Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Care | Research article

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing”: institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study

Authors: Pontius Bayo, Loubna Belaid, Elijo Omoro Tahir, Emmanuel Ochola, Alexander Dimiti, Donato Greco, Christina Zarowsky

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan.

Methods

A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data.

Results

Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery.

Conclusion

Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.
Appendix
Available only for authorised users
Footnotes
1
The stamp refers to the receipt that is given to the patients when they pay for certain supplementary medical services
 
2
A bar of soap is about 60 South Sudanese pounds (ssp) ($ 1) and a packet of sweets is about 200 ssp. ($3.3)
 
Literature
1.
Alkema L, et al. Global, regional, and national levels and trends in maternal mortality between 1990 And 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 387(10017):462–74.
2.
Begum S, Aziz-un N, Begum I. Analysis of maternal mortality in a tertiary care hospital to determine causes and preventable factors. J Ayub Med Coll Abbottabad. 2003;15(2):49–52.PubMed
3.
Say L, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.PubMedCrossRef
4.
Dumont A. Réduire la mortalité maternelle dans les pays en développement : quelles sont les interventions efficaces ? Revue de médecine périnatale. 2017;9(1):7–14.CrossRef
5.
Udo I, Doctor H. Trends in health facility births in sub-Saharan Africa: an analysis of lessons learned under the millennium development goal framework. Afr J Reprod Health. 2016;20(3):108–17.PubMedCrossRef
6.
7.
Paina L, et al. What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda. BMC Health Serv Res. 2016;16(7):621.PubMedCrossRef
8.
Moyer C, Mustafa A. Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review. Reprod Health. 2013;10(40):1–14.
9.
Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal: implications for achieving millennium development goal 5. Midwifery. 2013;29(10):1206–10.PubMedCrossRef
10.
Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9(34):1–18.
11.
Omer R. South Sudan: from independence to a detrimental civil war. Harvard Int Rev. 2016;37(3):11–2.
12.
13.
Lawry L, et al. A mixed methods assessment of barriers to maternal, newborn and child health in Gogrial west, South Sudan. Reprod Health. 2017;14(1):12.PubMedPubMedCentralCrossRef
14.
15.
Buesseler HM, Yugi J. Childbirth in South Sudan: preferences, practice and perceptions in the Kapoetas. South Sudan Med J. 2016;9(2):32–5.
16.
Macharia PM, et al. Spatial accessibility to basic public health services in South Sudan. Geospat Health. 2017;12(1):510–0.
17.
Creswell JW, Plano Clark V. Designing and conducting mixed methods research. 2nd ed. Thousand Oaks: Sage; 2011.
18.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.PubMedCrossRef
19.
NBS. Population Projections for South Sudan by Payam: 2015–2020, vol. 2015; 2015. [cited 2015].
20.
Penrod J, et al. A discussion of chain referral as a method of sampling hard-to-reach populations. J Transcult Nurs. 2003;14(2):100–7.PubMedCrossRef
21.
22.
Robson C. Real World Research: A Resource for Users of Social Research Methods in Applied Settings. r. ed. Chichester: Wiley; 2011.
23.
24.
Laperrière A. The criteria of scientificity of qualitative methods. In: Poupart J, Groulx L-H, Deslauriers J-P, Laperrière A, Mayer R, Pires AP, editors. Qualitative research Epistemological and methodological issues. Boucherville Gatan Morin editor; 1997. p. 376–89.
25.
26.
27.
Sacks E, Masvawure TB, Atuyambe LM, Neema S, Macwan'gi M, Simbaya J, Kruk M. Postnatal care experiences and barriers to care utilization for home- and facility-delivered newborns in Uganda and Zambia. Matern Child Health J. 2017;21(3):599-606. https://​doi.​org/​10.​1007/​s10995-016-2144-4. PMID: 27475823.
28.
29.
Kruk ME, et al. Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health. 2009;99(9):1666–72.PubMedPubMedCentralCrossRef
30.
Kruk M, et al. Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health. 2010;64(11):984–8.PubMedCrossRef
31.
Bohren M, et al. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(71):1–28.
32.
Bohren MA, et al. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reprod Health. 2017;14(1):9.PubMedPubMedCentralCrossRef
33.
34.
Bohren MA, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847.PubMedPubMedCentralCrossRef
35.
Spangler SA. “To open oneself is a poor Woman’s trouble”: embodied inequality and childbirth in south–Central Tanzania. Med Anthropol Q. 2011;25.
36.
Spangler S, Bloom S. Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities. Social Sci Med. 2010;71(4):760–8.CrossRef
37.
38.
McMahon SA, et al. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro region, Tanzania. BMC Pregnancy Childbirth. 2014;14(1):1–13.CrossRef
39.
Oyerinde K, et al. A qualitative evaluation of the choice of traditional birth attendants for maternity care in 2008 Sierra Leone: implications for universal skilled attendance at delivery. Matern Child Health J. 2013;17(5):862–8.PubMedCrossRef
40.
Warren C, et al. Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya. BMC Pregnancy Childbirth. 2013;13(21):1–9.
41.
Warren CE, et al. Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy Childbirth. 2017;17(1):102.PubMedPubMedCentralCrossRef
42.
Shiferaw S, et al. Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth. 2013;13(5):1–10.
43.
Kifle D, et al. Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, eastern Ethiopia: a triangulated community-based cross-sectional study. Reprod Health. 2017;13(14):1–11.
44.
45.
Mayom J. In war-torn South Sudan, children's education is a rarity USA today; 2016.
46.
Linden JVD, Blaak M, Andrew FA. The contribution of the diaspora to the reconstruction of education in South Sudan: the challenge of being involved from a distance. Compare. 2013;43(5):646–66.CrossRef
47.
Tekelab T, Yadecha B, Melka A. Antenatal care and women's decision making power as determinants of institutional delivery in rural area of Western Ethiopia. BMC Res Notes. 2015;12(11):769–9.
48.
August F, et al. Effectiveness of the home based life saving skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in rural Tanzania. BMC Pregnancy Childbirth. 2016;06(16):1–12.
49.
Ejigu TT, Afework M, Yalew A. Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: a prospective follow up study. PLoS One. 2018;13(2):1–14.
50.
Belaid L, Ridde V. Contextual factors as a key to understanding the heterogeneity of effects of a maternal health policy in Burkina Faso. Health Policy and Planning. 2014;29(2):1–13.
51.
Ben Ameur A, et al. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation. BMC Health Serv Res. 2012;12(1):412.PubMedCrossRef
52.
Ridde V, Diarra A. A process evaluation of user fees abolition for pregnant women and children under 5 years in two districts in Niger. BMC Health Serv Res. 2009;9(89):1–16.
53.
54.
Olivier de Sardan JP, Ridde V. L'exemption de paiement des soins au Burkina Faso, Mali et Niger. Les contradictions des politiques publiques Afrique Contemporaine. 2012;243:11–32.
55.
56.
Metadata
Title
“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing”: institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study
Authors
Pontius Bayo
Loubna Belaid
Elijo Omoro Tahir
Emmanuel Ochola
Alexander Dimiti
Donato Greco
Christina Zarowsky
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02910-2

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries

Research article

Pregnancy outcomes of patients with acute fatty liver of pregnancy: a case control study

Research article

Evaluation of emergency obstetric and neonatal care services in Kumba Health District, Southwest region, Cameroon (2011–2014): a before-after study

Case report

Successful monozygotic triplet pregnancy after a single blastocyst transfer following in vitro maturation of oocytes from a woman with polycystic ovary syndrome: a case report

Research article

Birth, attitudes and placentophagy: a thematic discourse analysis of discussions on UK parenting forums

Research article

Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya