Browsing by Author "Degomme, Olivier"

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    Mobility for maternal health among women in hard-to-reach fishing communities on Lake Victoria, Uganda; a community-based cross-sectional survey
    (BMC health services research, 2021) Ssetaala, Ali; Ssempiira, Julius; Nanyonjo, Gertrude; Okech, Brenda; Chinyenze, Kundai; Bagaya, Bernard; Price, Matt A.; Kiwanuka, Noah; Degomme, Olivier
    Maternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women’s mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda. Methods: A cross sectional survey among 450 consenting women aged 15–49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth. Results: The majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1–3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4–27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3–6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth. Conclusions: Despite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent.
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    Skilled Birth Attendance Among Women in Hard to Reach Island Fishing Communities on Lake Victoria; A Cross- Sectional Survey
    (Research Square, 2020) Ssetaala, Ali; Nanyonjo, Gertrude; Okech, Brenda; Chinyenze, Kundai; Price, Matt A.; Kiwanuka, Noah; Degomme, Olivier
    Maternal deaths continue to be a major challenge for maternal health in Uganda. Maternal deaths are at 336 maternal deaths per 100,000 live births, especially in rural hard to reach communities. Skilled birth attendance is key to preventing most maternal deaths. Rural fishing communities on Lake Victoria, Uganda could among communities with poor maternal health outcomes. We evaluated the extent of, and factors associated with skilled births attendance by women in fishing communities along Lake Victoria, Uganda at the most recent childbirth. Methods: A cross sectional survey among 486 consenting women aged 15-49 years, who were pregnant or had a birth or abortion in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January-May 2018. Interviewer administered questionnaires were used to collect data on sociodemographics, antenatal care and skilled birth attendance during the most recent childbirth. Regression modeling was used to determine factors associated with women’s skilled birth attendance among 450 women with a previous childbirth. Results: Majority of women had a skilled delivery during the most recent birth [86.9%,(391/450)], with less than two in five skilled births being at the islands [34.0%, (133/391)]. Women who received any one of the seven assessed ANC components were twice as likely to have had a skilled childbirth as those who didn’t receive any ANC components (AOR=2.1; 95% CI:1.1-4.0). Joint participant and partner health decisions, reporting no prior pregnancy loss, fewer than two lifetime births and none fishing related partner occupation were also associated with a likelihood of having had a skilled birth during the most recent delivery. Conclusion: Skilled births attendance is still low in these island fishing communities. Tailored interventions to expand provision of components of ANC may improve women’s skilled birth attendance in these islands.