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Khatun S, Poudyal JK, Parajuli S, Dhungana GP. IFA compliance and associated factors among postpartum mothers: a cross-sectional analytical study at public health facilities in Bharatpur metropolitan city, Chitwan Nepal. BMJ Open 2025; 15:e087459. [PMID: 40074254 PMCID: PMC11904323 DOI: 10.1136/bmjopen-2024-087459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 01/22/2025] [Indexed: 03/14/2025] Open
Abstract
OBJECTIVES Iron deficiency anaemia and inadequate compliance with iron-folic acid (IFA) supplementation among pregnant and postpartum women pose substantial public health challenges in Nepal. Hence, this study aimed to determine IFA compliance and identify associated factors among postpartum mothers in Bharatpur Metropolitan City, Chitwan, Nepal. DESIGN An analytical cross-sectional design was employed. SETTING This study was conducted in Bharatpur Metropolitan City, Chitwan, Nepal. PARTICIPANTS A total of 286 postpartum mothers were selected using non-probability purposive sampling. Ethical approval was obtained from the Institutional Review Committee of Shree Medical and Technical College, and informed consent was obtained from all participants before data collection. Semi-structured questionnaires were administered through face-to-face interviews to collect data and ensure an in-depth understanding of the participants' responses. RESULTS Among the 286 participants, 53.5% demonstrated compliance with the IFAs. Multivariable logistic regression showed that compliance was significantly and positively linked to the level of education ((AOR)=3.629; 95% CI: (1.438 to 9.153)) and knowledge regarding IFAs (AOR=3.751; 95% CI: (2.145 to 6.562)). The reasons for non-compliance included the consumption of too many tablets, lack of information provided by healthcare workers, experiencing side effects and forgetting to take the tablets. CONCLUSIONS IFA compliance was observed in more than half of the participants. Compliance was influenced by participants' education and knowledge. The authors hold a strong conviction that relevant authorities can provide the necessary education in specific areas of concern to enhance the design and improvement of IFA programme strategies.
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Affiliation(s)
- Sahera Khatun
- Department of Public Health, Shree Medical and Technical College, Bharatpur, Bagmati, Nepal
| | - Jiwan Kumar Poudyal
- Department of Public Health, Shree Medical and Technical College, Bharatpur, Bagmati, Nepal
- Central Department of Population Studies, Tribhuvan University, Kirtipur, Nepal
| | - Sumitra Parajuli
- Department of Nursing, Bharatpur Hospital, Bharatpur, Bagmati, Nepal
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Jongdeepaisal M, Khonputsa P, Sirimatayanant M, Khuenpetch W, Harriss E, Maude RJ. Expanded roles of community health workers beyond malaria in the Asia-Pacific: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003113. [PMID: 39413107 PMCID: PMC11482702 DOI: 10.1371/journal.pgph.0003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 09/09/2024] [Indexed: 10/18/2024]
Abstract
In the Greater Mekong Subregion (GMS), community health workers (CHWs) are a key component of malaria elimination strategies. As malaria declines, support for, and uptake of, malaria services may also subsequently decrease. Expanding their roles beyond malaria has been proposed to sustain the services. A systematic review was conducted to identify and characterize programmes with CHWs providing services in addition to those for malaria in the Asia Pacific. This review describes the expanded roles, identifies evidence of impact or success of the programmes, and explores strategies to ensure sustainability and factors for effective implementation to inform the design of malaria CHW programmes. Searches were conducted in 6 databases, for grey literature, and in bibliographies of retrieved articles. Data were extracted from 38 published articles, 12 programme reports, and 4 programme briefs and analysed using thematic coding and descriptive analysis. Twenty-nine programmes were identified with CHWs performing both malaria and non-malaria roles in the Asia Pacific. There was evidence of impact on malaria incidence in 4 of these, none on malaria mortality, and 4 on other diseases. Monitoring and evaluation mechanisms, multi-sectoral stakeholder collaborations, and adequate training and consistent supervision of CHWs were key to effective programme implementation. Integration of programmes into broader health services, ongoing political and funding support, and engagement with local communities were found to contribute to sustaining provision of health services by CHWs. Expanding CHW roles depends on programme management and strengthening linkages with local health systems. To sustain malaria CHW services, countries need adequate policies and financing, and sufficiently strong health systems to deliver basic health services that are adapted to the health needs of the community which means transitioning away from vertical disease programs. Further research should explore programmes that have not been captured in this review and address gaps in measuring malaria outcomes.
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Affiliation(s)
- Monnaphat Jongdeepaisal
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Panarasri Khonputsa
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Massaya Sirimatayanant
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Worarat Khuenpetch
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elinor Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Richard J. Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- The Open University, Milton Keynes, United Kingdom
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Adane F, Aryeetey R, Aryeetey G, Nonvignon J. The costs of implementing anaemia reduction interventions among women fish processors in Ghana. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:69. [PMID: 39289741 PMCID: PMC11409671 DOI: 10.1186/s12962-024-00559-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/08/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Anaemia among women of reproductive age (WRA) remains persistently high in Ghana, affecting 41% in 2022. Women in low-income communities in Ghana engaged in fish processing activities are at increased risk of anaemia due to inadequate diets, exposure to infectious pathogens, and pollutants. The Invisible Fishers (IFs) project was implemented among women fish processors in their reproductive age in Central and Volta regions of Ghana to mitigate anaemia. Despite the efficacy, feasibility and scalability of the intervention, the cost of implementing the intervention is unknown. The objective of this study was to estimate the costs of implementing the IFs project in Ghana. METHODS We used micro-costing approach to analyse the costs of implementing the IFs project. Data were collected as part of a pilot randomized control trial with three interventions: Behaviour Change Communication (BCC), Strengthening Market Engagement of fish processors plus Behaviour Change Communication (SME + BCC), and Fish Smoking Technology and Practices plus Behaviour Change Communication (FST + BCC). The interventions were delivered to 60 women fish processors in the Central region and 60 in Volta region. The cost of the intervention was estimated from the societal perspective. Economic costs were categorized as direct costs (i.e. personnel, transportation, meetings, training, and monitoring) and indirect cost (i.e. value of productive time lost due to women and community volunteers' participation in the activities of the IFs project). RESULTS The FST + BCC had the highest average cost per beneficiary (US$11898.62), followed by the SME + BCC (US8962.93). The least expensive was the BCC (US$4651.93) over the intervention period of 18 months. Recurrent costs constituted the largest component of economic costs (98%). Key drivers of direct costs were personnel (58%), administrative expenses (14%), and transportation (7%). CONCLUSION There is a high cost for implementing interventions included in the IFs project. Planning and scaling -up of the interventions across larger populations could bring about economies of scale to reduce the average cost of the interventions.
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Affiliation(s)
- Francis Adane
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Genevieve Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Godha D, Remancus S, Sanghvi T. Inequality in iron and folic acid consumption and dietary diversity in pregnant women following exposure to maternal nutrition interventions in three low- and middle-income countries. Public Health Nutr 2024; 27:e149. [PMID: 38785047 PMCID: PMC11617414 DOI: 10.1017/s1368980024001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Research is available on improved coverage and practices from several large-scale maternal nutrition programmes, but not much is known on change in inequalities. This study analyses wealth and education inequality using Erreygers and Concentration indices for four indicators: adequate iron and folic acid (IFA) consumption, women's dietary diversity, and counselling on IFA and dietary diversity. DESIGN A pre-test-post-test, control group design. SETTING Maternal nutrition intervention programmes conducted in Bangladesh, Burkina Faso and Ethiopia during 2015-2022. PARTICIPANTS Recently delivered women (RDW) and pregnant women (PW). RESULTS Statistically significant reductions in education inequality were observed for adequate IFA consumption, counselling on IFA and dietary diversity in intervention areas of Bangladesh and for adequate IFA consumption in intervention areas of Burkina Faso.A significant decrease in wealth inequality was observed for adequate IFA consumption in the intervention areas of Bangladesh, whereas a significant increase was observed in the non-intervention areas for counselling on IFA in Ethiopia and for dietary diversity in Burkina Faso. CONCLUSION The results can be attributed to the extensive delivery system at community level in Bangladesh and being predominantly facility-based in Burkina Faso and Ethiopia. COVID-19 disruptions (in Burkina Faso and Ethiopia) and indicator choice also had a role in the results.The main takeaways for nutrition programmes are as follows: (a) assessing inequality issues through formative studies during designing, (b) monitoring inequality indicators during implementation, (c) diligently addressing inequality through targeted interventions, setting aside resources and motivating frontline workers to reduce disparities and (d) making inequality analysis a routine part of impact evaluations.
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Affiliation(s)
- Deepali Godha
- Consultant for Alive & Thrive Initiative, FHI Solutions, FHI 360, Indore, MP, India
| | | | - Tina Sanghvi
- Alive & Thrive Initiative, FHI 360, Washington DC, USA
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Tikkanen RS, Closser S, Prince J, Chand P, Justice J. An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change. Int J Equity Health 2024; 23:70. [PMID: 38614976 PMCID: PMC11015651 DOI: 10.1186/s12939-024-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/06/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.
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Affiliation(s)
- Roosa Sofia Tikkanen
- Institute of Sociology and Political Science, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Edvard Bulls veg 1, 7491, Trondheim, Norway.
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Justine Prince
- Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, 21218, USA
| | - Priyankar Chand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Judith Justice
- Institute for Health & Aging, School of Nursing, University of California at San Francisco, 490 Illinois Street, San Francisco, CA, 94143, USA
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Alem AZ, Efendi F, McKenna L, Felipe-Dimog EB, Chilot D, Tonapa SI, Susanti IA, Zainuri A. Prevalence and factors associated with anemia in women of reproductive age across low- and middle-income countries based on national data. Sci Rep 2023; 13:20335. [PMID: 37990069 PMCID: PMC10663544 DOI: 10.1038/s41598-023-46739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low- and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low- and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Jl. Mulyorejo Kampus C Unair, Surabaya, 60115, Indonesia.
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Eva Belingon Felipe-Dimog
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Nursing Department, Mountain Province State Polytechnic College, Bontoc, Mountain Province, Philippines
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Agus Zainuri
- Faculty of Public Health, Universitas Cenderawasih, Jayapura, Indonesia
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Morrison J, Giri R, James P, Arjyal A, Kharel C, Saville N, Baral S, Hillman S, Harris-Fry H. Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study. Br J Nutr 2023; 130:211-220. [PMID: 36205216 PMCID: PMC10277664 DOI: 10.1017/s0007114522003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100 % of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an 'energy-giving' diet. Some foods were avoided because of religious or cultural taboos, or because they were low status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.
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Affiliation(s)
- Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, LondonWC1N 1EH, UK
| | - Romi Giri
- Herd International, Thapathali, Kathmandu, Nepal
| | - Philip James
- London School of Hygiene and Tropical Medicine, Keppel St, LondonWC1E 7HT, UK
| | | | | | - Naomi Saville
- UCL Institute for Global Health, 30 Guilford Street, LondonWC1N 1EH, UK
| | - Sushil Baral
- Herd International, Thapathali, Kathmandu, Nepal
| | - Sara Hillman
- UCL Institute for Women’s Health, 74 Huntley Street, LondonWC1E 6AU, UK
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Keppel St, LondonWC1E 7HT, UK
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Bhattarai S, Yadav SK, Thapaliya B, Giri S, Bhattarai B, Sapkota S, Manandhar S, Arjyal A, Saville N, Harris-Fry H, Haghparast-Bidgoli H, Copas A, Hillman S, Baral SC, Morrison J. Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: a mixed methods process evaluation. BMC Public Health 2023; 23:1301. [PMID: 37415262 PMCID: PMC10326951 DOI: 10.1186/s12889-023-16195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Anemia is estimated to cause 115,000 maternal deaths each year. In Nepal, 46% of pregnant women have anemia. As part of an integrated anemia-prevention strategy, family engagement and counseling of pregnant women can increase compliance to iron folic acid tablets, but marginalized women often have lower access to these interventions. We implemented the VALID (Virtual antenatal intervention for improved diet and iron intake) randomized controlled trial to test a family-focused virtual counseling mHealth intervention designed to inclusively increase iron folic acid compliance in rural Nepal; here we report findings from our process evaluation research. METHODS We conducted semi structured interviews with 20 pregnant women who had received the intervention, eight husbands, seven mothers-in-laws and four health workers. We did four focus groups discussions with intervention implementers, 39 observations of counseling, and used routine monitoring data in our evaluation. We used inductive and deductive analysis of qualitative data, and descriptive statistics of monitoring data. RESULTS We were able to implement the intervention largely as planned and all participants liked the dialogical counseling approach and use of story-telling to trigger conversation. However, an unreliable and inaccessible mobile network impeded training families about how to use the mobile device, arrange the counseling time, and conduct the counseling. Women were not equally confident using mobile devices, and the need to frequently visit households to troubleshoot negated the virtual nature of the intervention for some. Women's lack of agency restricted both their ability to speak freely and their mobility, which meant that some women were unable to move to areas with better mobile reception. It was difficult for some women to schedule the counseling, as there were competing demands on their time. Family members were difficult to engage because they were often working outside the home; the small screen made it difficult to interact, and some women were uncomfortable speaking in front of family members. CONCLUSIONS It is important to understand gender norms, mobile access, and mobile literacy before implementing an mHealth intervention. The contextual barriers to implementation meant that we were not able to engage family members as much as we had hoped, and we were not able to minimize in-person contact with families. We recommend a flexible approach to mHealth interventions which can be responsive to local context and the situation of participants. Home visits may be more effective for those women who are most marginalized, lack confidence in using a mobile device, and where internet access is poor.
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Affiliation(s)
- Sanju Bhattarai
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | | | - Bibhu Thapaliya
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Santosh Giri
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Basudev Bhattarai
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Suprich Sapkota
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Shraddha Manandhar
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Abriti Arjyal
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Naomi Saville
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | | | - Andrew Copas
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sara Hillman
- UCL Institute for Women's Health, Rm 237C Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
| | | | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Menezes R, Lelijveld N, Wrottesley SV, Brennan E, Mates E, James PT. Integrating Women and Girls' Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2022; 14:4488. [PMID: 36364750 PMCID: PMC9657561 DOI: 10.3390/nu14214488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/16/2023] Open
Abstract
Women's nutrition has been highlighted as a global priority to ensure the health and well-being of both them and future generations. This systematic review summarises the available literature on the integration of nutrition services for girls and women of reproductive age (GWRA) into existing public health systems across low- and middle-income countries, as well as any barriers to integration. We searched PubMed and Cochrane Database of Systematic Reviews for articles published since 2011 according to eligibility criteria. A total of 69 articles were included. Evidence suggested that several services for GWRA are well integrated into public health systems, including antenatal care services, nutrition education and counselling, and micronutrient supplementation programmes. However, there was limited evidence on the integration of family planning, adolescent health, and reproductive health services. Barriers to integration fell into five main themes: lack of training and capacity building, poor multisectoral linkages and coordination, weak advocacy, lack of M&E systems, and inequity. We identified a lack of evidence and services for non-pregnant GWRA and for women postpartum. Addressing barriers to integration and gaps in nutrition services for GWRA would increase service coverage and contribute to improving health outcomes for GWRA and future generations.
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Khatri RB, Durham J, Karkee R, Assefa Y. High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal? Reprod Health 2022; 19:163. [PMID: 35854265 PMCID: PMC9297647 DOI: 10.1186/s12978-022-01465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visits are vital to improve the health of mothers and newborns. Despite improved access to these routine maternal and newborn health (MNH) services in Nepal, little is known about the cascade of health service coverage, particularly contact coverage, intervention-specific coverage, and quality-adjusted coverage of MNH services. This study examined the cascade of MNH services coverage, as well as social determinants associated with uptake of quality MNH services in Nepal. METHODS We conducted a secondary analysis of data derived from the Nepal Demographic and Health Survey (NDHS) 2016, taking 1978 women aged 15-49 years who had a live birth in the 2 years preceding the survey. Three outcome variables were (i) four or more (4+) ANC visits, (ii) institutional delivery, and (iii) first PNC visit for mothers and newborns within 48 h of childbirth. We applied a cascade of health services coverage, including contact coverage, intervention-specific and quality-adjusted coverage, using a list of specific intervention components for each outcome variable. Several social determinants of health were included as independent variables to identify determinants of uptake of quality MNH services. We generated a quality score for each outcome variable and dichotomised the scores into two categories of "poor" and "optimal" quality, considering > 0.8 as a cut-off point. Binomial logistic regression was conducted and odds ratios (OR) were reported with 95% confidence intervals (CIs) at the significance level of p < 0.05 (two-tailed). RESULTS Contact coverage was higher than intervention-specific coverage and quality-adjusted coverage across all MNH services. Women with advantaged ethnicities or who had access to bank accounts had higher odds of receiving optimal quality MNH services, while women who speak the Maithili language and who had high birth order (≥ 4) had lower odds of receiving optimal quality ANC services. Women who received better quality ANC services had higher odds of receiving optimal quality institutional delivery. Women received poor quality PNC services if they were from remote provinces, had higher birth order and perceived problems when not having access to female providers. CONCLUSIONS Women experiencing ethnic and social disadvantages, and from remote provinces received poor quality MNH services. The quality-adjusted coverage can be estimated using household survey data, such as demographic and health surveys, especially in countries with limited routine data. Policies and programs should focus on increasing quality of MNH services and targeting disadvantaged populations and those living in remote areas. Ensuring access to female health providers and improving the quality of earlier maternity visits could improve the quality of health care during the pregnancy-delivery-postnatal period.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Jo Durham
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Nguyen PH, Singh N, Scott S, Neupane S, Jangid M, Walia M, Murira Z, Bhutta ZA, Torlesse H, Piwoz E, Heidkamp R, Menon P. Unequal coverage of nutrition and health interventions for women and children in seven countries. Bull World Health Organ 2022; 100:20-29. [PMID: 35017754 PMCID: PMC8722629 DOI: 10.2471/blt.21.286650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries. METHODS We used data from the most recent (2015-2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (n = 19 632), Bangladesh (n = 5051), India (n = 184 641), Maldives (n = 2368), Nepal (n = 3998), Pakistan (n = 8285) and Sri Lanka (n = 7138). We estimated co-coverage for a set of eight health and eight nutrition interventions and assessed within-country inequalities in co-coverage by wealth and geography. We examined opportunity gaps by comparing coverage of nutrition interventions with coverage of their corresponding health delivery platforms. FINDINGS Only 15% of 231 113 mother-child pairs received all eight health interventions (weighted percentage). The percentage of mother-child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for co-coverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points. CONCLUSION Co-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, 1201 I Street, NW, Washington DC, 20005, United States of America (USA)
| | - Nishmeet Singh
- International Food Policy Research Institute, New Delhi, India
| | - Samuel Scott
- International Food Policy Research Institute, New Delhi, India
| | - Sumanta Neupane
- International Food Policy Research Institute, Kathmandu, Nepal
| | - Manita Jangid
- International Food Policy Research Institute, New Delhi, India
| | - Monika Walia
- International Food Policy Research Institute, New Delhi, India
| | - Zivai Murira
- United Nations Children’s Fund, Regional Office for South Asia, Kathmandu, Nepal
| | | | - Harriet Torlesse
- United Nations Children’s Fund, Regional Office for South Asia, Kathmandu, Nepal
| | | | - Rebecca Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
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12
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Ali SA, Ali SA, Razzaq S, Khowaja N, Gutkind S, Raheman FU, Suhail N. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017-2018). BMC Pregnancy Childbirth 2021; 21:352. [PMID: 33941108 PMCID: PMC8091661 DOI: 10.1186/s12884-021-03825-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan. METHODS We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy of the last birth. Women who had last childbirth 5 years before the survey and who responded to the question of iron intake were included in the final analysis (n = 6370). We analyzed the data that accounted for complex sampling design by including clusters, strata, and sampling weights. RESULTS Around 30% of the women reported consumed iron tablets for ≥90 days during their last pregnancy. In the multivariable logistic regression analysis, we found that factors such as women's age (≥ 25 years) (adjusted prevalence ratio (aPR) = 1.52; 95% CI: 1.42-1.62)], wealth index (rich/richest) (aPR = 1.25; [95% CI: 1.18-1.33]), primary education (aPR = 1.33; [95% CI: 1.24-1.43), secondary education (aPR = 1.34; [95% CI: 1.26-1.43), higher education (aPR = 2.13; [95% CI: 1.97-2.30), women's say in choosing husband (aPR = 1.68; [95% CI: 1.57-1.80]), ≥ five antenatal care visits (aPR =2.65; [95% CI (2.43-2.89]), history of the last Caesarian-section (aPR = 1.29; [95% CI: 1.23-1.36]) were significantly associated with iron consumption for ≥90 days. CONCLUSION These findings demonstrate complex predictors of iron consumption during pregnancy in Pakistan. There is a need to increase the number of ANC visits and the government should take necessary steps to improve access to iron supplements by targeting disadvantaged and vulnerable women who are younger, less educated, poor, and living in rural areas.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Columbia University, New York, USA
| | - Savera Aziz Ali
- Department of Nursing, University of Alberta, Edmonton, Canada
| | - Shama Razzaq
- Department of Community Health Sciences Jinnah Medical and Dental College, Karachi, Pakistan
| | - Nayab Khowaja
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University, New York, USA
| | | | - Nadir Suhail
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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