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Losing women along the path to safe motherhood: why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda

Overview of attention for article published in BMC Pregnancy and Childbirth, November 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (85th percentile)
  • High Attention Score compared to outputs of the same age and source (82nd percentile)

Mentioned by

twitter
14 tweeters
facebook
1 Facebook page

Citations

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71 Dimensions

Readers on

mendeley
411 Mendeley
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Title
Losing women along the path to safe motherhood: why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda
Published in
BMC Pregnancy and Childbirth, November 2015
DOI 10.1186/s12884-015-0695-9
Pubmed ID
Authors

Erin Anastasi, Matthias Borchert, Oona M. R. Campbell, Egbert Sondorp, Felix Kaducu, Olivia Hill, Dennis Okeng, Vicki Norah Odong, Isabelle L. Lange

Abstract

Thousands of women and newborns still die preventable deaths from pregnancy and childbirth-related complications in poor settings. Delivery with a skilled birth attendant is a vital intervention for saving lives. Yet many women, particularly where maternal mortality ratios are highest, do not have a skilled birth attendant at delivery. In Uganda, only 58 % of women deliver in a health facility, despite approximately 95 % of women attending antenatal care (ANC). This study aimed to (1) identify key factors underlying the gap between high rates of antenatal care attendance and much lower rates of health-facility delivery; (2) examine the association between advice during antenatal care to deliver at a health facility and actual place of delivery; (3) investigate whether antenatal care services in a post-conflict district of Northern Uganda actively link women to skilled birth attendant services; and (4) make recommendations for policy- and program-relevant implementation research to enhance use of skilled birth attendance services. This study was carried out in Gulu District in 2009. Quantitative and qualitative methods used included: structured antenatal care client entry and exit interviews [n = 139]; semi-structured interviews with women in their homes [n = 36], with health workers [n = 10], and with policymakers [n = 10]; and focus group discussions with women [n = 20], men [n = 20], and traditional birth attendants [n = 20]. Seventy-five percent of antenatal care clients currently pregnant reported they received advice during their last pregnancy to deliver in a health facility, and 58 % of these reported having delivered in a health facility. After adjustment for confounding, women who reported they received advice at antenatal care to deliver at a health facility were significantly more likely (aOR = 2.83 [95 % CI: 1.19-6.75], p = 0.02) to report giving birth in a facility. Despite high antenatal care coverage, a number of demand and supply side barriers deter use of skilled birth attendance services. Primary barriers were: fear of being neglected or maltreated by health workers; long distance and other difficulties in access; poverty, and material requirements for delivery; lack of support from husband/partner; health systems deficiencies such as inadequate staffing/training, work environment, and referral systems; and socio-cultural and gender issues such as preferred birthing position and preference for traditional birth attendants. Initiatives to improve quality of client-provider interaction and respect for women are essential. Financial barriers must be abolished and emergency transport for referrals improved. Simultaneously, supply-side barriers must be addressed, notably ensuring a sufficient number of health workers providing skilled obstetric care in health facilities and creating habitable conditions and enabling environments for them.

Twitter Demographics

The data shown below were collected from the profiles of 14 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 411 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Tanzania, United Republic of 1 <1%
Uganda 1 <1%
Kenya 1 <1%
Brazil 1 <1%
United Kingdom 1 <1%
Unknown 406 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 90 22%
Researcher 56 14%
Student > Ph. D. Student 40 10%
Student > Bachelor 34 8%
Lecturer 31 8%
Other 74 18%
Unknown 86 21%
Readers by discipline Count As %
Nursing and Health Professions 113 27%
Medicine and Dentistry 97 24%
Social Sciences 51 12%
Environmental Science 8 2%
Agricultural and Biological Sciences 6 1%
Other 29 7%
Unknown 107 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 11. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 April 2018.
All research outputs
#2,010,331
of 16,733,947 outputs
Outputs from BMC Pregnancy and Childbirth
#573
of 3,104 outputs
Outputs of similar age
#42,312
of 288,856 outputs
Outputs of similar age from BMC Pregnancy and Childbirth
#55
of 304 outputs
Altmetric has tracked 16,733,947 research outputs across all sources so far. Compared to these this one has done well and is in the 87th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,104 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.4. This one has done well, scoring higher than 81% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 288,856 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 85% of its contemporaries.
We're also able to compare this research output to 304 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 82% of its contemporaries.