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Exaggerating contraceptive efficacy: the implications of the Advertising Standards Authority action against Natural Cycles.
BMJ Sexual and Reproductive Health. 2019 Jan; 45(1):71-72.Natural Cycles has launched a hugely successful marketing campaign, incorporating targeted advertising and social media influencers. The app, which has digitised fertility awareness based methods of contraception, was approved as a medical device in Europe in 2017. The authors were concerned that some of their claims were vulnerable to misinterpretation, and may have contravened the UK Code of Non-broadcast Advertising and Direct & Promotional Marketing (CAP code) and filed a complaint with the ASA.
Antiretroviral therapy clinic attendance among children aged 0-14 years in Kahama district, Tanzania: a cross-sectional study.
Tanzania Journal of Health Research. 2018 Jan; 20(1): p.Background: Efforts made to scale up care and treatment for HIV in Tanzania have started to pay off. The number of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) has massively increased owing to an increase in investment made. However, this is not reflected in all populations, especially children living with HIV. This study, therefore, aims to determine the magnitude and factors associated with ART uptake among children living with HIV in Kahama district, Tanzania. Methods: This cross-sectional study was conducted among pairs of children aged 0-14 years and their caregivers. A total of 423 randomly selected caregivers of HIV-positive children were interviewed using a structured questionnaire. The outcome variable was ART uptake while independent variables constituted of socio-demographic, health facility, and systemic factors. Results: A total of 132 (31%) of all caregivers reported to have missed at least one clinic visit for their children during a period of three months before the survey. Of them, one in four missed at least two clinics. Caregivers cited factors such as lack of transport fare and distance to the health facility as barriers to attend the planned clinics. After adjusting for the important confounders and other covariates, factors associated with ART uptake were being divorced/widowed (AOR= 0.57, 95% CI; 0.33-0.97) and having primary education or more (AOR 0.30, 95% CI 0.11-0, 82). Conclusion: One in every three HIV-positive children miss their scheduled routine ART clinics in Kahama, Shinyanga. Tailored interventions should target caregivers of such children who are divorced or widowed and those with low or no education while addressing distance and transportation challenges in this and other areas with similar contexts.
Evaluating medical and systemic factors related to maternal and neonatal mortality at Nyakahanga Hospital in north-western Tanzania.
Tanzania Journal of Health Research. 2017 Oct; 19(4): p.Background: This study examined maternal morbidity and mortality and neonatal mortality over a multi-year period from de-identified retrospective medical records at Nyakahanga Designated District Hospital in north-western Tanzania. The study aimed to examine factors related to maternal mortality (MMR) and morbidity in women who deliver their babies at the hospital, assess neonatal mortality of full-term infants, and analyse health care response to mother and neonate after admission. Methods: Information from hospital obstetric logs was analysed and relationships explored for obstetric outcomes including maternal deaths and complications, neonatal status, and types of delivery for 55.5 months during 2009-2014. Results: Results indicate that this rural hospital has achieved noteworthy improvement in their maternal mortality with MMR approximating the national average despite ongoing gaps in staffing needs. The majority of deliveries are under the age of 25 and a first or second pregnancy. Reported maternal complications are equivalent to global averages although some, i.e. uterine rupture, may be related to delays in obstetric delivery. Despite improvements in maternal mortality, neonatal mortality is elevated relative to Tanzania averages, particularly in caesarean sections. Neonatal deaths are positively related to maternal age. Conclusion: Since this hospital is an emergency obstetric referral centre, obstetric clients frequently arrive after prolonged labour and foetal distress is common, partially explaining the elevated caesarean section rate and perinatal death rate. Hospital initiatives are underway to provide more rapid response in these scenarios. In addition, it is recommended that since antenatal attendance is high, initiatives be expanded to educate multiparous and older women on seeking skilled care upon onset of labour or at the sign of any complications.
Tanzania Journal of Health Research. 2017 Oct; 19(4): p.Background: Birth weight is one of the key predictor for survival, health and future development of a child. In developing countries data on birth weights are limited to obtain due to difficulties in keeping records especially among rural women. Maternal recall of birth weight can therefore become a useful source of birth weight data. This study was carried out to determine recall of birth weight and delivery complications among mothers in Unguja West District of Zanzibar. Methods: This cross-sectional study involved mothers who had children below five years of age. Pretested structured questionnaire was used to collect information on socio-demographic characteristics of the mother, age of the child, birth weight of the child and delivery complications. Other information was obtained from maternal antenatal clinic and child’s growth monitoring cards. Results: A total of 260 women were included in the study. The mean age of the mothers was 29 years, ranging from 17 to 45 years. More than half (62%) had attained secondary education and few had informal education (6.5%) or post-secondary education (12%). Majority of the mothers (85%) delivered at the health facility assisted by trained health care provider. Those who delivered at home (15%) were either assisted by a relative or Traditional Birth Attendant (TBA). Over three quarters (78.5%) of the mothers had birth weights of their children recorded in the postnatal care cards. Out of 38 children who were born at home, 87% (n = 33) were not weighed and there were 23 women (10.4%) who delivered at the hospital but their children’s weight were not recorded. Overall, 46 (20%) mothers could not correctly recall birth weights of their children. There was strong correlation between recall and recorded birth weight (r2=0.79; p<0.01). Reported/recorded delivery complications were hypertension, excessive bleeding, low birth weight, episiotomy, anaemia and preeclampsia. Conclusion: Maternal recall can provide reliable information with regard to child’s birth weight and delivery complications. Health facility staff should measure child’s weight correctly, inform the mother and record in the child’s card in order to facilitate correct recall by the mothers.
The association between voucher scheme and maternal healthcare services among the rural women in Bangladesh: A cross sectional study.
Bangladesh Journal of Medical Science. 2018; 17(4):545-555.Background: Maternal health voucher scheme, providing financial support to poor women, is popularly known as subsidies in maternity care services including antenatal, delivery and postnatal care and also economic barriers while seeking treatment from qualified service providers. The aim of this study is to evaluate the association of voucher scheme on receiving maternal healthcare services among the rural women in Bangladesh. Methods: This is a cross sectional study where total sample size was (n=500) rural women who were selected by using convenience sampling method. Among them, 250 women were voucher scheme receivers and other 250 women were non-voucher scheme receivers. A structured questionnaire was adopted for data collection between November and December 2015. In the final analysis, cross tabular analysis and logistic regression model were used, and adjusted odds ratios (ORs) were reported. Results: The study found a strong relation between voucher scheme and maternal healthcare services among the rural women in Bangladesh where majority (88.4%) voucher scheme receivers received information or treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) while non-voucher scheme receivers received only 10%. Most of the respondents (93%) voucher scheme receivers received at least 3 times of antenatal care visit; but only 28% received non-voucher scheme receivers at least 3 times of antenatal care visit. Voucher scheme receivers received 17.127 times more likelihood to receive skilled birth attendance and 25.344 times more likelihood to receive institutional delivery services and positively significant (5 percent) compared to those who did not receive maternal heath voucher scheme. Moreover, 92.4% voucher receivers received transport cost and 73.2%, received safe home delivery services while 22.8% non-voucher scheme receivers received transport cost and only 20.4% received safe home delivery services. Majority (94%) voucher scheme receivers received long time birth control services while only 19.2% non-voucher scheme receivers received long time birth control services. Conclusion: Women who did not receive maternal health voucher scheme found the status of lower antenatal, delivery and postnatal care services receiving trends compared to the women who received the maternal health voucher scheme. It is recommended an effective monitoring system and necessary interventions getting overall developed health status in Bangladesh. © 2018, Ibn Sina Trust. All Rights Reserved.
PloS One. 2018; 13(11):e0207920.BACKGROUND: The control of maternal deaths continues to be a significant public health issue and commands an enormous amount of attention, especially under the future family planning policy. Here, we describe the epidemiology and trends of maternal deaths in Hunan province, and give several policy implications. METHODS: Maternal deaths in Hunan province between 2009 and 2014 were retrospectively reviewed and analyzed. Cochran-Armitage trend test was used to assess the time trends of maternal mortality rates. Binary logistic regression analyses were undertaken to identify the factors that were associated with unavoidable maternal deaths. RESULTS: In total, there were 987 maternal deaths, with the overall MMR declining by 45.24%. The most common causes of maternal death during this period were pregnancy complications (28.37%), obstetric hemorrhage (25.33%), and amniotic fluid embolism (15.70%). Obstetric hemorrhage (28.14%) was higher in rural areas, while pregnancy complications were higher (29.27%) in urban areas. In all, 627 (63.5%) deaths were avoidable. The risk factors associated with unavoidable maternal deaths was above 35 years (aOR = 1.80 95%CI: 1.27-2.55), without prenatal examination (aOR = 8.97 95%CI: 1.11-7.78), low household incomes (aOR = 1.15 95%CI: 1.02-1.29), without adopting the new way to deliver (aOR = 5.15 95%CI: 3.20-8.31), and death location (aOR = 1.09 95%CI: 1.02-1.18). The most frequent and important factors associated with avoidable deaths was improper knowledge and skills of the county medical institutions. CONCLUSIONS: Moderate progress was made in reducing the MMR in Hunan province. The government should aim to improve the basic midwifery skills in rural areas and the obstetric emergency rescue service for critically ill pregnant women in urban areas, and strengthen training to improve knowledge and skills in medical institutions in counties.
Understanding key drivers of performance in the provision of maternal health services in eastern cape, South Africa: a systems analysis using group model building.
BMC Health Services Research. 2018 Nov 29; 18(1):912.BACKGROUND: The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts. METHODS: The study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semi-structured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs). RESULTS: The stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished. CONCLUSION: Understanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance.
Health Affairs. 2017 Jun 1; 36(6):1160.Add to my documents.
Hospitals by day, dispensaries by night: Hourly fluctuations of maternal mortality within Mexican health institutions, 2010-2014.
PloS One. 2018; 13(5):e0198275.BACKGROUND: Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. OBJECTIVE: To analyze the hourly variation of maternal mortality within Mexican health institutions. METHODS: We performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010-2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies. RESULTS: Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays. CONCLUSIONS: Evidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.
Preventability of maternal near miss and mortality in Rwanda: A case series from the University Teaching Hospital of Kigali (CHUK).
PloS One. 2018; 13(6):e0195711.OBJECTIVE: Assess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK). METHODS: We reviewed records for all women admitted to CHUK with pregnancy-related complications between January 1st, 2015 and December 31st, 2015. All maternal deaths and near misses, based on WHO near miss criteria were reviewed (Appendix A). A committee of physicians actively involved in the care of pregnant women in the obstetric-gynecology department reviewed all maternal near misses/ pregnancy-related deaths to determine the preventability of these outcomes. Preventability was assessed using the Three Delays Model. Descriptive statistics were used to show qualitative and quantitative outcomes of the maternal near miss and mortality. RESULTS: We identified 121 maternal near miss (MNM) and maternal deaths. The most common causes of maternal near miss and maternal death were sepsis/severe systemic infection (33.9%), postpartum hemorrhage (28.1%), and complications from eclampsia (18.2%)/severe preeclampsia (5.8%)/. In our obstetric population, MNM and deaths occurred in 87.6% and 12.4% respectively. Facility level delays (diagnostic and therapeutic) through human error or mismanagement (provider issues) were the most common preventable factors accounting for 65.3% of preventable maternal near miss and 10.7% maternal deaths, respectively. Lack of supplies, blood, medicines, ICU space, and equipment (system issues) were responsible for 5.8% of preventable maternal near misses and 2.5% of preventable maternal deaths. Delays in seeking care contributed to 22.3% of cases and delays in arrival from home to care facilities resulted in 9.1% of near misses and mortalities. Cesarean delivery was the most common procedure associated with sepsis/death in our population. Previous cesarean delivery (24%) and obstructed/prolonged labor (13.2%) contributed to maternal near miss and mortalities. CONCLUSION: The most common preventable causes of MNM and deaths were medical errors, shortage of medical supplies, and lack of patient education/understanding of obstetric emergencies. Reduction in medical errors, improved supply/equipment availability and patient education in early recognition of pregnancy-related danger signs will reduce the majority of delays associated with MNM and mortality in our population.
Dynamics of postpartum IUD use in India. Quality of care received and interim results three months after insertion.
Washington, D.C., Population Council, The Evidence Project, 2018 Feb. 8 p. (Research Brief)This research brief explores the contraceptive use dynamics among 412 married women in India who received a postpartum intrauterine contraceptive device (PPIUD). The women were interviewed within one month of starting the method and again at a three-month follow-up. These preliminary findings should be of interest to program designers, policy makers and health service delivery professionals, especially family planning and antenatal care providers. Findings include reported quality of care received by PPIUD users at the time of insertion and dynamics of PPIUD use after three months, including method continuation, switching, and discontinuation. The brief also examines the role of husbands and frontline health workers in PPIUD use dynamics. This is the first in a series of briefs in a longitudinal study of the dynamics of contraceptive use among 2,699 married women aged 15-49 in Odisha and Haryana states in India. Future briefs will explore dynamics among IUD users, injectable users, and oral contraceptive pill users from enrollment through three-, six-, and twelve-month follow-up interviews.
Bulletin of the World Health Organization. 2018 Sep; 96(9):531-539.Objective: To assess the association between hypertensive disorders in pregnancy and the stillbirth rate. Methods: We obtained all data from China’s National Maternal Near Miss Surveillance System for 2012 to 2016. Associations between hypertensive disorders in pregnancy and stillbirths, stratified by fetus number and gestational age, were assessed using Poisson regression analysis with a robust variance estimator. Findings: For the period, 6 970 032 births, including 66 494 stillbirths, were reported to the surveillance system. The weighted stillbirth rate in women with a hypertensive disorder in pregnancy was 21.9 per 1000 births. The risk was higher in those who had received few antenatal care visits or who were poorly educated. For singleton pregnancies, the adjusted risk ratio (aRR) for a stillbirth among women with hypertensive disorders in pregnancy compared with normotensive women was 3.1 (95% confidence interval, CI: 2.85-3.37). The aRR for hypertensive disorder subtypes was: 6.66 (95% CI: 5.57-7.96) for superimposed preeclampsia; 4.15 (95% CI: 3.81-4.52) for preeclampsia or eclampsia; 2.32 (95% CI: 1.87-2.88) for chronic hypertension; and 1.21 (95% CI: 1.08-1.36) for gestational hypertension. For multiple pregnancies, the association between stillbirths and hypertensive disorders in pregnancy was not significant, except for superimposed preeclampsia (aRR: 1.95; 95% CI: 1.28-2.97). Conclusion: To minimize the incidence of stillbirths, more attention should be paid to chronic hypertension and superimposed preeclampsia in singleton pregnancies and to superimposed preeclampsia in multiple pregnancies. Better quality antenatal care and improved guidelines are needed in China.
Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middl-income countries.
BMJ Global Health. 2018 Dec 1; 3(6):e001011.Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.
Utilization of quality assessments in improving adolescent reproductive and sexual health services in rural block of Maharashtra, India.
International Journal of Community Medicine and Public Health. 2018 Apr; 5(4):1639-1646.Background: The present study was conducted with an objective to evaluate the quality of ARSH services; assess if these services met the National Standards of care and to utilize periodic program improvement recommendations through the WHO - quality assessment (QA) tools. Quality of ARSH services at twenty public health facilities in a rural block of a state in India were assessed using WHO-QA tools with a pre-test post-test interrupted time series design. Methods: Seven standards of care addressing provision of quality ARSH services (Standard I-IV); demand generation for these services (V-VI); and management information system (Standard VII) were assessed using WHO-QA tools for five years (2009-2014). Data analysis was done using Excel scoring template developed jointly with WHO. Scores were given for each standard and to each facility. Results: Periodic interventions resulted in improving the average facility score from 27% to 83% and overall standards score from 28% to 81% at baseline and endline survey respectively. The average scores for Standards I-IV improved from 43% 86%; for standards V–VI from 3% to 66% while for standard VII from 16% to 92% at baseline and endline survey respectively. Conclusions: Appropriate QA and periodic evidence-informed program inputs improved the quality and utilization of ARSH services. However, community outreach activities continued to be challenging. The assessment demonstrated feasibility and usefulness of using the WHO-QA tools to monitor and improve the quality of ARSH services.
Improving maternal and child health: a situational analysis of primary health care centres of Sokoto state, Nigeria.
International Journal of Community Medicine and Public Health. 2018 Dec; 5(12):5052-5062.Background: Primary health care facilities constitute the first point of contacts of public with healthcare and form integral part of the country’s health system. Methods: A descriptive cross sectional study was conducted among 88 primary care facilities in the State. A simple random sampling technique was used to select the facilities. Federal Ministry of Health integrated supportive supervision tool was adapted for data collection and analysis done using SPSS Version 20.0. The variables were summarised with frequency and percentage and results presented in tables. Results: Almost two-thirds (65%) of the facilities provide 24 hours service coverage for both maternal and child care services. Only 16% of the facilities had medical officers, 12.5% had required number of nurse/midwife while 27% had no single nurse/midwife. With respect to trainings, one third of the facilities had personnel trained on medium and extended lifesaving skills, 20% had a trained staff on emergency obstetrics and newborn care while 61% had no single trained personnel on integrated management of childhood illnesses. A large proportion of the facilities provide maternal services such as focused ANC and delivery but none use partograph to monitor labour. A good number of facilities were lacking basic equipment and medicine supply with about two third of facilities lacking misoprostol and magnesium sulphate, and only 15% had functional DRF. Conclusions: Health resources and the level of service provision in its current form may not lead to a significant improvement in maternal and child health in the state to guarantee universal coverage.
Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms?
Maternal and Child Nutrition. 2018 Oct 13; 13 p.Community health workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care, and/or cost-effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost-effective manner. Adequate training and close supervision were found to be essential to ensure high-quality performance of CHWs. Motivation through financial compensation and other incentives, which improve their social recognition, was also found to be an important factor contributing to high-quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e., ready-to-use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.
American Journal of Maternal Child Nursing. 2017 Mar/Apr; 42(2):118.Add to my documents.
International Journal of Community Medicine and Public Health. 2018 Jun; 5(6):2182-2189.Background: Antenatal care service is an evidence based interventions given to the pregnant women. Objective of the study was to assess quality of antenatal care services in selected health facilities of Kaski district, Nepal. Methods: A cross sectional study was conducted in selected health institutions in Kaski district of Nepal during June to November 2017. Two hundred seven participants were selected from health facilities of Kaski district. Structured questionnaires were employed as tool for data collection. Results: This study showed that 50.7 percent respondents waited less than 35 minutes for receiving service. More than half of the total respondents (63.3%) reported that the consultation time provided for them was less than 20 minutes. All respondents reported that weight and blood pressure measurement was undertaken while none of them reported that height was measured. It was found that maximum number of participants (99.0%) were received iron/folate tablets and tetanus vaccination. Similarly, 97.6% of participants reported that they were counselled on nutrition and 96.6% of reported they get counselling on danger signs. In overall, 48.3% of the respondents were satisfied with the services they received and 43% of the respondents received good quality ANC service from different health institutions. Conclusions: In overall satisfaction of antenatal care services was found to be low and more than half of respondent does not received good quality ANC services.
Lancet. 2018 Oct 13; 392(10155):1290-1291.Add to my documents.
The invisible magnitude of violence against women. A magnitude invisivel da violencia contra a mulher.
Epidemiologia e Servicos de Saude. 2016 Jul-Sep; 25(3):451-454.Add to my documents.
Exploring barriers to accessing maternal health and family planning services in ethnic minority communities in Viet Nam.
Hanoi, Vietnam, UNFPA, 2017. 132 p.This study draws on a mixed methods design to explore the perspectives of ethnic minority women in six provinces in the Central Highlands and Northern Midlands and Mountains regions of Viet Nam, answering the overarching research questions: According to the data available, what is the status of ethnic minority women’s access to and utilization of maternal health and family planning services? What is the extent of inequalities in access to maternal health care and family planning services compared to national estimates, and what is the extent of inequalities within the ethnic minority population? What are the reasons for women not having access (or having inadequate access) to maternal health care services? The primary objective of this report is to enhance understanding of childbirth practices, maternal health-seeking behaviour and the extent to which existing health services meet the needs and preferences of ethnic minority communities. The specific aims outlined in the Terms of Reference (ToR) for this study include to: Measure maternal health care utilization and family planning indicators of ethnic minority women in 60 communes selected from six provinces; Determine trends and disparities in maternal health care and family planning service utilization among women in ethnic minority communities; Identify determinants of maternal health care and family planning service utilization and non-utilization; Explore traditional customs, cultural beliefs and practices that shape the environment for service delivery and influence women’s health-seeking behaviours, utilization and non-utilization of maternal health care, and family planning services; Explore opportunities for the primary health care system to provide culturally appropriate services, adaptive to the local contexts and responsive to the needs of local people, and provide recommendations that support the provision of culturally appropriate maternal health and family planning services for women in ethnic minority and remote communes. The report is based on original survey data from 4,609 ethnic minority women, focus group discussions (FGDs) with more than 100 ethnic minority women, and interviews with health care providers and village leaders. The report covers key reproductive, maternal, newborn and child health (RMNCH) indicators related to health care access, disaggregated by four dimensions of inequality (place of residence, education level, economic status and ethnicity). The report summarizes both strengths and weaknesses of the current systems and practices with respect to ethnic minority women’s access to and utilization of maternal health and family planning services. The situation is better with respect to some indicators and subgroups of the population. For example, minimal differences were found in the use of modern contraceptives amongst ethnic minority participants compared to national estimates; coverage for community-based maternal health services is relatively high in Bac Kan Province, with more than 75% of women receiving antenatal care from commune health centres (CHCs); and more than 85% of women from the Tay and Gia Lai minority groups having their last birth attended by skilled health personnel. On the other hand, inequalities still persist for most indicators related to health care utilization compared to national estimates. The inequalities within the ethnic minority population in this study were most prominent among women in disadvantaged subgroups; that is, the poorest, the least educated, those residing in specific regions, and those from certain ethnic groups. There is still much progress to be made in improving RMNCH indicators and reducing inequalities related to maternal health care access.
International Journal of Community Medicine and Public Health. 2018 Jul; 5(7):2699-2704.Background: Maternity period is crucial and sensitive in the life of women due to various physiological changes that take place in the body during pregnancy and after. These changes need close monitoring to help optimize maternal and foetal health. This study explored pregnant women’s perceptions of maternity care services in the Volta Regional Hospital. Methods: Multiparous women (170) in the Ante Natal Clinic responded to a pretested questionnaire. The sample size was determined using Fischer’s formula for sample size calculation. Respondents were chosen using the convenient sampling method. The data was analysed using Statistical Package for Social Sciences version 20 in to descriptive statistics. Results: This study identified that women (42.5%) were never encouraged by health care providers to bring their partners during antenatal visits. Pregnant women (62.9%) reported that health care professionals did not allow their support persons including their husbands to be with them during labour. Women (34.1%) during labour were sometimes assaulted while 2.9% were always assaulted. Majority (74.2%) of the women received this five cardinal services that included vitamin K, eye care, cord care, bathing and immunization during the post natal period as 60.7% were introduced to family planning by midwives. Conclusions: Partner involvement in maternal health care needs to be encouraged by midwives to improve support from partners during pregnancy, labour and the post natal period. Support persons should be allowed to stay with women during labour to give the necessary support and encouragement and also take part in decision making concerning women’s care.
Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey.
Rockville, Maryland, ICF, DHS Program, 2018 Jun. 40 p. (DHS Working Papers No. 137)In Ethiopia, many mothers who attend the recommended number of antenatal care visits fail to use facility delivery and postnatal care services. This study identifies factors associated with facility delivery and use of postnatal care among mothers who had four or more antenatal care visits, using data from the 2016 Ethiopia Demographic and Health Survey (2016 EDHS). Methods: To identify factors associated with facility delivery, we studied background and service-related characteristics among 2,415 mothers who attended four or more antenatal care visits for the most recent birth. In analyzing factors associated with postnatal care within 42 days after delivery, the study included 1,055 mothers who attended four or more antenatal care visits and delivered at home. We focused on women who delivered at home because women who deliver at a health facility are more likely to receive postnatal care as well. A multivariable logistic regression model was fitted for each outcome to find significant associations between facility delivery and use of postnatal care. Results: Fifty-six percent of women had four or more antenatal care visits delivered at a health facility, while 44% delivered at home. Mothers with a secondary or higher level of education, urban residents, women in the richest wealth quintile, and women who were working at the time of interview had higher odds of delivering in a health facility. High birth order was associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Quality of antenatal care as measured by the content of care received during antenatal care visits stood out as an important factor that influences both facility delivery and postnatal care. Among mothers who attended four or more antenatal care visits and delivered at home, the content of care received during ANC visits was the only factor that showed a statistically significant association with receiving postnatal care. Conclusions: The more antenatal care components a mother receives, the higher her probability of delivering at a health facility and of receiving postnatal care. Thus, the health care system needs to increase the quality of antenatal care provided to mothers. Qualitative research is recommended to identify reasons why many women do not use facility delivery and postnatal care services even after attending four or more antenatal care visits.
Rockville, Maryland, ICF, DHS Program, 2018 Aug. 82 p. (DHS Analytical Studies No. 65; USAID Contract No. AID-OAA-C-13-00095)This report uses data from Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) to estimate effective coverage of health facility delivery in Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania—the six countries with both an SPA and a DHS survey occurring within two years of each other. Effective coverage can be considered as crude coverage—the conventional measure of the percentage of births delivered in a health facility—adjusted for the quality of care provided. In our analysis, quality of care for health facility delivery was measured using facility readiness scores, based on availability of items necessary for a facility to provide comprehensive delivery care. Results show that the estimates of effective coverage were substantially lower than the levels of crude coverage for facility delivery in all six countries—from 20% lower in Nepal to 39% lower in Haiti. Although Malawi has achieved almost universal coverage of facility delivery, at 93% of births, effective coverage was lower, at 66%. Senegal was the only other country with effective coverage higher than 50%. These findings suggest that many women who deliver in a health facility may not receive an adequate quality of care. Within a country, we estimated effective coverage for each region, accounting for facility type. Effective coverage estimates differed significantly among regions in every country with the exception of Malawi. Because facility readiness scores differed little across regions, the largest factor explaining regional differences in effective coverage was the prevalence of facility delivery for recent births. This study offers refined methods of producing effective coverage estimates of delivery care due to its adjustment for facility types and composition of a readiness score based on international guidance and empirical evidence. The fact that estimates of effective coverage—which account for a facility’s preparedness to provide the care—are substantially lower than the estimates using conventional measures of facility coverage provides insight into why maternal and neonatal mortality rates in many countries are not declining as rapidly as expected.
Quality of care and client satisfaction with maternal health services in Nepal. Further analysis of the 2015 Nepal Health Facility Survey.
Rockville, Maryland, ICF, DHS Program, 2018 Jul. 54 p. (DHS Further Analysis Reports No. 112; USAID Contract No. AID-OAA-C-13-00095)This report presents further analysis of the 2015 Nepal Health Facility Survey. Data analysis is based on the Donabedian framework for assessing quality of care in health services, which divides the indicators into three groups: structure, process, and outcome. The World Health Organization Service Availability and Readiness Assessment (SARA) indicator guideline was used to assess facility service readiness, service quality and client satisfaction with maternal health services. The study performed both bivariate and multivariate regression analysis to examine the association of maternal health service readiness and quality indicators with client satisfaction. The analysis revealed that 38% of antenatal care clients were very satisfied with the services provided at the health facility. Aspects such as nonpayment of service fees, sex of service provider, and regularity of conducting facility management committee meetings were significant predictors for client satisfaction with antenatal care services. Antenatal care clients were more satisfied if the facility had high service readiness and if they were not required to pay for the services received in the visit. Clients of Terai/Madhesi and other castes reported a higher level of satisfaction compared with the Brahmin/Chhetri. About half of postpartum clients were very satisfied with the services provided. Postpartum clients had 3.4 times higher odds of being satisfied with postpartum care if the facility had a protected client waiting area available compared with facilities without a protected waiting area. However, client satisfaction with postpartum care was not significantly associated with the service readiness indicator.