Wong, Kerry LM, Banke-Thomas, Aduragbemi ORCID: https://orcid.org/0000-0002-4449-0131, Sholkamy, Hania, Dennis, Mardieh L, Pembe, Andrea B, Birabwa, Catherine, Asefa, Anteneh, Delamou, Alexandre, Sidze, Estelle Monique, Dossou, Jean-Paul, Waiswa, Peter and Beňová, Lenka (2022) Tale of 22 cities: utilisation patterns and content of maternal care in large African cities. BMJ Global Health, 7:e007803. ISSN 2059-7908 (Online) (doi:10.1136/bmjgh-2021-007803)

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Abstract

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.

Item Type:	Article
Uncontrolled Keywords:	maternal health; maternity; city; Africa
Subjects:	H Social Sciences > HD Industries. Land use. Labor > HD61 Risk Management R Medicine > RG Gynecology and obstetrics R Medicine > RT Nursing
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM) Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families
Last Modified:	08 Apr 2022 13:30
URI:	http://gala.gre.ac.uk/id/eprint/35320

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