Top

Conflict and Health

Published in:

Open Access 01-12-2015 | Research

The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan

Author: Izzeldin F. Adam

Published in: Conflict and Health | Issue 1/2015

Abstract

Background

Armed conflict and socio-demographic characteristics of internally displaced persons (IDPs) are very important factors that influence the provision of reproductive health (RH) in humanitarian settings. Maternal health education plays a crucial role to overcome the barriers of RH care, reduce home births conducted by traditional birth attendants (TBAs), and improve increasing births in a health facility. The objectives of this study were to (1) determine the association between the place of delivery and home visits for maternal health education and (2) describe the socio-demographic characteristics of women who gave birth during the last two years.

Methods

A cross-sectional study among married women aged (15–49 years old) in IDP camps. All women were subjected to intensive maternal health education at their homes for 3 years prior to the survey. A sample of 640 women who gave birth during the last two years was randomly selected.

Results

Among all women investigated, 36.9 % (95 % CI: 33.1, 40.8) reported a home-based delivery, while 63.1 % (95 % CI: 59.2, 66.9) reported a facility-based delivery. Receiving visits for maternal health education at home was associated with an estimated 43.0 % reduction in odds of giving birth at home, compared to not receiving home visits (adjusted odds ratio [ aOR] 0.57; 95 % CI: 0.35, 0.93). The level of women’s education and camp of residence were important predictors for home birth.

Conclusion

Maternal health education at home was associated with a reduction in home-based delivery performed by TBAs in the conflict-affected setting of Darfur. Our study proposes that when facility-based delivery is made available in camp’s clinics, and the targeted women educated at home to refrain from home-based delivery, they will choose to undergo facility-based delivery.

Freedman LP, Graham WJ, Brazier E, Smith JM, Ensor T, Fauveau V, et al. Practical lessons from global safe motherhood initiatives: time for a new focus on implementation. Lancet. 2007;370(9595):1383–91.CrossRefPubMed

Islam M. The safe motherhood initiative and beyond. Bull World Health Organ. 2007;85(10):735.PubMedCentralCrossRefPubMed

Amoako Johnson F, Padmadas SS, Matthews Z. Are women deciding against home births in low and middle income countries? PLoS One. 2013;8(6):e65527.CrossRefPubMed

Mohindra KS, Haddad S, Narayana D. Women's health in a rural community in Kerala, India: do caste and socioeconomic position matter? J Epidemiol Community Health. 2006;60(12):1020–6.PubMedCentralCrossRefPubMed

Ghazi Tabatabaie M, Moudi Z, Vedadhir A. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran. Reprod Health. 2012;9:5.PubMedCentralCrossRefPubMed

Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth. 2004;4(1):8.PubMedCentralCrossRefPubMed

Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14:161.PubMedCentralCrossRefPubMed

Mayhew M, Hansen PM, Peters DH, Edward A, Singh LP, Dwivedi V, et al. Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study. Am J Public Health. 2008;98(10):1849–56.PubMedCentralCrossRefPubMed

Prata N, Sreenivas A, Vahidnia F, Potts M. Saving maternal lives in resource-poor settings: facing reality. Health Policy. 2009;89(2):131–48.CrossRefPubMed

10.

Speakman EM, Shafi A, Sondorp E, Atta N, Howard N. Development of the Community Midwifery Education initiative and its influence on women's health and empowerment in Afghanistan: a case study. BMC Women’s Health. 2014;14(1):111.PubMedCentralCrossRefPubMed

11.

United Nations Population Fund. Maternal Health: Stepping Up Efforts to Save Mothers’ Lives.: UNFPA Sudan, country office; 2012. Available at: http://countryoffice.unfpa.org/filemanager/files/sudan/facts/maternal_health.pdf. Accessed June 28, 2014.

12.

Abdel-Tawab N, El-Rabbt M. Maternal and neonatal health services in Sudan: results of a situation analysis; 2010. Available at: http://countryoffice.unfpa.org/sudan/drive/SudanPolicyBrief%28Updated13042010%29.pdf. Accessed August 15, 2014.

13.

Ministry of Health, Central Bureau of Statistics. Sudan Household Health Survey 2nd Round 2010. Summary Report 2011. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/MICS4_Sudan_2010.pdf. Accessed March 2, 2014

14.

Inter-agency Working Group on Reproductive Health in Crises. Inter-agency Field Manual on Reproductive Health in Humanitarian Settings. WHO; 2010. Available from: http://www.searo.who.int/entity/emergencies/documents/field_manual_rh_humanitarian_settings.pdf. Accessed May 15, 2015.

15.

African Union UNHoiDU. Background: The Darfur conflict. UNAMID; 2008. Available at: http://www.un.org/en/peacekeeping/missions/unamid/background.shtml. Accessed Oct. 12, 2014.

16.

UNICEF. Darfur - overview. UNICEF; 2008. Available at: http://www.unicef.org/infobycountry/sudan_darfuroverview.html. Accessed January 9, 2014.

17.

Degomme O, Guha-Sapir D. Patterns of mortality rates in Darfur conflict. Lancet. 2010;375(9711):294–300.CrossRefPubMed

18.

Depoortere E, Checchi F, Broillet F, Gerstl S, Minetti A, Gayraud O, et al. Violence and mortality in West Darfur, Sudan (2003–04): epidemiological evidence from four surveys. Lancet. 2004;364(9442):1315–20.CrossRefPubMed

19.

Ministry of Health, Central Bureau of Statistics. Sudan Household Health Survey 1st Round 2006. Federal Ministry of Health, Ministry of Health, Government of South Sudan, Central Bureau of Statistics Southern Sudan Commission of Census, Statistics & Evaluation; 2007. Available at: http://static1.1.sqspcdn.com/static/f/750842/10005392/1293722618287/SHHS+Published+report.pdf?token=w5ItPgbhiHUSBYMiAUNG3JVIpko%3D. Accessed May 2, 2015.

20.

Samia Elnagar, Hassan Abdel Ati, Lamia Eltigani, Huda Mohamed Mukhtar. An Update of Reproductive Health, Gender, Population and Development Situation in Sudan. UNFPA-Sudan; 2011. Available at: http://countryoffice.unfpa.org/filemanager/files/sudan/final.pdf. Accessed August 17, 2015.

21.

Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005;106(6):1228–34.CrossRefPubMed

22.

Javed SA, Anjum MD, Imran W, Haider A, Shiraz A, Shaheen F, et al. Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey. BMC Pregnancy Childbirth. 2013;13:137.PubMedCentralCrossRefPubMed

23.

Titaley CR, Dibley MJ, Roberts CL. Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994–2007 Indonesia Demographic and Health Surveys. Health Policy Plan. 2012;27(5):405–16.CrossRefPubMed

24.

GlaxoSmithKline(GSK). 20 % Reinvestment Initiative: The journey so far and results for 2012; 2013. Available at: http://partnerships.ifpma.org/uploads/documents/135_1405524298.pdf. Accessed August 26, 2014.

25.

Onyango MA, Hixson BL, McNally S. Minimum Initial Service Package (MISP) for reproductive health during emergencies: time for a new paradigm? Glob Public Health. 2013;8(3):342–56.CrossRefPubMed

26.

Physicians for Human Rights (PHR). Darfur: the culture and the people. 2006. Available at: http://healthreach.nlm.nih.gov/documents/DARFUR_THE_CULTURE_AND_THE_PEOPLE_English.pdf. Accessed August 17, 2015.

27.

Qayum M, Arooj H, Mohmand S. Minimum Initial Service Package (MISP) access to displaced people of Pakistan based on Sphere Standards and Indicators. J Pak Med Assoc. 2013;63(8):1027–30.

28.

Feyissa TR, Genemo GA. Determinants of institutional delivery among childbearing age women in Western Ethiopia, 2013: unmatched case control study. PLoS One. 2014;9(5):e97194.PubMedCentralCrossRefPubMed

29.

Bukar M, Jauro YS. Home births and postnatal practices in Madagali, north-eastern Nigeria. Niger J Clin Pract. 2013;16(2):232–7.CrossRefPubMed

30.

Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth. 2013;13:5.PubMedCentralCrossRefPubMed

31.

Kumbani L, Bjune G, Chirwa E, Malata A, Odland J. Why some women fail to give birth at health facilities: a qualitative study of women's perceptions of perinatal care from rural Southern Malawi. Reprod Health. 2013;10:9.PubMedCentralCrossRefPubMed

32.

Blum LS, Sharmin T, Ronsmans C. Attending Home vs. Clinic-Based Deliveries: Perspectives of Skilled Birth Attendants in Matlab, Bangladesh. Reprod Health Matters. 2006;14(27):51–60.CrossRefPubMed

33.

Pfeiffer C, Mwaipopo R. Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania. BMC Pregnancy Childbirth. 2013;13:55.PubMedCentralCrossRefPubMed

34.

Mekonnen MG, Yalew KN, Umer JY, Melese M. Determinants of delivery practices among Afar pastoralists of Ethiopia. Pan Afr Med J. 2012;13 Suppl 1:17.PubMed

35.

Faye A, Niane M, Ba I. Home birth in women who have given birth at least once in a health facility: contributory factors in a developing country. Acta Obstet Gynecol Scand. 2011;90(11):1239–43.CrossRefPubMed

36.

Gebrehiwot T, Goicolea I, Edin K, San SM. Making pragmatic choices: women's experiences of delivery care in Northern Ethiopia. BMC Pregnancy Childbirth. 2012;12:113.PubMedCentralCrossRefPubMed

37.

Brazier E, Fiorentino R, Barry MS, Diallo M. The value of building health promotion capacities within communities: evidence from a maternal health intervention in Guinea. Health Policy Plan. 2014;30(7):885–94.PubMedCentralCrossRefPubMed

38.

Wajid A, White F, Karim MS. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country. PLoS One. 2013;8(9):e75476.PubMedCentralCrossRefPubMed

39.

Gebrehiwot T, San Sebastian M, Edin K, Goicolea I. Health workers' perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia. BMC Pregnancy Childbirth. 2014;14:137.PubMedCentralCrossRefPubMed

40.

Owolabi OO, Glenton C, Lewin S, Pakenham-Walsh N. Stakeholder views on the incorporation of traditional birth attendants into the formal health systems of low-and middle-income countries: a qualitative analysis of the HIFA2015 and CHILD2015 email discussion forums. BMC Pregnancy Childbirth. 2014;14:118. doi:10.1186/1471-2393-14-118.PubMedCentralCrossRefPubMed

41.

Muchabaiwa L, Mazambani D, Chigusiwa L, Bindu S, Mudavanhu V. Determinants of Maternal Healthcare Utilization in Zimbabwe. International Journal of Economic Sciences and Applied Research. 2012(2):145–62

42.

Exavery A1, Kanté AM, Njozi M, Tani K, Doctor HV, Hingora A, Phillips JF. Access to institutional delivery care and reasons for home delivery in three districts of Tanzania. Int J Equity Health. 2014;13:48. doi:10.1186/1475-9276-13-48.

43.

Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria--looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009;9:43.PubMedCentralCrossRefPubMed

44.

Lalonde AB, McMullen H, Lee AC. Safe motherhood and newborn health: FIGO initiatives 2006–2010. Int J Gynaecol Obstet. 2009;106(2):112–4.CrossRefPubMed

Title: The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan
Author: Izzeldin F. Adam
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Conflict and Health / Issue 1/2015
Electronic ISSN: 1752-1505
DOI: https://doi.org/10.1186/s13031-015-0057-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The influence of maternal health education on the place of delivery in conflict settings of Darfur, Sudan

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: a retrospective cohort study 2012–2013

Internal displacement and the Syrian crisis: an analysis of trends from 2011–2014

Child health in Syria: recognising the lasting effects of warfare on health

Access to healthcare for the most vulnerable migrants: a humanitarian crisis

Availability and distribution of human resources for provision of comprehensive emergency obstetric and newborn care in Afghanistan: a cross-sectional study

Coping among trauma-affected youth: a qualitative study