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Effect of mHealth in improving antenatal care utilization and skilled birth attendance in low- and middle-income countries: a systematic review protocol.
JBI Database of Systematic Reviews and Implementation Reports. 2017 Jul; 15(7):1778-1782.REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify and synthesize the best available evidence on the effect of mobile health (mHealth) interventions in antenatal care utilization and skilled birth attendance in low- and middle-income countries.More specifically, the review questions are as follows.
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).
Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India.
Global Health: Science and Practice. 2017 Jun 27; 5(2):217-231.BACKGROUND: Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices. METHODS: We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers. RESULTS: Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coach was present (range: -1% to 62%). CONCLUSION: Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings.
[Geneva, Switzerland], WHO, 2011.  p.As part of its "Making Pregnancy Safer" series, the World Health Organization answers the following questions about skilled birth attendants: Who is a skilled birth attendant? In how many births do skilled attendants assist? How do skilled attendants care for mothers and babies? How does skilled birth care impact on maternal mortality? How can the coverage be increased? What does WHO do to increase skilled care at birth?
Obstetrics and Gynecology. 2007 Nov; 110(5):1017-1018.Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training remains limited and conflicting. The objectives were to assess effects of TBA training on health behaviors and pregnancy outcomes. We searched the Trials Registers of the Cochrane Pregnancy and Childbirth Group and Cochrane Effective Practice and Organisation of Care Group (EPOC) (June 2006); electronic databases representing fields of education, social, and health sciences (inception to June 2006); the internet; and contacted experts. Published and unpublished randomized controlled trials (RCT), controlled before/after and interrupted time series studies comparing trained and untrained TBAs or women cared for/living in areas served by TBAs. Three authors independently assessed study quality and extracted data. Four studies, involving over 2,000 TBAs and nearly 27,000 women, are included. One cluster-randomized trial found significantly lower rates in the intervention group regarding stillbirths (adjusted odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57-0.83, P less than .001), perinatal death rate (adjusted OR 0.70, 95% CI 0.59-0.83, P less than .001) and neonatal death rate (adjusted OR 0.71, 95% CI 0.61-0.82, P less than .001). Maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45-1.22, P=.24) while referral rates were significantly higher (adjusted OR 1.50, 95% CI 1.18-1.90, P less than .001). A controlled before/after study among women who were referred to a health service found perinatal deaths decreased in both intervention and control groups, with no significant difference between groups (OR 1.02, 95% CI 0.59-1.76, P=.95). Similarly, the mean number of monthly referrals did not differ between groups (P=.321). One RCT found a significant difference in advice about introduction of complementary foods (OR 2.07, 95% CI 1.10-3.90, P=.02) but no significant difference for immediate feeding of colostrum (OR 1.37, 95% CI 0.62-3.03, P=.44). Another RCT found no significant differences in frequency of postpartum hemorrhage (OR 0.94, 95% CI 0.76-1.17, P=.60) among women cared for by trained versus TBAs. The potential of TBA training to reduce peri-neonatal mortality is promising when combined with improved health services. However, the number of studies meeting the inclusion criteria is insufficient to provide the evidence base needed to establish training effectiveness. (author's)
Bulletin of the World Health Organization. 2007 Oct; 85(10):740-741.Indonesia's maternal mortality rate is one of the highest in south-east Asia. One East Java district has introduced a novel scheme to reduce those deaths. In many rural areas of Indonesia, traditional ways of delivering babies remain popular. For example, in Ugaikagopa in the country's east, traditional healers take the pregnant woman to the middle of the forest to deliver the baby. They may use fibres taken from bamboo to cut the umbilical cord and wipe the newborns' bodies with guava leaves. The instruments used are not sterile and can lead to infection. The traditional healer, or dukun in Indonesian language or Bahasa, may not be able to deal with complications during labour, and by the time the mother gets to a local clinic it may be too late. As a result, maternal mortality in Indonesia is high compared to most south-east Asian countries. In 2005, there were an estimated 262 maternal deaths per 100 000 live births, compared with 39 per 100 000 in Malaysia and 6 per 100 000 in Singapore. Figures for Papua province from 2003 show even higher death rates: 396 per 100 000 live births. (excerpt)
Midwifery. 2006 Sep; 22(3):194-195.The series of global health meetings planned around the 59th World Health Assembly (WHA), in Geneva, Switzerland, May 22--27 2006, was overshadowed by the sudden and unexpected death of the Director General of the World Health Organization, Dr LEE Jong-wook, on the morning of May 22. Dr Lee took up his post on May 21, 2003, following election by the Member States of WHO for a five-year term. Prior to his work as Director-General, Dr Lee was a world leader in the fight against two of the greatest challenges to international health and development-- tuberculosis, and vaccine preventable diseases of children. Following the death of Dr Lee, Dr Anders Nordstrom was appointed Acting Director-General by the WHO Executive Board. Dr Nordstrom had been WHO Assistant Director-General for General Management since 21 July, 2003. A new permanent Director-General will be appointed in November 2006. (excerpt)
UN Chronicle. 2005 Dec;  p..Afghan women have one of the world's highest maternal mortality rates. They face many obstacles when it comes to accessing health care: most are rural and do not live close to or cannot access medical facilities, if the need arises. The few existing facilities do not necessarily specialize in obstetric and gynaecological care and cannot always offer quality care. Many Afghan families do not recognize signs of complication during pregnancy and delivery, and may not seek medical attention soon enough to save the lives of mothers and babies. Also ongoing insecurity and cultural norms in the country often keep women from leaving the house to seek urgently needed medical care. Because of cultural pressures, families are reluctant to present women to male doctors, and few female doctors are trained to meet the overwhelming medical needs of women; these conditions constitute a death sentence for thousands of women each year. It is estimated that about 25 per cent of Afghan children die before their fifth birthday from mostly preventable illnesses. The World Health Organization reports that children in Afghanistan are particularly at risk of dying from diarrhoeal diseases that, according to surveys, result in 20 to 40 per cent of all deaths of children under five--an estimated 85,000 children per year. Diarrhoea is also a significant cause of malnutrition, which is a major contributing factor in children's death from other diseases. (excerpt)
Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2004.  p.In 2000, the largest-ever gathering of heads of state at the United Nations in New York, USA, adopted the UN Millennium Declaration. This historic compact among nations includes eight critical goals—the Millennium Development Goals (MDGs)—for combating poverty and accelerating human development. Two of the eight MDGs relate to reducing child mortality and improving maternal health, respectively, pointing to the importance of these health factors in global development and poverty reduction. The World Health Organization (WHO), the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are pleased to see the inclusion in the MDGs of the target to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. This inclusion is the result of many years of advocacy (by WHO, ICM and FIGO, among others) for the need to recognize the link between maternal health and development. The MDGs send yet another reminder to planners and policy-makers that for the world’s poor motherhood still carries a high risk of morbidity and mortality. But years of previous work in making motherhood safer has not all been in vain. There is now a global consensus on what must be done to eliminate the menace of maternal deaths once and for all. Already in 1999, a joint WHO/UNFPA/ UNICEF/World Bank statement called on countries to “ensure that all women and newborns have skilled care during pregnancy, childbirth and the immediate postnatal period”. (excerpt)
Journal of Midwifery and Women's Health. 2004 Jul-Aug; 49(4):306-311.Traditional birth attendant (TBA) training commenced in many places in the non-Western world in the 1970s, supported by the World Health Organization and other funding bodies. By 1997, senior policy makers decided to refocus priorities on the provision of “skilled attendants” to assist birthing women. The definition of skilled attendants excluded TBAs and resulted in the subsequent withdrawal of funding for TBA training globally. A review of the health and sociological literature and international policy documents that address TBA training revealed how international policy and professional orientation are reflected in education programs designed for the TBA. Policy makers risk ignoring the important cultural and social roles TBAs fulfill in their local communities and fail to recognize the barriers to the provision of skilled care. The provision of skilled attendants for all birthing women cannot occur in isolation from TBAs who in themselves are also highly skilled. This article argues a legitimacy of alternative world views and acknowledges the contribution TBAs make to childbearing women across the world. (author's)
[Technical cooperation of PAHO / WHO in the traditional midwives program] Cooperación técnica de OPS / OMS al programa de parteras tradicionales.
In: La partera tradicional en la atención materno infantil en México, [compiled by] Mexico. Secretaría de Salud. Programa Nacional de Parteras Tradicionales. Mexico City, Mexico, Secretaría de Salud, Programa Nacional de Parteras Traditionales, 1994. 137-145.Mexico is one of the pioneering countries with the most experience in the work of traditional midwives, not only in the Latin American region, but throughout the world. Formal activities were initiated in 1937 and were mainly focused on training. To date, the institutions authorized to train traditional midwives in the country (the Secretariat of Health, the National Indigenous Institute, and the Mexican Social Security Institute) have registered approximately 24,000 midwives, of which 75% are trained. During this period, many strategies developed in Mexico have been disseminated and adopted by other countries in the region. (excerpt)
[Operations research: an essential element in the evaluation of the impact and systematization of the experience of the National Program of Traditional Midwives] Investigación operativa: elemento esencial en la evaluación del impacto y sistematización de la experiencia del Programa Nacional de Parteras Tradicionales.
In: La partera tradicional en la atención materno infantil en México, [compiled by] Mexico. Secretaría de Salud. Programa Nacional de Parteras Tradicionales. Mexico City, Mexico, Secretaría de Salud, Programa Nacional de Parteras Tradicionales, 1994. 149-153.Linking operational research with general goals and achievements results in the scientific validation of the program's impact in terms of the modification of the situation of the population, the objective, and its environment. We can categorically state that without the evaluation process-understood in methodological terms as an operational investigation of all the strategies that make up an established program-it is not possible to establish scientifically valid correlations between the results and the impact of actions, nor to systematize the experience so that it can be replicated and disseminated. Within this framework, the Secretariat of Health, by way of the Board of Maternal-Infant Health, with the participation of the United Nations Children's Fund (UNICEF), decided to undertake an operational investigation to evaluate the impact of training for traditional midwives in the period 1989-1993 and to systematize this experience. (excerpt)
The role of the traditional midwife in the family planning program. Report of National Workshop to Review Researches into Dukun Activities related to MCH Care and Family Planning.
[Jakarta], Indonesia, Department of Health, 1972. 83 p.A number of studies conducted already have revealed that there are possibilities of using dukuns as potential helpers in the family planning programme. Bearing in mind that the number of dukuns at the present time is large, it is easy to imagine that they are capable of contributing a great deal towards progress in our family planning programme provided that the dukuns are assigned a role which is appropriate. In this respect, I am only referring to dukuns whose prime function is helping mothers during pregnancy and immediately afterwards, and who have close contact therefore, with the target of the family planning programme, i.e. the eligible couples. It would indeed be very helpful, if we could find out from the available data and from the results of applied research what exactly is the scope and usefulness of dukuns in the family planning programme. It seems to me that in this project we have to consider a twofold problem. The first aspect of the problem is that the dukuns are mostly of an advanced age and they are illiterate. The second aspect is that in spite of relationships with MCH centers extending over a period of years most of the dukuns still prefer their own way of doing things and they remain unaffected by modern ways of thinking. (excerpt)