Factors influencing access to antenatal services and delivery care in sub-Saharan Africa

Enyan, Nancy Innocentia Ebu; Gross, Janet

doi:10.12968/ajmw.2015.9.2.58

Cited by 10 publications

(10 citation statements)

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“…The inverse effects of low education (Adeneye et al, 2006) and low wealth status (Weiser et al, 2006;Worku & Enquselassie, 2007) on HIV testing were consistent with the findings of other studies. More so, women's socioeconomic characteristics have been shown to affect health-seeking behaviour and use of quality ANC among women (Joshi et al, 2014;Ebu & Gross, 2015). For example, access to health services is more difficult for uneducated and unemployed women, and women with a low income, as they are unable to afford health services.…”

Section: Discussionmentioning

confidence: 99%

Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey

Udoh

Ushie

2019

J. Biosoc. Sci.

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Children in Nigeria are frequently born with HIV, despite available services to prevent mother-to-child transmission (MTCT). Not offering, or non-acceptance of, HIV testing during antenatal care (ANC) delays anti-retroviral commencement for infected women, thereby increasing the risk of MTCT. This study assessed the determinants of HIV testing during antenatal care in Nigeria using nationally representative data from the 2013 Nigerian Demographic Health Survey. This study included 13,352 women aged 15–49 years who reported having at least one antenatal visit. The outcome variables were HIV testing during ANC and during labour, while socio-demographic and maternal factors, including number of ANC visits, offer of HIV testing during ANC and labour, place of delivery and knowledge and counselling on MTCT, were among the independent variables. Multivariate regression analysis was used to predict HIV testing during ANC and labour. About half (53%) of the women were tested for HIV during antenatal care with 85% of those tested receiving their test results. Only 6% had HIV tests during labour. There was a 33% excess probability of urban women testing during ANC compared with rural women. Never having a previous pregnancy terminated was associated with lower odds of testing during ANC. No counselling on MTCT and no counselling to get tested were associated with a lower probability of testing during ANC. Counselling on the prevention of MTCT is crucial for women’s willingness to be tested, and acceptance of testing. More effort is needed to ensure that providers in Nigeria offer these services to all women, educate women on the dangers of opting out and ensure the earliest commencement of ARV enrolment for those infected.

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Section: Discussionmentioning

confidence: 99%

Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey

Udoh

Ushie

2019

J. Biosoc. Sci.

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“…Similar findings from Tanzania and India indicate that even when user fees are minimal or waived for maternal health services, the cost of transport and waiting time are still substantial [ 18 , 28 ]. Long distance or transport difficulties to health facilities have been reported as a barrier to antenatal care utilization in Rwanda [ 29 ] and in other sub-Saharan countries [ 30 – 33 ], as has long waiting time [ 31 , 34 ]. There is a need for a profound equity analysis of antenatal care utilization.…”

Section: Discussionmentioning

confidence: 99%

Cost of antenatal care for the health sector and for households in Rwanda

Hitimana

Lindholm

Krantz

et al. 2018

BMC Health Serv Res

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BackgroundRwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far.MethodsCost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD.ResultsThe societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities.ConclusionsThe unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households’ time cost as a possible barrier to the use of antenatal care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3013-1) contains supplementary material, which is available to authorized users.

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“…On the other hand, women using the services also incur costs associated with their use of maternal health services. Costs are often times a barrier for women living in LMICs to access necessary maternal health services 22…”

Section: Introductionmentioning

confidence: 99%

Cost of maternal health services in low and middle-income countries: protocol for a systematic review

et al. 2019

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IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

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Factors influencing access to antenatal services and delivery care in sub-Saharan Africa

Cited by 10 publications

References 49 publications

Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey

Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey

Cost of antenatal care for the health sector and for households in Rwanda

Cost of maternal health services in low and middle-income countries: protocol for a systematic review

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