Factors determining the place of delivery in women who attended at least one antenatal consultation in a health facility (Senegal)

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Study Justification:
– Home birth is a significant contributor to maternal and neonatal deaths in Senegal.
– Understanding the factors that influence home birth can help inform interventions to reduce maternal and neonatal mortality.
– This study aims to identify the determinants of home birth in women who attended at least one antenatal consultation during their last pregnancy.
Study Highlights:
– The study was cross-sectional and analytical, involving a sample of 380 women who gave birth in the last 12 months in the Gossas health district.
– Data were collected through home interviews using a questionnaire.
– Multiple logistic regression was used to explore the determinants of home birth.
Study Recommendations:
– Training health care providers to improve the quality of prenatal exams and patient care in health facilities.
– Improving access to transportation for pregnant women, especially in rural areas.
– Addressing the distance between women’s residences and health facilities, particularly for those living more than 5 km away.
– Raising awareness about the risks associated with home birth and promoting the benefits of delivering in a health facility.
Key Role Players:
– Health care providers: Need training to improve the quality of prenatal exams and patient care.
– Transportation authorities: Should ensure adequate transportation options for pregnant women, especially in rural areas.
– Health facility administrators: Need to address the distance between women’s residences and health facilities, potentially through the establishment of satellite clinics or mobile health services.
– Community leaders and organizations: Can play a role in raising awareness about the risks of home birth and promoting the benefits of delivering in a health facility.
Cost Items for Planning Recommendations:
– Training programs for health care providers.
– Transportation infrastructure improvements, such as road maintenance or the provision of ambulances.
– Establishment and maintenance of satellite clinics or mobile health services.
– Awareness campaigns and educational materials for communities.
Please note that the cost items provided are general suggestions and may vary depending on the specific context and resources available in Senegal.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is cross-sectional and analytical, which allows for exploring the determinants of home birth. The sample size of 380 women is reasonable. Multiple logistic regression was used to analyze the data. However, the study is limited to a specific health district in Senegal, which may affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider a larger and more diverse sample, including multiple health districts in Senegal. Additionally, conducting a longitudinal study design could provide more robust evidence on the determinants of home birth.

Backgroud: Home birth remains a major cause of maternal and neonatal deaths in Senegal. The objective of this study was to identify the determinants of home birth in women who attended at least one antenatal consultation during their last pregnancy. Method: The study was cross-sectional and analytical. It covered a sample of 380 women selected at random among those who have given birth in the last 12. months in the health district Gossas. Data were collected at home using a questionnaire during an interview after informed consent. Multiple logistic regression was used to explore the determinants of childbirth at home using the Andersen model. Results: The mean age was 26.2 ± 6.1. years. Women were married (97.3%), illiterate (81.8%) and lived in rural areas (78.4%). Available means of transportation at home were car (7.6%), cart (62.9%) or none 29.5%. In addition, 52.2% of the women lived more than 5. km from a health facility. For 59.0% of the women, the prenatal exam was considered satisfactory. The prevalence of home birth was 24%. Factors related to birth at home are polygamous marriage (OR = 2.04 [1.13-3.70]), lack of transportation (OR = 2.11 [1.13-5.01]) and residence more than 5. km from a health facility (OR = 2.68 [1.56-4.16]). Late (3.90 [2.30-6.65]) or low quality (4.27 [2.25-8.10]) prenatal exams were also risk factors. Conclusion: Home birth is linked to access to health facilities but also to the prenatal consultation. Particular emphasis should be placed on training health care providers to improve the quality of the patients in the structures. © 2010 Elsevier Masson SAS.

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Based on the provided information, here are some potential innovations that could improve access to maternal health in Senegal:

1. Mobile health clinics: Implementing mobile health clinics that can travel to rural areas where women have limited access to health facilities. These clinics can provide prenatal care, education, and support to pregnant women, increasing their access to maternal health services.

2. Transportation support: Developing transportation initiatives to address the lack of transportation as a barrier to accessing health facilities. This could involve providing affordable transportation options or organizing community transportation systems to help pregnant women reach health facilities for antenatal care and delivery.

3. Telemedicine and teleconsultations: Introducing telemedicine and teleconsultation services to enable pregnant women in remote areas to receive medical advice and consultations from healthcare professionals without having to travel long distances. This can help address the issue of residence more than 5 km from a health facility.

4. Community health worker programs: Expanding community health worker programs to provide education, support, and basic healthcare services to pregnant women in rural areas. Community health workers can conduct prenatal exams, provide health education, and refer women to appropriate healthcare facilities when necessary.

5. Quality improvement initiatives: Implementing quality improvement initiatives to enhance the quality of prenatal exams and overall care provided in health facilities. This can involve training healthcare providers on best practices, improving infrastructure and equipment, and ensuring the availability of necessary resources for maternal health services.

These innovations aim to address the identified factors related to home birth and improve access to maternal health services in Senegal.
AI Innovations Description
Based on the study titled “Factors determining the place of delivery in women who attended at least one antenatal consultation in a health facility (Senegal)”, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve transportation options: Since lack of transportation was identified as a significant factor contributing to home births, an innovation could focus on improving transportation options for pregnant women in rural areas. This could involve implementing mobile health clinics or providing transportation vouchers to ensure women can easily access health facilities for delivery.

2. Strengthen prenatal care services: The study found that late or low-quality prenatal exams were risk factors for home births. To address this, the innovation could focus on strengthening prenatal care services by training healthcare providers to improve the quality of care provided during antenatal consultations. This could include ensuring timely and comprehensive examinations, providing education on the importance of facility-based delivery, and addressing any barriers or misconceptions about giving birth in a health facility.

3. Increase proximity to health facilities: The study found that women living more than 5 km from a health facility were more likely to have home births. To improve access, the innovation could involve establishing satellite health facilities or mobile clinics in remote areas to bring maternal healthcare services closer to the communities. This would reduce the distance women have to travel and increase the likelihood of facility-based deliveries.

Overall, the innovation should focus on addressing the barriers identified in the study, such as transportation, quality of prenatal care, and proximity to health facilities. By implementing these recommendations, access to maternal health can be improved, leading to a reduction in home births and associated maternal and neonatal deaths in Senegal.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health in Senegal:

1. Improve transportation infrastructure: Enhancing transportation options, such as increasing the availability of cars or providing better access to carts, can help women reach health facilities more easily during pregnancy and childbirth.

2. Increase the number of health facilities: Expanding the number of health facilities, especially in rural areas, can reduce the distance women have to travel to access maternal health services.

3. Enhance prenatal care quality: Improving the quality of prenatal exams can encourage women to seek care at health facilities and reduce the likelihood of home births. This can be achieved through training healthcare providers and ensuring the availability of necessary resources and equipment.

4. Address cultural factors: Addressing cultural factors, such as polygamous marriages, that contribute to home births can involve community engagement and education programs to promote the benefits of delivering in health facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Collect baseline data: Gather information on the current rates of home births, distance to health facilities, transportation options, and quality of prenatal care in the target area.

2. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage reduction in home births, the increase in the number of health facilities, or improvements in the quality of prenatal care.

3. Develop a simulation model: Create a simulation model that incorporates the baseline data and the potential impact of each recommendation. This model should consider factors such as population size, geographical distribution, and existing healthcare infrastructure.

4. Run simulations: Use the simulation model to run different scenarios, applying the potential recommendations individually or in combination. This will help estimate the potential impact of each recommendation on improving access to maternal health.

5. Analyze results: Evaluate the simulation results to determine the effectiveness of each recommendation in achieving the desired outcomes. Identify the most promising interventions and their potential synergistic effects when implemented together.

6. Refine and validate the model: Continuously refine the simulation model based on new data and feedback from stakeholders. Validate the model by comparing the simulated results with real-world data to ensure its accuracy and reliability.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different interventions and make informed decisions to improve access to maternal health in Senegal.

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