Socio-economic factors associated with maternal health-seeking behaviours among women from poor households in rural Egypt

International Journal for Equity in Health

George B Ploubidis¹  Hania Sholkamy²  Oona MR Campbell³  Lenka Benova³ 

[1] Centre for Longitudinal Studies, Institute of Education, London WC1H 0AL, UK;Social Research Center, American University in Cairo, Cairo, Egypt;Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

关键词: Poverty;    Health-seeking behaviour;    Facility delivery;    Ante-natal care;    Egypt;    Maternal health;   

Others  :  1146247
DOI  :  10.1186/s12939-014-0111-5

 received in 2014-07-18, accepted in 2014-11-03,  发布年份 2014

【 摘 要 】

Introduction

Socio-economic inequalities in basic maternal health interventions exist in Egypt, yet little is known about health-seeking of poor households. This paper assesses levels of maternal health-seeking behaviours in women living in poor households in rural Upper Egypt, and compares these to national averages. Secondly, we construct innovative measures of socio-economic resourcefulness among the rural poor in order to examine the association between the resulting variables and the four dimensions of maternal health-seeking behaviour.

Methods

We analysed a cross-sectional survey conducted in Assiut and Sohag governorates in 2010¿2011 of 2,242 women in households below the poverty line in 65 poorest villages in Egypt. The associations between four latent socio-economic constructs (socio-cultural resourcefulness, economic resourcefulness, dwelling quality and woman¿s status) and receipt of any antenatal care (ANC), regular ANC (four or more visits), facility delivery and private sector delivery for women¿s most recent pregnancy in five years preceding survey were assessed using multivariate logistic regression.

Results

In the sample, 58.5% of women reported using any ANC and 51.1% facility delivery, lower than national coverage (74.2% and 72.4%, respectively). The proportion of ANC users receiving regular ANC was lower (67%) than nationally (91%). Among women delivering in facilities, 18% of women in the poor Upper Egypt sample used private providers (63% nationally). In multivariate analysis, higher economic resourcefulness was associated with higher odds of receiving ANC but with lower odds of facility delivery. Socio-cultural resourcefulness was positively associated with receiving any ANC, regular ANC and facility delivery, whereas it was not associated with private delivery care. Dwelling quality was positively associated with private delivery facility use. Woman¿s status was not independently associated with any of the four behaviours.

Conclusions

Coverage of basic maternal health interventions and utilisation of private providers are lower among rural poor women in Upper Egypt than nationally. Variables capturing socio-cultural resourcefulness and economic resourcefulness were useful predictors of ANC and facility delivery. Further understanding of issues surrounding availability, affordability and quality of maternal health services among the poor is crucial to eliminating inequalities in maternal health coverage in Egypt.

【 授权许可】

   
2014 Benova et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1][http://www.countdown2015mnch.org/documents/2012Report/2012/2012_Egypt.pdf] webcite Countdown to 2015: Building a Future for women and children - the 2012 Report (Egypt). .
• [2]El-Zanaty F, Way A: Egypt Demographic and Health Survey 2008. Ministry of Health, El-Zanaty and Associates, and Macro International, Cairo, Egypt; 2009.
• [3]Rashad A: Catastrophic health expenditure and poverty in Egypt: an analysis of household survey data, MA thesis. American University in Cairo, School of Business; 2012.
• [4]Marmot M: Social determinants of health inequalities. Lancet 2005, 365:1099-1104.
• [5]Marmot M, Bobak M, Davey Smith G: Explanations for social inequalities in health. In Society and Health. Edited by Amick BC, Levine S, Tarlov A, Walsh DC. Oxford University Press, Oxford; 1995:172-210.
• [6]Palloni A, Milesi C, White R, Turner A: Early childhood health, reproduction of economic inequalities and the persistence of health and mortality differentials. Soc Sci Med 2009, 68:1574-1582.
• [7]Adda J, Chandola T, Marmot M: Socio-Economic Status and Health: Causality and Pathways. J Econometrics 2002, 112:57-63.
• [8]Stowasser T, Heiss F, McFadden D, Winter J: ¿Health, wealthy and wise?¿ Revisited: An analysis of the causal pathways from socio-economic status to health. National Bureau of Economic Research, Cambridge, MA; 2011.
• [9]Benova L, Campbell O, Ploubidis G: Socio-Economic Gradients in Maternal and Child Health-Seeking Behaviours in Egypt: Systematic Literature Review and Evidence Synthesis. PLoS One 2014, 9:e93032.
• [10]The most important results of Income, Expenditure and Consumption Survey 2012/2013. CAPMAS, Cairo, Egypt; 2013.
• [11]Hausmann-Muela S, Ribera J, Nyamongo I: Health-seeking behavior and the health system response. Disease Control Priorities Project, Population Reference Bureau, Washington, DC; 2003.
• [12]Kabeer N: Resources, Agency, Achievements: Reflections on the measurement of women¿s empowerment. Dev Change 1999, 30:435-464.
• [13]Sholkamy H: Power, Politics and Development in the Arab Context: Or how can rearing chicks change patriarchy? Development 2010, 53:254-258.
• [14]Kandiyoti D: Bargaining with Patriarchy. Gender Soc 1988, 2:274-290.
• [15]Hoodfar H: Between Marriage and the Market: Intimate Politics and Survival in Cairo. Universtiy of California Press, Berkeley, CA; 1997.
• [16]Nussbaum M: Capabilities as fundamental entitlements: Sen and Social justice. Feminist Econ 2003, 9:33-59.
• [17]Sen A: Development as Freedom. Oxford University Press, Oxford; 1999.
• [18]Randall S, Coast E, Leone T: Cultural constructions of the concept of household in sample surveys. Popul Stud 2011, 65:217-229.
• [19]Agarwal B: ¿Bargaining¿ and Gender Relations: Within and Beyond the Household. Feminist Econ 1997, 3:1-51.
• [20]Chant S: The `Feminisation of Poverty¿ and the `Feminisation¿ of Anti-Poverty Programmes: Room for Revision? J Develop Stud 2008, 44:165-197.
• [21]Roushdy R: Intrahousehold Resource Allocation in Egypt: Does Women¿s Empowerment Lead to Greater Investments in Children?. Population Council, West Asia and North Africa Region, Cairo, Egypt; 2004.
• [22]Lagarde M, Haines A, Palmer N: Conditional Cash Transfers for Improving Uptake of Health Interventions in Low- and Middle-Income Countries. JAMA 2007, 298:1900-1910.
• [23]Medeiros M, Britto T, Veras Soares F: Targeted Cash Transfer Programmes in Brazil: BPC and The Bolsa Familia. International Poverty Centre, United Nations Development Programme, Brasilia, Brazil; 2008.
• [24]Simkhada B, Teijlingen ER, Porter M, Simkhada P: Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008, 61:244-260.
• [25]Gabrysch S, Campbell OM: Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9:34. BioMed Central Full Text
• [26][http:/ / www.inter-disciplinary.net/ wp-content/ uploads/ 2009/ 06/ gowayed_and_benova_hid2009_draft_ma y_29.pdf] webcite Gowayed H, Benova L: This is all Koosa: Health-seeking for children in a Cairo slum: Balancing need, money and mistrust. 2009. . Accessed January 13, 2014.
• [27]Mackian S, Bedri N, Lovel H: Up the garden path and over the edge: where might health-seeking behaviour take us? Health Policy Plan 2004, 19:137-146.
• [28]Gammage S: A menu of options for intra-household poverty assessment. USAID, Washington DC; 2006.
• [29]Bartholomew DJ, Steele F, Moustaki I, Galbraith JI: Analysis of multivariate social science data. Chapman & Hall/CRC Press, Boca Raton, London, New York; 2008.
• [30]Rabe-Hesketh S, Skrondal A: Classical latent variable models for medical research. Stat Methods Med Res 2008, 17:5-32.
• [31]Ichoku HE: On the use of socioeconomic status indicators in the analysis of health inequalities and povery in Africa. J Int Develop 2011, 23:1004-1012.
• [32]Shavers V: Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 2007, 99:1013-1023.
• [33]Lynch J, Kaplan G, Salonen J: Why do poor people behave poorly? Variation in adult health behaviors and psychological characteristics by stages of the socioeconomic life course. Soc Sci Med 1997, 44:809-819.
• [34]Benova L, Campbell OMR, Ploubidis GB: Socio-economic gradients in maternal health-seeking behaviours in Egypt. 2014.
• [35]Boerma JT, Bryce J, Kinfu Y, Axelson H, Victora CG: Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet 2008, 371:1259-1267.
• [36]Thomsen S, Hoa DT, Malqvist M, Sanneving L, Saxena D, Tana S, Yuan B, Byass P: Promoting equity to achieve maternal and child health. Reprod Health Matters 2011, 19:176-182.
• [37]Bustreo F, Say L, Koblinsky M, Pullum TW, Temmerman M, Pablos-Méndez A: Ending preventable maternal deaths: the time is now. Lancet Global Health 2013.
• [38]Khadr Z: Monitoring socioeconomic inequity in maternal health indicators in Egypt: 1995¿2005. Int J Equity Health 2009, 8:38. BioMed Central Full Text
• [39]Mechanic D: Disadvantage, Inequality, And Social Policy. Health Aff 2002, 21:48-59.
• [40]Victora CG, Barros AJ, Axelson H, Bhutta ZA, Chopra M, Franca GV, Kerber K, Kirkwood BR, Newby H, Ronsmans C, Boerma JT: How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys. Lancet 2012, 380:1149-1156.
• [41]Mumtaz Z, Salway S, Bhatti A, McIntyre L: Addressing invisibility, inferiority, and powerlessness to achieve gains in maternal health for ultra-poor women. Lancet 2013, 383:1095-1097.
• [42]Meuwissen LE, Gorter AC, Knottnerus AJ: Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study. J Adolesc Health 2006, 38:56.
• [43]Agha S: Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention. Int J Equity Health 2011, 10:57. BioMed Central Full Text
• [44]Ahmed S, Khan MM: Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Soc Sci Med 2011, 72:1704-1710.
• [45]Steinhardt LC, Aman I, Pakzad I, Kumar B, Singh LP, Peters DH: Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan. Health Policy Plan 2011, 26(Suppl 2):ii92-103.
• [46]De Allegri M, Ridde V, Louis VR, Sarker M, Tiendrebeogo J, Ye M, Muller O, Jahn A: Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy 2011, 99:210-218.
• [47]Fink G, Robyn PJ, Sie A, Sauerborn R: Does health insurance improve health?: Evidence from a randomized community-based insurance rollout in rural Burkina Faso. J Health Econ 2013, 32:1043-1056.
• [48]Smith KV, Sulzbach S: Community-based health insurance and access to maternal health services: evidence from three West African countries. Soc Sci Med 2008, 66:2460-2473.
• [49]Lewycka S, Mwansambo C, Rosato M, Kazembe P, Phiri T, Mganga A, Chapota H, Malamba F, Kainja E, Newell M-L, Greco G, Pulkki-Brännström AM, Skordis-Worrall J, Vergnano S, Osrin D, Costello A: Effect of women¿s groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial. Lancet 2013, 381:1721-1735.
• [50]Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, Houweling TAJ, Fottrell E, Kuddus A, Lewycka S, MacArthur C, Manandhar D, Morrison J, Mwansambo C, Nair N, Nambiar B, Osrin D, Pagel C, Phiri T, Pulkki-Brännström AM, Rosato M, Skordis-Worrall J, Saville N, More NS, Shrestha B, Tripathy P, Wilson A, Costello A: Women¿s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet 2013, 381:1736-1746.
• [51]Sosa-Rubi SG, Walker D, Servan E, Bautista-Arredondo S: Learning effect of a conditional cash transfer programme on poor rural women¿s selection of delivery care in Mexico. Health Policy Plan 2011, 26:496-507.
• [52]Lagarde M, Haines A, Palmer N: Conditional Cash Transfers for Improving Uptake of Health Interventions in Low- and Middle-Income Countries. J Am Med Assoc 2007, 298:1900-1910.
• [53]Morris SS, Flores R, Olinto P, Medina JM: Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 2004, 364:2030-2037.
• [54]Magoma M, Requejo J, Campbell O, Cousens S, Merialdi M, Filippi V: The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial. Trop Med Int Health 2013, 18:435-443.
• [55]Sundari Ravindran TK, Fonn S: Are social franchises contributing to universal access to reproductive health services in low-income countries? Reprod Health Matters 2011, 19:85-101.
• [56]Nijmeijer KJ, Fabbricotti IN, Huijsman R: Is franchising in health care valuable? A systematic review. Health Policy Plan 2013, 29(2):164-176.
• [57]Innovations in Privately Delivered Maternal, Newborn and Child Health: Exploring the Evidence Behind Emerging Practices In Book Innovations in Privately Delivered Maternal, Newborn and Child Health: Exploring the Evidence Behind Emerging Practices. CHMI, Washington DC; 2013.
• [58]Amudhan S, Mani K, Rai SK, Pandav CS, Krishnan A: Effectiveness of demand and supply side interventions in promoting institutional deliveries¿a quasi-experimental trial from rural north India. Int J Epidemiol 2013, 42:769-780.
• [59]Malqvist M, Yuan B, Trygg N, Selling K, Thomsen S: Targeted interventions for improved equity in maternal and child health in low- and middle-income settings: a systematic review and meta-analysis. PLoS One 2013, 8:e66453.