Maternal referral systems in the northern region of Ghana

University of Technology Sydney. Faculty of Health.The Northern Region of Ghana experiences serious maternal healthcare challenges, including the appropriate referral of pregnant women. To date, no study has investigated maternal referral services in the Northern region of Ghana. This study, therefore, investigated the practice and quality of maternal referrals in comprehensive emergency obstetric care facilities in the Northern Region of Ghana. This research employed a convergent parallel mixed method design. The study was conducted in all the nine districts that have district hospitals in the Northern region. Descriptive statistics were applied to the quantitative data using SPSS version 22 and Excel. NVivo version 12 was used to manage the qualitative data and content analysis was conducted. All the ten hospitals assessed lacked some essential equipment and human resource. Delivery bed ratio per 10,000 population was 0.08 whilst maternity bed ratio was 0.42. Some referral forms were filled partially. Tricycle, locally termed as “yellow yellow”, was the principal means of transport for referrals. Most of the women acknowledged that there was no communication between the health facilities during referral. The regional health directorate should collaborate with non-governmental organisations in the region and mobilise resources to improve the availability of essential equipment to enhance referral services

Does knowledge of pregnancy complications influence health facility delivery? Analysis of 2014 Bangladesh Demographic and Health Survey

Introduction Only thirty-seven percent (37%) of deliveries occur in health facilities in Bangladesh despite the enormous benefits of health facility delivery. We investigated women’s recall of receiving counseling on pregnancy complications and how it affects health facility delivery in Bangladesh. Materials and methods Data from the 2014 Bangladesh Demographic and Health Survey was used for the study. After calculating the proportion of women who were informed about pregnancy complications during their last Antenatal Care (ANC) and the number of them who delivered in health facilities, Binary Logistic Regression was utilized in investigating chances of giving birth in health facilities among women who recalled they were told about pregnancy complications and those who were not told. The models were considered significant at 95%. Results A little above half of the women who were told about pregnancy complications during ANC delivered in health facilities (53.3%) and 43.6% of those who were not told delivered in health facilities. The findings revealed that women who were told about pregnancy complications during ANC were more likely to deliver at the health facility compared to those who were not told [COR = 1.56, CI = 1.31–1.87], and this persisted after controlling for the effect of covariates [AOR = 1.44, CI = 1.21–1.71]. Conclusion This study has stressed the importance of telling women about pregnancy complications during ANC by revealing that telling women about pregnancy complications during ANC is likely to result in health facility delivery. Health workers should intensify health education on pregnancy complications during ANC and motivate women to deliver in health facilities

Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys

© 2020, The Author(s). Introduction: Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods: Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results: The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion: Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women

Rural-urban variation in insecticide-treated net utilization among pregnant women:evidence from 2018 Nigeria Demographic and Health Survey

Background: In 2018, Nigeria accounted for the highest prevalence of malaria worldwide. Pregnant women and children under five years bear the highest risk of malaria. Geographical factors affect utilization of insecticide-treated nets (ITN), yet existing literature have paid little attention to the rural-urban dimension of ITN utilization in Nigeria. This study aimed at investigating the rural-urban variation in ITN utilization among pregnant women in Nigeria using data from the 2018 Demographic and Health Survey.Methods: A total of 2909 pregnant women were included in the study. The prevalence of ITN utilization for rural and urban pregnant women of Nigeria were presented with descriptive statistics. Chi-square test was employed to assess the association between residence, socio-demographic characteristics and ITN utilization at 95% level of significance. Subsequently, binary logistic regression was used to assess the influence of residence on ITN utilization.Results: Eight out of ten of the rural residents utilized ITN (86.1%) compared with 74.1% among urban residents. Relative to urban pregnant women, those in rural Nigeria had higher odds of utilizing ITNs both in the crude [cOR = 2.17, CI = 1.66-2.84] and adjusted models [aOR = 1.18, CI = 1.05-1.24]. Pregnant women aged 40-44 had lower odds of ITN utilization compared to those aged 15-19 [aOR = 0.63, CI = 0.44-0.92]. Poorer pregnant women had higher odds of ITN utilization compared with poorest pregnant women [aOR = 1.09, CI = 1.04-1.32]. Across regions, those in the south [aOR = 0.26, CI = 0.14-0.49] and south-west [aOR = 0.29, CI = 0.16-0.54] had lower odds of ITN use compared to their counterparts in the north-west region.Conclusion: The high use of ITNs among pregnant women in Nigeria may be due to the prioritization of rural communities by previous interventions. This is a dimension worth considering to enhance the attainment of the national anti-malarial initiatives. Since possession of ITN is not a guarantee for utilization, women in urban locations need constant reminder of ITN use through messages delivered at ANC and radio advertisements. Moreover, subsequent mass ITN campaigns ought to take cognizance of variations ITN use across regions and pragmatic steps be taken to increase the availability of ITN in households since there is a moderately high use in households with at least one ITN in Nigeria.</p

Determinants of early initiation of breastfeeding in Ghana: a population-based cross-sectional study using the 2014 Demographic and Health Survey data

Background The World Health Organisation (WHO) recommends that breastfeeding should be initiated within the first hour of delivery followed by exclusive breastfeeding up to 6 months. This study examined the determinants of early initiation of breastfeeding in Ghana using data from the 2014 Ghana Demographic and Health Survey. Methods A sample size of 4219 was used for the study. Descriptive statistics was conducted to ascertain the proportion of children who had early initiation of breastfeeding after which binary logistic regression analysis was carried out. Results were presented using frequencies, percentages, unadjusted and adjusted odds ratios. Statistical significance was pegged at p<0.05. Results Children of first birth order [AOR = 0.71, CI = 0.61–0.84], those who were delivered by non-professionals [AOR = 0.51, CI = 0.30–0.88] and those whose mothers were Traditionalists [AOR = 0.65, CI = 0.46–0.92] and Mole-Dagbanis [AOR = 0.69, CI = 0.54–0.89] were less likely to go through early initiation of breastfeeding compared to those of 2–4 birth order, those who were delivered by health professionals, those whose mothers were Christians and Akan, respectively. Conversely, children born to mothers who read newspaper/magazine at least once a week were more likely to go through early initiation of breastfeeding, compared to those who never read newspaper/magazine [AOR = 1.40, CI = 1.01–1.95]. Children born to mothers who watched television less than once a week were more likely to go through early initiation of breastfeeding compared to those who watched television at least once a week [AOR = 1.40, CI = 1.01–1.95]. Finally, women from the Northern [AOR = 2.40, CI = [1.77–3.26] and Upper East regions [AOR = 2.57, CI = [1.86–3.56] practiced early initiation of breastfeeding compared to those from the Ashanti region. Conclusions Empowering healthcare providers to be consistent in early breastfeeding initiation advocacy and effective community engagement on the need to embrace and practice early initiation of breastfeeding can improve the situation

Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey

Background: Increasing the use of healthcare is a significant step in improving health outcomes in both the short and long term. However, the degree of the relationship between utilization of health services and health outcomes is affected by the quality of the services rendered, the timeliness of treatment and follow-up care. In this study, we investigated whether the National Health Insurance Scheme (NHIS) is helping pregnant women in accessing health services in Ghana. Methods: Data for the study were obtained from the women’s file of the 2014 Ghana Demographic and Health Survey. All women with birth history and aged 15–49 constituted our sample (n = 4271). We employed binary logistic regression analysis in investigating whether the NHIS was helping pregnant women in accessing health service. Statistical significance was set at <0.05. Results: Most women had subscribed to the NHIS [67.0%]. Of the subscribed women, 78.2% indicated that the NHIS is helping pregnant women in accessing healthcare. Women who had subscribed to the NHIS were more likely to report that it is helping pregnant women in accessing health service [aOR = 1.70, CI = 1.38–2.10]. We further noted that women who had at least four antenatal visits were more likely to indicate that NHIS is helping pregnant women in accessing health services [aOR = 3.01, CI = 2.20–4.14]. Women with secondary level of education [aOR= 1.42; CI: 1.04–1.92] and those in the richest wealth quintile [aOR = 3.51; CI = 1.94–6.34] had higher odds of indicating that NHIS is helping pregnant women in accessing healthcare. However, women aged 45–49 [aOR = 0.49; CI = 0.26–0.94], women in the Greater Accra [aOR = 0.29; CI = 0.16–0.53], Eastern [aOR = 0.12; CI = 0.07–0.21], Northern [aOR = 0.29; CI = 0.12–0.66] and Upper East [aOR = 0.17; CI = 0.09–0.31] regions had lower odds of reporting that NHIS is helping pregnant women in accessing health services. Conclusion: To enhance positive perception towards the use of health services among pregnant women, non-subscribers need to be encouraged to enrol on the NHIS. Together with non-governmental organizations dedicated to maternal and child health issues, the Ghana Health Service’s Maternal and Child Health Unit could strengthen efforts to educate pregnant women on the importance of NHIS in maternity care

Impact of COVID-19 on maternal healthcare in Africa and the way forward COMMENT

Background: The impact of COVID-19 is weighing heavily on many African countries. As of November 14th 2021, 6,109,722 cases had been recorded with 151,173 deaths and 2.5% case fatality rate. Studies reveal substantial morbidity and socioeconomic impacts when accessing quality maternal healthcare including fear of infection and the containment measures in place, including social distancing and community containment. The pandemic has put additional strain on healthcare systems that are overburdened and under-resourced even in normal times and has exposed the vulnerabilities of high-risk population groups in addressing critical healthcare concerns. This study presents a mini review of how COVID-19 has disrupted maternal healthcare in Africa, and it further proposes ways to improve the situation. Main body: COVID-19 has disrupted antenatal, skilled birth, and postnatal family planning services. Women and girls are vulnerable to the impact of COVID-19 on several fronts and represent a group whose needs including antenatal, skilled birth, and postnatal family planning services have been disrupted, leading to unmet needs for contraception and an increase in unintended pregnancies. Restricted travel due to the fear and anxiety associated with contracting COVID-19 has resulted in delays in accessing prompt skilled care and essential healthcare services such as pregnancy care, immunisation, and nutritional supplementation. Misconceptions relating to COVID-19 have prompted concerns and created distrust in the safety of the healthcare system. Innovative measures are required to address these obstacles and ensure women are not denied access to available, accessible, acceptable, and quality maternal healthcare services in spite of COVID-19. Conclusions: In the immediate term while physical distancing measures remain in force, deliberate effort must be made to provide evidence-based guidelines, good practice and expert advice that addresses the unique sexual and reproductive health context of African countries. Efforts to train and motivate healthcare providers to adopt online, remote approaches such as use of telemedicine, and expand the involvement of frontline maternal healthcare providers to deliver information on the availability of services through phone-based referral networks, culturally appropriate social media, community radio and folklore messaging strategies are critical to mobilise and secure community confidence in the safety of sexual and reproductive health and maternal care services

Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery

Mass Media Exposure and Cervical Cancer Screening in Rural Sub-Saharan Africa:A Multi-Country Cross-Sectional Analysis

Background and AimsCervical cancer is a pressing global public health challenge, with sub-Saharan Africa (SSA) experiencing disproportionately high incidence and mortality rates compared to other regions. Early detection through screening and timely treatment is essential for mitigating the burden of this disease. Evidence suggests that mass media exposure can play a pivotal role in increasing cervical cancer screening uptake. This study aimed to examine the prevalence of cervical cancer screening in SSA and to identify factors associated with screening uptake, with a specific focus on the influence of mass media among rural women.MethodsThe analysis utilized data from the Demographic and Health Surveys (DHS) conducted in 11 SSA countries, encompassing responses from 72,565 rural women of reproductive age (15–49 years). The primary outcome variable was cervical cancer screening status. Descriptive statistics, including frequencies and cross-tabulations, were employed to characterize the sample. Given the skewed distribution of the outcome variable, complementary log-log regression models were applied to estimate adjusted odds ratios (AORs) in both bivariate and multivariable analyses. Robustness of the statistical models and their fitness were rigorously assessed to ensure the validity of the findings.ResultsThe overall prevalence of cervical cancer screening among women in the 11 countries was 8.47%. Women with exposure to mass media were significantly more likely to undergo screening. Specifically, women who watched television less than once a week (AOR = 1.22, 95% CI: 1.07–1.38) or at least once a week (AOR = 1.39, 95% CI: 1.26–1.53) had higher odds of being screened compared to those with no exposure to television. Similar positive associations were observed for radio and newspaper/magazine exposure. Women who listened to the radio at least once a week (AOR = 1.59, 95% CI: 1.45–1.74) and those who read newspapers/magazines at least once a week (AOR = 1.68, 95% CI: 1.48–1.90) demonstrated increased odds of undergoing screening. Additional predictors of screening included older age, higher education levels, greater wealth, higher parity, and fewer barriers to accessing healthcare, such as not needing permission or assistance to seek care.ConclusionThis study highlights the critical role of mass media—television, radio, and newspapers/magazines—in promoting cervical cancer screening among rural women in SSA. Public health stakeholders and governments should prioritize leveraging these platforms to design and disseminate culturally tailored campaigns aimed at overcoming barriers to screening in rural communities. By optimizing the reach and effectiveness of mass media, particularly traditional channels prevalent in rural SSA, cervical cancer screening rates can be significantly improved, thereby reducing the disease burden in the region

Understanding contraception-use intentions among women of reproductive age not currently using contraceptives in sub-Saharan Africa:Key insights from Demographic and Health Surveys

BackgroundThis study assesses the prevalence of contraception-use intentions and evaluates the associated factors among non-users in sub-Saharan Africa (SSA).MethodsData from 2014–2023 Demographic and Health Surveys of 30 countries in SSA consisting of 332 986 women aged 15–49 y not already using contraception were used.ResultsThe overall prevalence was 41.18% (95% CI 41.01 to 41.34%). Zimbabwe had the highest prevalence (72.34%; 95% CI 71.11 to 73.57%), whereas Ethiopia had the lowest (15.96%; 95% CI 15.40 to 16.51%). Women aged 25–49 y had lower odds of intending to use contraception compared with those aged 15–19 y, and this was striking among those aged 45–49 y (adjusted OR [AOR]=0.06, 95% CI 0.06 to 0.07). Those with a higher level of education displayed a greater likelihood of intending to use contraception (AOR=1.93, 95% CI 1.82 to 2.05) compared with those with no education. The odds increased with the number of children born, particularly for those with ≥4 children (AOR=1.59, 95% CI 1.52 to 1.67) compared with those with no children.ConclusionsPromoting the use of contraception requires tailored, multi-pronged interventions that account for the diverse sociodemographic, fertility and informational needs of women in this population