Non-uptake of facility-based maternity services in an inner-city community in Lagos, Nigeria: An observational study

Journal of Biosocial Science, Volume 42, No. 3, Year 2010

Interpretation

AI Digest

Study Justification:

– The study aims to understand the pattern and uptake of maternity services in an inner-city community in Lagos, Nigeria.
– The study is important because scaling-up skilled attendants and facility-based services is crucial for improving maternal and child care in developing countries.
– The effectiveness of these services is influenced by the uptake of such services, which needs to be understood and addressed.

Study Highlights:

– Over half (51.4%) of the participants delivered outside hospital facilities.
– 81.8% of those who delivered outside hospitals had no skilled attendants at delivery.
– Factors associated with non-hospital delivery and use of unskilled attendants include teenage mothers, Muslim religion, low or middle social class, use of herbal drugs in pregnancy, ethnicity (Yoruba tribe), lack of tertiary education or full-time employment, accommodation with shared sanitation facilities, and multiparity.

Study Recommendations:

– Efforts to improve maternal and child health in developing countries should consider the socio-demographic and cultural factors influencing maternal health-seeking behavior.
– Provision of facility-based services and strengthening of existing healthcare systems alone may not guarantee uptake of maternity services.
– Strategies should be developed to address the specific needs and preferences of urban mothers in accessing and utilizing maternity services.

Key Role Players:

– Healthcare providers and professionals
– Community leaders and influencers
– Government officials and policymakers
– Non-governmental organizations (NGOs) working in maternal and child health

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers
– Community outreach and awareness campaigns
– Development and implementation of culturally sensitive interventions
– Infrastructure improvement for healthcare facilities
– Monitoring and evaluation of interventions
– Research and data collection to inform evidence-based practices

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a cross-sectional analysis of over 6000 participants, providing a substantial sample size. The study also used multiple logistic regression analyses to determine the factors associated with non-hospital delivery and the use of unskilled attendants. However, the study only focused on one specific community in Lagos, Nigeria, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could consider conducting a multi-site analysis to include a more diverse population. Additionally, incorporating qualitative research methods could provide deeper insights into the socio-demographic and cultural factors influencing maternal health-seeking behavior.

Abstract

Scaling-up of skilled attendants and facility-based services is necessary for improving maternal and child care in developing countries but their effectiveness is crucially influenced by the uptake of such services. This study set out to establish the pattern and uptake of maternity services and associated factors against the backdrop of rapid urbanization in Nigeria. A cross-sectional study of socio-demographic and obstetric characteristics of mothers attending the Bacille Calmette-Guérin (BCG) immunization clinics in inner-city Lagos was conducted from July 2005 to December 2007, and their association with non-hospital delivery and use of unskilled attendants was determined by multiple logistic regression analyses. Of the 6465 participants, over half (51.4%) delivered outside hospital facilities and 81.8% of this group had no skilled attendants at delivery. Non-hospital delivery or the presence of unskilled attendants at delivery was associated with teenage mothers, Muslim religion, low or middle social class and use of herbal drugs in pregnancy. Additionally, non-hospital delivery was associated with ethnicity (Yoruba tribe), lack of tertiary education or full-time employment, accommodation with shared sanitation facilities and multiparity. The results suggest that availability of and access/proximity to hospital facilities or skilled attendants is no guarantee of uptake of maternity services. Efforts aimed at improving maternal and child health in developing countries should take cognisance of the socio-demographic and cultural underpinnings of maternal health-seeking behaviour of urban mothers beyond the provision of facility-based services or strengthening of the existing health care systems. © 2009 Cambridge University Press.

Materials

N/A

Innovations

Innovation 1: Community-based awareness and education programs
Innovation 2: Mobile health clinics
Innovation 3: Strengthening referral systems
Innovation 4: Financial incentives
Innovation 5: Collaborations with traditional birth attendants

Innovation 6: Improving infrastructure and facility accessibility

AI Innovations Description

Based on the study titled “Non-uptake of facility-based maternity services in an inner-city community in Lagos, Nigeria: An observational study,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Community-based awareness and education programs: Develop and implement targeted awareness campaigns to educate the community about the importance of facility-based maternity services and skilled attendants during delivery. These programs should address cultural beliefs, misconceptions, and barriers that prevent women from seeking hospital-based care.

2. Mobile health clinics: Establish mobile health clinics that can reach underserved areas and provide essential maternal health services, including antenatal care, skilled delivery, and postnatal care. These clinics can be equipped with trained healthcare professionals and necessary medical equipment to ensure safe and accessible care.

3. Strengthening referral systems: Improve the referral systems between community health centers and hospitals to ensure seamless transfer of pregnant women requiring specialized care. This can involve training healthcare workers on the importance of timely referrals and establishing clear communication channels between facilities.

4. Financial incentives: Introduce financial incentives, such as conditional cash transfers or subsidies, to encourage women to seek facility-based maternity services. This can help alleviate the financial burden associated with accessing healthcare services and incentivize women to prioritize their maternal health.

5. Collaborations with traditional birth attendants: Engage traditional birth attendants (TBAs) in the healthcare system by providing them with training and resources to ensure safe delivery practices. Collaborating with TBAs can help bridge the gap between traditional practices and modern healthcare, increasing the likelihood of women seeking skilled attendants during delivery.

6. Improving infrastructure and facility accessibility: Invest in improving the infrastructure of healthcare facilities, particularly in underserved areas, to ensure they are adequately equipped and accessible. This can involve upgrading existing facilities, constructing new ones, and improving transportation networks to facilitate easy access to healthcare services.

It is important to note that these recommendations should be tailored to the specific context and needs of the community in Lagos, Nigeria. Continuous monitoring and evaluation of the implemented innovations will also be crucial to assess their effectiveness and make necessary adjustments.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Baseline Data Collection: Collect data on the current utilization of facility-based maternity services in the inner-city community in Lagos, Nigeria. This can include information on the number of women accessing these services, the reasons for non-uptake, and any existing barriers.

2. Intervention Design: Develop a detailed plan for implementing the recommended interventions. This should include specific strategies for community-based awareness and education programs, mobile health clinics, strengthening referral systems, financial incentives, collaborations with traditional birth attendants, and improving infrastructure and facility accessibility.

3. Simulation Model Development: Create a simulation model that incorporates the baseline data and the proposed interventions. This model should simulate the impact of each intervention on improving access to maternal health services. It should consider factors such as population demographics, geographical distribution, and healthcare infrastructure.

4. Data Input: Input the baseline data into the simulation model, including information on the current utilization of facility-based maternity services and the identified barriers.

5. Intervention Implementation: Implement the recommended interventions in the inner-city community in Lagos, Nigeria. This should involve executing the community-based awareness and education programs, establishing mobile health clinics, strengthening referral systems, providing financial incentives, collaborating with traditional birth attendants, and improving infrastructure and facility accessibility.

6. Simulation Run: Run the simulation model using the implemented interventions. The model should project the potential impact of each intervention on improving access to maternal health services. It should provide estimates of the number of women utilizing facility-based maternity services, the reduction in non-hospital deliveries, and the increase in skilled attendants at delivery.

7. Evaluation and Analysis: Evaluate the results of the simulation model to assess the effectiveness of each intervention in improving access to maternal health services. Compare the projected outcomes with the baseline data to determine the impact of the interventions.

8. Refinement and Iteration: Based on the evaluation and analysis, refine the interventions if necessary and rerun the simulation model. Iterate this process until the desired level of improvement in access to maternal health services is achieved.

9. Reporting and Recommendations: Prepare a comprehensive report summarizing the findings of the simulation study. Provide recommendations based on the results to guide future interventions and policies aimed at improving access to maternal health services in the inner-city community in Lagos, Nigeria.

By following this methodology, stakeholders can gain insights into the potential impact of the recommended interventions and make informed decisions on how to allocate resources and implement strategies to improve access to maternal health services.

Author

Dima Health

Statistics:

Citations: 37

Identifiers:

DOI: 10.1017/S0021932009990526

ISSN: 00219320

Research Areas:

Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health

Study Countries:

Nigeria

Study Design:

Cross Sectional Study

Study Approach:

Quantitative