Women's health is an economic investment in any country. But, maternal mortality is a daunting effect in many developing countries. Many women are dying because of direct and indirect causes daily. In addition to the mentioned causes, underlying determinants of maternal health have a profound effect on maternal health. Identifying these determinants and assessing the challenges and roles of government leadership in addressing these factors will help the concerned bodies to take immediate measures to improve maternal health, especially in the sub Saharan Africa in which maternal mortality is the highest. Hence, it is not possible to plan development without healthy women community,improving maternal health is becoming a development agenda. Therefore,all these are on the hands of leadership and needs effective leadership.
Maternal health matters have dominated many forums in the world for over a long period of time. Regardless of various initiatives put in place to address maternal mortality/morbidity, very little progress has been made in this area especially in Kenya and other countries in Sub-Saharan Africa. Authoritative sources indicate that millions of women in developing countries continue to experience life threatening and other serious health problems related to pregnancy and/or childbirth as nearly 99 percent of maternal deaths occur to women in developing countries. Given the intricate relationship between utilization of maternal health care services and reduction of maternal mortality, understanding determinants of utilization of these services is a crucial step towards reduction of maternal morbidity and mortality. This book provides practical evidence based information useful to academicians and researchers interested in maternal health. Further, the book can be used as reference material by managers to design program interventions geared towards promotion of maternal health.
Mpigi District is a rural district in Uganda with high maternal morbidity and mortality. While most pregnant women in Uganda attend antenatal clinics, few ultimately deliver their infants in a health facility. A review of maternal determinants and factors associated with health facility delivery is the focus of this study. This is a quantitative, descriptive, cross-sectional study of 257 women in the Mpigi District. The results show that women delivered in health facilities because they expected a safe delivery. Ten factors were found to be significantly associated with a higher possibility of health facility delivery: eight or more years of education (P=0.002); previous health facility delivery (P
Many of women in developing countries are at high risk in terms of maternal morbidity and mortality due to factors related to pregnancy and childbirth. A cross sectional study was conducted at Gozamin Woreda to assess factors affecting utilization of maternal health care services. Structured questionnaires and FGD were used to collect quantitative and qualitative data respectively. The study revealed that about 59.3% of the women had at least one prenatal visit and 64% of those had less than four antenatal care contacts. Being healthy and being too busy were the most reasons not to attend ANC service. The risk of non-attendance of ANC and home delivery was higher for those women whose residence was rural, higher parity and being housewife at old age. About 71% of deliveries took place at home. Presence of relatives nearby, Transportation, and lack of privacy were the main reasons to home delivery. In conclusion, demographic and socio-cultural factors were found to be barriers to utilization of maternal health care services. Increasing maternal health service coverage and promotion of IEC in the community are recommended.
Bangladesh has one of the highest maternal mortality rates (MMR) in the world, i.e. 3/1000 live births. The situation is worse due to inadequate access to modern health care services & poor utilization. One of the public health challenges is, therefore, to identify vulnerable groups and to provide them with needed health care services. Considering this matter, this study examined the socio-economic, demographic & cultural determinants of utilization of maternal health care services in slum areas of Dhaka city. The primary data was collected from 540 women aged 15-49. A semi-structured questionnaire was used to collect the information from slum dwellers. The overall MHCS was utilized by 86.3% of women; however, utilization of different sorts of MHCS was very low, i.e., the mean utilization was found to be 2.25 out of 5 MHCS. Indicator wise, ANC, receiving TT, institutional delivery, delivery assistance by health professional & PNC were received by respectively 61.3%, 80.4%, 12.6%, 33.2% and 55.4% of women. Thus, this study might be a significant consideration in formulating the policy and future plan for reducing maternal mortality & morbidity in disadvantaged women of slum areas.
Present study examines the level and differential in utilization of maternal health care (MCH) services by various socio-economic and demographic factors with respect to “Janani Suraksha Yojana” scheme. There is a general consciences that the use of MHC services reduces maternal and child mortality and improve the reproductive health of women. The considerable variation in maternal and child health in the developing world is believed to partly in the availability of and access to health services. This study describes the determinants of MHC services utilization and also characteristic of women who received antenatal care, delivery care and post natal care by various socio-economic characteristic. Result indicates that determinants of MHC services are not same across states and for different MHC indicators. Place of residence, women and her spouse’s education, economic status has significantly affecting utilization of full ANC delivery care & post delivery care. Scheme has a strong and positive impact on coverage of antenatal care, natal care and postnatal care in different socio-economic demographic characteristics of women.
This work was developed in response to communities’ behavioural adaptation to the Alma Ata conference declaration as well as the community health strategy which stipulated intentions of involving communities actively in addressing their health and development issues. With reference to the Kenya Health Sector Strategic Plan II, 2006 (KHSSP II), the Kenyan situation can be highlighted by the implementation of the community strategy within the health system. Not all community sectors were equally willing or able to become involved in health care decision making (Starzomski, 2002).The aim of this work therefore was to identify and describe the determinants of community involvement in health partnerships. This community based study was conducted in Kakelo Kamroth a sub-location in Rachuonyo District of Kenya employing a cross sectional design using both qualitative and quantitative data collection methods. The study found that of the 300 households sampled; only 28% of households were involved in health partnerships (HP’s).It is therefore recommended that partners in health consider intensifying community mobilization on the community health strategy right from household level.
There is considerable interest at present in achieving the MDG-5 by implementation of the Free Maternal Health Policy embedded in the social health insurance to increase access to and affordability of health care in Ghana. Ghana's National Free Maternal Health Policy was passed into operation in July, 2007. This book aims to provide assessment of the explicit costs of maternal healthcare services rendered to NHIS clients in Ghana. The book revealed that there is increase utilization of the free maternal health service. The NHIS offers the entire maternal health package to their clients free of charge. There is a cost gap between the tariffs paid by the NHIA which uses the G-DRG compared to the cost of services rendered by the health providers if they use the itemized billing system. The challenges were the NHIA paying less to the service rendered by the health providers and payment of the claims on late. The free maternal health care in the Health insurance has become the alternative option of the health care financing in achieving the MDG-5 in Ghana.
Health institutional delivery (Birth by skilled health professional) plays great role in reducing maternal and child mortality rate. This book explores determinants of institutional delivery among mothers following antenatal care by assessing their perception using Health Belief Model. Practical guideline is given on how to assess determinants of institutional delivery among antenatal care followers - The case of Ethiopian Mothers.
Worldwide women die each year from complication arising from pregnancy, and a high proportion of this occurs in sub-Saharan Africa. Ethiopia is one of the countries with an unacceptably high maternal mortality of 676/100,000 live births (CSA and ICF International, 2012). One explanation for this poor health outcome is the nonuse of modern health care services by a sizable proportion of women. EDHS report shows 57 % women did not take at least one antenatal care, 90 % delivered without the assistance of health professionals and 52 % did not receive at least two tetanus toxiod injections (CSA and ICF International, 2012). The purpose of this study was to show the current levels, trends and determinants of maternal health care service by women’s demographic and socioeconomic characteristics and estimate the relative importance of family planning program intervention on the level of maternity care usage. The study used EDHS data of 2000, 2005 and 2011. Women aged 15- 49 were selected from Harari region by the criterion that they had at least one live birth in the five years preceding the survey. The level of each service was determined based on the recent EDHS survey.
This book investigates the utilization of delivery assistance in Ethiopia using data from the EDHS 2011. Findings reveal that there exist strong urban-rural differentials of receiving delivery assistance. Logistic regression analysis showed that place of residence , mother’s education, wealth index, religion, respondent’s age, husband/partner’s occupation are the significant determinants of receiving delivery assistance. Women’s education, place of residence, husbands’ education and Women’s age were found to be determinants of assistance during delivery. Encouraging women to complete at least secondary education and Government should ensure available maternal health care centre for providing delivery in the rural area are important to increase skilled attendance during delivery.
Over the years, Kenya has recorded poor maternal health indicators including among others a high maternal mortality rate and a declining trend in utilization of maternity services. It is estimated that the maternal mortality rate stands at 488 per 100,000 live-births making her one of the countries with highest maternal mortality rates.A survey was carried out in one of the rural districts with the aim of assessing utilization of these services in the District. This was a cross-sectional, descriptive study whose study population comprised of mothers bringing their children to the child welfare clinics following delivery in four government rural health centres of the District. A total of 200 mothers were systematically sampled on random visiting days and personal interviews carried out using a structured questionnaire. In each of the health centres, additional qualitative data was obtained using Focus Group Discussions.
Tibetans, living in the Tibet Autonomous Region and the Tibetan autonomous prefectures and counties in Qinghai, Gansu, Sichuan, and Yunnan provinces in China, have the highest illiteracy rates in Chinese and English in China, and are not doing well in today''s market. The poor quality of education, especially English education, is one of the core factors explaining this phenomenon. The poor quality of English education is caused by the poorly prepared teachers practicing inappropriate leadership styles and by teachers'' inability to properly address educational challenges in teaching. This study focuses on issues related to English teachers'' leadership styles and challenges at schools in Tibetan areas of China. It identifies English teachers'' common challenges and leadership styles in teachings; determines relationships among English teachers'' demographic variables, their leadership styles, levels of practice, and their challenges in teaching; synthesizes these findings; and provides recommendations for improving the quality of English education in Tibetan areas of China.
The cross sectional study was conducted to analyze the barriers and enabling factors affecting the use and non use of maternal health services especially among marginalized populations in urban slum areas in the Kathmandu valley. Total 200 mothers were interviewed in the study with the cluster sampling. The study found that many factors contribute to the maternal health utilization, among them education of mother, education of husband, distance to health services, parity of mother and ethnic category were determined by study. Similarly, the parity, occupation and ethnicity of mother influence the ANC utilization. The findings suggest that maternal health program need to develop explicit target social targeting strategy to intensify services to Dalit at squatter settlements and awareness raising program on “Aama Suraksha Program” could be beneficial to the improvement of maternal health services.
Financing health-care has gone through a chequered history in Ghana. Like other developing nations in modern times, the Government of Ghana has no choice but to establish a sustainable health-care financing policy for all Ghanaians. The aim of this book is to examine whether the introduction of a National Health Insurance Scheme (NHIS) will provide and deliver and improved health-care service in Ghana. The introduction of the NHIS is to help reduce the financial barriers which have denied ordinary people access to healthcare for decades. While the health system appears to be making progress in meeting the basic needs of the people of Ghana, the continuing exodus of trained health workers, lack of leadership, corruption and weak institutional capacity remains a major obstacle. There are also many persuasive reasons why the NHIS should be a success. Some of the laudable points are the philosophy of the NHIS, the popularity of the policy, the institutional components which are in place and the overall State commitment to the scheme.