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- Arunda, Malachi Ochieng, et al.
(författare)
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Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda : analysis of cross-sectional, demographic and health surveys data
- 2021
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DESIGN: A population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SETTING: Countrywide, Kenya and Uganda.PARTICIPANTS: Most recent live births of 24 502 mothers within 1-59 months prior to the 2014-2016 Demographic and Health Surveys.OUTCOMES: Care-seeking continuum and neonatal mortality.RESULTS: Overall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.CONCLUSION: Strategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother's continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.
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| 2. |
- Ochieng Arunda, Malachi
(författare)
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Improving neonatal survival in East Africa Analysis of maternal service utilization, effectiveness of care and risk factors for neonatal mortality in Kenya, Uganda, and Tanzania.
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite profound progress made in reducing neonatal mortality, it remains one of the major global health challenges. In 2019, the World Health Organization estimated that 2.4 million neonatal deaths occurred, accounting for over 45 percent of under-5 deaths worldwide. Most of these neonatal mortalities occur in low-and middle-income (LMIC) with East African countries of Kenya, Uganda and Tanzania among countries reporting persistent slow decline in neonatal death rates. The major causes of neonatal deaths include prematurity, infections and birth complications, most of which are preventable. Very limited population-based research has been conducted to examine determinants of continued care utilization from pregnancy to postnatal period, effectiveness of care as well as the impact of leading risk factors for neonatal deaths in Kenya, Uganda and Tanzania. Thus, the aim of this thesis was to examine the determinants of maternal care utilization, effectiveness of care and risk factors for neonatal mortality in Kenya, Tanzania, and Uganda. The findings, of which are contributing to further research around the world and could have significant implications for policy development, prioritization and resource allocations in public health and care systems in the three most populated East African Community countries. We used nationally representative cross-sectional data from the demographic and health surveys in the respective countries. In Study I we found that lack of antenatal (ANC) attendance, unskilled ANC provision and lack of check-ups for pregnancy complications were among the leading indirect risk factors for preventable neonatal mortality in Kenya. Study II concluded that low birthweight contributes a substantial proportion of neonatal deaths in Uganda. Study III reported that the disproportionate access to caesarean delivery has widened along socioeconomic lines in Tanzania and Kenya. Higher risk of caesarean-related deaths exists. Out of the findings of Study IV, we suggested the need for a comprehensive review to develop a toolkit using care utilization information to enable classification of maternal care-seeking behaviour and adopt new strategies to close the care-seeking gaps. Study V found much higher neonatal deaths among married adolescents with unintended pregnancies adolescent-born neonates from unintended pregnancies and proposed strengthening of existing strategies and use of new approaches to reduce adolescent pregnancies and provide focused obstetric care for adolescents. The thesis suggests an array of evidence-based interventions to improve neonatal survival ranging from education and contraceptive use to improved ANC and postnatal care attendance.
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