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The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa

Facility births and antenatal care (ANC) are key to improving maternal health. This study evaluates the relationship between physician and nurse/midwife densities and the use of key maternal health services in sub-Saharan Africa (SSA). We matched individual-level maternal health service indicators f...

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Autores principales: Rosser, Joelle I., Aluri, Kelly Z., Kempinsky, Arielle, Richardson, Shannon, Bendavid, Eran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8922518/
https://www.ncbi.nlm.nih.gov/pubmed/35026729
http://dx.doi.org/10.4269/ajtmh.21-0727
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author Rosser, Joelle I.
Aluri, Kelly Z.
Kempinsky, Arielle
Richardson, Shannon
Bendavid, Eran
author_facet Rosser, Joelle I.
Aluri, Kelly Z.
Kempinsky, Arielle
Richardson, Shannon
Bendavid, Eran
author_sort Rosser, Joelle I.
collection PubMed
description Facility births and antenatal care (ANC) are key to improving maternal health. This study evaluates the relationship between physician and nurse/midwife densities and the use of key maternal health services in sub-Saharan Africa (SSA). We matched individual-level maternal health service indicators from Demographic and Health Surveys between 2008 and 2017, to country-level physician and nurse/midwife per-capita densities, across 35 SSA countries. We performed univariate and multivariate probit regression analyses to evaluate the association between healthcare worker (HCW) densities and facility births as our primary outcome and additional ANC services as secondary outcomes. We controlled for established maternal health predictors, including literacy, child marriage, reported problems accessing healthcare, GDP per capita, political instability, and government effectiveness scores. HCW density across SSA was low at 0.13 physicians and 0.91 nurses/midwives per 1,000 people, compared with 2010 worldwide mean densities of 1.33 and 3.07, respectively. The probability of facility birth increased by 9.8% (95% CI: 2.1–17.5%) for every additional physician per 1,000 people and 8.9% (95% CI: 7.1–9.7%) for every additional nurse/midwife per 1,000 people. HCW densities were also associated with increased likelihood of ANC by the respective provider type, and with antenatal testing for preeclampsia (urine and blood pressure checks). Other ANC services demonstrated variable relationships with HCW densities based on provider type. In 35 SSA countries, HCW density was positively associated with many key measures of maternal health service utilization including facility birth and ANC testing for preeclampsia.
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spelling pubmed-89225182022-03-21 The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa Rosser, Joelle I. Aluri, Kelly Z. Kempinsky, Arielle Richardson, Shannon Bendavid, Eran Am J Trop Med Hyg Research Article Facility births and antenatal care (ANC) are key to improving maternal health. This study evaluates the relationship between physician and nurse/midwife densities and the use of key maternal health services in sub-Saharan Africa (SSA). We matched individual-level maternal health service indicators from Demographic and Health Surveys between 2008 and 2017, to country-level physician and nurse/midwife per-capita densities, across 35 SSA countries. We performed univariate and multivariate probit regression analyses to evaluate the association between healthcare worker (HCW) densities and facility births as our primary outcome and additional ANC services as secondary outcomes. We controlled for established maternal health predictors, including literacy, child marriage, reported problems accessing healthcare, GDP per capita, political instability, and government effectiveness scores. HCW density across SSA was low at 0.13 physicians and 0.91 nurses/midwives per 1,000 people, compared with 2010 worldwide mean densities of 1.33 and 3.07, respectively. The probability of facility birth increased by 9.8% (95% CI: 2.1–17.5%) for every additional physician per 1,000 people and 8.9% (95% CI: 7.1–9.7%) for every additional nurse/midwife per 1,000 people. HCW densities were also associated with increased likelihood of ANC by the respective provider type, and with antenatal testing for preeclampsia (urine and blood pressure checks). Other ANC services demonstrated variable relationships with HCW densities based on provider type. In 35 SSA countries, HCW density was positively associated with many key measures of maternal health service utilization including facility birth and ANC testing for preeclampsia. The American Society of Tropical Medicine and Hygiene 2022-03 2022-01-17 /pmc/articles/PMC8922518/ /pubmed/35026729 http://dx.doi.org/10.4269/ajtmh.21-0727 Text en © 2022 by The American Society of Tropical Medicine and Hygiene https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rosser, Joelle I.
Aluri, Kelly Z.
Kempinsky, Arielle
Richardson, Shannon
Bendavid, Eran
The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title_full The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title_fullStr The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title_full_unstemmed The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title_short The Effect of Healthcare Worker Density on Maternal Health Service Utilization in Sub-Saharan Africa
title_sort effect of healthcare worker density on maternal health service utilization in sub-saharan africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8922518/
https://www.ncbi.nlm.nih.gov/pubmed/35026729
http://dx.doi.org/10.4269/ajtmh.21-0727
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