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ANTENATAL AND DELIVERY CARE UTILIZATIONIN URBAN AND RURAL CONTEXTS IN VIETNAM: A study in two health and demographic surveillance sites
Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. Pregnant women need adequate antenatal care (ANC) and delivery care fortheir own health and for healthy children. Availability of such care has increased in Vietnam but maternal mortality remains high and variable between population groups.

Aims. The general aim of this thesis is to describe and discuss the use of antenatal and delivery care in relation to demographic and socio-economic status and other factors in two health and demographic surveillance sites (HDSS), one rural and one urban. One specificaim of the thesis is to present experiences of running the urban HDSS.

Methods. Between April 2008 and December 2009, 2,757 pregnant women were identifiedin the sites. Basic information was obtained from 2,515 of these. The use of ANC was followed to delivery for 2,132. Three indicators were used. ANC was considered overall adequate if the women started ANC within the first trimester, used three or more visits and received all the six recommended core services at least once during pregnancy. Delivery care was studied for all the 2,515 women.

Main Findings. Nearly all 2,132 participants used ANC. The mean numbers of visits were 4.4 and 7.7 in the rural and urban areas. Mainly due to less than recommended use of core ANC services, overall ANC adequacy was low in some groups, particularly in the rural area (15.2%). The main risk factors for not having adequate ANC were (i) living in a rural area,(ii) low level of education, (iii) low economic status and (iv) exclusive use of private ANC providers. Rural women accessed ANC mainly at commune health centers and private clinics. Urban women accessed ANC and gave birth at central hospitals and provincial hospitals. Caesarean section (CS) was common among urban women (38.5%). Good socioeconomic condition and male babies were associated with delivery in hospitals and CS births. Almost all women had one or more antenatal ultrasound examination, the mean was about 4.5. Rural women spent 3.0% and 19.0% of the reported annual household income percapita for ANC and delivery care, respectively, compared to 6.1% and 20.6% for urbanwomen. The relative economic burden was heaviest for poor rural women.

Conclusion. The coverage of ANC was high in both contexts but with large variations between population subgroups. The major concerns are that poor women in the rural area received incomplete services according to recommendations and that many women, particularly the well-off, in the urban area appeared to overuse technology, ultrasound scanning, delivery in highlevel health care and CS delivery. National maternal healthcare programs should focus on improving ANC service content in rural areas and controlling technology preference in urban. The pregnant women with relatives and friends as well as ANC providers share the responsibility for a positive development. All parties involved must be targeted to improve knowledge, attitudes and practices.

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden , 2012. , 68 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:7
Keyword [en]
Antenatal care, delivery care, utilization, adequacy, hospital delivery, caesarean section, health and demographic surveillance site, rural and urban, Vietnam.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3612ISBN: 978-91-86739-41-6 (print)OAI: oai:DiVA.org:norden-3612DiVA: diva2:782639
Public defence
2012-09-10, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2015-01-22Bibliographically approved
List of papers
1. Technology Preference in Choices of Delivery Care Utilization from User Perspective: A Community Study in Vietnam
Open this publication in new window or tab >>Technology Preference in Choices of Delivery Care Utilization from User Perspective: A Community Study in Vietnam
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2013 (English)In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 1, no 1, 10-17- p.Article in journal (Refereed) Published
Abstract [en]

Choices for delivery care are made based on the available resources and influence health outcomes of women and their children. The aim of the paper is to study utilization and preference for delivery care and related factors in one urban and one rural area of northern Vietnam. Two cohorts of pregnant women were carried out in DodaLab and FilaBavi Health and Demographic Surveillance Sites (HDSS) in Hanoi, Vietnam from April 2008 to December 2009. Together, 2515 pregnant women were identified and followed until delivery through quarterly household interviews using structured questionnaires. Almost all women delivered at health care facilities. Most of the rural women gave birth at primary health care facilities (88.5%) while urban women primarily used secondary and tertiary hospitals (93.6%). Caesarean section (CS) was used for 38.5% of births in the urban area and 12.4% in the rural. Giving birth in hospitals and CS were more common among highly educated women, employed women, women living in households or communities with good economic conditions, and women expected to give birth to a son. Technology preference in delivery care was associated with better socioeconomic conditions and expecting a boy. Improving the quality and reputation of primary health care facilities, informing women about CS risks and monitoring indications of CS are important policy issues.

Keyword
Technology preference, delivery care utilization, hospital delivery, caesarean section, rural and urban, Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3599 (URN)DOI: 10.12691/ajphr-1-1-2 (DOI)
Available from: 2015-01-19 Created: 2015-01-19 Last updated: 2017-12-05Bibliographically approved
2. DodaLab: an urban health and demographic surveillance site, the first three years in Hanoi, Vietnam.
Open this publication in new window or tab >>DodaLab: an urban health and demographic surveillance site, the first three years in Hanoi, Vietnam.
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2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 8, 765-72 p.Article in journal (Refereed) Published
Abstract [en]

RATIONALE: Health and demographic surveillance sites (HDSSs) are important sources for health planning and policy in many low and middle income countries. Almost all HDSSs are in rural settings. The article aims to present the experiences and some concrete results for the first three years of operation of an urban HDSS in Hanoi, Vietnam, and discuss advantages and disadvantages of conducting health studies in HDSSs.

DESIGN, POPULATION AND SAMPLE SIZE: The DodaLab urban HDSS was established in 2007 in three communes at different economic levels in Dong Da district, Hanoi, Vietnam. Demographic, social and economic information about 10,000 households and their 37,000 persons was obtained through household interviews. Quarterly follow-up was initiated to provide information about vital events, birth, death and migration. A new household survey was undertaken in 2009. The existing rural HDSS FilaBavi, started in 1999, with 12,000 households and 52,000 persons, was used as the blueprint.

CONCLUSIONS: It was possible to establish and run an urban HDSS with experiences from the rural site. The urban and rural contexts are different and demographically, economically and socially complex, but the use of HDSSs can facilitate research beyond very simplified models for comparisons. General statements about external validity of results from the HDSS cannot be made. This issue has to be considered specifically in every situation as an integral part of the research so that the results can be made useful outside the researched HDSS and in performing relevant comparisons.

Keyword
DodaLab, urban health and demographic surveillance site, validity applicability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3600 (URN)10.1177/1403494812464444 (DOI)23117211 (PubMedID)
Available from: 2015-01-19 Created: 2015-01-19 Last updated: 2017-12-05Bibliographically approved
3. Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam.
Open this publication in new window or tab >>Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam.
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2012 (English)In: BMC health services research, ISSN 1472-6963, Vol. 12, 40- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam.

METHODS: Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews.

RESULTS: Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector.

CONCLUSION: Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.

Keyword
Antenatal care; Socio-economic determinants; Adequacy; Urban and rural; Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3609 (URN)10.1186/1472-6963-12-40 (DOI)22335834 (PubMedID)
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2015-01-22Bibliographically approved
4. Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam.
Open this publication in new window or tab >>Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam.
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2011 (English)In: BMC health services research, ISSN 1472-6963, Vol. 11, 120- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of antenatal care (ANC) varies between countries and in different settings within each country. Most previous studies of ANC in Vietnam have been cross-sectional, and conducted in rural areas before the year 2000. This study aims to compare the pattern and the adequacy of ANC used in rural and urban Vietnam following two cohorts of pregnant women.

METHODS: A comparative study with two cohorts comprising totally 2132 pregnant women were followed in two health and demographic surveillance sites, one rural and one urban in Hanoi province, Vietnam. The women were quarterly interviewed using a structured questionnaire until delivery. The primary information obtained was the number and the content of ANC visits.

RESULTS: Almost all women reported some use of ANC. The average number of visits was much lower in the rural setting (4.4) than in the urban (7.7). In the rural area, 77.2% of women had at least three visits and 69.1% attended ANC during the first trimester. The corresponding percentages for the urban women were 97.2% and 97.2%. Only 20.3% of the rural women compared to 81.1% of the urban women received all core ANC services. As a result, the adequate use of ANC was 5.2 times in the urban than in the rural setting (78.3% compared to 15.2%). Nearly all women received ultrasound examination during pregnancy with a mean value of 6.0 scans per woman in the urban area and 3.5 in the rural. Most rural women used ANC at commune health centres and private clinics while urban women mainly visited public hospitals. Expenditure related to ANC utilization for the urban women was 7.1 times that for the urban women.

CONCLUSION: The women in the rural area attended ANC later, had fewer visits and received much fewer services than urban women. The large disparity in ANC adequacy between the two settings suggests special attention for the ANC programme in rural areas focusing on its content. Revision and enforcement of the national guidelines to improve the behaviour and practice of both users and providers are necessary.

Keyword
Antenatal care; adequacy; disparities; urban - rural comparison; Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3603 (URN)10.1186/1472-6963-11-120 (DOI)21605446 (PubMedID)
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2015-01-22Bibliographically approved

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