Post on 09-Feb-2016
description
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What does access to health care among the urban poor mean?
Factors associated with use of “appropriate” maternal health services in the slum
settlements of Nairobi, Kenya
By Jean-Christophe Fotso, Alex Ezeh, Nyovani Madise,Abdhalah Ziraba and Reuben Ogollah
INDEPTH Network AGMNairobi, September 3-7, 2007
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Background: Maternal Deaths and Mortality Ratio(Deaths per 100,000 live births)
Source: WHO/UNICEF/UNFPA, 2004
529,000 deaths 527,000 deaths
247,000 deaths 11,000 deaths
0
200
400
600
800
1,000
1,200
World Developingcountries
Sub-SaharanAfrica
Kenya
Mat
erna
l Mor
talit
y R
atio
(per
100
,000
)
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Background (Ct’d)
Kenya resolved to reduce MMR by 3/4 by 2015. Kenya NRHSDS (1997-2010)
• Safe motherhood and child survival• Key pillars include clean and safe delivery.
Urbanization, poverty and health inequities in SSA• More than 50% of SSA population will be living in urban
areas by 2030.• About 7 out 10 inhabitants of Nairobi live in slums.• Growing inequities between the poor and the non-poor.• MDG-5: Attention to the growing urban poor populations
in SSA.
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Background (Ct’d) In the slums co-exist:
• Private, sub-standard and often unlicensed clinics, with
• Well equipped public, religious or large NGO facilities, generally in the outskirts of the slums.
Preferable to deliver at home or at TBA’s?Misleading not to treat the two categories of HFs separately.
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Objectives
Improve understanding of maternity health seeking behaviors in resource-deprived urban settings • Identify the factors which influence the choice of
place of delivery among the urban poor;• Distinction between sub-standard and “appropriate”
health facilities;• Formulate recommendations aimed at improving
maternal health.
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Data and Methods Data from a DSS-nested MHP
• 1,927 who had pregnancy outcomes in 2004-2005• 25 HFs providing obstetric care
Dependent variable: Place of delivery• Public/religious/large NGO HF: coded 2• Private, sub-standard HF: coded 1• Not HF (home, TBA …): coded 0
Covariates• Socioeconomic variables• Biodemographic and health-related covariates• Slum residence (Korogocho, Viwandani)
Methods• Descriptive analysis• Ordered logistic - Partial proportional odds models
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Health facility deliveries in Kenya
(1): All types of HFs; (2): Appropriate HFs
70
48
78
33
0
10
20
30
40
50
60
70
80
90
Perc
enta
ge o
f wom
en (%
)
Nairobi slums (1) Nairobi slums (2) Nairobi Rural Kenya
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Multivariate results: Socioeconomic & Residence
†p<0.10; *p<0.05; **p<0.01
Education (Ref: Primary)None -0.275 0.034Secondary or higher 0.321 ** --
Working status (Ref: Not working)Currently working 0.330 ** -0.039
Ethnicity (Ref: Kikuyu)Kamba -0.968 ** --Luhya -1.463 ** --Luo -1.758 ** --Others -0.464 ** --
Household wealth (Ref: Poorest)Middle 0.238 * --Least poor 0.788 ** 0.354 **
Husband/partner's education (Ref: Primary)None/not in union 0.366 ** --Secondary or higher 0.576 ** --
Slum residenceViwandani -0.704 ** -1.839 **
All types of HF vs Not
HF
Appropriate HF vs (Inap or not HF)
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Multivariate results: Biodemo and health-related
†p<0.10; *p<0.05; **p<0.01
Parity (Ref: 1)2-3 -0.646 ** --4+ -0.844 ** --
Wanted index pregnancy then (Ref: No)Yes 0.203 † --
Antenatal care visits (Ref: 2-3)0-1 -0.636 ** -0.342 *
4+ 0.134 --Advised to deliver with a health professional (Ref: No)
Yes 0.403 ** --Age (Ref: 20-24 years)
<20 0.120 --25-29 0.075 0.326 *
30+ -0.236 0.277 †
All types of HF vs Not
HF
Appropriate HF vs (Inap or not HF)
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Multivariate results: InteractionsInteraction between Area of residence and Maternal education
Interaction between Area of residence and Household wealth
Interaction between Household wealth and Health advice
Interaction between Maternal education and Health advice
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Korogocho Viwandani
None vs (Inap & App)
Odd
s R
atio
None Primary Secondary+
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Korogocho Viwandani
None vs (Inap & App)
Odd
s Rat
io
Poorest Middle Least poor
0.0
0.5
1.0
1.5
2.0
2.5
3.0
None Primary Secondary
None vs (Inap & App)
Odd
s R
atio
Not advised Advised
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Poorest Middle Least poor
None vs (Inap & App)
Odd
s Rat
io
Not advised Advised
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Recommendations Provision of health services to the urban poor:
• Registration of private facilities and clinics – minimum criteria• Provision of public health services in/near the slums• Improvement of the quality of care (delays, attitude of staff) in
public HFs
Health education campaigns• Antenatal care attendance• Advice/counseling on delivery and postnatal care, and other
pregnancy-related issues• Target groups:
Poorest, not educated, not working women Higher parity women
Access to FP and RH services
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Acknowledgements:• The World Bank• The Wellcome Trust
Thank you