Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countries

Chukwuma, Adanna; Wosu, Adaeze C.; Mbachu, Chinyere; Weze, Kelechi

doi:10.1186/s12884-017-1337-1

Cited by 62 publications

(74 citation statements)

References 14 publications

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“…Moreover, there is an inadequate enabling environment for SBA service utilization, such as the limited capacity of health facilities to deliver the full range of basic services as well as distance for women to travel to the health facility . Likewise, poor quality of ANC service, as a result of low capacity of the health facilities, is one of the main factors for low SBA coverage …”

Section: Introductionmentioning

confidence: 99%

“…19 Likewise, poor quality of ANC service, as a result of low capacity of the health facilities, is one of the main factors for low SBA coverage. 20 A final factor, thought to be the main contributing factor to low SBA coverage, is the influence of social determinants of health, particularly the low socioeconomic status of women on maternal health service utilization. 21 As such, SSA is placed at the bottom of the pyramid with regard to the quality and coverage of ANC and SBA services.…”

mentioning

confidence: 99%

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Determinants of antenatal care and skilled birth attendance in sub‐Saharan Africa: A multilevel analysis

Woldegiorgis

Hiller

Mekonnen

et al. 2019

Health Services Research

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Objective To determine individual‐ and country‐level determinants of utilization of key maternal health services in sub‐Saharan Africa (SSA). Study Setting We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245 178 women who had at least one live birth 5 years preceding the survey. Study Design We used a two‐level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy. Principal Findings While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle‐income country increased the individual‐level association between ANC and SBA (OR = 2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services. Conclusions This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Determinants of antenatal care and skilled birth attendance in sub‐Saharan Africa: A multilevel analysis

Woldegiorgis

Hiller

Mekonnen

et al. 2019

Health Services Research

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“…Despite evidence that women's experiences during ANC can influence care seeking for childbirth [27][28][29][30][31][32][33][34], most studies on the effects of user fees on maternal health service coverage have looked exclusively at delivery care. Our study demonstrates the value of examining the influence of health financing strategies on a broader range of maternal health outcomes and comparing findings across service types and sub-populations.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…As the government of Kenya continues to develop their health financing mechanisms for maternal health, it is critical to understand the long-term effects of past reforms and identify strategies for ensuring that current and future financing policies have lasting impact. Given the strong link between ANC and subsequent use of intrapartum and postpartum maternal health services [27][28][29][30][31][32][33][34], it is important to investigate the relationship between the implementation of the 10/20 policy and women's experiences during pregnancy, and whether this may help explain why the policy did not increase coverage of facility deliveries, particularly among the poor. Additionally, studying ANC allows us to examine the effect of the policy on multiple dimensions of service use beyond coverage, including number and timing of visits, type of provider, and content of care.…”

Section: Introductionmentioning

confidence: 99%

Examining user fee reductions in public primary healthcare facilities in Kenya, 1997–2012: effects on the use and content of antenatal care

Dennis

Beňová

Goodman

et al. 2020

Int J Equity Health

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Background: In 2004, The Kenyan government removed user fees in public dispensaries and health centers and replaced them with registration charges of 10 and 20 Kenyan shillings (2004 $US 0.13 and $0.25), respectively. This was termed the 10/20 policy. We examined the effect of this policy on the coverage, timing, source, and content of antenatal care (ANC), and the equity in these outcomes. Methods: Data from the 2003, 2008/9 and 2014 Kenya Demographic and Health Surveys were pooled to investigate women's ANC care-seeking. We conducted an interrupted time series analysis to assess the impact of the 10/20 policy on the levels of and trends in coverage for 4+ ANC contacts among all women; early ANC initiation and use of public facility-based care among 1+ ANC users; and use of public primary care facilities and receipt of good content, or quality, of ANC among users of public facilities. All analyses were conducted at the population level and separately for women with higher and lower household wealth. Results: The policy had positive effects on use of 4+ ANC among both better-off and worse-off women. Among users of 1+ ANC, the 10/20 policy had positive effects on early ANC initiation at the population-level and among better-off women, but not among the worse-off. The policy was associated with reduced use of public facilitybased ANC among better-off women. Among worse-off users of public facility-based ANC, the 10/20 policy was associated with reduced use of primary care facilities and increased content of ANC. Conclusions: This study highlights mixed findings on the impact of the 10/20 policy on ANC service-seeking and content of care. Given the reduced use of public facilities among the better-off and of primary care facilities among the worse-off, this research also brings into question the mechanisms through which the policy achieved any benefits and whether reducing user fees is sufficient for equitably increasing healthcare access.

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“…Appropriate selection processes for medical professionals should also assess for behavioral attributes which reflect values that are compatible with high-quality health care provision [5]. The renewed attention being given to strengthening the quality of health care globally to facilitate improved health outcomes, provides an impetus to reexamine this norm to ensure that medical professionals have both the academic and behavioral competencies to provide effective care [6], [7], [8].…”

Section: Introductionmentioning

confidence: 99%

“To guide my life and art”: A triangulated study on the behavioral competencies for effective medical practice in Nigeria

Chukwuma

Obi

Agu

et al. 2019

Preprint

Self Cite

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Background: Variation in clinical performance is attributable to factors outside academic and clinical skills. Selection processes and training programs for medical professionals should be adapted to consider these behavioral factors, which may vary across contexts. This study was conducted to identify behavioral competencies considered relevant for effective medical practice among medical students and practitioners in Nigeria.Methods: We drew on a scoping review to develop a starting list of behavioral attributes that correlate with effective service provision. Drawing on nominal group technique exercises with 17 medical students and 11 physicians, this starting list was modified with scoring and ranking of selected competencies. We compared the list of competencies and rankings between medical students, doctors, and the scoping review.Results: The scoping review identified nine articles for full-text review, resulting in a starting list of 21 behavioral competencies defined in studies conducted in non-African countries. The nominal group technique exercises conducted with medical students and doctors yielded a condensed list of 32 and 27 behavioral competencies respectively. For doctor-client interactions, the behavioral competencies considered most important included effective communication and patient-centeredness. Whereas, for doctor-colleague interactions, team work, respectfulness, and management ability were ranked highly. However, there were clear divergences between groups and with the scoping review.Conclusions: This study is one of the first to identify the perspectives of medical students and physicians on behavioral competencies considered essential for effective medical practice in an African country. We found differences in the perspectives of medical physicians and students, and in the prioritized competencies across contexts. This illustrates the need for careful consideration in identifying subject matter experts and in generalizing competencies across contexts. Future research in this field in Nigeria should examine effective ways of testing for key behavioral competencies among medical students and for residency programs. Also, investigating the perspectives of medical faculty and administrators on important competencies, and exploring the generalizability of these competencies across cultures in Nigeria should be considered.

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Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countries

Cited by 62 publications

References 14 publications

Determinants of antenatal care and skilled birth attendance in sub‐Saharan Africa: A multilevel analysis

Determinants of antenatal care and skilled birth attendance in sub‐Saharan Africa: A multilevel analysis

Examining user fee reductions in public primary healthcare facilities in Kenya, 1997–2012: effects on the use and content of antenatal care

“To guide my life and art”: A triangulated study on the behavioral competencies for effective medical practice in Nigeria

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