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Table 5 Factors affecting maternal and neonatal service usage, ordered by service type and outcome

From: Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East

Author (year), country Outcomes Determinants Odds ratio or percentage
Skilled birth attendance
Choulagai et al. (2013) [16], Nepal SBA usage Education
 Informally educated
 Educated intermediate and above
OR 1.18 (CI0.92–1.51), p < 0.05
OR 4.41 (CI2.89–6.72), p < 0.05
Wealth quintile
 Q2 (poorer)
 Q5 (wealthiest)
OR 1.08 (CI 0.81–1.43), p < 0.05
OR 1.90 (CI 1.42–2.56), p < 0.05
Knowledge
 Knowledge of at least one danger sign OR 1.31 (CI 1.08–1.58), p < 0.05
Distance
 Staying ≤ 30 min from facility OR 1.31 (CI 1.08–1.58), p < 0.05
ANC use
  ≥ 4 ANC visits OR 2.39 (CI 1.97–2.89), p < 0.05
Mayhew et al. (2008) [20], Nepal SBA usage Wealth quintile
 Q2 (poorer)
 Q5 (wealthiest)
OR 1.6 (CI 1.2–2.3), p < 0.01
OR 6.3 (CI 4.4–8.9), p < 0.01
Distance
 Walking distance to clinic (31–60 min)
 Walking distance to clinic (>90 min)
OR 0.7 (CI 0.6–0.8), p < 0.01
OR 0.4 (CI 0.3–0.6), p < 0.01
Education
 Formally educated OR 3.8 (CI 3.2–4.5), P < 0.05
 Earlier been to this health facility OR 1.7 (CI 1.3–2.1), p < 0.05
 At least some basic EmONC equipment in facility OR 1.0 (CI 0.7–1.3), p < 0.05
  ≥ 1 Community health worker in catchment area OR 0.7 (CI 0.6–0.95), p < 0.05
  ≥ 1 female TBA in catchment area OR 1.3 (CI 1.0–1.7), p < 0.05
  ≥ 1 female doctor or midwife at health facility OR 1.4 (CI 1.1–1.8), p < 0.05
 User fees collected in facility OR 0.8 (CI 0.6–0.96), p < 0.05
 Antenatal care provided in facility OR 1.1 (CI 0.8–1.5), p < 0.05
Siziya et al. (2009) [29], Iraq TBA usage Wealth quintile
 Q2 (poorer)
 Q4 (wealthier)
OR 2.90 (CI 2.49–3.39), p < 0.05
OR 0.79 (CI 0.65–0.96), p < 0.05
Age
 Women aged 25–34 years AOR 1.22 (CI 1.08–1.39), p < 0.05
Education
 Formally educated OR 1.08 (CI 0.96–1.22), p < 0.05
Children
 Having 1–2 children AOR 0.72 (CI 0.59–0.87), p < 0.05
Facility-based delivery
Dhakal et al. (2011) [18], Nepal FBD Age
 25+ years
 20–24 years
OR1.38 (CI 0.34–5.55), p < 0.001
OR 2.67 (CI 0.70–10.19), p < 0.001
Occupation
 Housewife
 Working women
OR 4.77 (CI 2.16–10.54), p < 0.001
OR 5.80 (CI 0.91–36.84), p < 0.001
Education
 Educated up to primary level
 Educated to secondary and above
OR 2.29 (CI 0.82–6.37), p < 0.001
OR 16.59 (CI 6.27–43.80), p < 0.001
ANC use
  ≥ 1 ANC visit OR 20.0 (CI 2.64–151.51), p < 0.001
Giacaman et al. (2006) [33], Palestine FBD Client satisfaction
 Avoiding public facilities due to dissatisfaction OR 2.77 (CI 1.89–4.05), p < 0.001
Financial reasons
 Insurance or low cost for opting facility OR 5.83 (CI 3.96–8.59), p < 0.001
Karkee et al. (2013) [19], Nepal FBD Education
 Educated up to primary level
 Educated to higher-secondary or above
AOR 3.57 (CI 1.60–7.94), p < 0.001
AOR 12.39 (CI 5.09–30.2), p < 0.001
ANC use
  ≥ 4 ANC visits AOR 2.15 (CI 1.25–3.69), p < 0.005
Distance
  ≤ 30 min
 31–60 min
OR 11.61 (CI 5.77–24.0), p < 0.001
AOR 1.72 (CI 0.93–3.19), p < 0.001
Sharma et al. (2014) [21], Nepal FBD Education
 Formally educated OR 2.8 (CI 1.58–4.97), p < 0.001
Distance
  < 60 min to facility OR 3.12 (CI 1.61–0.04), p < 0.001
ANC use
 Had antenatal visits OR 5.82 (CI 2.95–11.5), p < 0.001
Shrestha et al. (2012) [22], Nepal FBD Distance
 Residing in remote area OR 2.81 (CI1.08–7.30), p < 0.05
Community
 Newer community OR 2.56 (CI 1.19–5.55), p < 0.05
Education
 Formally educated OR 2.66 (CI 1.18–6.01), p < 0.05
ANC use
 No ANC visits OR 5.53 (CI 2.12–14.4), p < 0.05
Emergency obstetric care
Hirose et al. (2011) [24], Afghanistan Delay in seeking EmONC ANC use
 Lack of ANC AOR 4.6 (CI 1.7–12.2), p < 0.05
Socio-cultural factors
 Usage of traditional healer
 Weak relationship with her birth family
 No plan to use health facility for delivery
AOR 3.2 (CI 1.2–8.5), p < 0.05
AOR 2.0 (CI 0.9–4.4), p < 0.05
AOR 2.0 ( CI 0.9–4.2), P < 0.05
System factors
 Absence of a midwife AOR 2.2 (CI 1.1–4.5), p < 0.05
Khorrami et al. (2008) [25], Afghanistan Timely EmONC usage Distance to facility
  < 100 miles
  ≥ 100 miles
N = 249 (85.3%)
N = 43 (14.7%)
Mode of travel
 Automobile
 Bus
N = 192 (65.8%)
N = 97 (33.2%)
Cost as a limitation
 Yes
 No
N = 38 (30.7%)
N = 86 (69.4%)
Safety felt about care at this hospital  
 Moderately safe
 Mildly safe
N = 100 (34.4%)
N = 177 (60.8%)
  1. NB: CI is 95% confidence interval. AOR is adjusted odds ratio