Maternal health outcomes in the context of fragility: a retrospective study from Lebanon

The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the ref...

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Published in:	Conflict and health Vol. 17; no. 1; p. 59
Main Authors:	Dimassi, Hani, Alameddine, Mohamad, Sabra, Nadine, El Arnaout, Nour, Harb, Ranime, Hamadeh, Randa, El Kak, Faysal, Shanaa, Abed, Mossi, Marta Orozco, Saleh, Shadi, AlArab, Natally
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 13-12-2023 BioMed Central BMC
Subjects:	Abortion Antenatal care Bivariate analysis Breastfeeding & lactation Cesarean section Charts COVID-19 Data collection Disadvantaged pregnant women Family planning Fragility Health aspects Health care Health care industry Health services Human rights International economic relations Maternal & child health Maternal health Maternal mortality Mothers NGOs Nongovernmental organizations Pandemics Patient outcomes Population studies Postpartum period Pregnancy Pregnant women Primary health care Primary healthcare Public health Refugees Regression analysis Regression models Reproductive health Statistical analysis Womens health Lebanon Syria Palestinian Territories Lebanon Primary healthcare Antenatal care Refugees Maternal health Disadvantaged pregnant women Fragility
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Summary:	The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon. A retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models. In the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery. This study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1752-1505 1752-1505
DOI:	10.1186/s13031-023-00558-1