Geographic access and maternal health services utilization in Sélingué Health District, Mali.

Abstract

Introduction. Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in high geographic-access regions. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality and denotes a lack of equity in the Malian health system.Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within moderate geographic access districts in Mali. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.Methods. We conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.Results. The majority of the participants were 20 to 24 years old. Over 68% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district impede the other roughly 40% of our sample from utilizing maternal healthcare. The concentration index demonstrated the impact of inequity in geographic access comparing women residing near and far from the referral care facility.Conclusion. Maternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

Individual and contextual factors associated with maternal healthcare utilisation in Mali: a cross-sectional study using Demographic and Health Survey data

“…15 This high maternal mortality ratio, however, comes at the backdrop of various interventions implemented by the government to ameliorate the status quo. [16][17][18][19] For instance, in efforts to improve access to maternal healthcare service, Mali, on 1 January 2005, introduced a fee exemption policy for C-sections which covered the cost of all C-sections including the surgical procedure and preoperative assessments, the surgical kit and postoperative treatment, and hospitalisation in public and private health facilities. 20 21 Also, since 2019, the Malian government has initiated a series of policies to reform national healthcare, expected to fully be in effect by 2022.…”

“…Poor maternal healthcare utilisation comprising late initiation/non-attendance of antenatal care (ANC) during pregnancy, births not being assisted by a skilled birth attendant (SBA) and poor postnatal care (PNC) are identified as major factors resulting in high maternal deaths 16 19 24 25. Skilled health service care before, during and after childbirth can save the lives of women and their newborns 1…”

Geographical clustering and geographically weighted regression analysis of home delivery and its determinants in developing regions of Ethiopia: a spatial analysis

“…Moreover, living in a rural residence was positively correlated with home delivery. This might be because due to inequity in geographic access to healthcare services across different residences [68]. Thus, women residing in rural settings might face challenges in accessing health facilities which negatively influences their opportunity to get appropriate health information on maternal healthcare services.…”

Recours aux Soins Prénatals au Mali : Une Analyse de la Qualité des Soins

“…Aussi, 23% des femmes rurales n'ont obtenu aucun soin prénatal contre 19% sur le plan national (EDSVI, 2018). C'est dans ce contexte qu'au Mali, plusieurs études ont lieu sur les facteurs associés à l'utilisation des services de soins prénatals, il s'agit entre autres de : (Bain et al, 2022;Tounkara et al, 2022;Diarra, 2020;Dumont et al, 2013;White et al, 2013;Gage, 2007). La plupart de ces études traitent de manière globale l'utilisation des services de santé maternelle sans un accent particulier sur le recours aux soins prénatals.…”