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      Factors associated with births protected against neonatal tetanus in Africa: Evidences from Demographic and health surveys of five African countries

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          Abstract

          Introduction

          Maternal and neonatal tetanus remains a global public health problem affecting mainly the poorest and most marginalized subpopulations. In spite of the problem, studies conducted on the associated factors of births protected against neonatal tetanus are scarce in Africa. Therefore, this study aimed to identify both individual and community-level factors associated with births protected against neonatal tetanus in the region.

          Methods

          The most recent Demographic and Health Survey datasets of five African countries (Ethiopia, Burundi, Comoros, Zimbabwe and Zambia) were used to investigate the associated factors of births protected from neonatal tetanus. STATA Version 14 statistical software was used for the analysis. The data were weighted before doing any statistical analysis and deviance was used for model comparison. Multilevel binary logistic regression was used to identify the associated factors of births protected against neonatal tetanus. Finally, the adjusted odds ratio (AOR) with its 95% confidence interval (CI) was calculated for each potential factors included in the multivariable multilevel logistic regression model.

          Results

          A total weighted sample of 30897 reproductive age women who had a birth within 5 years preceding the survey were included in the analysis. Those women with age of 20–34 (AOR = 1.32, 95%CI: 1.18–1.48) and 35–49 years (AOR = 1.26, 95% CI: 1.10–1.44), high community level of women education (AOR = 1.13, 95%CI: 1.04–1.23), being from poorer(AOR = 1.23, 95% CI: 1.14–1.33), middle (AOR = 1.31, 95%CI: 1.21–1.43), richer (AOR = 1.21, 95%CI: 1.11–1.32) and richest households (AOR = 1.59, 95%CI: 1.44–1.74), having antenatal care follow up (AOR = 9.62, 95% CI: 8.79–10.54), not perceiving distance to health facility as a big problem (AOR = 1.18, 95% CI: (1.11–1.25) had higher odds of having births protected against neonatal tetanus.

          Conclusion

          Both individual and community level factors were found to be associated with births protected against neonatal tetanus in Africa. This suggests that a variety of factors are affecting births protected against neonatal tetanus in the region. Hence, the impact of these factors should be recognized while developing strategies to reduce neonatal tetanus in the region.

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          Most cited references 34

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          Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

          Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.
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            Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis

            Background There has been an increasing availability and accessibility of modern health services in rural Bangladesh over the past decades. However, previous studies on the socioeconomic differentials in the utilization of these services were based on a limited number of factors, focusing either on preventive or on curative modern health services. These studies failed to collect data from remote rural areas of the different regions to examine the socioeconomic differentials in health-seeking behavior. Methods Data from 3,498 randomly selected currently married women from three strata of households within 128 purposively chosen remote villages in three divisions of Bangladesh were collected in 2006. This study used bivariate and multivariate logistic analyses to examine both curative and preventive health-seeking behaviors in seven areas of maternal and child health care: antenatal care, postnatal care, child delivery care, mother's receipt of Vitamin A postpartum, newborn baby care, care during recent child fever/cough episodes, and maternal coverageby tetanus toxoid (TT). Results A principal finding was that a household's relative poverty status, as reflected by wealth quintiles, was a major determinant in health-seeking behavior. Mothers in the highest wealth quintile were significantly more likely to use modern trained providers for antenatal care, birth attendance, post natal care and child health care than those in the poorest quintile (χ2, p < 0.01). The differentials were less pronounced for other factors examined, such as education, age, and the relative decision-making power of a woman, in both bivariate and multivariate analyses. Conclusion Within rural areas of Bangladesh, where overall poverty is greater and access to health care more difficult, wealth differentials in utilization remain pronounced. Those programs with high international visibility and dedicated funding (e.g., Immunization and Vitamin A delivery) have higher overall prevalence and a more equitable distribution of beneficiaries than the use of modern trained providers for basic essential health care services. Implications of these findings and recommendations are provided.
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              Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

              This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: ResourcesRole: Writing – original draft
                Role: Formal analysisRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Role: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                17 June 2021
                2021
                : 16
                : 6
                Affiliations
                [1 ] Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                [2 ] Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                [3 ] Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
                [4 ] Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                [5 ] Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
                FHI360, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-20-30964
                10.1371/journal.pone.0253126
                8211162
                34138922
                © 2021 Yeshaw et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 3, Pages: 11
                Product
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Bacterial Diseases
                Tetanus
                Biology and Life Sciences
                Developmental Biology
                Neonates
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Antenatal Care
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                People and Places
                Geographical Locations
                Africa
                Custom metadata
                All relevant data related to the study were included in the manuscript. The datasets used for the analysis of the study can also be obtained after reasonable request of the DHS Program using the link https://dhsprogram.com/data/dataset_admin/index.cfm.

                Uncategorized

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