MATERNAL MORTALITY RATE AND ASSOCIATED RISK FACTORS: PERCEPTIONS OF BIRTH ATTENDANTS, IN ABUDWAK DISTRICT, GALGUDUD REGION CENTRAL SOMALIA Public

Dualle, Maryan Abbi (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/5h73pw803?locale=fr
Published

Abstract

Abstract

MATERNAL MORTALITY RATE AND ASSOCIATED RISK FACTORS:

PERCEPTIONS OF BIRTH ATTENDANTS, IN ABUDWAK DISTRICT, GALGUDUD REGION CENTRAL SOMALIA

By

Maryan A. Dualle

Background: Maternal mortality is the leading cause of death for women in developing countries. Approximately 289,000 mothers died in the world in 2013, of which 62% occurred in Sub-Saharan Africa. Somalia has the 4th highest maternal mortality ratio (MMR) in the world at 850 maternal deaths per 100,000 live births. There is a paucity of research examining birth attendants' perceptions of maternal mortality and the associated determinants both on a global level as well as within Somalia. The goals of this study are to investigate birth attendants' perceptions of maternal mortality rate and the associated determinants in Abudwak district; to solicit their input on how to improve these determinants; and to compare findings with globally known maternal mortality determinants. An additional goal is to identify other key maternal mortality indicators such as availability of SBAs, birth attendants' educational background, and referral practices of complicated pregnancies.

Methods: A mixed method approach was employed. Purposive sampling was utilized to recruit participants. Observation, closed-ended questionnaires and in-depth semi-structured interview data collection tools were used. Data were analyzed with SPSS data analysis software and manual content analysis.

Results: The majority of the birth attendants in this study are older females, illiterate (76.2%), lived in the community over 10 years (81%), have > 10 years of experience (81%), assisted > 10 births in 2013 (90.5%), have > 5 children (95.2%) and referred (71.4%) complicated pregnancies to a higher level of care. Skilled birth attendants (SBAs) and trained traditional birth attendants (TTBAs) have better pregnancy risk recognition and higher referrals than traditional birth attendants (TBAs). TBAs in this study had no training/apprenticeship before they started practicing. All participants thought maternal mortality is high in Abudwak district and lack of competent health professionals and nutrition have been identified as the top determinants for maternal mortality in Abudwak.

Conclusions: These findings highlight the effect of lack of nutrition on pregnant women from this district; the district's urgent need for competent health professionals; and the importance of training TBAs. More pragmatic strategies that incorporate TBAs in the health system are needed for Somalia and beyond to reduce maternal mortality.

Table of Contents

Table of Contents

Introduction. 10

General background. 10

Research question(s). 13

Problem overview and review of previous research. 14

Maternal causes of death. 15

Determinants of maternal death. 16

Purpose of the study. 31

Significance and rationale. 32

Theoretical framework. 33

Target journal 34

Literature review.. 35

Keywords. 35

Introduction. 35

Summary. 45

Data collection, analysis, and result 46

Methodology. 46

Design. 47

Sampling frame. 47

Sample size. 47

Inclusion and recruitment 48

Procedures. 49

Data analysis. 49

Data management and statistical analysis. 49

Results. 50

Birth attendants' characteristics. 51

Frequency tables 1-11. 52

Birth attendants' perceptions. 55

Different types of birth attendants. 58

Key informants' characteristics. 63

Key informant perceptions. 63

Discussion. 65

Limitations. 73

Conclusion. 74

Future research. 76

Journal article. 77

Introduction. 78

General background. 78

Research question (s). 79

Problem statement 80

Income per capita & health expenditures as percent of GDP. 81

Health care system and health facilities. 81

Health workforce. 82

Empowering girls. 83

Contraceptive use. 84

Harmful cultural practices. 84

Summary. 85

Purpose of the study. 85

Significance. 86

Methodology. 86

Design. 87

Sample size. 87

Inclusion and recruitment 87

Procedures. 87

Data management and statistical analysis. 88

Results. 88

Birth attendants' characteristics. 88

Birth attendants' perceptions. 90

Key informants' characteristics. 91

Key informant perceptions. 91

Discussion. 92

Limitations. 95

Conclusion. 96

Future research. 97

Acknowledgements. 98

Tables. 98

Birth attendants' frequency tables. 98

Key informants' frequency tables. 101

References. 103

Appendices. 106

Appendix A: IRB Approval Letter. 106

Appendix B: Emory University Oral Consent and HIPAA Authorization Script/Information Sheet for a Research Study. 108

Introduction and Study Overview.. 108

Contact Information. 108

Consent. 109

Appendix C: Emory University Oral Consent and HIPAA Authorization Script/Information Sheet for a Research Study. 110

Hor u dhac iyo sharaxada baritaanka. 110

Appendix D: Oral recruitment script 112

Appendix E: Questionnaires. 113

Appendix F: Interview guide. 115

Appendix G: Questionnaire translation. 117

Appendix H: Interview guide translation. 120

Appendix I: Translation authentication letter. 122

References. 122

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