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Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria

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      Abstract

      Background

      Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women’s access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility.

      Methods

      Cross-sectional data on 37,086 community dwelling women aged between 15–49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don’t trust facility/poor service, 5) No female provider, 6) Husband/family didn’t allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations.

      Results

      In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3–57.9) in Nigeria and 45.4% (42.0–47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high.

      Conclusion

      Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.

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      Most cited references 39

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      Constructing socio-economic status indices: how to use principal components analysis.

      Theoretically, measures of household wealth can be reflected by income, consumption or expenditure information. However, the collection of accurate income and consumption data requires extensive resources for household surveys. Given the increasingly routine application of principal components analysis (PCA) using asset data in creating socio-economic status (SES) indices, we review how PCA-based indices are constructed, how they can be used, and their validity and limitations. Specifically, issues related to choice of variables, data preparation and problems such as data clustering are addressed. Interpretation of results and methods of classifying households into SES groups are also discussed. PCA has been validated as a method to describe SES differentiation within a population. Issues related to the underlying data will affect PCA and this should be considered when generating and interpreting results.
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        Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

        High-quality obstetric delivery in a health facility reduces maternal and perinatal morbidity and mortality. This systematic review synthesizes qualitative evidence related to the facilitators and barriers to delivering at health facilities in low- and middle-income countries. We aim to provide a useful framework for better understanding how various factors influence the decision-making process and the ultimate location of delivery at a facility or elsewhere. We conducted a qualitative evidence synthesis using a thematic analysis. Searches were conducted in PubMed, CINAHL and gray literature databases. Study quality was evaluated using the CASP checklist. The confidence in the findings was assessed using the CERQual method. Thirty-four studies from 17 countries were included. Findings were organized under four broad themes: (1) perceptions of pregnancy and childbirth; (2) influence of sociocultural context and care experiences; (3) resource availability and access; (4) perceptions of quality of care. Key barriers to facility-based delivery include traditional and familial influences, distance to the facility, cost of delivery, and low perceived quality of care and fear of discrimination during facility-based delivery. The emphasis placed on increasing facility-based deliveries by public health entities has led women and their families to believe that childbirth has become medicalized and dehumanized. When faced with the prospect of facility birth, women in low- and middle-income countries may fear various undesirable procedures, and may prefer to deliver at home with a traditional birth attendant. Given the abundant reports of disrespectful and abusive obstetric care highlighted by this synthesis, future research should focus on achieving respectful, non-abusive, and high-quality obstetric care for all women. Funding for this project was provided by The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization. Electronic supplementary material The online version of this article (doi:10.1186/1742-4755-11-71) contains supplementary material, which is available to authorized users.
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          Measuring living standards with proxy variables.

          Very few demographic surveys in developing countries have gathered information on household incomes or consumption expenditures. Researchers interested in living standards therefore have had little alternative but to rely on simple proxy indicators. The properties of these proxies have not been analyzed systematically. We ask what hypotheses can be tested using proxies, and compare these indicators with consumption expenditures per adult, our preferred measure of living standards. We find that the proxies employed in much demographic research are very weak predictors of consumption per adult. Nevertheless, hypothesis tests based on proxies are likely to be powerful enough to warrant consideration.
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            Author and article information

            Affiliations
            [1 ] School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
            [2 ] Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
            [3 ] Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
            London School of Economics and Political Science, UNITED KINGDOM
            Author notes

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

            Contributors
            ORCID: http://orcid.org/0000-0002-4876-6043, Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Investigation, Role: Methodology, Role: Project administration, Role: Resources, Role: Software, Role: Supervision, Role: Validation, Role: Visualization, Role: Writing – original draft
            Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Investigation, Role: Methodology, Role: Project administration, Role: Resources, Role: Software, Role: Supervision, Role: Validation, Role: Visualization, Role: Writing – original draft
            ORCID: http://orcid.org/0000-0002-8567-3081, Role: Methodology, Role: Writing – original draft, Role: Writing – review & editing
            Role: Methodology, Role: Writing – review & editing
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            3 May 2018
            2018
            : 13
            : 5
            29723253
            5933759
            10.1371/journal.pone.0196896
            PONE-D-18-01909
            (Editor)
            © 2018 Yaya 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.

            Counts
            Figures: 1, Tables: 3, Pages: 11
            Product
            Funding
            The author(s) received no specific funding for this work.
            Categories
            Research Article
            People and Places
            Geographical Locations
            Africa
            Nigeria
            People and Places
            Geographical Locations
            Africa
            Ethiopia
            Medicine and Health Sciences
            Health Care
            Health Care Policy
            Medicine and Health Sciences
            Women's Health
            Maternal Health
            Birth
            Labor and Delivery
            Medicine and Health Sciences
            Women's Health
            Obstetrics and Gynecology
            Birth
            Labor and Delivery
            Medicine and Health Sciences
            Health Care
            Health Services Research
            Engineering and Technology
            Transportation
            Medicine and Health Sciences
            Health Care
            Socioeconomic Aspects of Health
            Medicine and Health Sciences
            Public and Occupational Health
            Socioeconomic Aspects of Health
            Earth Sciences
            Geography
            Geographic Areas
            Rural Areas
            Custom metadata
            Data is available here: https://dhsprogram.com/data/available-datasets.cfm.

            Uncategorized

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