increase social participation as well as to promote physical health and reduce depression.

Health seeking behavior during pregnancy and delivery in Morang District of Nepal

Background and objectives: Importance of maternal health has been recognized over the last decade, however information about the perception of illness and health care behavior of obstetric complication is lacking. So, this study was conducted to find out the prevalence of taking care during pregnancy and delivery, and to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Material and Methods: The study is a cross-sectional study conducted among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semi-structured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Results: Almost forty percent of pregnant women have taken care during pregnancy and delivery i.e. delivery conducted in Health Care Center (HCC). Only 21.8% of women were applied antiseptics after cutting cord and sixty three percent of women have fed colostrums to their babies. All of the women with Brahmin/ Chhetri have conducted delivery in Health Care Center. The women with SLC and higher education have conducted delivery at HCC more (91.1%) than below SLC (51%) and illiterate (12.5%). The women with service have conducted delivery at HCC more than other occupational groups. Conclusion: The problem of taking care during pregnancy and delivery is common and has become a key public health concern for all. Lack of education and poor occupation of wife and husband led some of the respondents not taking care during pregnancy and delivery.

Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

Pattern of Newborn care and associated Health Problems among home delivered children

Background and Objectives: Newborn Care practices during neonatal period contribute to risk of mortality and morbidity. It is estimated that in Nepal nearly 50,000 children under one year of age die every twelve months. This study aims to identify newborn care and practices in rural area in the study population. Methodology: 248 mothers having children of age < 6 months having delivery at home were selected from ten VDCs of Sunsari district using multistage random sampling. Standardized questionnaire were filled through interview with mothers/ female head of the family who assisted the delivery. Data were analyzed by using statistical package for social sciences (SPSS) version 17. Chi-square test was conducted and p-value < 0.05 considered as statistically significant. Results: More than half (53.6%) of the newborns were assisted with Clean Home Delivery Kit. However, only 32.6% of the newborn babies applied antiseptic disinfectant to umbilical stump. Majority (76.6%) of the newborns bathed within 24 hour after birth. Less than half of respondents (41.9%) started breast feeding within 1 hour of birth and majority of the respondents (82.7%) fed colostrums to the newborn. Majority (37.9%) of children suffered from Acute Respiratory tract Infection, jaundice, redness and discharge around the cord, skin rashes and eye discharge. The methods used to make room warm was significantly associated (χ2 = 13.68, p- value = 0.001) with the occurrence of ARI. Materials applied for dressing of cord was significantly associated with problems of cord in babies (χ2 = 10.89, p- value = 0.004). Discharge from eye was found more among the babies who applied kajal however it was statistically insignificant. (χ2 = 0.60 p=0.439). Conclusion: High-risk traditional newborn care practices are common and need to be addressed.

Qualitative study on home delivery meal services for the elderly / 한국영양학회지

As the importance of elderly's dietary life have increased, low-income elderly's meal should be taken care by social policies. Nevertheless, there is a lack of systematic management in home-delivery meal service. This study aims to investigate the elderly's experience on home-delivered meal service, especially identifying the symbolic meaning of home-delivered meal service on elderly's dietary life. Using an in-depth interview, qualitative data was collected from five elderly participants who received home-delivered meals. Data was analyzed based on Colaizzi's 6 steps method, deriving 148 significant statements, 18 formulated meanings, and 5 themes: , , , , and . Elderly participants regarded the home delivered meal as not only a decent meal but also felt appreciated. The home-delivered meals were found to be their only meal all day; thus, they considered these meals as a means of survival. Home-delivered meals are considered as a lack of consideration for the elderly's physical condition, including their tastes, portion size, and cooking method. Also, these elderly seemed to lose their appetite due to aging and it caused the enjoyment of eating. The elderly have kept silence never expressing any opinions regarding the home delivered meals because they were offered for free. The results suggested that the home-delivered meal service should be developed with the multilateral evaluation methods to reflect the elderly's needs to improve the quality of the home-delivered meal service.

Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar.

Background: In Myanmar a large proportion of antenatal and intrapartum care in rural areas is provided by skilled birth attendants (SBAs), this study assessed the coverage by these health workers of all births, their adherence to service guidelines, and community opinion on the antenatal and delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Region to identify the challenges and improve antenatal and intrapartum service delivery provided by the SBAs. Method: A structured questionnaire was used to interview 304 women who had infants under one year of age, and in-depth interviews were held with 12 SBAs and 10 community members. Results: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these were covered by SBAs at an average 15 weeks’ gestation. The average frequency of ANC visits was 9. Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries, use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers (traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysis showed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education at primary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of the rural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. The categories of supervision, referral, and health education activities of SBAs were not in line with service guidelines. The main reasons were lack of access and community acceptance of TBAs. Conclusion: Heavy workload, geographical location, transportation and financial concerns were major challenges for SBAs, along with community compliance and mutual coordination. Good communication and service management skills were important to overcome these challenges.

Home delivery in Luong Son, Hoa Binh

Background: There are about 600.000 deaths related to pregnancy and delivery in the world every year. In Vietnam, the rate of maternal death is 165/100.00. The majority of maternity and new born deaths occurred in the first week after delivery, especially 24 hours after delivery. Objective: To investigate the status of delivery and various factors related to home delivery and propose recommendations to reduce the rate of home delivery in Luong Son, Hoa Binh. Subject and method: The cross sectional study using a structured questionnaire with women who gave birth in 2003 was conducted in two communes of Luong Son district. Result: The home delivery rate was high (31.5%) and only 36.1% women decided themselves where to deliver. The main reasons for home delivery was perception related to last home delivery was normal, therefore this delivery should be at home (53.8%). Among 108 women interviewed, only 72% gave birth with the assistance of health professionals and 28% delivered with none health professional assistance. The rate of obstetric complications and new born death was relatively high among those that had homebirths. Conclusion: In order to increase the delivery rate at health care facilities and with the assistance of health professionals, there is required the cooperation of stakeholders for improving infrastructure, economic development, health education for increasing awareness of people on safe delivery. The public should change their perception, custom and behavior toward homebirths. Besides, the health sector should better manage the maternal health care program, monitor the pregnant women, plan the delivery dates and advocate their families (husbands and parent in laws) to take the women to deliver at the health care facilities.