International Health最新文献

{"title":"Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis.","authors":"Jemal Y Hassen, Adera Debella, Addis Eyeberu, Ibsa Mussa","doi":"10.1093/inthealth/ihae015","DOIUrl":"10.1093/inthealth/ihae015","url":null,"abstract":"<p><strong>Background: </strong>Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context.</p><p><strong>Methods: </strong>Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot.</p><p><strong>Results: </strong>This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth.</p><p><strong>Conclusions: </strong>The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"577-591"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial distribution and factors associated with health insurance subscription among women in Ghana.","authors":"Richard Gyan Aboagye, Ebenezer N K Boateng, Yaw Marfo Okyere, Joshua Okyere, Kwamena Sekyi Dickson, Abdul-Aziz Seidu, Bright Opoku Ahinkorah","doi":"10.1093/inthealth/ihad092","DOIUrl":"10.1093/inthealth/ihad092","url":null,"abstract":"<p><strong>Background: </strong>This study examined the spatial distribution and factors associated with health insurance subscription among women in Ghana.</p><p><strong>Methods: </strong>We analysed a representative sample of 9380 women aged 15-49 y from the 2014 Ghana Demographic and Health Survey. Descriptive and multilevel regression analyses were performed. The study also employed spatial analysis techniques, including spatial autocorrelation, hotspot analysis, cluster and outlier analysis, as well as geographically weighted regression to explore the geographic distribution and predictors of non-subscription to health insurance.</p><p><strong>Results: </strong>The analysis revealed a moderately high prevalence of health insurance subscription among women in Ghana (62.4%). The spatial analyses indicated substantial variations in health insurance subscription across different regions in Ghana. The coastal and middle zones reported higher rates of non-subscription compared with the northern zone. We observed that young women (aged 20-24 y) had a lower likelihood of subscribing compared with adolescent girls (aged 15-19 y). Also, higher educational attainment, listening to the radio, being in a marital union and higher wealth status were positively associated with health insurance subscription.</p><p><strong>Conclusions: </strong>The study calls for targeted interventions and policies to promote equitable access to healthcare services, focusing on improving health infrastructure in coastal and middle zones, educational campaigns for individuals with lower education levels, leveraging media platforms for health insurance awareness and implementing equitable and affordable processes for individuals in poorer households.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"610-624"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal pain management practice in the neonatal intensive care unit of public hospitals: a survey of healthcare providers in eastern Ethiopia.","authors":"Sinetibeb Mesfin Kebede, Meron Degefa, Tamirat Getachew, Magarsa Lami, Barkot Tadesse, Habtamu Bekele","doi":"10.1093/inthealth/ihad095","DOIUrl":"10.1093/inthealth/ihad095","url":null,"abstract":"<p><strong>Background: </strong>Newborns experience multiple painful and stressful procedures during their hospitalization in neonatal intensive care units (NICUs). Repeated or untreated pain can have negative consequences for the health and development of newborns. Despite the growing knowledge of pain assessment and intervention, several studies have shown that the practice of neonatal pain management among healthcare providers is poor. Therefore, data regarding neonatal pain management practice and affecting factors are essential for taking appropriate actions. This study assessed neonatal pain management practice and associated factors among healthcare providers working in the NICUs of public hospitals in eastern Ethiopia from 1 January to 28 February 2022.</p><p><strong>Methods: </strong>An institution-based cross-sectional study design was used among 372 randomly selected healthcare providers working in the NICUs of public hospitals in eastern Ethiopia. Data were collected using a pre-tested structured self-administered questionnaire and an observation checklist. The collected data were reviewed, coded and entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis. Bivariate and multivariable logistic regression were used to identify the associations between outcome and predictor variables at a 95% confidence level and P-values <0.05 were considered statistically significant.</p><p><strong>Results: </strong>The study found that 185 (53.9%; 95% confidence interval [CI] 48.4 to 59.2) of the 343 respondents had good neonatal pain management practice with a mean of 11.38 (standard deviation 3.64). Receipt of in-service training in neonatal pain management (adjusted odds ratio [AOR] 2.12 [95% CI 1.15 to 3.91]), availability of protocols and guidelines in the NICUs (AOR 2.94 [95% CI 1.74 to 4.91]) and accessibility of analgesics in the NICUs (AOR 4.302 [95% CI 2.46 to 7.53]) were significantly associated with good neonatal pain management practice.</p><p><strong>Conclusions: </strong>The overall practice of healthcare providers in neonatal pain management in public hospitals in eastern Ethiopia is relatively high compared with previous studies conducted in Ethiopia. Improving the availability of analgesics as well as neonatal pain management protocols and guidelines in NICUs will aid in the promotion of good neonatal pain management practices. In addition, providing ongoing in-service training on neonatal pain management will allow healthcare providers to better care for newborns in pain.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"625-635"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instituting coronavirus disease 2019 testing: opportunities and challenges of molecular laboratory diagnosis in a Southern Nigerian teaching hospital.","authors":"Iriagbonse I Osaigbovo, Isaac O Igbarumah, Darlington E Obaseki","doi":"10.1093/inthealth/ihae023","DOIUrl":"10.1093/inthealth/ihae023","url":null,"abstract":"<p><p>The coronavirus disease 2019 pandemic emphasised the importance of laboratory preparedness, including molecular diagnostic capacity, in the control of infectious disease outbreaks. This article reflects on diagnostic capacity-building opportunities presented by the pandemic, the challenges experienced along the way and the lessons learned from the perspective of a university teaching hospital in Southern Nigeria. We advocate for these lessons to inform strategic planning for laboratory preparedness at subnational, national and continental levels.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"573-576"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood donation practices, processing and utilisation of blood components in government tertiary hospitals in Nigeria: a multicentre cooperative study.","authors":"Garba Umar, Ibrahim Abdulqadir, Ngozi Ugwu, Titilope Adeyemo, Nabila Yau, Abdulazziz Hassan, John Olaniyi, Abubakar Musa, Sharafa Abubakar, Muhammad Ndakotsu, Jasini James, Chika Uche, Awwal Musa, Chikadibia Ukoma, Benedict Nwogoh, Ekaete David, Angela Ugwu, Chizoba Nwankwo, Olaitan Omokanye, Aisha Abba, Temilola Owojuyigbe, Mujtabba Isyaku, Esther Obi, Ezra Jatau, Timothy Ekwere, Rashidat Oladosu-Olayiwola, Hezekiah Isah, Sirajo Diggi, Alexander Nwannadi, Saleh Yuguda, Obinna Iheanacho, Hadiza Tikau, Ibijola Adeleke, Mabel Ekanem, Anazoeze Madu, Augustina Ikusemoro, Celestine Chukwu, Amal Galadanci, Okon Bassey, Theresa Otu, Obineche Agwu, Patrick Osho, Aisha Gwarzo, Sadiya Hassan, Adepoju Majeed, Anas Umar, Habib Abubakar, Mohamed Gimba, Michael Ugbor, Abdulmalik Ali, Clara Ajuba","doi":"10.1093/inthealth/ihad105","DOIUrl":"10.1093/inthealth/ihad105","url":null,"abstract":"<p><strong>Background: </strong>Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to determine blood donation practices, processing and utilization of blood components across government tertiary hospitals (THs) in Nigeria.</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study done in Nigeria in June-July 2020. Data were analysed with SPSS version 21.0.</p><p><strong>Results: </strong>Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23 [46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The manual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely perform extended red cell typing. The average time to process routine, emergency and uncross-matched requests were a mean of 109.58±79.76 min (range 45.00-360.00), 41.62±25.23 (10.00-240.00) and 11.09±4.92 (2.00-20.00), respectively.</p><p><strong>Conclusion: </strong>Facilities for blood component preparation were not widely available. Concerned government authorities should provide facilities for blood component preparation.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"636-641"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92157075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to: Uptake and challenges with daily oral pre-exposure prophylaxis among men who have sex with men and transgender women, suburban Yangon, Myanmar.","authors":"","doi":"10.1093/inthealth/ihae053","DOIUrl":"10.1093/inthealth/ihae053","url":null,"abstract":"","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"678"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of a novel neonatal warming device in Malawi: an implementation science study.","authors":"Mc Geofrey Mvula, Alejandro Frade Garcia, Lemekeza Namwali, Beatrice Lydia Matanje, Isaac Mphande, Fabien Munyaneza, Sitalire Kapira, Anne Hansen","doi":"10.1093/inthealth/ihad114","DOIUrl":"10.1093/inthealth/ihad114","url":null,"abstract":"<p><strong>Background: </strong>Neonatal hypothermia significantly contributes to infant morbidity and mortality in low-resource settings like Malawi. Kangaroo mother care (KMC) is essential but faces challenges in providing continuous thermal support. The Dream Warmer is a neonatal warming device that was developed to complement KMC. We studied its implementation outside a research environment.</p><p><strong>Methods: </strong>Using an implementation science approach, we conducted a prospective interventional cohort study in two hospitals and four health centres in Malawi. Through audits and surveys, we assessed the effect of the Dream Warmer on neonatal hypothermia as well as healthcare provider (HCP) and parent attitudes regarding thermoregulation and related issues.</p><p><strong>Results: </strong>The Dream Warmer raised no safety concerns and effectively treated hypothermia in 90% of uses. It was positively received by HCPs and parents, who reported it had a favourable effect on the care of small and sick newborns. Challenges identified included a scarcity of water and electricity, lack of availability of the device and HCPs forgetting to prepare it in advance of need or to use it when indicated. Feedback for future training was obtained. The Dream Warmer's strong safety and effectiveness performance is consistent with results from strict research studies. Training materials can be adapted to optimize integration into daily practice and provide educational content for parents.</p><p><strong>Conclusions: </strong>The Dream Warmer is a safe and effective device to treat neonatal hypothermia, particularly when KMC is insufficient. We gained an understanding of how to optimize implementation through robust HCP and family education to help combat hypothermia.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"592-601"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck circumference as a predictor of all-cause mortality in middle-aged and older adults in rural Ecuador.","authors":"Oscar H Del Brutto, Denisse A Rumbea, Maitri Patel, Robertino M Mera","doi":"10.1093/inthealth/ihad119","DOIUrl":"10.1093/inthealth/ihad119","url":null,"abstract":"<p><strong>Background: </strong>Neck circumference (NC) has been associated with mortality secondary to cardiovascular diseases and other conditions. However, information on this association in the population at large is limited. We aimed to assess this association in community dwellers living in rural Ecuador.</p><p><strong>Methods: </strong>Individuals aged ≥40 y who were enrolled in the population-based Three Villages Study cohort were prospectively followed to estimate mortality risk according to baseline measurements of NC, after adjusting for relevant confounders.</p><p><strong>Results: </strong>Analysis included 1521 individuals followed for a mean of 6.4±3.4 y. Mean NC was 36.2±3.7 cm, with 509 (33%) individuals allocated to the first (25-34 cm), 319 (21%) to the second (36-37 cm), 417 (27%) to the third (37-39 cm) and 276 (18%) to the fourth (40-50 cm) quartile. A total of 211 (14%) individuals died during the follow-up. Overall, the crude mortality rate was 2.3 per 100 person-years, which increased to 5.63 for those in the fourth NC quartile. An adjusted Cox-proportional hazards model showed that individuals in the fourth quartile of NC had higher mortality risk compared with the first quartile (HR: 2.98; 95% CI 1.77 to 5.02).</p><p><strong>Conclusion: </strong>Larger NC increases mortality risk in middle-aged and older adults of indigenous ancestry living in rural Ecuador.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"664-669"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, inequality and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 years.","authors":"Md Sabbir Ahmed, Safayet Khan, Mansura Islam, Md Irteja Islam, Md Musharraf Hossain, Bayezid Khan, Fakir Md Yunus","doi":"10.1093/inthealth/ihae012","DOIUrl":"10.1093/inthealth/ihae012","url":null,"abstract":"<p><strong>Background: </strong>The objective of the current study was to estimate the prevalence and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 y and to identify whether wealth-related inequality exists for overweight/obesity among Bangladeshi older adolescents.</p><p><strong>Methods: </strong>We analyzed publicly available national representative secondary data from the 2019-2020 Bangladesh Adolescent Health and Wellbeing Survey. This cross-sectional survey was carried out among 18 249 adolescents aged 15-19 y regardless of their marital status using a two-stage stratified sampling technique (the data of 9128 eligible adolescents were included in this analysis). The WHO reference population for body mass index-for-age (1+Z score) was considered as overweight/obesity.</p><p><strong>Results: </strong>We found that girls had significantly (p<0.05) higher prevalence of overweight/obesity (11.63%) than boys (8.25%); however, their biological sex as well their age were not significantly associated with higher odds of overweight/obesity. Those who were in their higher grade (grade 11 and higher) in the school and had been exposed to media were more likely (1.67 and 1.39 times, respectively) to be overweight/obesity compared with primary grade (0-5) and those who experienced no media exposure, respectively. Inequality analysis revealed that adolescents belonging to wealthy households had significantly higher rates of overweight/obesity than those in poorer households (concentration index=0.093).</p><p><strong>Conclusions: </strong>The study exhibited the multifaceted nature of overweight/obesity among Bangladeshi older teenagers, revealing that their school grade, exposure to media content and wealth-related inequality emerged as significant contributing factors. The findings underscore the urgent need for targeted interventions and public health strategies to address the escalating burden of overweight and obesity in this age group.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"670-677"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multilevel analysis of social determinants of skilled birth attendant utilisation among married and cohabiting women of Madagascar.","authors":"Ebenezer Kwesi Armah-Ansah, Benedicta Bawa, John Dindas, Eugene Budu, Bright Opoku Ahinkorah, Edward Kwabena Ameyaw","doi":"10.1093/inthealth/ihad108","DOIUrl":"10.1093/inthealth/ihad108","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality ratio (MMR) in Madagascar is 392 deaths per 100 000 live births, and this is a major public health concern. One of the strategies for reducing MMR and achieving target 3.1 of the Sustainable Development Goals (i.e. reducing the global MMR below 70 per 100 000 live births) is the utilisation of skilled birth attendants (SBAs). This analysis examined the prevalence and social determinants of SBA utilisation among married and cohabiting women of Madagascar.</p><p><strong>Methods: </strong>Data from the 2021 Madagascar Demographic and Health Surveys was analysed on a weighted sample of 6997 married and cohabiting women. A multilevel regression was carried out to determine the social determinants of utilising SBAs. The results are presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and a p-value <0.05 to determine the significant associations.</p><p><strong>Results: </strong>The prevalence of SBAs among married and cohabiting women of Madagascar was 64.4% (95% CI 0.62 to 0.68). In model 3 of the multilevel regression, women 35-39 y of age (adjusted OR [aOR] 1.86 [95% CI 1.30 to 2.60]), women with secondary/higher education (aOR 1.67 [95% CI 1.32 to 2.10]), women whose partners had secondary/higher education (aOR 1.58 [95% CI 1.25 to 1.99]), cohabiting women (aOR 1.33 [95% CI 1.07 to 1.65]), women who had four or more antenatal care visits (aOR  2.05 [95% CI 1.79 to 2.35]), female household head (aOR 1.44 [95% CI 1.06 to 1.95]), Muslims (aOR 1.58 [95% CI 0.71 to 3.53]), those of the richest wealth index (aOR 4.32 [95% CI 2.93 to 6.36]) and women who lived in communities with high literacy levels (aOR 2.17 [95% CI 1.57 to 3.00]) had higher odds of utilisation of SBA.</p><p><strong>Conclusion: </strong>This current analysis revealed low SBA utilisation among married and cohabiting women in Madagascar. The analysis points to the fact that understaffing and inaccessibility of health facilities remain major contributors to the low utilisation of SBAs. The findings call on the government and stakeholders in Madagascar to consider implementing programs that will empower women and focus on disadvantaged groups. These programs could include providing free maternal healthcare services to all pregnant women and intensifying health education programs that target women and their partners with no formal education.</p>","PeriodicalId":49060,"journal":{"name":"International Health","volume":" ","pages":"642-652"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}