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Risk Factors for Non-use of Skilled Birth Attendants: Analysis of South Sudan Household Survey, 2010

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Abstract

Objectives South Sudan has the lowest percentage of births attended by skilled health personnel in the world. This paper aims to identify potential risk factors associated with non-use of skilled birth attendants at delivery in South Sudan. Methods Secondary data analyses of the 2010 South Sudan Household Health Survey second round were conducted with data for 3504 women aged 15–49 years who gave birth in the 2 years prior to the survey. The risk of non-use of skilled birth attendants was examined using simple and multiple logistic regression analyses. Results The prevalence rates for skilled, unskilled and no birth attendants at delivery were 41 [95 % confidence interval (CI) 38.2, 43.0], 36 [95 % CI 33.9, 38.8], and 23 % [95 % CI 20.6, 24.9] respectively. Multivariable analyses indicated that educated mothers [adjusted odds ratio (AOR) 0.70; 95 % CI 0.57, 0.86], mothers who had three and more complications during pregnancy [AOR 0.77; 95 % CI 0.65, 0.90], mothers who had at least 1–3 ANC visits [AOR 0.38; 95 % CI 0.30, 0.49] and mothers from rich households [AOR 0.52; 95 % CI 0.42, 0.65] were significantly more likely to use skilled birth attendants (SBAs) at delivery. Mothers who lived in rural areas [AOR 1.44; 95 % CI 1.06, 1.96] were less likely to deliver with SBAs. Conclusion Intensive investments to recruit and train more skilled birth attendants’ on appropriate delivery care are needed, as well as building a community-based skilled birth attendants’ program to reduce avoidable maternal mortality in South Sudan.

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References

  1. WHO, UNICEF, UNFPA. (2014). The World Bank, The United Nations. Trends in maternal mortality: 1990–2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva, Switzerland.

  2. WHO. (2005). Reducing maternal deaths: The challenge of the new millennium in the African Region. Brazzaville: WHO.

    Google Scholar 

  3. Mengesha, Z. B., Biks, G. A., Ayele, T. A., Tessema, G. A., & Koye, D. N. (2013). Determinants of skilled attendance for delivery in Northwest Ethiopia: A community based nested case control study. BMC Public Health, 13, 130. (PubMed PMID: 23402542. Pubmed Central PMCID: 3577480. English).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Graham, W. J., Bell, J. S., & Bullough, C. H. (2001). Can skilled attendance at delivery reduce maternal mortality in developing countries. Safe Motherhood Strategies: A Review of the Evidence, 17, 97–130.

    Google Scholar 

  5. Ministry of Health (MoH). (2013). National Bureau of Statistics (NBS). The Republic of South Sudan: The Sudan Household Health Survey 2010. Juba: Ministry of Health (MoH).

    Google Scholar 

  6. World Health Organization. (2014). South Sudan Country cooperation strategy at a glance. WHO - Regional Office for Africa: World Health Organization.

    Google Scholar 

  7. UNICEF, WHO, UNFPA. (1997). Guidelines for monitoring the availability and use of obstetric services. New York: UNICEF.

    Google Scholar 

  8. Ministry of Health. (2010). Health strategic plan (2011–2015). Juba: Ministry of Health.

    Google Scholar 

  9. Gupta, N., Maliqi, B., Franca, A., Nyonator, F., Pate, M. A., Sanders, D., et al. (2011). Human resources for maternal, newborn and child health: From measurement and planning to performance for improved health outcomes. Human Resources for Health, 9, 16. (PubMed PMID: 21702913. Pubmed Central PMCID: 3157412.).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ministry of Health, Government of South Suda. (2012). Health sector development plan 2012–2016. Juba: Ministry of Health, Government of South Suda.

    Google Scholar 

  11. Mugo, N., Zwi, A. B., Botfield, J. R., & Steiner, C. (2015). Maternal and Child Health in South Sudan: Priorities for the post-2015 Agenda. SAGE Open, 5(2), 2158244015581190.

    Article  Google Scholar 

  12. Ministry of Health Government of Southern Sudan (MOH-GOSS). (2007). Southern Sudan Commission for Census Statistics and Evaluation (SSCCSE) Southern Sudan Household Health Survey 2006. Juba: Ministry of Health Government of Southern Sudan (MOH-GOSS).

    Google Scholar 

  13. Baldo, M., & Gerais, S. (2008). Is maternal mortality worsening in Sudan. Sudan Medical Journal, 4(2), 1–11.

    Google Scholar 

  14. Dhakal, S., van Teijlingen, E., Raja, E. A., & Dhakal, K. B. (2011). Skilled care at birth among rural women in Nepal: Practice and challenges. Journal of Health, Population and Nutrition, 29(4), 371–378. (Pubmed Central PMCID: 3190368. English).

    Article  Google Scholar 

  15. Paxton, A., Maine, D., Freedman, L., Fry, D., & Lobis, S. (2005). The evidence for emergency obstetric care. International Journal of Gynaecology and Obstetrics, 88(2), 181–193. (PubMed PMID: 15694106).

    Article  CAS  PubMed  Google Scholar 

  16. Doctor, H. V., & Dahiru, T. (2010). Utilization of non-skilled birth attendants in northern Nigeria: A rough terrain to the health-related MDGs. African Journal of Reproductive Health, 14(2), 37–45. (PubMed PMID: 21243917).

    PubMed  Google Scholar 

  17. Ijadunola, K., Ijadunola, M., Esimai, O., & Abiona, T. (2010). New paradigm old thinking: The case for emergency obstetric care in the prevention of maternal mortality in Nigeria. BMC Women’s Health, 10, 6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Baral, Y. R., Lyons, K., Skinner, J., & van Teijlingen, E. R. (2010). Determinants of skilled birth attendants for delivery in Nepal. Kathmandu University Medical Journal, 8(31), 325–332. (PubMed PMID: 22610739. English).

    CAS  Google Scholar 

  19. Gabrysch, S., & Campbell, O. M. R. (2009). Still too far to walk: Literature review of the determinants of delivery service use. Bmc Pregnancy and Childbirth, 9(34), 1–18. (PubMed PMID: WOS:000208106900034. English).

    Google Scholar 

  20. Yanagisawa, S., Oum, S., & Wakai, S. (2006). Determinants of skilled birth attendance in rural Cambodia. Tropical Medicine & International Health, 11(2), 238–251. (PubMed PMID: 16451349. English).

    Article  Google Scholar 

  21. Uganda Bureau of Statistics (UBOS), Macro International Inc. (2006). Uganda Demographic and Health Survey (UDHS) 2006. Calverton, Maryland, USA: UBOS and Macro International Inc.

    Google Scholar 

  22. World Health Organization. (2005). The World health report: 2005: Make every mother and child count: Overview Geneva. Switzerland: World Health Organization.

    Google Scholar 

  23. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does It matter? Journal of Health and Social Behavior, 36(1), 1–10.

    Article  CAS  PubMed  Google Scholar 

  24. Filmer, D., & Pritchett, L. H. (2001). Estimating wealth effects without expenditure data—or tears: An application to educational enrollments in states of India. Demography, 38(1), 115–132. (PubMed PMID: WOS:000167027400009. English).

    CAS  PubMed  Google Scholar 

  25. Nigussie, M., Mariam, D. H., & Mitike, G. (2005). Assessment of safe delivery service utilization among women of childbearing age in north Gondar Zone, North West Ethiopia. Ethiopian Journal of Health Development, 18(3), 145–152.

    Article  Google Scholar 

  26. Ekele, B. A., & Tunau, K. A. (2007). Place of delivery among women who had antenatal care in a teaching hospital. Acta Obstetricia et Gynecologica Scandinavica, 86(5), 627–630. (PubMed PMID: 17464595. English).

    Article  PubMed  Google Scholar 

  27. Navaneetham, K., & Dharmalingam, A. (2002). Utilization of maternal health care services in Southern India. Social Science and Medicine, 55(10), 1849–1869.

    Article  CAS  PubMed  Google Scholar 

  28. New Sudan Centre for Statistics and Evaluation (NSCSE)/UNICEF. (2004). Towards a baseline: Best estimates of social indicators for Southern Sudan. Rumbek: NSCSE.

    Google Scholar 

  29. National Bureau of Statistics (NAB). National Baseline Household Survey. (2009). Report for South Sudan. Juba: National Bureau of Statistics (NAB). National Baseline Household Survey. 2012.

    Google Scholar 

  30. Tayie, F., & Lartey, A. (2008). Antenatal care and pregnancy outcome in Ghana, the importance of women’s education. African Journal of Food, Agriculture, Nutrition and Development, 8(3), 291–303.

    Article  Google Scholar 

  31. Mekonnen, Y., & Mekonnen, A. (2003). Factors influencing the use of maternal healthcare services in Ethiopia. Journal of Health Population and Nutrition, 21(4), 374–382. (PubMed PMID: WOS:000220645900011. English).

    Google Scholar 

  32. Beeckman, K., Louckx, F., & Putman, K. (2013). Content and timing of antenatal care: Predisposing, enabling and pregnancy-related determinants of antenatal care trajectories. The European Journal of Public Health., 23(1), 67–73.

    Article  PubMed  Google Scholar 

  33. Lewis, G. (2003). Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer. British Medical Bulletin, 67(1), 27–37. (PubMed PMID: WOS:000187975600003. English).

    Article  PubMed  Google Scholar 

  34. Abor, P. A., Abekah-Nkrumah, G., Sakyi, K., Adjasi, C. K. D., & Abor, J. (2011). The socio-economic determinants of maternal health care utilization in Ghana. International Journal of Social Economics, 38(7), 628–648.

    Article  Google Scholar 

  35. Celik, Y., & Hotchkiss, D. R. (2000). The socio-economic determinants of maternal health care utilization in Turkey. Social Science and Medicine, 50(12), 1797–1806.

    Article  CAS  PubMed  Google Scholar 

  36. Hailu, M., Gebremariam, A., Alemseged, F., & Deribe, K. (2011). Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS One, 6(6), e21432. (Pubmed Central PMCID: PMC3120869. English).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Karkee, R., Lee, A. H., & Binns, C. W. (2013). Birth preparedness and skilled attendance at birth in Nepal: Implications for achieving millennium development goal 5. Midwifery, 29(10), 1206–1210. (PubMed PMID: WOS:000324751200019. English).

    Article  PubMed  Google Scholar 

  38. Mugo, N. S., Dibley, M. J., & Agho, K. E. (2015). Prevalence and risk factors for non-use of antenatal care visits: Analysis of the 2010 South Sudan household survey. BMC Pregnancy Childbirth, 15, 68. (Pubmed Central PMCID: 4396873).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Duong, D. V., Binns, C. W., & Lee, A. H. (2004). Utilization of delivery services at the primary health care level in rural Vietnam. Social Science & Medicine, 59(12), 2585–2595. (PubMed PMID: WOS:000224945200016. English).

    Article  Google Scholar 

  40. Do, M. (2009). Utilization of skilled birth attendants in public and private sectors in Vietnam. Journal of Biosocial Science, 41(3), 289–308. (PubMed PMID: 19254425. English).

    Article  PubMed  Google Scholar 

  41. Cheung, N. F. (2002). The cultural and social meanings of childbearing for Chinese and Scottish women in Scotland. Midwifery, 18(4), 279–295. (PubMed PMID: 12473443).

    Article  PubMed  Google Scholar 

  42. Word Heath Organization. (2014). Puplic health risk assessment and interventions-conflict and humantrain crises in South Sudan. Geneva: Word Heath Organization.

    Google Scholar 

  43. USAID. (2014). Conflict causes major displacement and destruction of markets, East Africa. Washington, D.C.: USAID.

    Google Scholar 

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Author’s Contributions

NSM and MJD contributed in the study design. NSM and KA performed the analysis and NSM prepared the manuscript. Revision of the manuscript and data analysis advice was provided by MJD and KA. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia

    Ngatho Samuel Mugo & Michael J. Dibley

  2. School of Science and Health, Building (24), University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia

    Kingsley E. Agho

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  1. Ngatho Samuel Mugo
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Correspondence to Ngatho Samuel Mugo.

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Mugo, N.S., Agho, K.E. & Dibley, M.J. Risk Factors for Non-use of Skilled Birth Attendants: Analysis of South Sudan Household Survey, 2010. Matern Child Health J 20, 1266–1279 (2016). https://doi.org/10.1007/s10995-016-1928-x

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