Utilization of Delivery Services at the Primary Health Care Level in Rural Vietnam

Program for Appropriate Technology in Health, 5th Floor, 57 Quang Trung Street, Hanoi, Viet Nam.
Social Science & Medicine (Impact Factor: 2.89). 01/2005; 59(12):2585-95. DOI: 10.1016/j.socscimed.2004.04.007
Source: PubMed


The objective of this study is to investigate factors that influence the utilization of delivery services at the primary health care level in rural Vietnam. A quantitative survey was conducted amongst 200 women who had given birth within the past 3 months. Focus group discussions and in-depth-interviews were then undertaken using the attitudes--social influence--self-efficacy model to obtain complementary information on the delivery decision. The results show that client-perceived quality of services and socio-cultural and economic factors, rather than geographical access, can affect the utilization of delivery services. It is therefore important to improve the cost-efficiency of the health care network, and delivery services should be provided in a client-oriented manner taking into account economic, social and cultural factors.

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Available from: Dat Van Duong, Apr 21, 2014
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    • "Cultural inappropriateness of care, disrespectful and inhumane services, and lack of emotional support, can deter them from accessing obstetric care [13-16]. On the other hand, positive client perception of doctor and nurse skills can increase utilisation of delivery services [17,18]. Support in the form of comfort, reassurance and praise during childbirth is particularly beneficial [19]. "
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    ABSTRACT: In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.
    BMC Pregnancy and Childbirth 01/2014; 14(1):45. DOI:10.1186/1471-2393-14-45 · 2.19 Impact Factor
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    • "Another barrier stemmed from the reported negative attitudes of HCWs to men’s participation in maternity care, which appeared to reinforce marginalisation of men and the notion that pregnancy care is a female domain. Negative staff attitude as an obstacle to the utilisation of facility-based ANC and delivery care has been described in other settings [40,41]. Some participants reported a reluctance to accompany their wives for fear of being ignored or chastised by HCWs. "
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    ABSTRACT: Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. Studies suggest that the participation of men in antenatal and delivery care is associated with better health care seeking behaviour, yet many reproductive health programs do not facilitate their involvement. This qualitative study conducted in rural Western Kenya, explored men's perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement. Eight focus group discussions were conducted with 68 married men between 20-65 years of age in May 2011. Participants were of the Luo ethnic group residing in Asembo, western Kenya. The area has a high HIV-prevalence and polygamy is common. A topic guide was used to guide the discussions and a thematic framework approach for data analysis. Overall, men were positive in their views of antenatal and delivery care, as decision makers they often encouraged, some even 'forced', their wives to attend for antenatal or delivery care. Many reasons why it was beneficial to accompany their wives were provided, yet few did this in practice unless there was a clinical complication. The three main barriers relating to cultural norms identified were: 1) pregnancy support was considered a female role; and the male role that of provider; 2) negative health care worker attitudes towards men's participation, and 3) couple unfriendly antenatal and delivery unit infrastructure. Although men reported to facilitate their wives' utilisation of antenatal and delivery care services, this does not translate to practice as adherence to antenatal-care schedules and facility based delivery is generally poor. Equally, reasons proffered why they should accompany their wives are not carried through into practice, with barriers outweighing facilitators. Recommendations to improve men involvement and potentially increase services utilisation include awareness campaigns targeting men, exploring promotion of joint HIV testing and counselling, staff training, and design of couple friendly antenatal and delivery units.
    BMC Pregnancy and Childbirth 06/2013; 13(1):134. DOI:10.1186/1471-2393-13-134 · 2.19 Impact Factor
    • "In northern Nigeria, studies have been carried out to determine the levels of utilisation of MHS and to identify the factors that influence it.12–15 However, most of these studies appeared to have used only close-ended questions, which usually have a limitation in such studies.16 Therefore, this study was conducted to determine, from the mothers' perspective, barriers to utilisation of MHS in a semi-urban community in northern Nigeria vis-à-vis the changes that they believe will improve these services. "
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    ABSTRACT: Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. A cross-sectional study of 150 mothers, selected through multistage technique, was conducted. Data were collected using a structured interviewer-administered questionnaire, and analysed using SPSS statistics 17.0. Only 2.7% utilised preconception service, 98.7% antenatal care service (ANC), 24.0% delivery, 35.3% postnatal care and 14.0% utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57% (CI = 47.4-66.1)) and negative provider attitude (23.7% (CI = 16.4-32.7)). For non-utilisation of postnatal care, the major reasons were also not having a postnatal complication in the past (60.8% (CI = 50.4-70.4)) and negative provider attitude (27.8% (CI = 19.4-38.0)). As for non-utilisation of family planning service, the major reason was desire to have more children (32.6% (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0%) were aware of preconception care in the first place and only 2 (1.3%) were not using ANC. Despite living near a health facility, most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services, bring it closer to the mothers and make it more affordable, there is a more pressing need to improve its quality, especially through the alleviation of negative attitude of health care providers.
    Journal of the Nigeria Medical Association 03/2013; 54(1):27-32. DOI:10.4103/0300-1652.108890
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