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Use of healthcare services at time of delivery: a prospective community based study in Madagascar
Abstract Background Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra reg...
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| Published in: | European journal of public health 2020-09, Vol.30 (Supplement_5) |
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| container_title | European journal of public health |
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| creator | Pourette, D Andrianantoandro, T V Rakotoarimanana, F M J Razakamanana, M Rakotomalala, O Ramiaramanana, J |
| description | Abstract
Background
Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region.
Methods
This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'.
Results
Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p |
| doi_str_mv | 10.1093/eurpub/ckaa166.908 |
| format | article |
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Background
Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region.
Methods
This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'.
Results
Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family.
Conclusions
Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare.
Key messages
Collaborations between health workers and traditional healers should be formalized.
The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.</description><identifier>ISSN: 1101-1262</identifier><identifier>EISSN: 1464-360X</identifier><identifier>DOI: 10.1093/eurpub/ckaa166.908</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Access ; Appeals ; Birth ; Births ; Childbirth & labor ; Cost analysis ; Families & family life ; Health care ; Health care facilities ; Health facilities ; Health services ; Life Sciences ; Local government ; Logistics ; Maternal mortality ; Medical personnel ; Mothers ; Municipalities ; Pregnancy ; Public health ; Qualitative analysis ; Qualitative research ; Quality of care ; Registration ; Regression analysis ; Santé publique et épidémiologie ; Women ; Womens health ; Workers</subject><ispartof>European journal of public health, 2020-09, Vol.30 (Supplement_5)</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-3599-8806</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1604,27866,27924,27925</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/eurpub/ckaa166.908$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://hal.science/hal-04095749$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Pourette, D</creatorcontrib><creatorcontrib>Andrianantoandro, T V</creatorcontrib><creatorcontrib>Rakotoarimanana, F M J</creatorcontrib><creatorcontrib>Razakamanana, M</creatorcontrib><creatorcontrib>Rakotomalala, O</creatorcontrib><creatorcontrib>Ramiaramanana, J</creatorcontrib><title>Use of healthcare services at time of delivery: a prospective community based study in Madagascar</title><title>European journal of public health</title><description>Abstract
Background
Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region.
Methods
This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'.
Results
Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family.
Conclusions
Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare.
Key messages
Collaborations between health workers and traditional healers should be formalized.
The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.</description><subject>Access</subject><subject>Appeals</subject><subject>Birth</subject><subject>Births</subject><subject>Childbirth & labor</subject><subject>Cost analysis</subject><subject>Families & family life</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health facilities</subject><subject>Health services</subject><subject>Life Sciences</subject><subject>Local government</subject><subject>Logistics</subject><subject>Maternal mortality</subject><subject>Medical personnel</subject><subject>Mothers</subject><subject>Municipalities</subject><subject>Pregnancy</subject><subject>Public health</subject><subject>Qualitative analysis</subject><subject>Qualitative research</subject><subject>Quality of care</subject><subject>Registration</subject><subject>Regression analysis</subject><subject>Santé publique et épidémiologie</subject><subject>Women</subject><subject>Womens health</subject><subject>Workers</subject><issn>1101-1262</issn><issn>1464-360X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>7TQ</sourceid><recordid>eNqNUMtOwzAQjBBIlMIPcLLEiUNaP1I75lZVQJGKuFCJm7V11jSlbYKdVMrf45KKM6dd7c6MZiZJbhkdMarFGFtft6ux_QJgUo40zc-SActklgpJP87jzihLGZf8MrkKYUMpnaicDxJYBiSVI2uEbbO24JEE9IfSYiDQkKbc_b4L3JYH9N0DAVL7KtRom3ggttrt2n3ZdGQFAQsSmrboSLknr1DAJ4QoeJ1cONgGvDnNYbJ8enyfzdPF2_PLbLpILctVHn3mFLRlTkmBDCjnnCpXMCzcSoFAWXANyJ0tJCp0XOSgQQqmNVIlHRXD5L7XXcPW1L7cge9MBaWZTxfmeKMZ1ROV6QOL2LseG7N8txgas6lav4_2DM-UZEqI7KjIe5SNiYNH9yfLqDnWbvrazal2E2uPpLQnVW39H_wP88GH-A</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Pourette, D</creator><creator>Andrianantoandro, T V</creator><creator>Rakotoarimanana, F M J</creator><creator>Razakamanana, M</creator><creator>Rakotomalala, O</creator><creator>Ramiaramanana, J</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><general>Oxford University Press (OUP): Policy B - Oxford Open Option D</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7TQ</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-3599-8806</orcidid></search><sort><creationdate>20200901</creationdate><title>Use of healthcare services at time of delivery: a prospective community based study in Madagascar</title><author>Pourette, D ; Andrianantoandro, T V ; Rakotoarimanana, F M J ; Razakamanana, M ; Rakotomalala, O ; Ramiaramanana, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1878-3680a9c1f763e1a022207fd1edfb7a3e6d29ae2fcd6e7ef238a9a63199e076f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Access</topic><topic>Appeals</topic><topic>Birth</topic><topic>Births</topic><topic>Childbirth & labor</topic><topic>Cost analysis</topic><topic>Families & family life</topic><topic>Health care</topic><topic>Health care facilities</topic><topic>Health facilities</topic><topic>Health services</topic><topic>Life Sciences</topic><topic>Local government</topic><topic>Logistics</topic><topic>Maternal mortality</topic><topic>Medical personnel</topic><topic>Mothers</topic><topic>Municipalities</topic><topic>Pregnancy</topic><topic>Public health</topic><topic>Qualitative analysis</topic><topic>Qualitative research</topic><topic>Quality of care</topic><topic>Registration</topic><topic>Regression analysis</topic><topic>Santé publique et épidémiologie</topic><topic>Women</topic><topic>Womens health</topic><topic>Workers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pourette, D</creatorcontrib><creatorcontrib>Andrianantoandro, T V</creatorcontrib><creatorcontrib>Rakotoarimanana, F M J</creatorcontrib><creatorcontrib>Razakamanana, M</creatorcontrib><creatorcontrib>Rakotomalala, O</creatorcontrib><creatorcontrib>Ramiaramanana, J</creatorcontrib><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>European journal of public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Pourette, D</au><au>Andrianantoandro, T V</au><au>Rakotoarimanana, F M J</au><au>Razakamanana, M</au><au>Rakotomalala, O</au><au>Ramiaramanana, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of healthcare services at time of delivery: a prospective community based study in Madagascar</atitle><jtitle>European journal of public health</jtitle><date>2020-09-01</date><risdate>2020</risdate><volume>30</volume><issue>Supplement_5</issue><issn>1101-1262</issn><eissn>1464-360X</eissn><abstract>Abstract
Background
Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region.
Methods
This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'.
Results
Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family.
Conclusions
Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare.
Key messages
Collaborations between health workers and traditional healers should be formalized.
The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><doi>10.1093/eurpub/ckaa166.908</doi><orcidid>https://orcid.org/0000-0002-3599-8806</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of public health, 2020-09, Vol.30 (Supplement_5) |
| issn | 1101-1262 1464-360X |
| language | eng |
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| source | Oxford Journals Open Access Collection |
| subjects | Access Appeals Birth Births Childbirth & labor Cost analysis Families & family life Health care Health care facilities Health facilities Health services Life Sciences Local government Logistics Maternal mortality Medical personnel Mothers Municipalities Pregnancy Public health Qualitative analysis Qualitative research Quality of care Registration Regression analysis Santé publique et épidémiologie Women Womens health Workers |
| title | Use of healthcare services at time of delivery: a prospective community based study in Madagascar |
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