Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review

In Nigeria, the lifetime risk of death from pregnancy or childbirth complications is 1 in 30. Maternal healthcare utilisation addresses the risk of maternal mortality and morbidity but its utilisation is influenced by varying factors of which autonomy has been neglected especially for young married women. Therefore, this study examined the relationship between young married women's level of autonomy and maternal health care utilisation in Nigeria. Secondary data from the 2013 Nigeria Demographic and Health Survey was analysed (n=4996) with consideration of young ever married women (age 15 to 24), who had at least one live birth in the last five years preceding the survey. The binary logistic regression models were fitted into the data. Findings revealed that only 30% of women aged 15 to 24 delivered at a health facility while 44% of the total pregnant women had four or more antenatal care visits before delivery. Also, young women with low autonomy were less likely to meet the minimum requirement of four antenatal visits (OR=0.35: CI: 0.29-0.43) and less likely to deliver at a health facility (OR=0.32: CI: 0.27-0.39). The study underscores the need to empower young women to achieve higher levels of autonomy due to its obvious implication on their health and to encourage integrated interventions that considers engaging household and community structures on the benefits of women autonomy and its importance for mother and child's health. Policy and program considerations that would enable the removal of socio-cultural/demographic barriers towards women autonomy in Nigeria should be encouraged.

This study aimed at determining the factors associated with maternal and child health services uptake and their association with maternal and child health outcomes. Design and setting:The study was conducted in two districts in Mashonaland East namely Murewa and Seke in Zimbabwe. An analytical cross sectional study design was conducted between November 2016 and March 2017. Women with children 0-48 months who were being recruited for an interventional study were targeted with an aim of determining the baseline characteristics and comparability of participants in the intervention and control arm. A sample of 672 mothers was interviewed. Data was analyzed in SPSS version 20 and STATA 13. Main outcome(s):The study focused on maternal and child health outcomes. Results:The mean age for the women was 28.0 years (SD=6.8) and the mean birth weight for children was 3061 g (SD=537). Women had a mean weight of 62.5 kg (SD=11.5) and the mean number of children per woman were 2.6 (SD=1.5). In this study 154 (22.9%) of the participants booked for Antenatal Care (ANC) in the first trimester and 321 (47.7%) and 171 (25.4%) booking in the second and third trimester respectively. There was a statistically significant association between a child's gestational age and birth weight (OR=2.14; 95% CI: 1.22-3.75). Maternal complications were significantly associated with the number of children delivered prior to the last pregnancy (OR=4.4; 95% CI: 2.45-8.04). First ANC timing was strongly associated with the place of delivery (OR=2.84, 95% CI: 1.53-5.25) and so was ANC registration decision making (OR=3.52; 95% CI: 1.88-6.58). The weaning time was significantly associated with child morbidity (OR=5.28; 95% CI: 2.57-9.86). Conclusion:This study revealed that though there is a satisfactory health seeking behavior among pregnant and lactating women, there is still a significant gap in knowledge of critical recommended Maternal Neonatal and Child Health (MNCH) practices. Good knowledge and practices are essential in the reduction of preventable maternal and child morbidity and mortality. Universal maternal health access is only achievable if the women and the community take decisions about their own health in a supportive environment; hence the need to have community based interventions for maternal health access. The results of the study have shown that the quality and methods of delivery of antenatal care education need to reviewed to improve effectiveness of antenatal care.

Background: There is dearth of data regarding the treatment-seeking practice of women living with vaginal fistula. The paper describes the health-seeking behaviour of fistula cases in the sub-Saharan Africa (SSA) where the burden of the problem is high. Methods:We analysed the data of 1,317 women who ever experienced vaginal fistula, extracted from 16 national Demographic and Health Surveys carried out in SSA between 2010 and 2017. The association between treatment-seeking and basic socio-demographic characteristics assessed via mixed-effects logistic regression and the outputs are provided using adjusted odds ratio (AOR) with 95% confidence intervals (CI).Results: Two-thirds (67.6%) of the women encountered the fistula soon after delivery implying obstetric fistula. Fewer identified sexual assault (3.8%) and pelvic surgery (2.7%) as the cause. In 25.8% of the cases clear-cut causes couldn't be ascertained and excluding these ambiguous causes, 91.2% of the women had obstetric fistula. Among those who ever had fistula, 60.3% (95% CI: 56.9-63.6%) sought treatment and 28.5% (95% CI: 25.3-31.6%) underwent fistula-repair surgery. The leading reasons for not seeking treatment were:unaware that it can be repaired (21.4%), don't know where to get the treatment (17.4%), economic constraints (11.9%), healed by itself (11.9%) and embarrassment (7.9%). The regression analysis indicated, teenagers as compared to adults 35 years or older [AOR=0.31 (95 % CI: 0.20-47)]; and women devoid of formal education when compared to women with any formal education [AOR=0.69 (95% CI: 0.51-0.93)], had reduced odds of treatmentseeking. In 25.9% of the women who underweight fistula-repair surgery, complete continence after surgery was not achieved.Conclusion: Treatment-seeking for fistula remains low and it should be augmented via mix of strategies for abridging health-system, psycho-social, economic and awareness barriers.