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Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.
Tropical Medicine and Health. 2018; 46(1)Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Geneva, Switzerland, United Nations High Commissioner for Refugees [UNHCR], 2008 Apr. 20 p.This Guidance on Infant feeding and HIV aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in refugees and displaced populations. Its purpose is to provide an overview of the current technical and programmatic consensus on infant feeding and HIV, and give guidance to facilitate elective implementation of HIV and infant feeding programmes in refugee and displaced situations, in emergency contexts, and as an integral element of coordinated approach to public health, HIV and nutrition programming. The goal of this guidance is to provide tools to prevent malnutrition, improve the nutritional status of infants and young children, to reduce the transmission of HIV infection from mother to child after delivery, and to increase HIV-free survival of infants.
In: Shaping policy for maternal and newborn health: a compendium of case studies, edited by Sandra Crump. Baltimore, Maryland, JHPIEGO, 2003 Oct. 15-22.In Bangladesh, immediate breastfeeding was not traditionally practiced, and exclusive breastfeeding was virtually nonexistent. Mothers tended to discard colostrum (first milk), substituting prelacteal feeds such as sugar water, honey, or oil instead of breast milk as the first feed for all newborn babies. Initiation of breastfeeding by most mothers took place on the third or fourth day. In the event of illness, mothers would cease breastfeeding. Complementary feeding practices were also unsatisfactory, consisting of bulky, energy-thin feeds, with weaning occurring either too early or too late. Such was the state of affairs in Bangladesh in 1979, when the World Health Organization (WHO) and UNICEF held a meeting in Geneva for the first time to emphasize the importance of breastfeeding--the first in a series of important initiatives to address this issue and other child health and nutrition concerns. Before 1980, there was hardly any discussion within the medical profession in Bangladesh of the importance of breastfeeding, let alone of a public health intervention to promote it. But the leadership of global agencies on this important issue had a significant impact on breastfeeding policy and practice in Bangladesh. This case stud), describes the origins of the breastfeeding movement in Bangladesh, the government of Bangladesh's support for the initiative, and the partnership that was established among the health professions, United Nations (UN) agencies, bilateral agencies, and the World Bank to change breastfeeding practices. The introduction of breastfeeding contributed to better health and nutritional status among the nation's children within a decade. (excerpt)
What are maternal health policies in developing countries and who drives them? A review of the last half-century.
In: Safe motherhood strategies: a review of the evidence, edited by Vincent De Brouwere, Wim Van Lerberghe. Antwerp, Belgium, ITGPress, 2001. 412-445. (Studies in Health Services Organisation and Policy No. 17)This paper examines maternal health policies in developing countries and identifies contributions made by policy makers, health professionals and users. It starts by reviewing the broader health systems within which maternity services sit, and the specific maternity-service configurations that appear to lead to low maternal mortality. Next, it lays out the main actors (politicians and policy makers, health professionals and women’s groups) operating internationally. This is followed by presenting the maternal health policy agenda at the international level and discussing the ideological paradigms that influenced these policies. Mention of the main actors (as above but including and organised groups of service users) at the national level is more superficial, but examples of the impact of various actors on national-level maternal health policies are given. The overall aim is to better understand how policies have developed and to suggest lessons and ways forward for the future. (author's)
Perspectives in Health. 2003; 8(2):15-21.Andean ministers of health meeting last April proposed an Andean vaccination week. The idea was soon expanded to include South America and later Mexico, Central America and the Caribbean. Eventually 19 countries joined together for the first Vaccination Week in the Americas. The focus was on children who had never been vaccinated: those in hard-to-reach rural areas or marginal urban zones whom earlier campaigns had left behind. (excerpt)