Knowledge and attitudes of adult HIV positive patients to HIV/AIDS in Yola, Nigeria

Skilled attendance at birth is widely recognized as a single most effective strategy for reducing maternal mortality and morbidity and this is being used as an indicator to measure progress toward the fifth Millennium Development Goal of improving maternal health (MDG 5). However around half of the deliveries in the developing world are not attended by skilled professionals. The situation is worse in some regions such as South Asia where only less than one-third of deliveries are attended by skilled professionals. Safe motherhood still remains a distant dream for many around the world especially in developing countries leading to most of the maternal deaths in poor countries suggesting that most of these can be attributed to low level of supply and utilization of skilled maternal health services. Research studies have documented a range of social economic and geographic factors that act as barriers to low use of skilled maternity care during childbirth around the world. As far as India is concerned maternal education economic status of household caste and religion; availability of and accessibility to a health facility presence of a lady medical doctor availability of drugs; community attributes and programme-related factors play a critical role in the utilization of facility-based maternity care. Though costs - both direct and indirect-have also been shown to be an important barrier to womens use of facility-based maternity care there are a limited number of studies that have explored the issue in detail at regional level unlike at national level. India has avoided significant maternal and neonatal deaths in j:he last two decades. The Maternal Mortality Ratio (MMR) has declined from 398 (per 100 000 live births) in 1997-98 to 212 in 2007-09 and the neonatal mortality has declined from 45 (per 1000 live births) to 34 during the same period. Despite this recent achievement India still is one of the countries having high MMR in the world accounting for 19 percent of maternal deaths worldwide. Findings of a study report on MDGs progress in Bangladesh suggest that utilization of maternal health care is less in rural and poorest household as compared to their counterpart. Unlike developed countries in India more than 70 percent of the health care expenditure is paid by individuals and the government bears only 20 percent the rest is from businesses and external flows. In many situations health care expenditure which also includes maternal and neonatal care is catastrophic; this in tum can push the households into poverty. Especially rural households the less educated slum dwellers and poor households because these households in India are more likely to finance health care through borrowing and sale of assets than well off population groups. The District Level Household Survey DLHS4 has pointed out that at the public health facilities on an average a household has to spend INR 3130 for each delivery and it is INR 3000 in rural areas of Karnataka. Hence in this background using information from a baseline survey the present article aims to examine household expenses incurred for availing maternal healthcare services by rural women in North Kamataka.