Factors influencing the use of maternal healthcare services in Ethiopia

This study examined the factors that influence the use of maternal healthcare services in Ethiopia and particularly assessed the use of antenatal and delivery-care services. Data for the study were drawn from the 2000 Ethiopia Demographic and Health Survey. Multivariate logistic regression analysis was employed to explore the relative importance of a number of demographic and sociocultural variables in the likelihood of using these services. Results of the study showed that the coverage of maternity-care services was very low in Ethiopia, i.e. about 27% and 6% of women, respectively, received professionally-assisted antenatal and delivery-care services in the five years preceding the survey. The study also revealed that demographic and sociocultural factors were the most important aspects that influenced the use of maternal healthcare services in Ethiopia. The independent factors influencing the use of maternal healthcare services included education of mothers, marital status, place of residence, parity, and religion. However, this cannot detract from the relevance of service-related factors, especially in the rural areas of the country.     

Factors influencing partners' involvement in women's contraceptive services

BackgroundInvolving women's partners in family planning services may be one avenue by which rates of unplanned pregnancies can be reduced.Study DesignIn 2009, we surveyed a nationally representative sample of 2113 women aged 18–49 years receiving services from Title X family planning clinics in the United States about their contraceptive use and their current partner, including partners' past involvement in seeking and obtaining contraceptive services.ResultsMore than half of the women in the sample (56%) indicated that their partners were at least partially involved in their contraceptive services. In the multivariable analysis, race/ethnicity, union status and relationship satisfaction were all significant predictors of partner involvement in contraceptive services. Women reporting that their partners interfere with their birth control were nearly twice as likely as women without interfering partners to report those partners being involved in their contraceptive services. Contraceptive use at last sex was not associated with partner involvement in contraceptive services in either bivariable or multivariable analyses.ConclusionIn designing future couple-focused programs, clinics may need to focus on the interpersonal dynamics of couple-based decision-making and behaviors and tailor their programs given the characteristics of clients most likely to avail themselves of these services.     

流动妇女保健服务的可及性及其影响因素研究

目的:了解育龄流动妇女保健服务的可及性,分析主要影响因素。方法:2003年7~9月在武汉和深圳采取整群抽样方法,抽取若干社区的育龄流动妇女进行定性研究。结果:①就医:普遍小病不看,病重才就医。②医疗费支付:大多数人完全自费。③妇科病普查:少数人接受过流入地居委会组织的普查,其中部分人仅接受了查环。④产前检查:早孕建册者很少,大部分人初检在中孕,仅少数人完成了8次产检。⑤住院分娩:绝大多数人住院分娩。在流入地顺产约需1500~2000元,剖宫产3500~4000元,大部分人认为收费太高。⑥健康教育:存在需求,但提供不足。结论:目前我国育龄流动妇女保健服务的可及性较差、利用不够,在提供服务的条件及措施等方面需进一步加强和改善。     

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.     

孕前保健服务利用及影响因素调查分析

目的:了解我国孕前保健服务需求和利用现状,探讨影响孕前保健服务利用的关键因素。方法:随机选择2009年7～12月在山东、河南、甘肃分娩的产后妇女并应用自行设计的调查问卷进行调查,利用统计学方法对孕前保健服务利用的影响因素进行分析。结果:多因素logistic回归分析结果显示,年龄、民族、居住地、文化程度以及对孕前优生健康检查的重视程度等是影响孕前保健服务利用的重要因素。结论:应该加大对育龄人群的宣传力度,完善基层医疗条件和合作医疗制度,提高群众对服务的可及性,有针对性地开展孕前保健服务工作。     

Inequality and changes in women's use of maternal health-care services in Tajikistan

Using recently available survey data for Tajikistan, this study explores changes in the pattern of maternal health care during the last decade and the extent to which inequalities in access to that care have emerged. In particular, the links between poverty and women's educational status and the use of maternal health-care services are investigated. The survey findings demonstrate a significant decline in the use of maternal health-care services in Tajikistan since the country gained independence from the Soviet Union in 1991. They show changes in the location of delivery and the person providing assistance, with a clear shift away from giving birth in a medical facility toward giving birth at home. More than two-fifths of all women who gave birth in the year prior to the survey delivered their baby at home. Women from the poorest quintile are three times more likely than women from the richest quintile to undergo a home delivery without a trained assistant.     

Factors explaining the use of health care services by the elderly.

The Anderson model of health services utilization, which relates use of service to predisposing, enabling, and need factors, has not often been applied to an elderly population. In this study, the factors of the Andersen model were used prospectively to predict utilization for a population sample of 1,317 elderly persons. Taken alone, the NEED construct was the most important single predictor of use of physician services, hospitalizations, ambulatory care, and home care. PREDISPOSING factors were better predictors of the use of dental services. Some of the variables studied were not related to utilization in the direction that would have been predicted from previous studies on general populations. Multivariate analyses demonstrated that the three constructs should be applied simultaneously when predicting use of services. These findings can be applied to the specific task of planning services for older people.     

Low-income women's use of substance abuse and mental health services

This paper examines the utilization of mental health, alcohol, and drug treatment in a sample of low-income women. We analyze data from the Women's Employments Study, a study examining the barriers to employment for welfare recipients, and compare prevalence rates of mental health disorders and service utilization with the National Comorbidity Survey. Fewer than one in five of the respondents with a current mental health and/or substance dependence problem in the Women's Employment Study (WES) received treatment in the past 12 months. A logistic regression model of the association among demographic variables, risk factors, and service utilization in the WES found that having a co-occurring substance dependence and mental health disorder was significantly associated with receiving treatment. Those respondents with an increased number of barriers were significantly less likely to receive treatment. The authors argue that the success of welfare reform may hinge on low-income women's access to and utilization of appropriate services.     

Trends in US women's use of sexual and reproductive health care services, 1995-2002

I examined the 1995 and 2002 National Survey of Family Growth for patterns and trends in the use of sexual and reproductive health care services by US women according to type of provider. The percentage of women reporting receipt of contraceptive services rose between 1995 and 2002 (from 36% to 41%), and the level and mix of services received varied considerably according to type of provider. Women visiting publicly funded providers received a broader mix of services than did clients of private providers.     

Utilization of maternal health care services in Southern India

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.     

高绩效政府管理的保障机制与途径选择

  目的  评价京沪两地妇女健康需要对妇女保健目标动态调整的影响程度,并检验量化指标的可行性。  方法  系统收集两地公开发布的政策文件中关于目标的表述和发布问题敏感指标信息的权威报告,量化计算目标的动态调整程度;运用Spearman相关、线性回归等方法,分析根据妇女保健需要目标的动态调整程度与孕产妇死亡率之间的关系。  结果  北京2017年妇女育龄期、孕产期目标的动态调整程度分别为10.0 %和25.0 %,上海2017年妇女育龄期、孕产期目标的动态调整程度分别为20.0 %和25.0 %;两地2000 — 2017年妇保领域目标动态调整程度呈现波动趋势,2000年均为0.0 %,2017年分别提高到17.9 %和21.3 %。两地妇保领域目标动态调整程度与孕产妇死亡率均无相关关系（P > 0.05）。  结论  京沪两地依据妇女健康需要动态调整目标的程度较低,两地健康需要对妇女保健目标动态调整的影响未充分体现;经验证,本研究采用的量化指标用以评价妇保体系状况是可行的,该方法可推广应用于其他地区和其他公共卫生领域。     

Health systems factors influencing maternal health services: a four-country comparison

It is widely understood that maternal health care relies on the entire health system. However, little empirical, country-specific, research has been done to trace out the ways in which health system elements can shape maternal health outcomes. This study seeks to redress this situation, by providing an example of how a health systems approach can benefit the understanding of maternal health services. A comparative analysis was conducted based on extensive case studies of maternal health and health systems in Bangladesh, Russia, South Africa, and Uganda. A number of cross-cutting health system characteristics affecting maternal health were identified by comparing these diverse settings. The most important common systems issues underlying maternal health care were found to be the human resource structures, the public-private mix of service provision, and the changes involved with health sector reforms. Specific country contexts can further determine many factors influencing maternal health outcomes and service performance. Systems issues were found to influence the access to and utilization of services, quality of care provided, and ultimately maternal health outcomes. This paper provides a first step in tracing out how such broad systems issues actually work to influence maternal health.     

Influence of women's knowledge on maternal health care utilization in southern Laos

This study aims to clarify women's knowledge on obstetric care and to analyse the situation of maternal health care (MHC) utilization in southern Laos. Face to face structured questionnaire and focus group discussions were carried out for 205 mothers aged 29.6 +/- 6.7 who had children under the age of five. Three measurements of MHC utilization comprised: 1) antenatal care (ANC), 2) tetanus toxoid (TT) inoculation, and 3) attendance delivery by health professional. Women's knowledge on obstetric care was scored. Women's knowledge was positively correlated with ANC and TT inoculation. It was found that the women with strong superstitious belief were less likely to utilize all three types of MHC than the others. Accessibility to health care facilities strongly affected ANC and attendance delivery. Enhancing women's knowledge on obstetric care and reducing barriers related with sociocultural beliefs are essential to improving maternal health in southern Laos.     

Factors associated with non-use of maternal health services in Botswana

The study investigated individual and household factors associated with non-use of maternal health services in Botswana. Nationally-representative data, drawn from the 1996 Botswana Family Health Survey, were used. A weighted sample of 19,031 women, aged 15-49 years, who had at least one pregnancy history in the five years prior to the survey was considered for analysis. Both simple cross-tabulations and logistic regression were used for analyzing the data. Consistently, the teenagers were less likely to seek prenatal care, to have their babies delivered by a qualified person, and to seek postnatal check-up. Using results from logistic regression analysis, it can be observed that low-parity women were less likely to use maternal services. Another consistent finding is that women with low educational level, those residing in rural areas, and those with low socioeconomic status were less likely to use maternal services. More focussed investigation is needed, but understanding the differentials of the use of maternal services allows policy-makers to identify problem areas that need attention.     

Improvement of women's breast health services

Improvement efforts for women's breast health services were initiated to provide a co-ordinated comprehensive breast health system and increase patient satisfaction for women using the service. The Breast Health Center, initially established to better meet the needs of the community with screening services provided an environment that reduced the anxiety associated with screening mammography services. However, women that required diagnostic follow-up expressed dissatisfaction and increased anxiety as they waited for test results. The diagnostic follow-up process in need of improvement required additional scheduling for services and often lead to delays, added anxiety, and decreased patient satisfaction for women maneuvering through a complex system.     

Obesity and the use of health care services

OBJECTIVE: This study investigated differences in the use of health care services and associated costs between obese and nonobese patients. RESEARCH METHODS AND PROCEDURES: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of medical services and related charges was monitored for 1 year. Data collected included sociodemographics, self-reported health status using the Medical Outcomes Study Short Form-36, evaluation for depression using the Beck Depression Index, and measured height and weight to calculate BMI. RESULTS: Obese patients included a significantly higher percentage of women and had higher mean age, lower mean education, lower mean health status, and higher mean Beck Depression Index scores. Obese patients had a significantly higher mean number of visits to both primary care (p = 0.0005) and specialty care clinics (p = 0.0006), and a higher mean number of diagnostic services (p < 0.0001). Obese patients also had significantly higher primary care (p = 0.0058), specialty clinic (p = 0.0062), emergency department (p = 0.0484), hospitalization (p = 0.0485), diagnostic services (p = 0.0021), and total charges (p = 0.0033). Controlling for health status, depression, age, education, income, and sex, obesity was significantly related to the use of primary care (p = 0.0364) and diagnostic services (p = 0.0075). There was no statistically significant relationship between obesity and medical expenditures in any of the five categories or for total charges. DISCUSSION: Obesity is a chronic condition requiring long-term management, with an emphasis on prevention. If this critical health issue is not appropriately addressed, the prevalence of obesity and obesity-related diseases will continue to grow, resulting in escalating use of health care services.     

Factors influencing the use of community health and social services by those aged 65 and over

Interview data collected in a 1990/91 health and life-style survey is used to investigate in those aged 65 years and over the relationship to the use of community health and social services of age, health status and social and economic factors. One thousand eight hundred and forty-one respondents were included in the study. Contacts with general practitioners (GPs), district nurses and home helps and use of “meals on wheels”, day centres for elderly people and lunch clubs were related to age, chronic illnesses, gender, mental well-being, living alone, income and social class. Age and chronic illness were strongly related to the use of all services. A distinctive pattern of service use was found for particular chronic illnesses. Musculoskeletal conditions were most strongly related. Significant relationships between mental well-being, living alone, gender, income and social class remained after the effects of age and chronic illness were removed. Consideration is given to the implications for those who plan community health and social services.     

Costs of maternal health care services in three anglophone African countries

This paper is a synthesis of a case study of provider and consumer costs, along with selected quality indicators, for six maternal health services provided at one public hospital, one mission hospital, one public health centre and one mission centre, in Uganda, Malawi and Ghana. The study examines the costs of providing the services in a selected number of facilities in order to examine the reasons behind cost differences, assess the efficiency of service delivery, and determine whether management improvements might achieve cost savings without hurting quality. This assessment is important to African countries with ambitious goals for improving maternal health but scarce public health resources and limited government budgets. The study also evaluates the costs that consumers pay to use the maternal health services, along with the contribution that revenues from fees for services make to recovering health facility costs. The authors find that costs differ between hospitals and health centres as well as among mission and public facilities in the study sample. The variation is explained by differences in the role of the facility, use and availability of materials and equipment, number and level of personnel delivering services, and utilization levels of services. The report concludes with several policy implications for improvements in efficiency, financing options and consumer costs.     

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.