Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets

Springer Science and Business Media LLC - Tập 7 - Trang 1-7 - 2007
Rose NM Mpembeni1, Japhet Z Killewo1, Melkzedeck T Leshabari2, Siriel N Massawe3, Albrecht Jahn4, Declare Mushi4, Hassan Mwakipa5
1School of Public Health and Social Sciences, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania
2Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Tanzania
3Department of Obstetrics and Gynaecology, School Of Medicine, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania
4Department of Tropical Hygiene and Public Health, Heidelberg University, Heidelberg, Germany
5Mtwara District Council, Mtwara, Tanzania

Tóm tắt

Almost two decades since the initiation of the Safe motherhood Initiative, Maternal Mortality is still soaring high in most developing countries. In 2000 WHO estimated a life time risk of a maternal death of 1 in 16 in Sub- Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health. Cross sectional study which employed quantitative research methods. We interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. Distance to the health facility (OR = 4.09 (2.72–6.16)), discussion with the male partner on place of delivery (OR = 2.37(1.75–3.22)), advise to deliver in a health facility during ANC (OR = 1.43 (1.25–2.63)) and knowledge of pregnancy risk factors (OR 2.95 (1.65–5.25)) showed significant association with use of skilled care at delivery even after controlling for confounding factors. Use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. We recommend the following in order to increase the pace towards achieving the MDG targets: to improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.

Tài liệu tham khảo

WHO: Maternal mortality in 2000. Estimates developed by WHO, UNICEF, UNFPA. [http://whqlibdoc.who.int/publications/2004/9241562706.pdf] Starrs A: The Safe Motherhood Action Agenda: Priorities for the next decade. 1997, Colombo, SriLanka, de Bernis L, Sherratt DR, AbouZahr C, Van Lerberghe W: Skilled attendants for pregnancy, childbirth and postnatal care. Br Med Bull. 2003, 67: 39-57. 10.1093/bmb/ldg017. Koblinsky MA, Campbell O, Heichelheim J: Organizing delivery care: what works for safe motherhood?. Bull World Health Organ. 1999, 77: 399-406. De Brouwere V, Tonglet R, Van Lerberghe W: Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West?. Trop Med Int Health. 1998, 3: 771-782. 10.1046/j.1365-3156.1998.00310.x. Kwast BE: Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?. Eur J Obstet Gynecol Reprod Biol. 1996, 69: 47-53. 10.1016/0301-2115(95)02535-9. UNFPA: Key actions for further implementation of the program of action of the ICPD-ICPD+5. [http://www.unfpa.org/icpd/icpd5.htm] National Bureau of Statistics (NBS) {Tanzania} & ORC Macro 2005: Tanzania Demographic and Health Survey 2004-05. Dar-Es-Salaam, Tanzania, National Bureau of Statistics & ORC Macro Tanzania Ministry of Health: Policy Implications of Adult Morbidity and Mortality. End of Phase I Report. 1997 Olsen BE, Hinderaker SG, Kazaura M, Lie RT, Bergsjo P, Gasheka P, Kvale G: Estimates of maternal mortality by the sisterhood method in rural nothern Tanzania: a household sample and an antenatal clinic sample. Bjog. 2000, 107: 1290-1297. The United Republic of Tanzania: 2002 Population and Housing Census Volume II, Age and Sex Distribution. 2003, , Central Census Office, National Bureau of Statistics, Presidents Office, Planning and Privatization Mpembeni R, Moshiro C, Mnyika KS, Hussein A, Mamuya S, Kisanga F, Kawemama P: Baseline survey to assess maternal health situation in 30 CSPD districts in Tanzania. 1999, Dar-Es-Salaam, Hussein A, Fischel J, Voet : Facility based ANC/RH services performance assessment in four pilot districts (Arusha urban, Monduli, Iringa rural and Ludewa). 2001, Dar-Es-Salaam, Muhimbili University College of Health Sciences Gharoro EP, Igbafe AA: Antenatal care: some characteristics of the booking visit in a major teaching hospital in the developing world. Med Sci Monit. 2000, 6: 519-522. van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA: Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health. 2006, 3: 2-10.1186/1742-4755-3-2. Yanagisawa S, Oum S, Wakai S: Determinants of skilled birth attendance in rural Cambodia. Trop Med Int Health. 2006, 11: 238-251. 10.1111/j.1365-3156.2005.01547.x. Onah HE, Ikeako LC, Iloabachie GC: Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med. 2006, 63: 1870-1878. 10.1016/j.socscimed.2006.04.019. Stekelenburg J, Kyanamina S, Mukelabai M, Wolffers I, van Roosmalen J: Waiting too long: low use of maternal health services in Kalabo, Zambia. Trop Med Int Health. 2004, 9: 390-398. 10.1111/j.1365-3156.2004.01202.x. Mekonnem Y: Patterns of maternity care service utilization in Southern Ethiopia: Evidence from a community and family survey. Ethiopian Journal of Health Development. 2003, 17: 27-33. Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med. 2000, 50: 203-213. 10.1016/S0277-9536(99)00275-0. Nwakoby BN: Use of obstetric services in rural Nigeria. J R Soc Health. 1994, 114: 132-136. 10.1177/146642409411400304. Osubor KM, Fatusi AO, Chiwuzie JC: Maternal health-seeking behavior and associated factors in a rural Nigerian community. Matern Child Health J. 2006, 10: 159-169. 10.1007/s10995-005-0037-z. Beegle K, Frankenberg E, Thomas D: Bargaining power within couples and use of prenatal and delivery care in Indonesia. Stud Fam Plann. 2001, 32: 130-146. 10.1111/j.1728-4465.2001.00130.x. Kumbani L, Mc Inerney P: The knowledge of obstetric complications among primigravidae in a rural health centre in the district of Blantyre, Malawi. Curationis. 2002, 25: 43-54. Mwaniki PK, Kabiru EW, Mbugua GG: Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya. East Afr Med J. 2002, 79: 184-187. Vanneste AM, Ronsmans C, Chakraborty J, De Francisco A: Prenatal screening in rural Bangladesh: from prediction to care. Health Policy Plan. 2000, 15: 1-10. 10.1093/heapol/15.1.1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/7/29/prepub