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Utilization of Maternal Health Care Services in Rural Mali: The Role of Traditional Values

Bulambo, Henriette Kazadi (2012)
Master's Thesis (60 pages)
Committee Chair / Thesis Adviser: Stephenson, Robert
Committee Members: Winskell Enger, Kate
Research Fields: Health Sciences, Public Health
Partnering Agencies: International Non-governmental organization (e.g., CARE, Inc.)
Keywords: Maternal Health
Program: Rollins School of Public Health, Career Masters of Public Health (Prevention Science)
Permanent url: http://pid.emory.edu/ark:/25593/brndg

Abstract

Abstract

Background

Every day, nearly 1000 women die worldwide as a result of complication during pregnancy and childbirth. Well over half of these deaths take place in Sub-Saharan Africa. Mali's maternal mortality rate is one of the highest in the world: over 830 maternal deaths per 100,000 births in 2008.The study's aim was to examine the associations between beliefs in traditional values around pregnancy and childbirth and the receipt of maternal healthcare.
Methods
Quantitative data were collected using a cross-sectional survey carried out in 600 households across 60 villages in the health districts of Bankass and Badiangara between June and July 2011. To be eligible to participate in the survey, a household had to contain a woman who gave birth within the last twelve months. In order to assess the relationship of traditional values and socio demographic factors on maternal health care utilization, this study used two levels of analysis, namely bivariate and multivariate analysis.
Results
Multivariate analysis showed that tradition was significantly associated with the receipt of the standard minimum of care for pregnant women (OR=0.21 95% CI, 0.05-0.86). Both bivariate and multivariate analysis confirmed the importance of mother's ethnicity and age at marriage as significantly associated with the use of maternal health care. Peulh women have significantly lower odds of delivering in a medical institution (OR 0.26 95%, CI 0.09-0.78) and of using antenatal care services (OR 0.49 95%, CI 0.26-0.94) when compared to other ethnic groups. Women who got married at age 20+ have significantly lower odds of receiving their first antenatal care check up within the first 6 months (OR 0.28 95%, CI 0.11 - 0.68) compared to women who got married younger (OR 0.39 95%,CI 0.19- 0.83). This finding is likely attributable to the fact that the overwhelming majority of women surveyed had no formal education, hence higher age at marriage is not associated with higher educational level.
Conclusion
Multivariate analysis confirmed that tradition is an important determinant of maternal health care utilization in rural Mali. This study also showed that socio-demographic factors such as ethnicity and age at marriage were also important determinants of health care utilization in rural Mali.

Table of Contents

Utilization of Maternal Health Care in Mali: The Role of Traditional Values
By
Henriette Bulambo
Bs, University of Natal
1996
Thesis Committee Chair: Robert Stephenson, PhD, MSc
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Public Health
2012


Acknowledgments
I would like to express my appreciation to my advisor, Dr. Robert Stephenson, for his constant guidance, support, and high expectations throughout this process. Additionally, I would like to thank him, CARE MALI and CARE USA for allowing me to use data from the 2011 Survey conducted in Mali. I would also like to thank Dr. Kate Winskell for agreeing to be on my thesis committee.
To my friend Susan Sunay who has experienced a thesis, thank you for all the tips of advice and for being the person who encourage me to enroll in the MPH program. To my husband Jules Senga, thank you for your encouragement, support and understanding while I pursued my Master of Public Health degree. Finally, to mom and dad you have always been there for me, thank you for your support and encouragement.


PAGE
DISTRIBUTION AGREEMENT i
APPROVAL SHEET ii
ABSTRACT iii
ACKNOWLEDGEMENTS Vi
TABLE OF CONTENTS Vii
1 INTRODUCTION
Overview of Maternal Health 1
Objective 3
Significance of Study 4

Overview of Mali 4
Figure 1: Trends in Maternal Mortality Ratio, Mali 1990-2008 6
Figure 2: Trends in percentage of women having at least four 7

antenatal care visits for the most recent birth in

Western and Central Africa, 1990-2009
Outline of Research Study 9
2 REVIEW OF LITERATURE
Maternal Healthcare 10
Antenatal Care
Delivery Care
Postpartum Care
Traditional Beliefs 15
Socio-demographic Factors 18
Conceptual Framework 21
3 METHODS
Study Setting 23
Sampling and Data Collection 24
Tools for Data Collection 26
Picture 1: Interview of a Peulh woman who gave birth within 27
the previous twelve months in the village of Balanguina in Bankass
Table 1: Questions on traditional practices in the woman's 28

questionnaire
Statistical Analysis 29

4 RESULTS
Socio demographic characteristics 31
Table2: Socio demographic characteristic of the study sample 32
Traditional beliefs and practices 33
Table3: Traditional beliefs and practices of respondents 34
Outcomes variables 35
Table 4: Pattern of maternal health care utilization 35
in Bankass and Badiangara
Bivariate analysis 36
Table 5: Bivariate analysis 37
Multivariate analysis 38
Table 6: Multivariate analysis 39
5 DISCUSSION 40
6 CONCLUSION 43
7 RECOMMENDATION 43
8 REFERENCES











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