Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study
Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access...
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| Veröffentlicht in: | Health policy and planning 2017-07, Vol.32 (6), p.769-780 |
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| creator | Hernandez, Bernardo Colombara, Danny V. Gagnier, Marielle C. Desai, Sima S. Haakenstad, Annie Johanns, Casey McNellan, Claire R. Nelson, Jennifer Palmisano, Erin B. Ríos-Zertuche, Diego Schaefer, Alexandra Zúñiga-Brenes, Paola Iriarte, Emma Mokdad, Ali H. |
| description | Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1–2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
La atención profesional especializada ha demostrado ser una de las estrategias más prometedoras para reducir la mortalidad materna, y los partos en la instalación son una manera costo-efectiva de garantizar nacimientos seguros. Los países en Mesoamérica han hecho énfasis en la atención del parto en la instalación por parte de asistentes profesionales calificados, pero el acceso a los servicios de parto de buena calidad sigue siendo escaso para muchas mujeres. Examinamos las características de las mujeres que tuvieron un parto en un centro d |
| doi_str_mv | 10.1093/heapol/czx010 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_TOX</sourceid><recordid>TN_cdi_proquest_miscellaneous_1881263801</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>48509202</jstor_id><oup_id>10.1093/heapol/czx010</oup_id><sourcerecordid>48509202</sourcerecordid><originalsourceid>FETCH-LOGICAL-c448t-c9b68748cc547bf6a6975957373c31f45165d1ea0cbc7a9a1dd037a61c675a703</originalsourceid><addsrcrecordid>eNqFkE1r3DAQhkVpaTbbHntsMfSSi5MZ69PHZskXJBRKezazspxosS1XstOkvz4OThPIpaeB4eF9Zx7GPiEcIpT86MbRENoj-_cOEN6wFQoFeVFw_ZatoFAmRzCwx_ZT2gGgEEK-Z3uF4VwCiBX7cUwxehdTRn2dNWR960caw7xoQsx8n0Y_TqMPPbVZ7Vp_6-J9Rl3or7MhzMSVS4E6F72lPvsTOtd_YO8aapP7-DTX7Nfpyc_NeX75_exi8-0yt0KYMbflVhktjLVS6G2jSJVallJzzS3HRkhUskZHYLdWU0lY18A1KbRKS9LA1-xgyR1i-D25NFadT9a1LfUuTKlCY7BQ3ADO6NdX6C5McX4pVYXgCKgea9csXygbQ0rRNdUQfUfxvkKoHmVXi-xqkT3zX55Sp23n6mf6n92XC8M0_Dfr84Lu0iz_GRZGQllAwR8ARAuT2w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2431016737</pqid></control><display><type>article</type><title>Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study</title><source>Oxford Journals Open Access Collection</source><creator>Hernandez, Bernardo ; Colombara, Danny V. ; Gagnier, Marielle C. ; Desai, Sima S. ; Haakenstad, Annie ; Johanns, Casey ; McNellan, Claire R. ; Nelson, Jennifer ; Palmisano, Erin B. ; Ríos-Zertuche, Diego ; Schaefer, Alexandra ; Zúñiga-Brenes, Paola ; Iriarte, Emma ; Mokdad, Ali H.</creator><creatorcontrib>Hernandez, Bernardo ; Colombara, Danny V. ; Gagnier, Marielle C. ; Desai, Sima S. ; Haakenstad, Annie ; Johanns, Casey ; McNellan, Claire R. ; Nelson, Jennifer ; Palmisano, Erin B. ; Ríos-Zertuche, Diego ; Schaefer, Alexandra ; Zúñiga-Brenes, Paola ; Iriarte, Emma ; Mokdad, Ali H.</creatorcontrib><description>Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1–2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
La atención profesional especializada ha demostrado ser una de las estrategias más prometedoras para reducir la mortalidad materna, y los partos en la instalación son una manera costo-efectiva de garantizar nacimientos seguros. Los países en Mesoamérica han hecho énfasis en la atención del parto en la instalación por parte de asistentes profesionales calificados, pero el acceso a los servicios de parto de buena calidad sigue siendo escaso para muchas mujeres. Examinamos las características de las mujeres que tuvieron un parto en un centro de salud y los factores determinantes de la decisión de no ir a una instalación cercana y en vez viajar a una instalación distante. Usamos la información de referencia de la Iniciativa Salud Mesoamérica (ISM). Los datos fueron recolectados en una gran muestra de hogares e instalaciones en el quintil más pobre de la población en Guatemala, Honduras y Nicaragua. El análisis incluyó 1592 partos. Después de controlar las características de las mujeres y las instalaciones de salud, se asociaron las siguientes características con los partos en las instalaciones: ser primíparas (RR=1.15, 95% IC 1.10, 1.21), ser alfabetizadas (RR=1.24; 95% IC 1.04, 1.48), haber tenido atención prenatal (RR=1.68; 95% IC 1.24, 2.27), haber sido informadas de la necesidad de tener una cesárea (RR=1.07, 95% IC 1.02, 1.11) y el tiempo de viaje hasta la instalación más cercana de entre 1-2 horas vs. de menos de 30 minutos (RR=0.88, 95% IC: 0.77, 0.99). En Guatemala, el aumento de la disponibilidad de medicamentos y equipos en una instalación lejana se asoció fuertemente con el acto de evitar la instalación más cercana a favor de una instalación distante para el parto (RR=2.10; IC 95% 1.08, 4.07). Nuestro estudio mostró una fuerte correlación entre las instalaciones bien equipadas y el parto atendido en las áreas pobres de Mesoamérica. De hecho, las mujeres eran más propensas a viajar a instalaciones más distantes si las instalaciones tenían un nivel más alto, las cuales tuvieron una calificación más alta en nuestra puntuación de capacidad. Nuestros hallazgos sugieren la necesidad de mejorar la capacidad de las instalaciones de salud, la calidad de la atención y de abordar las barreras culturales y de accesibilidad para aumentar el parto institucional entre la población pobre de Mesoamérica.
专业护理是降低孕产妇死亡率最有前景的策略之一, 而院内分 娩是确保安全分娩的有效方式。中美洲国家已经重视由专业 熟练护理人员提供院内分娩护理, 但许多妇女仍然不能获取高 质量的分娩服务。我们调查了院内分娩的妇女的特征, 以及促 使她们在选择医疗机构时舍近求远的决定因素。我们使用 Salud Mesoamerica项目的基线信息。数据来自危地马拉、洪 都拉斯和尼加拉瓜最贫困五分之一人口的大型住户和卫生机 构样本。分析1592 次分娩情况。控制妇女和卫生机构特征 后, 与院内分娩相关的因素为初产 （RR=1.15, 95% CI 1.10, 1.21） 、受过教育 （RR=1.24, 95% CI 1.04, 1.48） 、接受产 前护理 （RR=1.68, 95% CI 1.24, 2.27） 、被告知需要剖腹产 （RR=1.07, 95% CI 1.02, 1.11） 及到最近医疗机构路程为1-2 小时vs. 30分钟以下 （RR=0.88, 95% CI 0.77, 0.99） 。 在危地 马拉, 较远医疗机构可使用更好药品和器械与产妇舍近求远, 选择较远处医疗机构相关 （RR=2.10, 95% CI 1.08, 4.07） 。 本研究显示, 中美洲贫困地区的院内分娩与医疗机构实力相关 性较强。如果距离较远的机构水平更好, 即能力评分的分数更 高, 妇女会更倾向于前往这些较远的机构分娩。因此需要改善 医疗机构能力, 提高医疗质量, 消除文化和可及性障碍, 以提 高中美洲贫困人口的院内分娩率。</description><identifier>ISSN: 0268-1080</identifier><identifier>EISSN: 1460-2237</identifier><identifier>DOI: 10.1093/heapol/czx010</identifier><identifier>PMID: 28335004</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Access ; Adolescent ; Adult ; Births ; Central America - epidemiology ; Cesarean section ; Consumer Behavior ; Correlation analysis ; Cost analysis ; Cross-Sectional Studies ; Delivery, Obstetric - utilization ; Distant ; Female ; Health administration ; Health care ; Health care facilities ; Health facilities ; Health Facilities - utilization ; Health Services Accessibility ; Humans ; Maternal Health Services - organization & administration ; Maternal Health Services - standards ; Maternal mortality ; Middle Aged ; ORIGINAL ARTICLES ; Poverty ; Pregnancy ; Prenatal care ; Quality of care ; Quality of Health Care ; Travel ; Travel time ; Women ; Working women</subject><ispartof>Health policy and planning, 2017-07, Vol.32 (6), p.769-780</ispartof><rights>The Author 2017</rights><rights>The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2017</rights><rights>The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-c9b68748cc547bf6a6975957373c31f45165d1ea0cbc7a9a1dd037a61c675a703</citedby><cites>FETCH-LOGICAL-c448t-c9b68748cc547bf6a6975957373c31f45165d1ea0cbc7a9a1dd037a61c675a703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/48509202$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/48509202$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,1604,27866,27924,27925,30999,58017,58250</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/heapol/czx010$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28335004$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hernandez, Bernardo</creatorcontrib><creatorcontrib>Colombara, Danny V.</creatorcontrib><creatorcontrib>Gagnier, Marielle C.</creatorcontrib><creatorcontrib>Desai, Sima S.</creatorcontrib><creatorcontrib>Haakenstad, Annie</creatorcontrib><creatorcontrib>Johanns, Casey</creatorcontrib><creatorcontrib>McNellan, Claire R.</creatorcontrib><creatorcontrib>Nelson, Jennifer</creatorcontrib><creatorcontrib>Palmisano, Erin B.</creatorcontrib><creatorcontrib>Ríos-Zertuche, Diego</creatorcontrib><creatorcontrib>Schaefer, Alexandra</creatorcontrib><creatorcontrib>Zúñiga-Brenes, Paola</creatorcontrib><creatorcontrib>Iriarte, Emma</creatorcontrib><creatorcontrib>Mokdad, Ali H.</creatorcontrib><title>Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study</title><title>Health policy and planning</title><addtitle>Health Policy Plan</addtitle><description>Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1–2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
La atención profesional especializada ha demostrado ser una de las estrategias más prometedoras para reducir la mortalidad materna, y los partos en la instalación son una manera costo-efectiva de garantizar nacimientos seguros. Los países en Mesoamérica han hecho énfasis en la atención del parto en la instalación por parte de asistentes profesionales calificados, pero el acceso a los servicios de parto de buena calidad sigue siendo escaso para muchas mujeres. Examinamos las características de las mujeres que tuvieron un parto en un centro de salud y los factores determinantes de la decisión de no ir a una instalación cercana y en vez viajar a una instalación distante. Usamos la información de referencia de la Iniciativa Salud Mesoamérica (ISM). Los datos fueron recolectados en una gran muestra de hogares e instalaciones en el quintil más pobre de la población en Guatemala, Honduras y Nicaragua. El análisis incluyó 1592 partos. Después de controlar las características de las mujeres y las instalaciones de salud, se asociaron las siguientes características con los partos en las instalaciones: ser primíparas (RR=1.15, 95% IC 1.10, 1.21), ser alfabetizadas (RR=1.24; 95% IC 1.04, 1.48), haber tenido atención prenatal (RR=1.68; 95% IC 1.24, 2.27), haber sido informadas de la necesidad de tener una cesárea (RR=1.07, 95% IC 1.02, 1.11) y el tiempo de viaje hasta la instalación más cercana de entre 1-2 horas vs. de menos de 30 minutos (RR=0.88, 95% IC: 0.77, 0.99). En Guatemala, el aumento de la disponibilidad de medicamentos y equipos en una instalación lejana se asoció fuertemente con el acto de evitar la instalación más cercana a favor de una instalación distante para el parto (RR=2.10; IC 95% 1.08, 4.07). Nuestro estudio mostró una fuerte correlación entre las instalaciones bien equipadas y el parto atendido en las áreas pobres de Mesoamérica. De hecho, las mujeres eran más propensas a viajar a instalaciones más distantes si las instalaciones tenían un nivel más alto, las cuales tuvieron una calificación más alta en nuestra puntuación de capacidad. Nuestros hallazgos sugieren la necesidad de mejorar la capacidad de las instalaciones de salud, la calidad de la atención y de abordar las barreras culturales y de accesibilidad para aumentar el parto institucional entre la población pobre de Mesoamérica.
专业护理是降低孕产妇死亡率最有前景的策略之一, 而院内分 娩是确保安全分娩的有效方式。中美洲国家已经重视由专业 熟练护理人员提供院内分娩护理, 但许多妇女仍然不能获取高 质量的分娩服务。我们调查了院内分娩的妇女的特征, 以及促 使她们在选择医疗机构时舍近求远的决定因素。我们使用 Salud Mesoamerica项目的基线信息。数据来自危地马拉、洪 都拉斯和尼加拉瓜最贫困五分之一人口的大型住户和卫生机 构样本。分析1592 次分娩情况。控制妇女和卫生机构特征 后, 与院内分娩相关的因素为初产 （RR=1.15, 95% CI 1.10, 1.21） 、受过教育 （RR=1.24, 95% CI 1.04, 1.48） 、接受产 前护理 （RR=1.68, 95% CI 1.24, 2.27） 、被告知需要剖腹产 （RR=1.07, 95% CI 1.02, 1.11） 及到最近医疗机构路程为1-2 小时vs. 30分钟以下 （RR=0.88, 95% CI 0.77, 0.99） 。 在危地 马拉, 较远医疗机构可使用更好药品和器械与产妇舍近求远, 选择较远处医疗机构相关 （RR=2.10, 95% CI 1.08, 4.07） 。 本研究显示, 中美洲贫困地区的院内分娩与医疗机构实力相关 性较强。如果距离较远的机构水平更好, 即能力评分的分数更 高, 妇女会更倾向于前往这些较远的机构分娩。因此需要改善 医疗机构能力, 提高医疗质量, 消除文化和可及性障碍, 以提 高中美洲贫困人口的院内分娩率。</description><subject>Access</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Births</subject><subject>Central America - epidemiology</subject><subject>Cesarean section</subject><subject>Consumer Behavior</subject><subject>Correlation analysis</subject><subject>Cost analysis</subject><subject>Cross-Sectional Studies</subject><subject>Delivery, Obstetric - utilization</subject><subject>Distant</subject><subject>Female</subject><subject>Health administration</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health facilities</subject><subject>Health Facilities - utilization</subject><subject>Health Services Accessibility</subject><subject>Humans</subject><subject>Maternal Health Services - organization & administration</subject><subject>Maternal Health Services - standards</subject><subject>Maternal mortality</subject><subject>Middle Aged</subject><subject>ORIGINAL ARTICLES</subject><subject>Poverty</subject><subject>Pregnancy</subject><subject>Prenatal care</subject><subject>Quality of care</subject><subject>Quality of Health Care</subject><subject>Travel</subject><subject>Travel time</subject><subject>Women</subject><subject>Working women</subject><issn>0268-1080</issn><issn>1460-2237</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNqFkE1r3DAQhkVpaTbbHntsMfSSi5MZ69PHZskXJBRKezazspxosS1XstOkvz4OThPIpaeB4eF9Zx7GPiEcIpT86MbRENoj-_cOEN6wFQoFeVFw_ZatoFAmRzCwx_ZT2gGgEEK-Z3uF4VwCiBX7cUwxehdTRn2dNWR960caw7xoQsx8n0Y_TqMPPbVZ7Vp_6-J9Rl3or7MhzMSVS4E6F72lPvsTOtd_YO8aapP7-DTX7Nfpyc_NeX75_exi8-0yt0KYMbflVhktjLVS6G2jSJVallJzzS3HRkhUskZHYLdWU0lY18A1KbRKS9LA1-xgyR1i-D25NFadT9a1LfUuTKlCY7BQ3ADO6NdX6C5McX4pVYXgCKgea9csXygbQ0rRNdUQfUfxvkKoHmVXi-xqkT3zX55Sp23n6mf6n92XC8M0_Dfr84Lu0iz_GRZGQllAwR8ARAuT2w</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Hernandez, Bernardo</creator><creator>Colombara, Danny V.</creator><creator>Gagnier, Marielle C.</creator><creator>Desai, Sima S.</creator><creator>Haakenstad, Annie</creator><creator>Johanns, Casey</creator><creator>McNellan, Claire R.</creator><creator>Nelson, Jennifer</creator><creator>Palmisano, Erin B.</creator><creator>Ríos-Zertuche, Diego</creator><creator>Schaefer, Alexandra</creator><creator>Zúñiga-Brenes, Paola</creator><creator>Iriarte, Emma</creator><creator>Mokdad, Ali H.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T2</scope><scope>7TQ</scope><scope>8BJ</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Barriers and facilitators for institutional delivery among poor Mesoamerican women</title><author>Hernandez, Bernardo ; Colombara, Danny V. ; Gagnier, Marielle C. ; Desai, Sima S. ; Haakenstad, Annie ; Johanns, Casey ; McNellan, Claire R. ; Nelson, Jennifer ; Palmisano, Erin B. ; Ríos-Zertuche, Diego ; Schaefer, Alexandra ; Zúñiga-Brenes, Paola ; Iriarte, Emma ; Mokdad, Ali H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-c9b68748cc547bf6a6975957373c31f45165d1ea0cbc7a9a1dd037a61c675a703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Access</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Births</topic><topic>Central America - epidemiology</topic><topic>Cesarean section</topic><topic>Consumer Behavior</topic><topic>Correlation analysis</topic><topic>Cost analysis</topic><topic>Cross-Sectional Studies</topic><topic>Delivery, Obstetric - utilization</topic><topic>Distant</topic><topic>Female</topic><topic>Health administration</topic><topic>Health care</topic><topic>Health care facilities</topic><topic>Health facilities</topic><topic>Health Facilities - utilization</topic><topic>Health Services Accessibility</topic><topic>Humans</topic><topic>Maternal Health Services - organization & administration</topic><topic>Maternal Health Services - standards</topic><topic>Maternal mortality</topic><topic>Middle Aged</topic><topic>ORIGINAL ARTICLES</topic><topic>Poverty</topic><topic>Pregnancy</topic><topic>Prenatal care</topic><topic>Quality of care</topic><topic>Quality of Health Care</topic><topic>Travel</topic><topic>Travel time</topic><topic>Women</topic><topic>Working women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hernandez, Bernardo</creatorcontrib><creatorcontrib>Colombara, Danny V.</creatorcontrib><creatorcontrib>Gagnier, Marielle C.</creatorcontrib><creatorcontrib>Desai, Sima S.</creatorcontrib><creatorcontrib>Haakenstad, Annie</creatorcontrib><creatorcontrib>Johanns, Casey</creatorcontrib><creatorcontrib>McNellan, Claire R.</creatorcontrib><creatorcontrib>Nelson, Jennifer</creatorcontrib><creatorcontrib>Palmisano, Erin B.</creatorcontrib><creatorcontrib>Ríos-Zertuche, Diego</creatorcontrib><creatorcontrib>Schaefer, Alexandra</creatorcontrib><creatorcontrib>Zúñiga-Brenes, Paola</creatorcontrib><creatorcontrib>Iriarte, Emma</creatorcontrib><creatorcontrib>Mokdad, Ali H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Health policy and planning</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Hernandez, Bernardo</au><au>Colombara, Danny V.</au><au>Gagnier, Marielle C.</au><au>Desai, Sima S.</au><au>Haakenstad, Annie</au><au>Johanns, Casey</au><au>McNellan, Claire R.</au><au>Nelson, Jennifer</au><au>Palmisano, Erin B.</au><au>Ríos-Zertuche, Diego</au><au>Schaefer, Alexandra</au><au>Zúñiga-Brenes, Paola</au><au>Iriarte, Emma</au><au>Mokdad, Ali H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study</atitle><jtitle>Health policy and planning</jtitle><addtitle>Health Policy Plan</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>32</volume><issue>6</issue><spage>769</spage><epage>780</epage><pages>769-780</pages><issn>0268-1080</issn><eissn>1460-2237</eissn><abstract>Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1–2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
La atención profesional especializada ha demostrado ser una de las estrategias más prometedoras para reducir la mortalidad materna, y los partos en la instalación son una manera costo-efectiva de garantizar nacimientos seguros. Los países en Mesoamérica han hecho énfasis en la atención del parto en la instalación por parte de asistentes profesionales calificados, pero el acceso a los servicios de parto de buena calidad sigue siendo escaso para muchas mujeres. Examinamos las características de las mujeres que tuvieron un parto en un centro de salud y los factores determinantes de la decisión de no ir a una instalación cercana y en vez viajar a una instalación distante. Usamos la información de referencia de la Iniciativa Salud Mesoamérica (ISM). Los datos fueron recolectados en una gran muestra de hogares e instalaciones en el quintil más pobre de la población en Guatemala, Honduras y Nicaragua. El análisis incluyó 1592 partos. Después de controlar las características de las mujeres y las instalaciones de salud, se asociaron las siguientes características con los partos en las instalaciones: ser primíparas (RR=1.15, 95% IC 1.10, 1.21), ser alfabetizadas (RR=1.24; 95% IC 1.04, 1.48), haber tenido atención prenatal (RR=1.68; 95% IC 1.24, 2.27), haber sido informadas de la necesidad de tener una cesárea (RR=1.07, 95% IC 1.02, 1.11) y el tiempo de viaje hasta la instalación más cercana de entre 1-2 horas vs. de menos de 30 minutos (RR=0.88, 95% IC: 0.77, 0.99). En Guatemala, el aumento de la disponibilidad de medicamentos y equipos en una instalación lejana se asoció fuertemente con el acto de evitar la instalación más cercana a favor de una instalación distante para el parto (RR=2.10; IC 95% 1.08, 4.07). Nuestro estudio mostró una fuerte correlación entre las instalaciones bien equipadas y el parto atendido en las áreas pobres de Mesoamérica. De hecho, las mujeres eran más propensas a viajar a instalaciones más distantes si las instalaciones tenían un nivel más alto, las cuales tuvieron una calificación más alta en nuestra puntuación de capacidad. Nuestros hallazgos sugieren la necesidad de mejorar la capacidad de las instalaciones de salud, la calidad de la atención y de abordar las barreras culturales y de accesibilidad para aumentar el parto institucional entre la población pobre de Mesoamérica.
专业护理是降低孕产妇死亡率最有前景的策略之一, 而院内分 娩是确保安全分娩的有效方式。中美洲国家已经重视由专业 熟练护理人员提供院内分娩护理, 但许多妇女仍然不能获取高 质量的分娩服务。我们调查了院内分娩的妇女的特征, 以及促 使她们在选择医疗机构时舍近求远的决定因素。我们使用 Salud Mesoamerica项目的基线信息。数据来自危地马拉、洪 都拉斯和尼加拉瓜最贫困五分之一人口的大型住户和卫生机 构样本。分析1592 次分娩情况。控制妇女和卫生机构特征 后, 与院内分娩相关的因素为初产 （RR=1.15, 95% CI 1.10, 1.21） 、受过教育 （RR=1.24, 95% CI 1.04, 1.48） 、接受产 前护理 （RR=1.68, 95% CI 1.24, 2.27） 、被告知需要剖腹产 （RR=1.07, 95% CI 1.02, 1.11） 及到最近医疗机构路程为1-2 小时vs. 30分钟以下 （RR=0.88, 95% CI 0.77, 0.99） 。 在危地 马拉, 较远医疗机构可使用更好药品和器械与产妇舍近求远, 选择较远处医疗机构相关 （RR=2.10, 95% CI 1.08, 4.07） 。 本研究显示, 中美洲贫困地区的院内分娩与医疗机构实力相关 性较强。如果距离较远的机构水平更好, 即能力评分的分数更 高, 妇女会更倾向于前往这些较远的机构分娩。因此需要改善 医疗机构能力, 提高医疗质量, 消除文化和可及性障碍, 以提 高中美洲贫困人口的院内分娩率。</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28335004</pmid><doi>10.1093/heapol/czx010</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0268-1080 |
| ispartof | Health policy and planning, 2017-07, Vol.32 (6), p.769-780 |
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| subjects | Access Adolescent Adult Births Central America - epidemiology Cesarean section Consumer Behavior Correlation analysis Cost analysis Cross-Sectional Studies Delivery, Obstetric - utilization Distant Female Health administration Health care Health care facilities Health facilities Health Facilities - utilization Health Services Accessibility Humans Maternal Health Services - organization & administration Maternal Health Services - standards Maternal mortality Middle Aged ORIGINAL ARTICLES Poverty Pregnancy Prenatal care Quality of care Quality of Health Care Travel Travel time Women Working women |
| title | Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study |
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