RT Journal Article
SR Electronic
T1 A tale of 22 cities: utilisation patterns and content of maternal care in large African cities
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e007803
DO 10.1136/bmjgh-2021-007803
VO 7
IS 3
A1 Wong, Kerry LM
A1 Banke-Thomas, Aduragbemi
A1 Sholkamy, Hania
A1 Dennis, Mardieh L
A1 Pembe, Andrea B
A1 Birabwa, Catherine
A1 Asefa, Anteneh
A1 Delamou, Alexandre
A1 Sidze, Estelle Monique
A1 Dossou, Jean-Paul
A1 Waiswa, Peter
A1 Beňová, Lenka
YR 2022
UL http://gh.bmj.com/content/7/3/e007803.abstract
AB Introduction Globally, the majority of births happen in urban areas. Ensuring that women and their newborns benefit from a complete package of high-quality care during pregnancy, childbirth and the postnatal period present specific challenges in large cities. We examine health service utilisation and content of care along the maternal continuum of care (CoC) in 22 large African cities.Methods We analysed data from the most recent Demographic and Health Survey (DHS) since 2013 in any African country with at least one city of ≥1 million inhabitants in 2015. Women with live births from survey clusters in the most populous city per country were identified. We analysed 17 indicators capturing utilisation, sector and level of health facilities and content of three maternal care services: antenatal care (ANC), childbirth care and postnatal care (PNC), and a composite indicator capturing completion of the maternal CoC. We developed a categorisation of cities according to performance on utilisation and content within maternal CoC.Results The study sample included 25 326 live births reported by 19 217 women. Heterogeneity in the performance in the three services was observed across cities and across the three services within cities. ANC utilisation was high (>85%); facility-based childbirth and PNC ranged widely, 77%–99% and 29%–94%, respectively. Most cities showed inconsistent levels of utilisation and content across the maternal CoC, Cotonou and Accra showed relatively best and Nairobi and Ndjamena worst performance.Conclusion This exploratory analysis showed that many DHS can be analysed on the level of large African cities to provide actionable information about the utilisation and content of the three maternal health services. Our comparative analysis of 22 cities and proposed typology of best and worst-performing cities can provide a starting point for extracting lessons learnt and addressing critical gaps in maternal health in rapidly urbanising contexts.Data may be obtained from a third party and are not publicly available. Data from the DHS are available for research purposes, upon registration, at www.DHSprogram.com.