Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review

Abstract While the most important factors associated with facility-based delivery (FBD) have been explored within individual countries in Africa, no systematic review has explored the factors associated with FBD across sub-Saharan Africa. A systematic search of the peer-reviewed literature was conducted to identify articles published in English from 1/1995-12/2011 that reported on original research conducted entirely or in part in sub-Saharan Africa and included a primary outcome variable of FBD, delivery location, or skilled birth attendance (SBA). Out of 1,168 citations identified, 65 met inclusion criteria. 62 of 65 were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorized as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied. This may be a result of the overwhelming reliance on household survey data – where maternal sociodemographic factors are likely to be well-represented and non-maternal factors may be less consistently and accurately represented. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. Research to date has been dominated by analysis of cross-sectional household survey data. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.http://deepblue.lib.umich.edu/bitstream/2027.42/112697/1/12978_2013_Article_214.pd

Prevalence of maternal near miss and community‐based risk factors in Central Uganda

ObjectiveTo examine the prevalence of maternal near‐miss (MNM) and its associated risk factors in a community setting in Central Uganda.MethodsA cross‐sectional research design employing multi‐stage sampling collected data from women aged 15–49 years in Rakai, Uganda, who had been pregnant in the 3 years preceding the survey, conducted between August 10 and December 31, 2013. Additionally, in‐depth interviews were conducted. WHO‐based disease and management criteria were used to identify MNM. Binary logistic regression was used to predict MNM risk factors. Content analysis was performed for qualitative data.ResultsSurvey data were collected from 1557 women and 40 in‐depth interviews were conducted. The MNM prevalence was 287.7 per 1000 pregnancies; the majority of MNMs resulted from hemorrhage. Unwanted pregnancies, a history of MNM, primipara, pregnancy danger signs, Banyakore ethnicity, and a partner who had completed primary education only were associated with increased odds of MNM (all P < 0.05).ConclusionsMNM morbidity is a significant burden in Central Uganda. The present study demonstrated higher MNM rates compared with studies employing organ‐failure MNM‐diagnostic criteria. These findings illustrate the need to look beyond mortality statistics when assessing maternal health outcomes. Concerted efforts to increase supervised deliveries, access to emergency obstetric care, and access to contraceptives are warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135484/1/ijgo214.pd

Three years of data on the impact of obstetrician/gynecologist coverage in rural Uganda

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135481/1/ijgo284.pd

Global Connections: The Health Sciences Library's Role in Medical Campus Collaborations

http://deepblue.lib.umich.edu/bitstream/2027.42/94437/1/global_connections_the_health_sciences_librarys_role_in_medical_campus_collaborations.pd

Simpatico

This is the catalogue of the exhibition "Simpatico" at Boston University Art Gallery

Root causes and social consequences of birth injuries in Western Uganda

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/1/ijgo12257.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138287/2/ijgo12257_am.pd

Contraceptive practices of women visiting a gynecology clinic in Beijing, China

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135321/1/ijgo64.pd

The relationship between facility‐based delivery and maternal and neonatal mortality in Sub‐Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135613/1/ijgo263.pd

Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana

BACKGROUND: Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients\u27 perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS: Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale (\u27Counseling Composite Score\u27). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points (\u27Preeclampsia/Eclampsia Knowledge Score\u27 (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS: A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 +/- 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (beta 1.4, SE 0.3, p \u3c 0.001) and higher level of education (beta 1.3, SE 0.48, p = 0.008). CONCLUSIONS: Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality

The relationship between facility delivery and infant immunization in Ethiopia

ObjectiveTo determine whether facility delivery is related to compliance with recommended infant immunizations, particularly those that occur weeks or months after delivery.MethodsIn a retrospective analysis, multivariate logistic regression was used to assess data from the 2011 Ethiopia Demographic and Health Survey (EDHS) to determine the strongest correlates of facility delivery. These correlates were then used, along with facility delivery itself, to determine the relationship between facility delivery and infant immunization.ResultsIn total, 3334 women delivered a newborn 12–24 months before the 2011 EDHS: 90.2% (3007) delivered at home, and 9.8% (327) delivered in a facility. Education, wealth status, urban residence, and number of children under 5 years living in the household were the factors most strongly associated with facility delivery. When facility delivery and its strongest correlates were entered into multivariate logistic regression models with infant immunizations as the outcome, facility delivery was significantly associated with increased likelihood of DPT‐HepB‐Hib, polio, and measles vaccination, and increased likelihood of being fully immunized (all P < 0.01). Facility delivery was the strongest single factor associated with infants being immunized, doubling the odds of full immunization.ConclusionThe impact of facility delivery on health outcomes transcends the immediate delivery and postpartum period.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135167/1/ijgo217.pd