A Systematic Appraisal of the Factors Influencing Antenatal Services and Delivery Care in Sub-Saharan Africa

Transcription

1 A Systematic Appraisal of the Factors Influencing Antenatal Services and Delivery Care in Sub-Saharan Africa Nancy Innocentia Ebu University of Cape Coast School of Nursing, Ghana Commonwealth Nurses Conference March, 2014 Royal College of Physicians, London

2 Acknowledgement Authors of all the literature I used University of Cape Coast Organizers of the event

3 Background Maternal mortality is an issue of global health concern In 2012, United Nations report indicated that 287,000 women died due to pregnancy, delivery and postnatal causes

4 Background 56% of the cases occurring in Sub-Saharan Africa 29 percent in Southern Asia in 2010, and accounting for a total of 245,000 maternal deaths (United Nations, 2012) Millennium Development Goal (MDG) five Countries are expected to make progress towards meeting the target by 2015

5 Background The World Health Organisation (WHO) has recommended at least four ANC visits for pregnant women (WHO, 2010) The proportion of women who had enough ANC visits had seen a reduction in Sub- Saharan Africa between 2000 and 2010 (United Nations, 2012)

6 Fig. 1: Trend Analysis of Utilization of ANC 50 Percent of Attendants Year 2010

7 Background Many women in the developing world carry pregnancy to term and deliver without accessing ANC services (Gage and Calixte, 2006) Disparities persist in sub-saharan Africa where maternal death is high due to inadequate access to skilled personnel during delivery (United Nations, 2010)

8 Purpose of the study This systematic appraisal sought to investigate the factors influencing access to antenatal services and delivery care among women of childbearing age in Sub-Saharan Africa

9 Specific research questions What are the different factors influencing access to antenatal services and delivery care in sub-saharan Africa? To what extent does antenatal care influence hospital delivery?

10 Methods Relevant studies retrieved from CINAHL, MEDLINE, ASSIA, and PUBMED from February to April 2012 Key words used: antenatal, prenatal, delivery, care, childbirth, access, utilisation, maternal health

11 Quality assessment checklist criteria Studies published in English In peer reviewed journals Since 2001 Conducted in sub-saharan African country Survey design Population- Women of childbearing age years Sampling described Data collection procedures described Data analysis explicit Results discussed Ethical issues mentioned Findings including information on access to antenatal and delivery care

12 Included studies Author and Place of Publication Tann, C. J., Kizza, M., Morison, L., Mabey, D., Muwanga M., Grosskurth, H., Elliott, A.M. (Uganda) Eijk van, A. M., Bles, H. M., Odhiambo, F., Ayisi, J. G., Blokland, I. E., Rosen, D. H., Adazu, K., Slutsker, L.and Lindblade, A. K. (Kenya) Rockers, P. C., Wilson, M. L., Mbaruku, G. Kruk, M. E. (Tanzania) Publication Title Use of Antenatal Services and Delivery Care in Entebbe, Uganda: A Community Survey. BMC Pregnancy and Childbirth 2007, 7:23 Use of Antenatal and Delivery Care Among Women in Rural Western Kenya: A Community Based Survey. Reproductive Health 2006, 3:2 Source of Antenatal Care Influences Facility Delivery in Rural Tanzania: A Population- Based Study. Maternal Child Health Journal 2008, 13: Study number S1 S2 S3

13 Included studies Iyaniwura, C. A. Yussuf, Q. (Nigeria) Onah, H. E., Ikeako, L. C., Iloabachie, G. C. (Nigeria) 2006 Utilisation of Antenatal Care and Delivery Services in Sagamu, South Western Nigeria. African Journal of Reproductive Health 2009, 13:3 Factors associated with the use of maternity services in Enugu, Southern Nigeria. Social Science & Medicine 2006, 63 :7 S4 S5 Bawa, S. B., Umar, U.S., and Onadeko, M. (Nigeria) Utilisation of Obstetric Care Services in a Rural Community in South Western Nigeria. African Journal of Medicine and Medical Sciences 2004, 33, S6

14 Data extraction Names of the authors Year of publication Country Focus of the study Outcome measures of interest Number of antenatal visits Place of delivery Level of education Income Distance to health facility Methodology issuessampling techniques, type of instrument for data collection, whether informed consent was obtained

15 Possible sources of bias Only quantitative studies Limited to publications in English Further limitation of the publication year to 2001 Data extraction was conducted by one person

16 Meta Analysis of ANC Attendance and Percentage of Non-Hospital Deliveries Data Variable % of ANC % of Non-Hospital Deliveries 0 S1(n=413) S2(n=635) S3(n=1204) S4(n=392) Studies and Sample Sizes S5(n=392) S6(n=100)

17 Results Results of five studies indicate that 84% to 96% women had at least one ANC visit during pregnancy Women with more years of education were more likely to use ANC services in non government health facility Odds Ratio (OR 3.32, 95% CI )

18 Results Women with no formal education or fewer years of education were more likely to seek care from TBA`s (OR=3.07; 95% CI= ) Results of four studies showed low use of hospital delivery. One study reported that Christians were more likely to use institutional delivery facilities compared to Moslems and traditional worshippers (p<0.05)

19 Discussion Educated women with partners who are highly educated were likely to use ANC services and is consistent with the results of Charkraborty et al. (2003) Navaneetham and Dharmalingam ( 2002) The poor road system and inadequate transportation opportunities in most rural parts of sub-saharan Africa are possible barriers to effective healthcare delivery (United Nations, 2010, Titaley, Dibley and Roberts, 2010)

20 Discussion Pregnant women in rural communities have greater chances of delivering in a non health facility assisted by friends and other family relations (Zere et al., 2010) Few studies demonstrate a correlation between women of Muslim and the Catholic faith and use of maternity services (Addai, 2000, Overbosch et al., 2004) Implementation of free maternal health services by some governments in the developing world, for instance, Ghana and Nepal have had a positive influence on improving financial barriers to care (Witter et al., 2007)

21 Implications Maternal health care - a key priority by all governments in Sub-Saharan Africa Higher priority on education of the female child and women in general Maternal health policies to remove financial and physical barriers Improving the socio-economic environment Health care providers need to educate women on the importance of ANC and delivery with skilled personnel Health care workers need to be more sensitive towards clients

22 Conclusion Access to ANC services and delivery care are influenced by; Women s and partner s sociodemographic characteristics, Education and economic status, Distance to health facility, Quality of care and cost of service

23 Conclusion Access inequalities affect the health of women in sub-saharan Africa. Promoting safe motherhood would require improving the socioeconomic and political environments that addresses the multiple barriers women encounter

24 References Addai, I. (2000) 'Determinants of Use of Maternal-Child Health Services in Rural Ghana', Journal of Biosocial Science, 32, pp [Online]. Available at: (Accessed: 18/4/11) Charkraborty, N., Ataharul Islam, M., Chowdhury, I. R., Bari, W. & Akhter, H. H. (2003) 'Determinants of the Use of Maternal Health Services in Rural Bangladesh', Health Promotion International, 18 (44), pp [Online]. Available at: (Accessed: 20/3/11) Gage, J. A. & Calixte, G. M. (2006) 'Effects of the Physical Accessibility of Maternal Health Services on their Use in Rural Haiti', Population Studies, 60 (3), pp [Online]. Available at: (Accessed: 3/3/11) Navaneetham, K. & Dharmalingam, A. (2002) 'Utilisation of Maternal Care Services in Southern India', Social Science Medicine, 55 (10), pp [Online]. Available at: (Accessed: 18/4/11)

25 References Overbosch, G. B., Nsowah-Nuamah, N. N. N., van den Boom, G. J. M. & Damnyag, L. (2004) 'Determinants of Antenatal Care Use in Ghana', Journal of African Economies, 13 (2), pp [Online]. Available at: (Accessed: 18/4/11) Titaley, R. C., Dibley, M. J. & Roberts, C. L. (2010) 'Factors Associated with Underutilisation of Antenatal Care Services in Indonesia: Results of Indonesia Demographic and Health Survey 2002/2003 and 2007', BMC Public Health, 10 (485) [Online]. Available at: (Accessed: 2/5/11) United Nations (2012) Millennium Development Goals Report. [Online].Retrieved from: %20-low%20res% %20-.pdf (24/1/2014) United Nations (2010) Millennium Development Goals Report. [Online]. Retrieved from: (Accessed: 20/1/2014)

26 References WHO (2010) Trends in Maternal Mortality : A Joint WHO/UNFPA/World Bank Statement. Geneva: [Online]. Available at: (Accessed: 20/3/13) Witter, S., Arhinful, D. K., Kusi, A. & Zakariah-Akoto, S. (2007) 'The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care', Reproductive Health Matters, 15 (30), pp [Online]. Available at: (Accessed: 23/3/11) Zere, E., Tumusiime, P., Walker, O., Kirigia, J., Mwikisa, C. & Mbeeli, T. (2010) 'Inequities in Utilisation of Maternal Health Interventions in Namibia: Implications for Progress Towards MDG 5 Target', International Journal for Equity in Health, 9 (16) [Online]. Available at: (Accessed: 21/4/11)

27 Thank You!