Socioeconomic barriers to facility-based delivery in urban poor communities of Lagos: Wealth, linguistic capacity, and residential area

Kawakatsu, Yoshito; Aiga, Hirotsugu; Ubani, Osy; Adesina, Adefunke Oyeniyi; Honda, Sumihisa; Otaki, Junko; Kadoi, Nobuhiro

doi:10.1016/j.hpopen.2020.100019

Cited by 4 publications

(8 citation statements)

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“…47 48 On the other hand, those living in urban poor communities, particularly slum dwellers, may have language barriers to accessing health services in addition to financial and geographic barriers. 8 Consistent with several earlier studies, longer travel times to the most accessible health facility were significantly associated with the utilisation of most, though not all, essential maternal and child health services. 43 49 50 In addition, households with at least one health facility within 20 km were significantly more likely to use child immunisation services and treatments of fever and/or cough, and diarrhoea, suggesting the opportunity and/ or financial cost of travel matters for utilisation.…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

“…3 Development of an effective service delivery strategy must begin by identifying the characteristics of the underserved populations who are less likely to have access to essential maternal and child health services. A majority of earlier studies conducted in Nigeria identified and assessed the factors associated with utilisation of only one or two types of essential maternal and child health services such as ANC, [4][5][6] facility-based delivery, [6][7][8] family planning, 9 10 childhood immunisation [11][12][13] and treatment of childhood illnesses. 14 15 The factors identified in these studies include individual characteristics (eg, age, education status, ethnic group, religion, occupation, pregnancy history, wealth status, access to media) and contextual characteristics (eg, distance to a health facility, rurality, neighbourhood socioeconomic status and ethnic diversity).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)

et al. 2022

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Objective This study aims to identify the individual and contextual factors consistently associated with utilisation of essential maternal and child health services in Nigeria across time and household geolocation. Design, setting and participants Secondary data from five nationally representative household surveys conducted in Nigeria from 2003 to 2018 were used in this study. The study participants are women and children depending on essential maternal and child health (MCH) services. Outcome measures The outcome measures were indicators of whether participants used each of the following essential MCH services: antenatal care, facility-based delivery, modern contraceptive use, childhood immunisations (BCG, diphtheria, tetanus, pertussis/Pentavalent and measles) and treatments of childhood illnesses (fever, cough and diarrhoea). Methods We estimated generalised additive models with logit links and smoothing terms for households’ geolocation and survey years. Results Higher maternal education and households’ wealth were significantly associated with utilisation of all types of essential MCH services (p<0.05). On the other hand, households with more children under 5 years of age and in poor communities were significantly less likely to use essential MCH services (p<0.05). Except for childhood immunisations, greater access to transport was positively associated with utilisation (p<0.05). Households with longer travel times to the most accessible health facility were less likely to use all types of essential MCH services (p<0.05), except modern contraceptive use and treatment of childhood fever and/or cough. Conclusion This study adds to the evidence that maternal education and household wealth status are consistently associated with utilisation of essential MCH services across time and space. To increase utilisation of essential MCH services across different geolocations, interventions targeting poor communities and households with more children under 5 years of age should be appropriately designed. Moreover, additional interventions should prioritise to reduce inequities of essential MCH service utilisation between the wealth quantiles and between education status.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)

et al. 2022

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“…A similar study in Lagos, Nigeria [ 31 ], and Addis Ababa Slums in Ethiopia [ 6 ] showed a financial barrier to women living in urban poor populations using health facilities for delivery care. Policymakers and government authorities should take note of our findings to provide skilled delivery care in neglected metropolitan areas.…”

Section: Discussionmentioning

confidence: 99%

Women’s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

2021

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Background Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited. Objective The study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility—delivery service among slums women, Addis Ababa, Ethiopia Methods Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge. Results The FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

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“…However, government health facilities manage 42% of deliveries in the state, while private health facilities take up about 28%. 19 Two studies that estimated institutional SBR in Nigerian public hospitals reported 39.6 and 61.8 per 1000 births, respectively. 20 21…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria

et al. 2021

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IntroductionAccess to emergency obstetric care can lead to a 45%–75% reduction in stillbirths. However, before a pregnant woman can access this care, she needs to travel to a health facility. Our objective in this study was to assess the influence of distance and travel time to the actual hospital of care on stillbirth.MethodsWe conducted a retrospective cross-sectional study of pregnant women who presented with obstetric emergencies over a year across all 24 public hospitals in Lagos, Nigeria. Reviewing clinical records, we extracted sociodemographic, travel and obstetric data. Extracted travel data were exported to Google Maps, where typical distance and travel time for period-of-day they travelled were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on stillbirth.ResultsOf 3278 births, there were 408 stillbirths (12.5%). Women with livebirths travelled a median distance of 7.3 km (IQR 3.3–18.0) and over a median time of 24 min (IQR 12–51). Those with stillbirths travelled a median distance of 8.5 km (IQR 4.4–19.7) and over a median time of 30 min (IQR 16–60). Following adjustments, though no significant association with distance was found, odds of stillbirth were significantly higher for travel of 10–29 min (OR 2.25, 95% CI 1.40 to 3.63), 30–59 min (OR 2.30, 95% CI 1.22 to 4.34) and 60–119 min (OR 2.35, 95% CI 1.05 to 5.25). The adjusted OR of stillbirth was significantly lower following booking (OR 0.37, 95% CI 0.28 to 0.49), obstetric complications with mother (obstructed labour (OR 0.11, 95% CI 0.07 to 0.17) and haemorrhage (OR 0.30, 95%CI 0.20 to 0.46)). Odds were significantly higher with multiple gestations (OR 2.40, 95% CI 1.57 to 3.69) and referral (OR 1.55, 95% CI 1.13 to 2.12).ConclusionTravel time to a hospital was strongly associated with stillbirth. In addition to birth preparedness, efforts to get quality care quicker to women or women quicker to quality care will be critical for efforts to reduce stillbirths in a principally urban low-income and middle-income setting.

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Socioeconomic barriers to facility-based delivery in urban poor communities of Lagos: Wealth, linguistic capacity, and residential area

Cited by 4 publications

References 22 publications

Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)

Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)

Women’s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria

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