ABSTRACT
OBJECTIVES: The study aims to gain a better understanding of the needs and health behaviours of young women at the University of Lomé (Togo) with regard to gynaecological care. STUDY DESIGN: The data comes from a self-administered online survey. METHODS: A logistic regression was applied to model the likelihood of non-use of gynaecological care. RESULTS: Among the 281 women who completed the survey, 75% declared they had not consulted a gynaecologist or healthcare professional for a question related to intimacy or contraception in the last 12 months, mainly because of the financial barrier (65%). But needs do exist as 73% of women would like to be able to consult for such reasons. Multivariate analysis shows that increasing age (21-24 years, odds ratio [OR] = 0.442, P value < 0.05); 25-33 years, OR = 0.190, P value < 0.001), practicing Christian religion (OR = 0.331, P value < 0.1), being insured (OR = 0.398, P value < 0.05), having a father with primary education level (OR = 0.320, P value < 0.05) were protective factors. In contrast, the size of the households [6-8 members, OR = 2.763, P value < 0.1), and the student's income (Q2, OR = 3.136, P value < 0.05; Q3, OR = 2.993, P value < 0.05; Q4, OR = 4.433, P value < 0.001) favoured a higher probability of non-use of gynaecological care. CONCLUSION: Gynaecological needs are real among young women, and gynaecological health promotion is a necessity among this cohort. Quality health promotion can be achieved practically through the enlargement of health insurance, and partnership with healthcare professionals as well as community/religious leaders. This would further demystify biases related to seeking gynaecological care.
ABSTRACT
OBJECTIVES: Togo is experiencing a growing phenomenon of migration and consequently receives remittances from international migrants back to their relatives. Remittances represent about 9.4% of the gross domestic product (GDP), placing Togo in the top 10 recipients of remittances in the world in 2014. Despite the importance of remittances, information on their health outcomes is inadequate, particularly if remittances have a positive impact on the utilisation of maternal and child health services. The aim of this article is to evaluate the impacts of migration on maternal and child health services utilisation. STUDY DESIGN: Cross-sectional data analysis of mothers aged 15-49 years who have recently given birth. METHODS: We used propensity score matching to compare the utilisation of health services by mothers and children from households with migrants to those without migrants. We simulated a potential confounder to assess the robustness of the effects of the estimated treatment (i.e. migration). We also addressed the problem of hidden biases with the bounding approach. RESULTS: Deliveries attended by skilled health personnel were found to be 10.3% higher in migrant households than in households without migrants. The antenatal visits of mothers in migrant households were 3.5%-9.5% higher than those of matched control groups. Compared to the non-migrant households, the migrant households had a positive welfare (postnatal checks at the hospital) impact of 11.9%-12.5% percentage points. Furthermore, through access to health insurance, mothers in migrant families enjoy more financial protection with regard to delivery, prenatal and postnatal care. We also found that children in migrant households benefit from more preventive health inputs such as postnatal checks and vaccinations. CONCLUSION: Our results suggest that migration contributes greatly to improving births at hospitals, skilled birth assistance, and utilisation of antenatal and postnatal care through the return flow of financial resources. Efforts in health care reforms in Togo should take into account the scope of the positive impacts of migration on the utilisation of maternal and child health services.
