This journal club presentation summarizes a study on determinants of antenatal care, institutional delivery, and postnatal care service utilization in Nigeria. The study used 2013 Nigeria Demographic and Health Survey data and found that 54% of women had at least four antenatal care visits, 37% delivered in a health facility, and 29% of newborns received postnatal care. Key factors predicting utilization of these maternal and child health services were education level, residence, wealth, and parity. Antenatal care strongly predicted institutional delivery and postnatal care use. The presentation provides a thorough summary of the objectives, methods, results, discussion, and conclusions of the original research article.

1. Journal Club Presentation
Presented By:
Name: Binod Budha
Roll No: 10
BPH, VIII Semester, SHAS, PU.
12/7/2020 Binod Budha 1

2. Presented for the partial fulfillment of requirement
of
PHA 451 Journal Club/Health Seminar
of
Bachelor of Public Health, VIII Semester,
School of Health and Allied Sciences, Pokhara University
under the cardinal supervision of
Assistant Professor Dr. Hari Prasad Kaphle
By
Binod Budha,
Symbol number: ……,
PU registration number: ……..
12/7/2020 Binod Budha 2

3. Selected Article for Presentation
“Determinants of antenatal care, institutional delivery and postnatal care
services utilization in Nigeria”. The Pan African Medical Journal (PAMJ)
• Published on : 2015 Aug 31;
• Volume 21, Article 321
12/7/2020 Binod Budha 3

4. 12/7/2020 Binod Budha 4

5. Journal Information
12/7/2020 Binod Budha 5
Pan African Medical Journal (PAMJ)
Open
access
Peer
reviewed SJR 2019 : 0.29
ISSN:
1937-8688
Manuscript: Online
submission
Article publishing
charge is required
DOI:10.11604/pamj.20
15.21.321.6527
Indexing: 13
sites

6. Journal Information
PAMJ was launched in early 2008 by Dr Raoul Kamadjeu and Dr Landry Tsague,
with inputs and ideas from public health and medical professionals across the
continent.
Focuses on scientific research on clinical, public health, social, political, economic
and all other factors affecting the health of populations in Africa.
PAMJ accepts the articles in English and in French only.
Has a proper article submission guideline.
12/7/2020 Binod Budha 6

7. Contd..
• Article processing charges is $180 US per manuscripts accepted for publication.
• do not charge article submission fees.
• Authors can request partial or complete waiver during the submission process but
it is rearly granted as the charge is very low already.
12/10/2020 <Insert your name here> 7

8. Editors
• Editor in Chief - Raoul Kamadjeu
Global Health Professional, Kenya (Public Health, Epidemiology, Immunization,
Health Emergencies)
• Editorial Border consist of 2 Managing Editors and other 53 editorial board
members.
• Managing Editor- Landry Tsague
Global Health Professional, Senegal (Public Health, HIV)
• Managing Editor- Sheba Gitta
Public health consultant, Uganda (Public Health, Epidemiology)
12/7/2020 Binod Budha 8

9. Indexed/Abstracted- In 13 sites
• DOAJ
• AIM
• Google Scholar
• AJOL
• EBSCO
• Scopus
• Embase
• IC
• HINARI
• Global Health
• PubMed Central, PubMed/Medline and ESCI.
12/7/2020 Binod Budha 9

10. Critical Appraisal of Journal
• Easy accessibility of the article.
• Journal focuses the articles researched on African region.
• Peer reviewed
• Paid journal
• Has a proper article submission guideline.
12/7/2020 Binod Budha 10

11. Tittle of Article
• “Determinants of antenatal care, institutional delivery and postnatal care services
utilization in Nigeria”
12/7/2020 Binod Budha 11

12. Critical Appraisal of Tittle
• Clear indication of the focus of the study.
• Objective is predictable through the title of the study.
• Gives clear idea about the study area.
• Number of words used is appropriate.
• No indication about the design of the study.
12/7/2020 Binod Budha 12

13. Authors
• Tukur Dahiru
Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna
State, Nigeria
• Oche Mansur Oche
Department of Community Health, Usmanu Danfodio University, Sokoto, Sokoto
State, Nigeria
12/7/2020 Binod Budha 13

14. Critical Appraisal of Authors
• Two authors.
• Name of the authors are well- mentioned.
• Authors are from different university and the different state.
12/7/2020 Binod Budha 14

15. Abstract
12/7/2020 Binod Budha 15

16. Critical Appraisal of Abstract
• Extracted from the article.
• Abstract is informative.
• Has used more than 3 key words like 2013; ANC; DHS; Nigeria; institutional
delivery; postnatal.
• Appropriate in its length (i.e. leass than 250 words as per journal guideline).
• Gives the gist of whole text.
• The sections and manuscript are well maintained as per the guideline.
.
12/7/2020 Binod Budha 16

17. Introduction
• Recent estimates show that the overall ante-natal care (ANC) coverage in Nigeria
stood at 61% which is an abysmal three percentage points increase from 58% a
decade ago; 36% of deliveries were delivered in a health facility while only 14%
of newborns received postnatal care within two months of delivery.
• The rural and urban ANC coverages are 47% and 86% respectively.
• Despite high coverage of ANC, Nigeria still remains a major contributor of under-
five mortality, contributing about 13%, 9.4% and 14% of global under-five,
neonatal and maternal deaths respectively.
• Antenatal care affords the medical personnel the opportunity to detect and treat
symptomless ailments such high blood pressure and pregnancy-induced diabetes
and facilitates informed decision-making by the pregnant woman such as seeking
skilled attendance at delivery and delivery in health care facility
12/7/2020 Binod Budha 17

18. Contd..
• The second element of care, institutional delivery/skilled attendance at delivery
allows provision of intervention to detect risk around labour and childbirth during
which interventions can maximally be provided by skilled medical personnel at
health facilities.
• The third element of care, postnatal care has been argued that promoting the
utilization of ANC and institutional delivery/skilled attendance at delivery alone is
not enough to improve maternal and child health and that postnatal care has to be
provided to sustain the reduction in neonatal mortality.
• Utilization of antenatal care, institutional delivery and postnatal care services in
Nigeria are poor even by african average.
12/7/2020 Binod Budha 18

19. Critical Appraisal of Introduction
• Aim of the study is well mentioned.
• Contains sufficient literature review.
• States the need for the study.
• All the citations are followed with correct references in the list of references.
• Shown Comparative study with previous research and other nations research
related with the title.
• Importance of the study is logically presented.
12/7/2020 Binod Budha 19

20. Materials and methods
The survey was conducted by the National Population Commission (NPC) in
collaboration with ICF Macro, Calverton, MD, USA.
Target Population: 15 – 49 Years (both permanent resident and visitors are taken)
Target Area : Nigeria nationwide
Study design : Cross-sectional descriptive study
Sample Size: Nationally-representative sample of women and men
(38,945 eligible women and 17, 359 men)
12/7/2020 Binod Budha 20

21. Contd..
Sampling method : Stratified three-stage cluster sampling method
Procedure: Interview using structured Questionaire (Household Questionnaire,
Woman's Questionnaire and Man’s Questionnaire)
Dependent variable : Antenatal care , Place of delivery and Postnatal care
Independent variables: Sociodemographic and socio-economic factors of the
woman
12/7/2020 Binod Budha 21

22. Contd..
Statistical Analysis : Data were entered using Stata v12.0, bivariate and
multivariate logistic regressions were performed.
Ethical Approval : As the researcher analysed the dataset of NDHS 2013 , the
permission was given by NDHS measures and NDHS 2013 had taken ethical
approval from the National Health Research Ethics Committee of Nigeria,
Federal Ministry of Health, Abuja, Nigeria.
12/7/2020 Binod Budha 22

23. Critical Appraisal of Materials and Methods
• Mention about the dependent and independent variables to be studied.
• Use of questionnaire based on study settings.
• Inclusion and exclusion criteria both are clearly mentioned.
• Sampling technique and sample size are also mentioned.
12/7/2020 Binod Budha 23

24. Results
• Overall, 54% of women had at least four ANC visits.
• 37% of women delivered in health facility.
• 29% of new born had postnatal care.
• Factors that consistently predict the utilization of the three MCH services are
maternal and husband's level education, place of residence, wealth level and
parity.
12/7/2020 Binod Budha 24

25. Result Contd..
• Antenatal care strongly predicts health facility delivery (OR = 2.16, 95%CI: 1.99-
2.34).
• ANC also strongly predicts the postnatal care utilization (OR = 4.67, 95%CI:
3.95-5.54).
• While health facility delivery equally predicting postnatal care (OR = 2.84,
95%CI: 2.20-2.80).
12/7/2020 Binod Budha 25

26. Critical Appraisal of Results
• Results are found according to the aim of the study.
• Systematic presentation of data on the table.
• Full-filled aims and objective of the study.
• Clear illustration of the results.
• Well-described and logical.
12/7/2020 Binod Budha 26

27. Discussion
• The purpose of this study was to determine the factors influencing the utilization
of antenatal care (ANC), health facility delivery and postnatal care among
Nigerian women using the 2013 Nigeria DHS data set.
• Use of ANC as well as institutional delivery remains some of the important
strategies in reducing maternal and child morbidity and mortality.
• Nigeria continued to be one the largest sources of maternal and child mortality
worldwide.
• Therefore, investigating the determinants of ANC, institutional use of delivery as
well as postnatal care will provide evidence for policy directions and basis for
programmatic planning.
12/7/2020 Binod Budha 27

28. Critical Appraisal of Discussion
• The discussion of the article is meaningful and has highlighted the important
findings of the study.
• Previous study findings were studied comparatively.
• Comparison was done properly.
• Authors have presented the associated factors clearly so it can be used as
foundation for further research for similar hypothesis.
• Both the dependent and independent factors which were assessed were discussed.
12/7/2020 Binod Budha 28

29. Conclusion
• This study corroborates previous research investigations on the potential roles of
maternal and husband's level of education, place of residence (urban/rural), parity
and wealth level in predicting utilization of MCH services.
• These factors consistently predicted utilization of all the three indicators of
maternal and child health services, that is ANC, institutional delivery and postnatal
care.
• ANC positive influences place of delivery as well as postnatal care while place of
delivery influences postnatal care.
• Non-uniform predictors of these MCH indicators are maternal age, geopolitical
zone, employment status of mother, pregnancy wantedness, and health insurance
coverage and decision maker.
12/7/2020 Binod Budha 29

30. Critical Appraisal of Conclusion
• Meaningful conclusions along with well supported results.
• Based on aim and objective of the study.
• Has answered the research questions.
• Had concluded the improve in ANC service available and access could lead to
improve in facility delivery and facility delivery could lead to improve in PNC
services.
12/7/2020 Binod Budha 30

31. References
12/7/2020 Binod Budha 31

32. Critical Appraisal of References
• Proper numbering of the reference materials.
• Vancouver style of referencing.
• Citation and references match with each other.
• 68 references were citated.
12/7/2020 Binod Budha 32

33. Strengths
• An important strength of this study is the utilization of a nationally representative
sample of women as respondents.
• With this approach, national averages are generated for the whole country.
• However, as can be seen, there are a lot of regional variations the estimates
generated; though this could be provide region-based policy direction and
programming.
12/7/2020 Binod Budha 33

34. Weaknesses
• The study is further limited by the fact that is based on recall of events that could
have happened some five years earlier.
• Cross-sectional studies allow generation of hypotheses only.Testing such
hypotheses and drawing causal inferences requires experimental study designs.
12/7/2020 Binod Budha 34

35. Overall significance of the article
• The article can be very useful for review in similar research.
• The output of the article can be useful in planning and policy making decision.
• The article can encourage the people to use MCH services properly.
• The article can contribute good impact in reducing the maternal mortality ratio.
12/7/2020 Binod Budha 35

36. Significance for my research
• Provides guideline for my research.
• Results obtained here can be used for the comparison of the study.
• Helps to minimize the errors of my study.
• Can be used as references for my study.
12/7/2020 Binod Budha 36

37. Questions?
Quarries?
Suggestions?
Feedbacks?
12/7/2020 Binod Budha 37

38. Thank You!
12/7/2020 Binod Budha 38