Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey

Background: Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia. Methods: A population-based survey was conducted in 2007 as part of the ‘REsponse to ACcountable priority setting for Trust in health systems’ (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban–rural residence. Results: There were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with health facility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi. Conclusion: Strong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a health facility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery

Flow of women with complicated institutional deliveries from basic to comprehensive EmONC facility in Kapiri Mposhi in 2010.

<p>Flow of women with complicated institutional deliveries from basic to comprehensive EmONC facility in Kapiri Mposhi in 2010.</p

Basic and Comprehensive Emergency Obstetric and Neonatal Care.

<p>Basic and Comprehensive Emergency Obstetric and Neonatal Care.</p

Characteristics of women who had facility childbirths in EmONC facilities in Kapiri Mposhi district and referrals from Kapiri Mposhi to Kabwe general hospital, 2010.

<p>Characteristics of women who had facility childbirths in EmONC facilities in Kapiri Mposhi district and referrals from Kapiri Mposhi to Kabwe general hospital, 2010.</p

Maternal COVID-19 infection and associated factors: A cross-sectional study

Background Since the declaration of COVID-19 as a global pandemic, several studies have been conducted to examine associated factors. However, few studies have focused on pregnant women infected with COVID-19 in sub-Saharan Africa. Therefore, this study investigated the prevalence and factors associated with COVID-19 infection among pregnant women at the Levy Mwanawasa University Teaching Hospital and Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia. Methods A cross-sectional study was conducted between March and July 2021. Women were recruited as they presented for antenatal care. Data was collected using a structured questionnaire to capture variables of interest (socio-demographic, clinical and obstetric). COVID-19 diagnosis was made using a nasopharyngeal swab by PCR test. Multivariable logistic regression was used to control for confounding and calculate the odds ratios for each explanatory variable and respective 95% confidence intervals. Results The study enrolled 352 participants with a mean (standard deviation [SD]) age of 30.1 years (5.6). One hundred thirty of 352 (36.9%; 95% CI: 31.9 to 42.2) participants had a confirmed positive SARS-CoV-2 test result. At univariable analysis, factors associated with COVID-19 were increased gestational age, education status and maternal HIV serostatus. Women with a secondary level of education were less likely to have COVID-19 infection than those with a primary level of education (AOR = 0.23, 95% CI: 0.09–0.63). On the other hand, a one-week increase in gestational age was associated with higher odds of COVID-19 infection (AOR = 1.03, 95% CI: 1.01–1.06). Conclusion The results showed that the prevalence of COVID-19 infection among pregnant women was 36.9% and was associated with increased gestational age and a lower level of education. To mitigate adverse maternal outcomes, there is a need to screen for COVID-19 strictly and broadly monitor prenatal women presenting for healthcare

Frequency and proportions of complications in pregnant women who were referred to Kabwe general hospital from urban and rural EmONC facilities in Kapiri Mposhi, 2010.

<p>Frequency and proportions of complications in pregnant women who were referred to Kabwe general hospital from urban and rural EmONC facilities in Kapiri Mposhi, 2010.</p

Distribution of health facilities with and without EmONC in Kapiri Mposhi, 2010.

<p>Distribution of health facilities with and without EmONC in Kapiri Mposhi, 2010.</p

Major obstetric interventions (MOI) for absolute maternal indications (AMI) referred from urban hospital and rural EmONC centres in Kapiri Mposhi to Kabwe general hospital, 2010 (women aged 12–48 years).

<p>Major obstetric interventions (MOI) for absolute maternal indications (AMI) referred from urban hospital and rural EmONC centres in Kapiri Mposhi to Kabwe general hospital, 2010 (women aged 12–48 years).</p

Maternal COVID-19 Infection and Associated Factors: A Cross-Sectional Study

This is raw data for a study done in Lusaka, Zambia at two tertiary centres that were the main referral centres for maternal Covid-19 infection. Data was collected between March to July 2021. </p