Use of healthcare services at time of delivery: a prospective community based study in Madagascar - Pourette, Dolorès; Andrianantoandro, T V; Rakotoarimanana, F M J; Razakamanana, M; Rakotomalala, O; Ramiaramanana, J (European Journal of Public Health, 2020)
Abstract Background Maternal mortality remains high in Madagascar (478 deaths per 100,000 live births) and more than 60% of birth are not assisted by professional health workers. This study aimed to determine factors that influence choices of delivery place in two municipalities of Vakinakaratra region. Methods This was a prospective study. 245 pregnant women in the 2nd and 3rd trimester of pregnancy were included and surveyed during Oct-Nov 2016. The same women were re-surveyed 3 months or more after their respective deliveries (June-July 2017). Binary logistic regression was used and the analysis were supported by qualitative interviews conducted with 35 women from the sample, 7 community health workers, 5 professionals health workers and 15 traditional healers and traditional births attendants or 'reninjaza'. Results Overall, 91.8 % of women intended to give birth at health facilities. The reasons given are the quality of services and the medical support in case of complications, the registration of birth and the referrals and encouragement from reninjaza. However, out of 229 mothers interviewed after delivery, only 60.7% gave birth in a health facility. Educated mothers were ORa=6.6 (p < 0.001) times more likely to deliver at health facility and mothers with at least 4 births are ORa=0.17 (p < 0.01) times less likely to do it. The qualitative analysis highlights the cost (logistics and care) as well as the fear of caesarean sections as a brake on childbirth in a health facility. The distance from the health center and the lack of preparation to travel there were also identified. Decisions at the time of childbirth come under the close family. Conclusions Use of maternity services remains low. The implementation of free delivery care policies, formalizing the collaboration between reninjaza and health workers and raising awareness among close family should improve the access to healthcare. Key messages Collaborations between health workers and traditional healers should be formalized. The close family of pregnant women (spouse, mother, mother-in-law) should be the target of awareness raising strategies.
WOS:000605268703516 Lien Horizon FDI : http://www.documentation.ird.fr/hor/fdi:010080604
Keywords: journalArticle