A community survey on maternal and child health services utilization in rural Ethiopia

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits.Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's dirrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.     

Migration, health status and utilization of health services

Abstract Evidence concerning the relations of migration to health status and health care utilization is inconclusive. This paper outlines the theoretical positions on these relations and reviews the empirical findings supporting varying positions. The paper also presents the findings of a survey of a probability sample of the U.S. population concerning these issues. The analysis is organized around comparisons among immigrants from other societies, internal migrants, and non-migrants on important dimensions of health status and the utilization of different types of health services. Comparisons were also made among first generation, second generation, and'old stock.'Finally, immigrants were grouped by country and area of origin to assess the influence of cultural differences on health and the utilization of services. Attempts were made to control the influence of demographic characteristics while assessing the relations between migration and health status. The controlled analysis showed immigrants to enjoy better health conditions followed by migrants and then the non-migrants. Significant differences in physical performance were manifested among immigrants from varying areas of origin, and also among generations of nativity. Controlling for both demographic characteristics and health status, immigrants were consistently the least utilizers of services and internal migrants the highest. An increase in utilization was associated with generational residence in the U.S. First generation were least utilizers, followed by second generation with the'old stock'being the greatest utilizers. Immigrants from different countries and regions of the world also exhibited significant differences in the patterns of utilization of health services.     

Inequalities in maternal health care utilization in rural Bangladesh

The article examines the inequalities in utilization of maternal health care in rural areas of Bangladesh. It also attempts to identify the expenditure pattern for these services. Findings suggest that large disparities in the maternal health care utilization exist between the poorest and the richest population in Bangladesh. Two in three women in the highest wealth group receive antenatal care from qualified doctors as opposed to one in five women in the lowest wealth group. Almost all the deliveries occur at home among the lowest wealth group, whereas 16% of deliveries occur at health facilities among the highest wealth group. Wealth is also associated with the seeking of care for delivery-related complications. The practice of seeking services during post-natal period is not common and it varies positively with economic condition. Family savings is found to be the dominant source of paying the maternal health care services among the women in the highest wealth group. Cost has been found to be the most commonly cited reason for not seeking care for delivery complications. Eighty-four percent of women in the lowest wealth group compared to 13% of women in the highest wealth group did not seek treatment for delivery complications due to cost. Lack of perceived need of antenatal care (ANC) and postnatal care is the most pressing reason for not seeking these services. The study findings contain a number of implications for policy purposes that could be useful in devising ways to increase the utilization of maternal health care services.     

农村高血压患者卫生服务利用研究

分析山东省农村地区高血压患者2007年（干预前）和2010年（干预后）卫生服务利用变化情况及其原因。结果显示：干预后农村高血压患者四周就诊率、住院率均高于干预前;但仍有农村高血压患者卫生服务需求不能得到满足,健康意识和经济原因是农村高血压患者卫生服务需求得不到满足的主要原因。     

Determinants of the utilization of maternal and child health services in Jordan

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.     

A model for analyzing utilization of maternal and child health services

Identifying the factors that deter the use of maternal and child health services is a matter of concern in light of the high rate of infant mortality in this country. The model presented here offers a framework for analyzing available knowledge about consumers' use of such services and strategies that may be effective in encouraging that use.     

Health care financing and utilization of maternal health services in developing countries

BACKGROUND: The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. METHODS: We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. FINDINGS: In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P < 0.01) and Caesarean section (P < 0.01). DISCUSSION: Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.     

An overview of maternal and infant health services in rural America.

Economically disadvantaged rural families, like their urban counterparts, face significant difficulties obtaining adequate maternity and infant health care resulting, in part, from an unequal distribution of resources as well as economic and racial barriers to health care nationwide. Rural women and infants must contend with additional access problems that reflect the inherent constraints of rural existence as well as specific state policies that exacerbate the barriers associated with isolation. This article provides an overview of the availability and accessibility of maternal and infant health services in nonmetropolitan America and identifies policy reforms to improve access to care.     

Barriers to the utilization of maternal health care in rural Mali

This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.     

Determinants of the use of maternal health services in rural Bangladesh

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.     

新疆农村居民卫生服务需求与利用状况调查

目的：了解新疆农村居民卫生服务需求利用现状,为制定农村卫生服务策略与计划提供依据。方法：采用随机整群抽样,抽取新疆新源县阿热勒托别镇、呼图壁县方草湖镇、霍城县芦草沟乡、哈密市天山乡4个乡镇的各100名农村居民,由调查员入户对农村居民卫生服务需求与利用现状等进行问卷调查。结果：调查地区农村居民新农合参合率99．5％,两周患病率15．62％,半年内高血压、糖尿病患病率分别为6．31％和1．33％。两周未就诊但自己买药者34．04％。32．6％的高血压患者和36．8％的糖尿病患者在村卫生室有健康档案。结论：新疆农村居民的卫生服务需要量大,但利用率较低,利用主要在村级医疗机构。应继续贯彻、完善新农合制度,加强农村基层医疗卫生机构能力建设与管理,开展健康教育,进一步提高农村基层医疗服务利用率。     

昆山市孕产妇保健服务利用现状分析

目的了解昆山市孕产妇保健服务利用现状,探讨影响孕产妇保健服务利用的因素,为改善服务利用提供信息支持。方法应用自拟问卷对2009年以后分娩的昆山市536名孕产妇进行调查,了解孕产妇保健服务利用情况及分析影响因素。结果孕产妇产前检查≥1次占99.1%,产前检查≥5次占96.6%,首检孕周12周占80.2%,建卡率占96.0%,产后访视≥1次占71.0%,产后访视≥3次占6.1%,剖宫产率占40.5%。孕产妇保健服务利用水平在收入和距最近医院距离上差异无统计学意义(P0.05)。户籍对产前检查率、建卡率、首检孕周12周无影响,差异无统计学意义(P0.05)。结论昆山市孕产妇保健服务利用水平总体较高,外来人口孕产妇保健服务利用仅产后访视较低,市内公立医院的住院分娩服务面临较大的供给压力。     

Expansion of rural health care and the use of maternal services in Nepal

In order to improve living standards among the rural poor, the government of Nepal has invested heavily in improving the provision of health care services in rural areas. The purpose of this paper is to assess the impact of this investment on the use of maternal health care services. A bivariate probit model is used to estimate the effect of physical access to government health care services, along with individual-, household-, and other location-specific characteristics, on the use of prenatal care and birth delivery care. The results of the estimation are used to carry out policy simulations that assess the magnitude of the impact of improvements in health care availability on service utilization. The results indicate that physical access to a health care facility, as it is currently structured in rural areas, has a statistically significant but modest impact on the use of maternal services.     

农村孕产期保健服务需求的定性分析

目的:从需方角度分析中部地区农村孕产期保健的服务需求及其影响因素。方法:采用定性研究的半结构式访谈方法,对当地分管卫生工作的县长,卫生局长、人口与计划生育委员会主任、妇联主任、新型农村合作医疗办公室主任进行个人深入访谈,对乡镇卫生院院长、医护人员、乡村医生、计划生育工作者和3年内有分娩史的育龄妇女进行焦点小组访谈。访谈内容包括农村孕产期保健服务的现况,育龄妇女的孕产期保健服务需求及其影响因素。结果:当地产前检查工作中早孕检查率较低,高危妊娠管理欠佳;产妇基本住院分娩,但产后访视流于形式。孕产妇希望孕产期保健服务质量能够提高。医疗技术低和保健意识薄弱对当地农村孕产妇的保健需求产生主要影响,经济、交通等影响因素次之。结论:农村育龄妇女对孕产期保健服务有强烈的需求,提高孕产期保健服务能力和完善医疗保障体制是满足农村妇女孕产期保健服务需求的关键。     

Access and utilization of health services by British Columbia's rural Aboriginal population

PURPOSE: To provide a picture of the access and use of health services by Aboriginal British Columbians living in both reserve and off-reserve communities. DESIGN/METHODOLOGY/APPROACH: This project represents a collaborative effort between the University of British Columbia and multiple Aboriginal community partners. Between June and November 2003, 267 face-to-face interviews were conducted with Aboriginal persons in seven rural community organizations across the province. FINDINGS: This paper reports on the results of a survey of 267 Aboriginal clients. It was found that a substantial number of survey respondents accessed health services provided by an Aboriginal person. Although most respondents felt that services were available, they also identified a number of concerns. These revolved around the need to travel for services, as well as a lack of access to more specialized services. A number of self-reported barriers to service were also identified. These findings have several policy implications and will be useful to service planners. RESEARCH LIMITATIONS/IMPLICATIONS: Several questions for additional research were identified including the need to establish an inventory of service problem areas and investigating service and benefit policy and community awareness issues. ORIGINALITY/VALUE: This paper provides policy makers with knowledge on the rural Aboriginal population, a population that has faced long standing problems in accessing appropriate health services.     

河北省城乡居民卫生服务需求和利用抽样调查

\t\t\t\t\t  目的  \t\t\t\t\t了解河北省城乡居民的卫生服务需要、需求和利用情况, 为合理配置卫生资源、有效开展卫生服务提供依据.\t\t\t\t\t  方法  \t\t\t\t\t采取多级分层整群随机抽样, 确定5 998户的20 529名常住居民作为调查对象, 用统一的调查表进行询问调查.\t\t\t\t\t  结果  \t\t\t\t\t调查人群的两周患病率为18.75%;两周就诊率为14.32%, 两周未就诊率为57.60%;慢性病患病率为169.0;15岁及以上人口身心状态不佳的比例为28.40%:居民住院率为2.56%.\t\t\t\t\t  结论  \t\t\t\t\t城乡居民的卫生服务需求量和利用率明显低于卫生服务需要, 应采取有效措施, 提高卫生服务利用率.     

中国妇女孕产期保健服务利用地区差异分析

目的:了解我国妇女孕产期保健服务利用状况的地区差异。方法:以2008年中国卫生服务调查研究资料为基础,用差异指数和地理分布图比较分析地区差异。结果:产前检查、孕早期检查、住院分娩和产后访视4项指标中,城市妇女的住院分娩率最高(95.10%),产后访视率最低(61.00%);农村妇女的住院分娩率最高(87.10%),产前检查率最低(41.10%)。按照地理区域划分,产前检查率较高的是东北(59.50%)和华东(55.20%),最低的是西南(41.10%);孕早期检查率最高的是东北(80.30%),较低的是中南(62.30%)和西南(51.10%);住院分娩率较高的是东北(98.70%)和华东(95.70%),较低的是西北(85.00%)和西南(66.10%)。城乡居民的产前检查率分布不均衡性较大(0.12),其它3项指标显示城乡间差异均较小。产前检查率、孕早期检查率和住院分娩率在西南地区差异最大,差异指数分别为0.27、0.19和0.16;最小的都是东北地区,分别为0.15、0.05和0.01。结论:我国妇女孕产期保健服务利用存在较为明显的地域及城乡不均衡性。     

Patterns of health service utilization and perceptions of needs and services in rural Orissa

Despite emphasis on strengthening local health care provision, concern remains regarding the rates of utilization of state-provided services within Orissa. The reported study examined patterns of service utilization across the rural population of four districts of Orissa, with special reference to perceptions of the availability and quality of state services at the primary care level. Within the selected districts, 219 interviews were conducted across 66 villages. Households reported utilizing a wide range of health care providers, although hospitals constituted the most frequently--and primary health care centres (PHCs) the least frequently--accessed services. Private practitioners (qualified and unqualified) represented a major sector of provision. This included high rates of access by scheduled tribes and castes (running at approximately twice the rate of access to both local and PHC provision). Key factors guiding patterns of utilization were reputation of the provider, cost and physical accessibility. Local health provision through assistant nurse midwives and male health workers was generally perceived of poor quality, with the lowest rates of resolution of health problems of all service providers. The location of a sub-centre base for assistant nurse midwives within a village had no demonstrable impact on access to services. Acknowledging constraints on broader generalization, the implications of the findings for informing health policy and programming within Orissa are noted. This includes support for current efforts to strengthen the capacity of PHC and sub-centre level provision within the state, and acknowledgement of the potentially growing role of effectively regulated private provision in meeting the needs of the rural poor.     

Husbands and maternal health matters in rural Guatemala: wives' reports on their spouses' involvement in pregnancy and birth

This paper explores the content, prevalence, and determinants of husbands' involvement in two aspects of their wives' maternal health: (1) providing advice and care during pregnancy and (2) attending birth. Using primarily women's reports of their spouses' involvement taken from qualitative and survey data from a sample of rural Guatemalan households, I find that husband participation is relatively high compared to some expectations and that the dynamics of male involvement differ between the two aspects. The analysis of receiving advice or care from husbands during pregnancy, an analysis done only among women who experienced a complication during pregnancy, suggests that the type of prenatal care sought and the quality of the familial and marital relationships are important factors. On the other hand, husbands' attendance at birth seems driven more by men's availability and access to birth. Together, the data show that "male involvement" is not a singular behavior and point to ways to conceptualize its complexity.     

Migration and the diffusion of modern contraceptive knowledge and use in rural Guatemala

This article uses the concept of social networks as it is employed in the research literature on family planning and migration to explore the impact of out-migration on modern contraceptive knowledge and use in rural Guatemala. Data for this study come from the 1995 Guatemalan Survey of Family Health. Results from multilevel regression models indicate that urban migration experience, having migrant kin in urban or international destinations, and living in a community where urban migration is common are all associated with greater contraceptive knowledge. Social ties to urban or international migrants are also associated with a greater likelihood of modern contraceptive use among married women, but this association works primarily through increased contraceptive knowledge. The findings of significant diffusion effects provide support for recent theories of fertility decline that emphasize the role of social interactions.