The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.
Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study
Open accessAbstract
To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB.
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A prospective cohort study in rural Rwanda found that distance from childbirth services predicts the use of skilled birth attendants but does not affect the number of visits women make to antenatal care facilities.
“a prospective cohort study in rural Rwanda found that distance from childbirth services predicts the use of skilled birth attendants but does not affect the number of visits women make to antenatal care facilities [4]”
From Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study (2021) · cites this paper as [4]
The Results report that distance to the delivery site predicted skilled attendance at birth. The Discussion says distance to the ANC site was not a significant predictor of having at least three ANC visits; the Methods confirm visits were analyzed using that threshold. This does not establish that distance has no effect on the number of visits women make. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPeople who must travel far distances to receive care may be more prone toward ceasing regular visits, with their final pregnancy outcome never being documented.
“Finally, people who must travel far distances to receive care may be more prone toward ceasing regular visits, with their final pregnancy outcome never being documented [4, 13].”
From Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study (2021) · cites this paper as [4]
The Results report that women with fewer than three antenatal visits lived farther from the ANC site on average, but distance was not an independent predictor of visit frequency. The Results also report 13 women lost to follow-up; the paper does not link those losses, or undocumented pregnancy outcomes, to travel distance. (LLM, conf=0.84)
Experimental — accuracy not yet measuredGeographic distance can be a major barrier to achieving care throughout the course of pregnancy.
“Geographic distance can be a major barrier to achieving care throughout the course of pregnancy.”
From Distance matters: barriers to antenatal care and safe childbirth in a migrant population on the Thailand-Myanmar border from 2007 to 2015, a pregnancy cohort study (2021) · cites this paper as [4]
The Discussion reports that women living farther from a delivery site were less likely to have skilled attendance at birth, supporting distance as a barrier to delivery care. It also reports that distance to an antenatal-care site did not significantly predict antenatal-care visits, so the paper does not establish distance as a barrier throughout pregnancy. Page numbers were not available in the supplied passages. (LLM, conf=0.86)
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Cites
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Reduction of Maternal Mortality
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Why Do At-Risk Mothers Fail to Reach Referral Level? Barriers beyond Distance and Cost
Kowalewski, M., Jahn, A., & Kimatta, S. S. (2000) · African Journal of Reproductive Health · doi:10.2307/3583247 · Cited by 100
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Magadi, M. A., Diamond, I. D., & RODRIGUES, R. D. N. (2000) · Biodemography and Social Biology · doi:10.1080/19485565.2000.9989017 · Cited by 55
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Impact of organizational change on the delivery of reproductive services: a review of the literature
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Steinbrook, E., Min, M. C., Kajeechiwa, L., Wiladphaingern, J., Paw, M. K., Pimanpanarak, M. P. J., Hiranloetthanyakit, W., Min, A. M., Tun, N. W., Gilder, M. E., et al. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-04276-5 · Cited by 46
Metadata
- Authors
- Nathan, L. M., Shi, Q., Plewniak, K., Zhang, C., Nsabimana, D., Sklar, M., Mutimura, E., Merkatz, I. R., Einstein, M. H., & Anastos, K.
- Affiliations
- Albert Einstein College of Medicine (US)
- New York Medical College (US)
- Corresponding author
- Nathan, Lisa M.
- Venue
- Maternal and Child Health Journal
- Published
- 2015-02-05
- Volume
- 19
- Issue
- 9
- Pages
- 1949-1955
- ISSN
- 1092-7875 (ISSN-L)
- 1573-6628
- PMC
- PMC4522213
- OpenAlex
- W2051811736
- Cited by
- 20
- References
- 12
- Citations by year
- 2023: 1 · 2021: 2 · 2020: 3 · 2019: 6 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 1
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Maternal and Child Health Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Georgia Clinical and Translational Science Alliance
- National Institutes of Health (KL2TR000088, UL1TR001073, UL1TR000086)
- National Institute of Allergy and Infectious Diseases (U01AI096299)
- National Center for Research Resources (TL1RR000087)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- decentralization of health services, antenatal care utilization, intrapartum care, rural Rwanda, access to maternal health services, distance to health facility
- MeSH terms
- Adolescent, Clinical Competence, Female, Humans, Health Knowledge, Attitudes, Practice, Maternal Health Services, Politics, Pregnancy, Prenatal Care, Prospective Studies, Rural Population, Rwanda, Cohort Studies, Parturition, Young Adult
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