What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya

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Study Justification:
– The study aims to improve understanding of maternity health seeking behaviors in resource-deprived urban settings.
– It focuses on identifying the factors that influence the choice of place of delivery among the urban poor, specifically looking at sub-standard and “appropriate” health facilities.
– The study provides valuable insights into the challenges faced by urban poor women in accessing quality obstetric health services.
Study Highlights:
– 70% of women reported delivering in a health facility, but only 48% delivered in a facility with a skilled attendant.
– Factors influencing the place of delivery included education, wealth, advice received during antenatal care, pregnancy “wantedness,” and parity.
– Health promotion, particularly advice received during antenatal care visits, had a significant impact on the place of delivery, especially among the poorest women.
Study Recommendations:
– Interventions should focus on improving the provision of and access to quality obstetric health services for urban poor women.
– Encouraging women to attend antenatal care visits, where they can receive advice on delivery care and other pregnancy-related issues, is crucial.
– Targeted interventions should prioritize the poorest, less educated, and higher parity women to ensure equitable access to appropriate maternal health services.
Key Role Players:
– Government health departments and policymakers
– Non-governmental organizations (NGOs) working in maternal health
– Health facility administrators and staff
– Community health workers and volunteers
– Maternal health researchers and experts
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on quality obstetric care
– Infrastructure improvements in health facilities
– Outreach and awareness campaigns targeting urban poor communities
– Development and distribution of educational materials on maternal health
– Support for antenatal care services, including staffing and equipment
– Monitoring and evaluation activities to assess the impact of interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study includes a large sample size of 1,927 women and assesses 25 health facilities. It uses ordered logit models to quantify the effects of covariates on the choice of place of delivery. The results show that only 48% of women delivered in a facility with skilled attendants, and factors such as education, wealth, advice during antenatal care, pregnancy ‘wantedness’, and parity influenced the place of delivery. The study suggests interventions to improve the health of urban poor women, including improvements in the provision of quality obstetric health services and encouraging attendance at antenatal care. To improve the strength of the evidence, future studies could consider using a control group, conducting randomized controlled trials, and including a longer follow-up period to assess the impact of interventions.

Objectives: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. Methods: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women. © Springer Science+Business Media, LLC 2008.

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Innovation 1: Telemedicine for Obstetric Health Services
Develop a telemedicine program that allows pregnant women in resource-deprived urban settings to access quality obstetric health services remotely. This innovation would utilize technology to connect skilled attendants with pregnant women during deliveries, providing guidance and support. It would also ensure that health facilities have the necessary equipment and resources to provide safe and effective maternal care.

Innovation 2: Mobile Antenatal Care Clinics
Implement mobile antenatal care clinics that visit slum settlements and provide comprehensive antenatal care services to pregnant women. These clinics would bring the necessary resources and skilled attendants directly to the urban poor population, making it easier for them to attend antenatal care visits. The clinics would also offer advice on delivery care and address any pregnancy-related issues, helping women make informed decisions about their place of delivery.

Innovation 3: Community-Based Maternal Health Programs
Establish community-based maternal health programs that specifically target the poorest, less educated, and higher parity women. These programs would provide tailored support and resources to overcome barriers to care, such as transportation or financial constraints. They would also focus on raising awareness about the benefits of delivering in a health facility with skilled attendants and addressing any misconceptions or fears that may prevent women from seeking appropriate maternal care.

Innovation 4: Peer-to-Peer Health Promotion
Implement a peer-to-peer health promotion initiative during antenatal care visits, particularly for the poorest women. Trained community health workers or peer educators would provide comprehensive information on the benefits of delivering in a health facility with skilled attendants. They would also address any misconceptions or fears, using relatable experiences and stories to help women feel more comfortable and confident in seeking appropriate maternal care.

By implementing these innovations, access to maternal health services among the urban poor population can be improved, leading to better maternal and child health outcomes.
AI Innovations Description
Based on the research study titled “What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve the provision of quality obstetric health services: Enhance the quality of care provided in health facilities, particularly in resource-deprived urban settings. This can be achieved by ensuring that skilled attendants are available during deliveries and that facilities have the necessary equipment and resources to provide safe and effective maternal care.

2. Increase access to antenatal care: Encourage pregnant women, especially those from the urban poor population, to attend antenatal care visits. During these visits, women can receive advice on delivery care and other pregnancy-related issues, which can help them make informed decisions about their place of delivery.

3. Target the poorest, less educated, and higher parity women: Develop targeted interventions that specifically address the needs of the most vulnerable groups, such as the poorest women, those with lower levels of education, and women with higher parity. These interventions should focus on improving access to maternal health services and providing tailored support to overcome barriers to care.

4. Strengthen health promotion efforts: Enhance health promotion activities during antenatal care visits, particularly for the poorest women. This can involve providing comprehensive information on the benefits of delivering in a health facility with skilled attendants and addressing any misconceptions or fears that may prevent women from seeking appropriate maternal care.

By implementing these recommendations, it is expected that access to maternal health services among the urban poor population can be improved, leading to better maternal and child health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a potential methodology could involve the following steps:

1. Selection of study population: Identify a representative sample of urban poor women in slum settlements of Nairobi, Kenya, similar to the population studied in the research article.

2. Baseline data collection: Conduct a survey to collect information on the women’s demographic characteristics, socioeconomic status, education level, pregnancy “wantedness,” and parity. Also, assess their current utilization of maternal health services, including the place of delivery and whether it was in a facility with a skilled attendant.

3. Intervention implementation: Implement the four main recommendations outlined in the research article. This could involve improving the provision of quality obstetric health services in selected health facilities, increasing access to antenatal care through targeted interventions, providing tailored support to the most vulnerable groups, and strengthening health promotion efforts during antenatal care visits.

4. Follow-up data collection: After a specified period, conduct a second survey to collect data on the women’s utilization of maternal health services following the implementation of the recommendations. Assess whether there have been any changes in the place of delivery, utilization of appropriate health facilities, and other relevant indicators.

5. Data analysis: Use statistical analysis techniques, such as ordered logit models, to quantify the effects of the implemented recommendations on the choice of place of delivery. Compare the results with the baseline data to determine the impact of the interventions.

6. Evaluation and interpretation: Evaluate the findings to assess the effectiveness of the implemented recommendations in improving access to maternal health services among the urban poor population. Interpret the results to understand the factors that influenced the changes observed and identify any additional insights or areas for further improvement.

By following this methodology, researchers can simulate the impact of the main recommendations on improving access to maternal health and gain valuable insights into the effectiveness of these interventions in a real-world setting.

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