1
|
AlDughaishi MYK, Matua GA, Seshan V. A Qualitative Inquiry of Women's Perspective of Antenatal Education Services in Oman. SAGE Open Nurs 2023; 9:23779608231159336. [PMID: 36895708 PMCID: PMC9989448 DOI: 10.1177/23779608231159336] [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: 08/28/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Antenatal care (ANC) provides an opportunity for systematic assessment and follow-up of pregnant women to ensure positive outcomes for mother and foetus. Pregnant women should be offered evidence-based information with support to enable them to make informed decisions. Objective To identify the gap between the current practices and the recommended guidelines for antenatal education services in Oman. Methods A qualitative inquiry was implemented through semistructured in-depth interviews guided by open-ended questions and probes. A purposive non-probability sampling technique was used to select 13 pregnant women who had completed 30 weeks of gestation. The women were selected from 9 antenatal healthcare facilities among them: 7 primary health centers, one polyclinic and one, tertiary hospital. Results Antenatal education focused on four thematic areas of safe pregnancy; safe labor and birth; postpartum care; and new-born care. Regarding antenatal education for safe pregnancy, the findings indicate that most healthcare workers provided pregnant women adequate information to promote healthy dietary habits; cope with pregnancy symptoms; recognize and manage medical conditions, and to adhere to dietary supplements and medication. In addition, the findings revealed that the healthcare team did not provide the required antenatal education to meet the pregnant women's needs to ensure they had safe labor and birth, postpartum care, and new-born care. Conclusion This study is the first of its kind in Oman to provide baseline data regarding the current antenatal education services from the perspective of pregnant women. These findings will help in developing strategies to improve maternal and neonatal outcomes in the country.
Collapse
Affiliation(s)
| | | | - Vidya Seshan
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
2
|
Kananura RM. Mediation role of low birth weight on the factors associated with newborn mortality and the moderation role of institutional delivery in the association of low birth weight with newborn mortality in a resource-poor setting. BMJ Open 2021; 11:e046322. [PMID: 34031115 PMCID: PMC8149436 DOI: 10.1136/bmjopen-2020-046322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess low birth weight's (LBW) mediation role on the factors associated with newborn mortality (NM), including stillbirth and the role of institutional delivery in the association between LBW and NM. DESIGN AND PARTICIPANTS I used the 2011-2015 event histories health demographic data collected by Iganga-Mayuge Health Demographic and Surveillance Site (HDSS). The dataset consisted of 10 758 registered women whose birth occurred at least 22 weeks of the gestation period and records of newborns' living status 28 days after delivery. SETTING The Iganga-Mayuge HDSS is in Eastern Uganda, which routinely collects health and demographic data from a registered population of at least 100 000 people. OUTCOME MEASURE The study's key outcomes or endogenous factors were perinatal mortality (PM), late NM and LBW (mediating factor). RESULTS The factors that were directly associated with PM were LBW (OR=2.55, 95% CI 1.15 to 5.67)), maternal age of 30+ years (OR=1.68, 95% CI 1.21 to 2.33), rural residence (OR=1.38, 95% CI 1.02 to 1.85), mothers with previous experience of NM (OR=3.95, 95% CI 2.86 to 5.46) and mothers with no education level (OR=1.63, 95% CI 1.21 to 2.18). Multiple births and mother's prior experience of NM were positively associated with NM at a later age. Institutional delivery had a modest inverse role in the association of LBW with PM. LBW mediated the association of PM with residence status, mothers' previous NM experience, multiple births, adolescent mothers and mothers' marital status. Of the total effect attributable to each of these factors, LBW mediated +25%, +22%, +100%, 25% and -38% of rural resident mothers, mothers with previous experience of newborn or pregnancy loss, multiple births, adolescent mothers and mothers with partners, respectively. CONCLUSION LBW mediated multiple factors in the NM pathways, and the effect of institutional delivery in reducing mortality among LBW newborns was insignificant. The findings demonstrate the need for a holistic life course approach that gears the health systems to tackle NM.
Collapse
Affiliation(s)
- Rornald Muhumuza Kananura
- Department of International Development, London School of Economics and Political Science, London, UK
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal and Newborn Health, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
3
|
Marchant T, Beaumont E, Makowiecka K, Berhanu D, Tessema T, Gautham M, Singh K, Umar N, Usman AU, Tomlin K, Cousens S, Allen E, Schellenberg JA. Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India. CMAJ 2020; 191:E1179-E1188. [PMID: 31659058 DOI: 10.1503/cmaj.190219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India. METHODS We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity. RESULTS In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria (n = 1100 women), Ethiopia (n = 404) and Uttar Pradesh, India (n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups (p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%. INTERPRETATION Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas.
Collapse
Affiliation(s)
- Tanya Marchant
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Emma Beaumont
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Krystyna Makowiecka
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Della Berhanu
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Tsegahun Tessema
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Meenakshi Gautham
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Kultar Singh
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Nasir Umar
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Adamu Umar Usman
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Keith Tomlin
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Simon Cousens
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Elizabeth Allen
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| | - Joanna Armstrong Schellenberg
- Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria
| |
Collapse
|
4
|
Tomlin K, Berhanu D, Gautham M, Umar N, Schellenberg J, Wickremasinghe D, Marchant T. Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it? BMC Pregnancy Childbirth 2020; 20:289. [PMID: 32397964 PMCID: PMC7218484 DOI: 10.1186/s12884-020-02926-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Good quality maternal and newborn care at primary health facilities is essential, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality to assess their readiness to provide routine maternal and newborn care, and proportions of women using facilities that were ready to offer good quality care. Surveys were conducted in 2012 and 2015 to assess changes over time. Methods Surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. At each facility the staffing, infrastructure and commodities were quantified. These formed components of four “signal functions” that described aspects of routine maternal and newborn care. A facility was considered ready to perform a signal function if all the required components were present. Readiness to perform all four signal functions classed a facility as ready to provide good quality routine care. From facility registers we counted deliveries and calculated the proportions of women delivering in facilities ready to offer good quality routine care. Results In Ethiopia the proportion of deliveries in facilities classed as ready to offer good quality routine care rose from 40% (95% confidence interval (CI) 26–57) in 2012 to 43% (95% CI 31–56) in 2015. In Uttar Pradesh these estimates were 4% (95% CI 1–24) in 2012 and 39% (95% CI 25–55) in 2015, while in Nigeria they were 25% (95% CI 6–66) in 2012 and zero in 2015. Improved facility readiness in Ethiopia and Uttar Pradesh arose from increased supplies of commodities, while in Nigeria facility readiness fell due to depleted commodity supplies and fewer Skilled Birth Attendants. Conclusions This study quantified the readiness of health facilities to offer good quality routine maternal and newborn care, and may help explain inconsistent outcomes of facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of such facility readiness. Incorporating data on facility deliveries and repeating the analyses highlighted adjustments that could have greatest impact upon routine maternal and newborn care.
Collapse
Affiliation(s)
- Keith Tomlin
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Della Berhanu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Meenakshi Gautham
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Nasir Umar
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Deepthi Wickremasinghe
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tanya Marchant
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
5
|
Assefa M, Fite RO, Taye A, Belachew T. Institutional delivery service use and associated factors among women who delivered during the last 2 years in Dallocha town, SNNPR, Ethiopia. Nurs Open 2020; 7:186-194. [PMID: 31871702 PMCID: PMC6917976 DOI: 10.1002/nop2.378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To determine the institutional delivery service use and identify factors associated among women who delivered during the last two years in Dallocha town. Design A community-based cross-sectional study. Methods The study was conducted from 10 March-10 April 2016. A total of 411 study participants were selected by using systematic sampling method. The source population was all reproductive age group mothers. Bivariate and multiple logistic regression was conducted. Results Institutional delivery was 304 (74%). Factors associated with increased likelihood of institutional delivery were owning a radio or television, making more than four antenatal care visits, knowing at least one maternity service advantage. Not knowing about at least one benefit institutional delivery decreased the likelihood of institutional delivery. Conclusion Three-quarters of the mothers delivered at the health institution. Accordingly, promotion of antenatal care follow-up, in-service training of health professionals and health education is recommended.
Collapse
Affiliation(s)
- Masresha Assefa
- Department of NursingCollege of Health Sciences and MedicineWolaita Sodo UniversityWolaita SodoEthiopia
| | - Robera Olana Fite
- Department of NursingCollege of Health Sciences and MedicineWolaita Sodo UniversityWolaita SodoEthiopia
| | - Ayanos Taye
- Department of MidwiferyCollege of Health SciencesJimma UniversityJimmaEthiopia
| | - Tefera Belachew
- Department of Reproductive Health and Family PolicyCollege of Health SciencesJimma UniversityJimmaEthiopia
| |
Collapse
|
6
|
Karim AM, Guichon D, Yihun BY, Zemichael NF, Lorenzana K, Barofsky J, Betemariam W. Application of behavioral economics principles to reduce injectable contraceptive discontinuation in rural Ethiopia: A stratified-pair, cluster-randomized field trial. Gates Open Res 2019; 3:1494. [PMID: 32803127 PMCID: PMC7416084 DOI: 10.12688/gatesopenres.12987.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Contraceptive prevalence in Ethiopia jumped from 6% in 2000 to 36% in 2016, mainly due to increased injectable method use. However, discontinuation rates among injectable users were high (38%). Given that the public sector is the major source for injectable contraceptives, John Snow Inc. (JSI) in collaboration with ideas42 worked with Ethiopia's flagship Health Extension Program to apply behavioral design to mitigate discontinuation of injectable contraceptives. Methods: We applied behavioral economics insights to mitigate the discontinuation of injectable contraceptives. This process created an intervention package, consisting of a health worker planning calendar, a client counseling job aid, and client appointment cards. A stratified-pair cluster-randomized field trial tested the effectiveness of the intervention. The study area included two districts from the four regions where JSI was implementing a family planning program. One district from each region was randomly allocated to the intervention arm. Women visiting health posts to use injectable contraceptives were enrolled in the study. Regression methods, adjusted for study design, participants' backgrounds, and contextual factors, estimated the intervention's effect on discontinuation rates. Results: A behavioral design methodology was feasibly implemented in a rural, low-resource setting in Ethiopia. The resultant intervention package was successfully delivered in 19 satellite health posts in four districts. Intervention adherence was high for the appointment cards and counseling job aid, but not for the planning calendar. The injectable discontinuation rate was 10.8 % (95% confidence interval: 2.2, 19.3) points lower in the intervention area compared to the control area during the post-intervention follow-up survey. Conclusion: The use of two tools informed by behavioral economics -the appointment card and counseling job aid-effectively decreased injectable discontinuation even with the presence of other health system bottlenecks. Behavioral economics insights and the behavioral design methodology have the potential to enhance family planning programs in Ethiopia and elsewhere.
Collapse
Affiliation(s)
- Ali Mehryar Karim
- Global Development, Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
| | | | - Bantalem Yeshanew Yihun
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | - Wuleta Betemariam
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| |
Collapse
|
7
|
Makowiecka K, Marchant T, Betemariam W, Chaturvedi A, Jana L, Liman A, Mathewos B, Muhammad FB, Semrau K, Wunnava SS, Sibley LM, Berhanu D, Gautham M, Umar N, Spicer N, Schellenberg J. Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India. BMJ Glob Health 2019; 4:e001405. [PMID: 31406587 PMCID: PMC6666810 DOI: 10.1136/bmjgh-2019-001405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the 'characterisation framework', based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where.
Collapse
Affiliation(s)
- Krystyna Makowiecka
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Wuleta Betemariam
- The Last Ten Kilometers Project, JSI Research and Training Institute, Addis Ababa, Ethiopia
| | - Anuraag Chaturvedi
- Public Health and Nutrition, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Audu Liman
- Atiku Centre for Development, American University of Nigeria, Yola, Adamawa, Nigeria (formerly with PACT Nigeria)
| | | | | | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sita Shankar Wunnava
- Public Health Consultant, Coimbatore, Tamilnadu, India (formerly with PATH, New Delhi)
| | | | - Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Meenakshi Gautham
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nasir Umar
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Spicer
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
Karim AM, Guichon D, Yihun BY, Zemichael NF, Lorenzana K, Barofsky J, Betemariam W. Application of behavioral economics principles to reduce injectable contraceptive discontinuation in rural Ethiopia: A stratified-pair, cluster-randomized field trial. Gates Open Res 2019; 3:1494. [PMID: 32803127 PMCID: PMC7416084 DOI: 10.12688/gatesopenres.12987.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/12/2023] Open
Abstract
Background: Contraceptive prevalence in Ethiopia jumped from 6% in 2000 to 36% in 2016, mainly due to increased injectable method use. However, discontinuation rates among injectable users were high (38%). Given that the public sector is the major source for injectable contraceptives, John Snow Inc. (JSI) in collaboration with ideas42 worked with Ethiopia's flagship Health Extension Program to apply behavioral economics informed approaches to mitigate discontinuation of injectable contraceptives. Methods: Behavioral diagnosis was conducted to identify the primary drivers of discontinuation of injectable contraceptives. Using these insights, a user-centered behavioral design approach was implemented to create an intervention package, consisting of a health worker planning calendar, a client counseling job aid, and client appointment cards. The study area included two districts from the four regions where JSI was implementing a family planning program. One district from each region was randomly allocated to the intervention arm. Women visiting health posts to use injectable contraceptives were enrolled in the study. Regression methods adjusted for study design, participants' backgrounds, and contextual factors, were used to estimate the intervention's effect on discontinuation rates. Results: Intervention adherence was high for the appointment cards and counseling job aid, but not for the planning calendar. This was not surprising as using appointment cards and the job aid was within the routine workflow of health extension workers, but using the planner was not. The injectable discontinuation rate was 10.8 % points lower in the intervention area compared to the control area during the post intervention follow-up survey. Conclusion: The use of two behavioral economics informed tools-the appointment card and counseling job aid-effectively decreased injectable discontinuation even with the presence of other health system bottlenecks. Behavioral economics approaches have the potential to enhance family planning programs in Ethiopia and elsewhere. Trial registration: ISRCTN ISRCTN17390653 (10/04/2019).
Collapse
Affiliation(s)
- Ali Mehryar Karim
- Global Development, Bill & Melinda Gates Foundation, Addis Ababa, Ethiopia
| | | | - Bantalem Yeshanew Yihun
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | - Wuleta Betemariam
- The Last Ten Kilometers Project 2020, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| |
Collapse
|
9
|
Karim AM, Fesseha Zemichael N, Shigute T, Emaway Altaye D, Dagnew S, Solomon F, Hailu M, Tadele G, Yihun B, Getachew N, Betemariam W. Effects of a community-based data for decision-making intervention on maternal and newborn health care practices in Ethiopia: a dose-response study. BMC Pregnancy Childbirth 2018; 18:359. [PMID: 30255793 PMCID: PMC6157194 DOI: 10.1186/s12884-018-1976-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Community participation and community health volunteer programs are an essential part of the health system so that health services are responsive and accountable to community needs. Information systems are necessary for community health volunteer programs to be effective, yet effectiveness evaluations of such information systems implemented at scale are rare. In October 2010, a network of female volunteers with little or no literacy, the Women's Development Army (WDA), was added to extend Ethiopia's Health Extension Program services to every household in the community. Between July 2013 and January 2015, a health management information system for the WDA's Community-Based Data for Decision-Making (CBDDM) strategy was implemented in 115 rural districts to improve the demand for and utilization of maternal and newborn health services. Using the CBDDM strategy, Health Extension Workers (HEWs) fostered the WDA and community leaders to inform, lead, own, plan, and monitor the maternal and newborn health interventions in their kebeles (communities). This paper examines the effectiveness of the CBDDM strategy. METHODS Using data from cross-sectional surveys in 2010-11 and 2014-15 from 177 kebeles, we estimated self-reported maternal and newborn care practices from women with children aged 0 to 11 months (2124 at baseline and 2113 at follow-up), and a CBDDM implementation strength score in each kebele. Using kebele-level random-effects models, we assessed dose-response relationships between changes over time in implementation strength score and changes in maternal and newborn care practices between the two surveys. RESULTS Kebeles with relatively high increases in CBDDM implementation strength score had larger improvements in the coverage of neonatal tetanus-protected childbirths, institutional deliveries, clean cord care for newborns, thermal care for newborns, and immediate initiation of breastfeeding. However, there was no evidence of any effect of the intervention on postnatal care within 2 days of childbirth. CONCLUSIONS This study shows the extent to which an information system for community health volunteers with low literacy was implemented at scale, and evidence of effectiveness at scale in improving maternal and newborn health care behaviors and practices.
Collapse
Affiliation(s)
- Ali Mehryar Karim
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Tesfaye Shigute
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Dessalew Emaway Altaye
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Selamawit Dagnew
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Firew Solomon
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Mulu Hailu
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Gizachew Tadele
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Bantalem Yihun
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| | - Nebiyu Getachew
- Ethiopia Performance Monitoring and Evaluation Service (EPMES), Social Impact, Bole Sub-City, Woreda 13, House # 478, Addis Ababa, Ethiopia
| | - Wuleta Betemariam
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc, Bole Sub-City, Kebele 03/05, Hs # 2111, Addis Ababa, Ethiopia
| |
Collapse
|
10
|
Ekirapa-Kiracho E, Muhumuza Kananura R, Tetui M, Namazzi G, Mutebi A, George A, Paina L, Waiswa P, Bumba A, Mulekwa G, Nakiganda-Busiku D, Lyagoba M, Naiga H, Putan M, Kulwenza A, Ajeani J, Kakaire-Kirunda A, Makumbi F, Atuyambe L, Okui O, Namusoke Kiwanuka S. Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts. Glob Health Action 2018; 10:1363506. [PMID: 28871853 PMCID: PMC5645678 DOI: 10.1080/16549716.2017.1363506] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17–1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.
Collapse
Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Moses Tetui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,b Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Gertrude Namazzi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Aloysius Mutebi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Asha George
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,d School of Public Health , University of the Western Cape , Bellville , South Africa
| | - Ligia Paina
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Peter Waiswa
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,e Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda.,f Global Health Division , Karolinska Institutet , Stockholm , Sweden
| | - Ahmed Bumba
- g Kibuku District Health Office , Kibuku , Uganda
| | | | | | | | | | - Mary Putan
- h Pallisa District Health Office , Pallisa , Uganda
| | | | - Judith Ajeani
- j Department of Obstetrics and Gynaecology , Makerere University Medical School , Kampala , Uganda
| | - Ayub Kakaire-Kirunda
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- k Department of Epidemiology and Biostatistics , Makerere University School of Public Health , Kampala , Uganda
| | - Lynn Atuyambe
- l Department of Community Health and Behavioural Sciences , Makerere University School of Public Health , Kampala , Uganda
| | - Olico Okui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| |
Collapse
|
11
|
Amare Y, Scheelbeek P, Schellenberg J, Berhanu D, Hill Z. Early postnatal home visits: a qualitative study of barriers and facilitators to achieving high coverage. BMC Public Health 2018; 18:1074. [PMID: 30157816 PMCID: PMC6116449 DOI: 10.1186/s12889-018-5922-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/01/2018] [Indexed: 11/14/2022] Open
Abstract
Background Timely interventions in the postnatal period are important for reducing newborn mortality, and early home visits to provide postnatal care are recommended. There has been limited success in achieving timely visits, and a better understanding of the realities of programmes is needed if improvements are to be made. Methods We explored barriers and facilitators to timely postnatal visits through 20 qualitative interviews and 16 focus group discussions with families and Health Extension Workers in four Ethiopian sites. Results All sites reported some inaccessible areas that did not receive visits, but, Health Extension Workers in the sites with more difficult terrain were reported to make more visits that those in the more accessible areas. This suggests that information and work issues can be more important than moderate physical issues. The sites where visits were common had functioning mechanisms for alerting workers to a birth; these were not related to postnatal visits but to families informing Health Extension Workers of labour so they could call an ambulance. In the other sites, families did not know they should alert workers about a delivery, and other alert mechanisms were not functioning well. Competing activities reducing Health Extension Worker availability for visits, but in some areas workers were more organized in their division of their work and this facilitated visits. The main difference between the areas where visits were reported as common or uncommon was the general activity level of the Health Extension Worker. In the sites where workers were active and connected to the community visits occurred more often. Conclusions If timely postnatal home visits are to occur, CHWs need realistic catchment areas that reflect their workload. Inaccessible areas may need their own CHW. Good notification systems are essential, families will notify CHWs if they have a clear reasons to do so, and more work is needed on how to ensure notification systems function. Work ethic was a clear influencer on whether home visits occur, studies to date have focused on understanding the motivation of CHWs as a group, more studies on understanding motivation at an individual level are needed.
Collapse
Affiliation(s)
- Yared Amare
- Consultancy for Social Development, PO Box 70196, Addis Ababa, Ethiopia
| | - Pauline Scheelbeek
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joanna Schellenberg
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Della Berhanu
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Zelee Hill
- University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| |
Collapse
|
12
|
Allen E, Schellenberg J, Berhanu D, Cousens S, Marchant T. Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia. PLoS One 2018; 13:e0199937. [PMID: 30071026 PMCID: PMC6071969 DOI: 10.1371/journal.pone.0199937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts. Methods and findings Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period. Conclusions Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.
Collapse
Affiliation(s)
- Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
13
|
Mulenga T, Moono M, Mwendafilumba M, Manasyan A, Sharma A. Home deliveries in the capital: a qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia. BMC Pregnancy Childbirth 2018; 18:203. [PMID: 29859063 PMCID: PMC5984831 DOI: 10.1186/s12884-018-1837-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/21/2018] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND A shortage of skilled birth attendants and low quality of care in health facilities along with unattended home deliveries contribute to the high maternal and neonatal mortality in sub Saharan Africa. Identifying and addressing context-specific reasons for not delivering at health care facilities could increase births assisted by skilled attendants who, if required, can provide life-saving interventions. METHODS We conducted 22 in-depth interviews (IDIs) with midwives at three health facilities in peri-urban communities and 24 semi-structured surveys with mothers in two areas served by health facilities with the highest number of reported home deliveries in Lusaka, Zambia. Both IDIs and surveys were audio-recorded, transcribed and coded to identify themes around delivery and birthing experience. RESULTS We found that most women preferred institutional deliveries to home deliveries, but were unable to utilize these services due to inability to recognize labour symptoms or lack of resources. Midwives speculated that women used herbal concoctions to reduce the duration of delivery with the result that women either did not present in time or endangered themselves and the baby with powerful contractions and precipitous labour. Respondents suggested that disrespectful and abusive maternity care dissuaded some women from delivering at health facilities. However, some midwives viewed such tactics as necessary to ensure women followed instructions and successfully delivered live babies. CONCLUSION Difference in beliefs and birthing practices between midwives and mothers suggest the need for open dialogue to co-design appropriate interventions to increase facility usage. Further examination of the pharmaceutical properties and safety of herbal concoctions being used to shorten labour are required. Measures to reduce the economic burden of care seeking within this environment, increase respectful and patient-centred care, and improve the quality of midwifery could increase institutional deliveries.
Collapse
Affiliation(s)
- Tamara Mulenga
- Centre For Infectious Diseases Research In Zambia (CIDRZ), P.O. Box 34681 Plot 34620 Off Alick Nkhata Road, Mass Media, 10101 Lusaka, Zambia
| | - Misinzo Moono
- Centre For Infectious Diseases Research In Zambia (CIDRZ), P.O. Box 34681 Plot 34620 Off Alick Nkhata Road, Mass Media, 10101 Lusaka, Zambia
| | - Martha Mwendafilumba
- Centre For Infectious Diseases Research In Zambia (CIDRZ), P.O. Box 34681 Plot 34620 Off Alick Nkhata Road, Mass Media, 10101 Lusaka, Zambia
| | - Albert Manasyan
- Centre For Infectious Diseases Research In Zambia (CIDRZ), P.O. Box 34681 Plot 34620 Off Alick Nkhata Road, Mass Media, 10101 Lusaka, Zambia
- University of Alabama at Birmingham, Birmingham, USA
| | - Anjali Sharma
- Centre For Infectious Diseases Research In Zambia (CIDRZ), P.O. Box 34681 Plot 34620 Off Alick Nkhata Road, Mass Media, 10101 Lusaka, Zambia
- University of Washington, Seattle, USA
| |
Collapse
|
14
|
Game changing: hepatitis B vaccine in a controlled temperature chain. LANCET GLOBAL HEALTH 2018; 6:e596-e597. [DOI: 10.1016/s2214-109x(18)30233-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023]
|
15
|
Ríos-Blancas MJ, Cahuana-Hurtado L, Lamadrid-Figueroa H, Lozano R. [Effective coverage of treatment of hypertension in Mexican adults by states]. SALUD PUBLICA DE MEXICO 2018; 59:154-164. [PMID: 28562716 DOI: 10.21149/8195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/28/2016] [Indexed: 01/13/2023] Open
Abstract
Objective: To estimate the effective coverage (EC) of treatment of hypertension (HT) in Mexican adults in 2012 and compared with those reported in 2006. Materials and methods: The National Health and Nutrition Survey 2012 was analyzed. The EC has three dimensions: health need as prevalence of HT, utilization of health services when the need is real and quality as recovering health after the treatment. The EC of treatment of HT was estimated using instrumental variables. Results: In 2012, the EC national of treatment of HT was 28.3% (95%CI 26.5-30.1), ranging from Michoacan with 19.3% (15.3-23.4) to State of Mexico with 39.7% in (25.3-54.0). From 2006 to 2012 the national EC increased 22.5%. Conclusion: The EC treatment of hypertension is low and heterogeneous. The use of synthetic indicators should be a daily exercise of measurement, because report summarizes the performance of state health systems.
Collapse
Affiliation(s)
| | | | | | - Rafael Lozano
- Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.,Institute for Health Metric and Evaluation, University of Washington. Seattle, USA
| |
Collapse
|
16
|
Joseph G, da Silva ICM, Fink G, Barros AJD, Victora CG. Absolute income is a better predictor of coverage by skilled birth attendance than relative wealth quintiles in a multicountry analysis: comparison of 100 low- and middle-income countries. BMC Pregnancy Childbirth 2018; 18:104. [PMID: 29661161 PMCID: PMC5902965 DOI: 10.1186/s12884-018-1734-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Having high-quality data available by 2020, disaggregated by income, is one of the Sustainable Development Goals (SGD). We explored how well coverage with skilled birth attendance (SBA) is predicted by asset-based wealth quintiles and by absolute income. Methods We used data from 293 national surveys conducted in 100 low and middle-income countries (LMICs) from 1991 to 2014. Data on household income were computed using national income levels and income inequality data available from the World Bank and the Standardized World Income Inequality Database. Multivariate regression was used to explore the predictive capacity of absolute income compared to the traditional measure of quintiles of wealth index. Results The mean SBA coverage was 68.9% (SD: 24.2), compared to 64.7% (SD: 26.6) for institutional delivery coverage. Median daily family income in the same period was US$ 6.4 (IQR: 3.5–14.0). In cross-country analyses, log absolute income predicts 51.5% of the variability in SBA coverage compared to 22.0% predicted by the wealth index. For within-country analysis, use of absolute income improved the understanding of the gap in SBA coverage among the richest and poorest families. Information on income allowed identification of countries – such as Burkina Faso, Cambodia, Egypt, Nepal and Rwanda – which were well above what would be expected solely from changes in income. Conclusion Absolute income is a better predictor of SBA and institutional delivery coverage than the relative measure of quintiles of wealth index and may help identify countries where increased coverage is likely due to interventions other than increased income. Electronic supplementary material The online version of this article (10.1186/s12884-018-1734-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gary Joseph
- International Center for Equity in Health; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS, 96020-220, Brazil.
| | - Inácio C M da Silva
- International Center for Equity in Health; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS, 96020-220, Brazil
| | - Günther Fink
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Building 1, Room 110, Boston, MA, 02115, USA
| | - Aluisio J D Barros
- International Center for Equity in Health; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS, 96020-220, Brazil
| | - Cesar G Victora
- International Center for Equity in Health; Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS, 96020-220, Brazil
| |
Collapse
|
17
|
Sabot K, Marchant T, Spicer N, Berhanu D, Gautham M, Umar N, Schellenberg J. Contextual factors in maternal and newborn health evaluation: a protocol applied in Nigeria, India and Ethiopia. Emerg Themes Epidemiol 2018; 15:2. [PMID: 29441117 PMCID: PMC5800046 DOI: 10.1186/s12982-018-0071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the context of a health programme is important in interpreting evaluation findings and in considering the external validity for other settings. Public health researchers can be imprecise and inconsistent in their usage of the word “context” and its application to their work. This paper presents an approach to defining context, to capturing relevant contextual information and to using such information to help interpret findings from the perspective of a research group evaluating the effect of diverse innovations on coverage of evidence-based, life-saving interventions for maternal and newborn health in Ethiopia, Nigeria, and India. Methods We define “context” as the background environment or setting of any program, and “contextual factors” as those elements of context that could affect implementation of a programme. Through a structured, consultative process, contextual factors were identified while trying to strike a balance between comprehensiveness and feasibility. Thematic areas included demographics and socio-economics, epidemiological profile, health systems and service uptake, infrastructure, education, environment, politics, policy and governance. We outline an approach for capturing and using contextual factors while maximizing use of existing data. Methods include desk reviews, secondary data extraction and key informant interviews. Outputs include databases of contextual factors and summaries of existing maternal and newborn health policies and their implementation. Use of contextual data will be qualitative in nature and may assist in interpreting findings in both quantitative and qualitative aspects of programme evaluation. Discussion Applying this approach was more resource intensive than expected, in part because routinely available information was not consistently available across settings and more primary data collection was required than anticipated. Data was used only minimally, partly due to a lack of evaluation results that needed further explanation, but also because contextual data was not available for the precise units of analysis or time periods of interest. We would advise others to consider integrating contextual factors within other data collection activities, and to conduct regular reviews of maternal and newborn health policies. This approach and the learnings from its application could help inform the development of guidelines for the collection and use of contextual factors in public health evaluation. Electronic supplementary material The online version of this article (10.1186/s12982-018-0071-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kate Sabot
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Tanya Marchant
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Neil Spicer
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,3Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Della Berhanu
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Meenakshi Gautham
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nasir Umar
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Schellenberg
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
18
|
Webber G, Chirangi B, Magatti N. Community member and policy maker priorities in improving maternal health in rural Tanzania. Int J Gynaecol Obstet 2018; 141:80-84. [PMID: 29315557 DOI: 10.1002/ijgo.12435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/05/2017] [Accepted: 01/05/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine community member and policy maker priorities in improving maternal health in rural Tanzania. METHODS The present participatory action research project was conducted in Rorya District, Mara Region, Tanzania, between November 20 and 25, 2015. A convenience sample of four community and one policy maker discussion groups were held to identify factors impacting on maternal health. The inclusion criterion for community members was a recent personal or partner experience with childbirth, or experience as a village leader. The policy maker participants were enrolled from all members of the District Council Health Management Team. RESULTS There was considerable overlap in priorities expressed by community members and policy makers. The most common priorities were to improve the transportation options for women to get to the health facility, the availability of supplies in the health facilities, and healthcare provider attitudes toward women, and to increase the number of skilled healthcare providers. Policy makers also prioritized improved health education of women, improved access to health facilities, and increased power in decision-making for women. CONCLUSIONS Community members and policy makers have similar priorities for improving maternal health, which involve both social and structural changes.
Collapse
Affiliation(s)
- Gail Webber
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | | |
Collapse
|
19
|
Kananura RM, Ekirapa-Kiracho E, Paina L, Bumba A, Mulekwa G, Nakiganda-Busiku D, Oo HNL, Kiwanuka SN, George A, Peters DH. Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda. Health Res Policy Syst 2017; 15:107. [PMID: 29297410 PMCID: PMC5751403 DOI: 10.1186/s12961-017-0274-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda. Method The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. Results At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Conclusion Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0274-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda. .,Department of Social Policy, London School of Economic and Political Science, London, United Kingdom.
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Ligia Paina
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America
| | - Ahmed Bumba
- District Health Office, Kibuku District Local Government, Kampala, Uganda
| | - Godfrey Mulekwa
- District Health Office, Pallisa District Health Office, Kampala, Uganda
| | | | - Htet Nay Lin Oo
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America
| | - Suzanne Namusoke Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Asha George
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America.,University of the Western Cape, Cape Town, South Africa
| | - David H Peters
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
20
|
Sacks E, Swanson RC, Schensul JJ, Gleave A, Shelley KD, Were MK, Chowdhury AM, LeBan K, Perry HB. Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2017; 37:139-149. [PMID: 29086630 DOI: 10.1177/0272684x17738089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas-planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy-and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.
Collapse
Affiliation(s)
- Emma Sacks
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Anna Gleave
- 4 15851 School of Nursing, Johns Hopkins University , Baltimore, MD, USA
| | - Katharine D Shelley
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Karen LeBan
- 7 USAID's Maternal and Child Survival Program (MCSP), 10822 CORE Group , Washington, DC, USA
| | - Henry B Perry
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Newell R, Spillman I, Newell ML. The Use of Facilities for Labor and Delivery: The Views of Women in Rural Uganda. J Public Health Afr 2017; 8:592. [PMID: 28890773 PMCID: PMC5585585 DOI: 10.4081/jphia.2017.592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/23/2022] Open
Abstract
The aim of the paper is to explore factors associated with home or hospital delivery in rural Uganda. Qualitative interviews with recently-delivered women in rural Uganda and statistical analysis of data from the 2011 Ugandan Demographic and Health Survey (DHS) to assess the association between socio-demographic and cultural factors and delivery location in multivariable regression models. In the DHS, 61.7% (of 4907) women had a facility-based delivery (FBD); in adjusted analyses, FBD was associated with an urban setting [adjusted odds ratio (aOR) 3.38, 95% confidence interval (CI) 2.66 to 4.28)], the upper wealth quintile (aOR: 3.69, 95%CI 2.79 to 3.87) and with secondary education (aOR: 3.07, 95%CI 2.37 to 3.96). In interviews women quoted costs and distance as barriers to FBD. Other factors reported in interviews to be associated with FBD included family influence, perceived necessity of care (weak women needed FBD), and the reputation of the facility (women bypassed local facilities to deliver at better hospitals). Choosing a FBD is a complex decision and education around the benefits of FBD should be combined with interventions designed to remove barriers to FBD.
Collapse
|
22
|
Mbachu II, Ezeama C, Osuagwu K, Umeononihu OS, Obiannika C, Ezeama N. A cross sectional study of maternal near miss and mortality at a rural tertiary centre in southern nigeria. BMC Pregnancy Childbirth 2017; 17:251. [PMID: 28754161 PMCID: PMC5534124 DOI: 10.1186/s12884-017-1436-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study evaluated the pattern of severe maternal outcome, near miss indicators and associated patient and healthcare factors at a private referral hospital in rural Nigeria. METHODS This was a cross sectional study conducted from September 2014 to August 2015 in Madonna University Teaching Hospital Elele, Rivers State, Nigeria. Pregnant and postpartum women were recruited for the study using Nigeria near miss network proforma which was adopted from the WHO near miss proforma. We explored administrative, patient related and medical delays. Statistical analysis was done using SPSS version 20. RESULTS Of the 262 deliveries, 5 women died and 52 women had a near miss event. The maternal mortality rate was 1908/100,000. The maternal near miss mortality ratio was 11.4: 1 while the mortality index was 8.8%. Three out of the five deaths that occurred were in the age category of 20-24 years. Abortive outcome was the leading cause of maternal mortality contributing 2 of the 5 maternal mortality. The severe maternal outcome ratio was 218/1000 and maternal near miss incidence ratio was 198/1000. Hypertensive disorders of pregnancy contributed 16(28.1%) of the 57 cases with severe maternal outcome while Obstetrics hemorrhage and abortive outcome each contributed 14(24.6%). 6(10.5%) received treatment within 30 min of diagnosis while 19(33.3%) waited for greater than 240 min before they received intervention. There was a statistically significant association between time of intervention and final maternal outcome (p-value = 0.003). Administrative delay was noted in 20 cases, while patient related delay was noted in 44 cases. CONCLUSION There is a high burden of near miss and unmet need for reproductive health services in rural areas of Nigeria. Different levels of delays abound and contribute to the disease burden. Periodic reviews will aid in elimination of the delays. There should be better communication between different levels of care and emphasis should be on early identification and referral of women for prompt management.
Collapse
Affiliation(s)
- Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Awka, Nnewi Campus, Nnewi, Anambra State, Nigeria.
| | - Chukwuemeka Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Awka, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - Kelechi Osuagwu
- Department of Obstetrics and Gynaecology, Madonna University Teaching Hospital, Elele, Rivers State, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chibuzor Obiannika
- Department of Obstetrics and Gynaecology, Madonna University Teaching Hospital, Elele, Rivers State, Nigeria
| | - Nkeiru Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| |
Collapse
|
23
|
Canavan ME, Brault MA, Tatek D, Burssa D, Teshome A, Linnander E, Bradley EH. Maternal and neonatal services in Ethiopia: measuring and improving quality. Bull World Health Organ 2017; 95:473-477. [PMID: 28603314 PMCID: PMC5463811 DOI: 10.2471/blt.16.178806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 12/06/2016] [Accepted: 01/30/2017] [Indexed: 11/29/2022] Open
Abstract
Problem Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. Approach We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Local setting Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. Relevant changes Significant improvements in quality of intrapartum care were detected from baseline (June–July 2015) to follow-up (February–March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). Lessons learnt The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.
Collapse
Affiliation(s)
- Maureen E Canavan
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Marie A Brault
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Dawit Tatek
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | | | | | - Erika Linnander
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| | - Elizabeth H Bradley
- Global Health Leadership Institute, Yale University School of Public Health, 2 Church Street South, New Haven, Connecticut, 06519, United States of America
| |
Collapse
|
24
|
Pardosi JF, Parr N, Muhidin S. Fathers and infant health and survival in Ende, a rural district of Eastern Indonesia. JOURNAL OF POPULATION RESEARCH 2017. [DOI: 10.1007/s12546-017-9183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Blanco Esquivel LA, Urbina JM, Zerón HM. Approach to an obstetric prognosis scale: The modified SOFA scale. Ghana Med J 2016; 50:129-135. [PMID: 27752186 PMCID: PMC5044792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Severe obstetric morbidity constitutes a serious problem worldwide; however, an effective obstetrical prognosis scale is still missing. OBJECTIVE To propose a modified Sequential Organ Failure Assessment Score (SOFA) score based on time before reaching specialized medical attention. METHOD This was an ambispective, descriptive study, including all women treated at the Obstetrical Intensive Care Unit (OICU) of the "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Toluca, Mexico, from June 2009 to June 2013. The patient's SOFA score and clinical evolution were registered daily. A modified obstetrical SOFA scale was constructed adjusting the value of 180 instead of 200 in the punctuation column of 3 for the PaO2/FiO2 ratio and adding a file of disease evolution time with sepsis prior to reaching specialized medical attention. RESULTS Two hundred thirty two patients, with an average age (SD) of 26.42 (±7.54) years, mean gestational age of 33 (±7.5) weeks were included in the study; 118 suffered from pre-eclampsia, 56 obstetric haemorrhages, 41 eclampsia (25 preceded by pre-eclampsia) and 23, sepsis. ROC curves showed a higher area under the curve (AUC) for the modified SOFA (0.868; p<0.001) than SOFA (0.796; p=0.003), in the prediction of maternal mortality. CONCLUSIONS The SOFA score, taking into account a lower value for the Kirby index and a threshold time of 12-h with sepsis before getting specialized medical attention, shows a good predictive value for maternal death and could be considered for evaluating the severity of complicated obstetrical patients. FUNDING None declared.
Collapse
Affiliation(s)
- Lourdes A Blanco Esquivel
- “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México
| | - Jorge Macia Urbina
- “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México
| | - Hugo Mendieta Zerón
- “Mónica Pretelini Sáenz” Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México
- Ciprés Grupo Médico (CGM) and Asociación Científica Latina (ASCILA). Felipe Villanueva sur 700, Col. Morelos, 50120, Toluca, México
| |
Collapse
|
26
|
Bazzano AN, Felker-Kantor E, Kaji A, Saldanha L. Parent and caregiver perspectives on home-based newborn care in low-income settings: protocol for a systematic review of qualitative studies. BMJ Open 2016; 6:e012137. [PMID: 27531737 PMCID: PMC5013505 DOI: 10.1136/bmjopen-2016-012137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Newborn health and survival are closely linked to essential newborn care provided within the first days and weeks of an infant's life by parents and caregivers at home and within the community. Newborn care practices are often socially and culturally determined and have been explored in qualitative and formative research related to improving neonatal survival. We aim to provide a comprehensive review of qualitative studies on parent and caregiver experiences of newborn care practices with a view to identifying barriers and facilitators that may impact on newborn health. The rationale is that providing this information will be useful for intervention design and programme scale up for newborn survival. METHODS AND ANALYSIS We will systematically review qualitative studies reporting on newborn care practices. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement will be used for reporting the stages of the review and dissemination. The search period will include all studies published from 2006 to 2016. Study selection will incorporate the ENTREQ and Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines and quality assessment will be completed using Critical Appraisal Skills Programme (CASP) guidelines. Pending the identification of sufficient data of good quality, we will conduct a full synthesis of the studies identified by the review. ETHICS AND DISSEMINATION The results will be disseminated through peer-reviewed publications, conference presentation and directly to organisations involved in newborn health. Formal ethical approval from the author's institution is not required, as no primary data or identifying data will be collected. TRIAL REGISTRATION NUMBER CRD42016035674.
Collapse
Affiliation(s)
- Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aiko Kaji
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lisa Saldanha
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| |
Collapse
|
27
|
Bensaïd K, Yaroh AG, Kalter HD, Koffi AK, Amouzou A, Maina A, Kazmi N. Verbal/Social Autopsy in Niger 2012-2013: A new tool for a better understanding of the neonatal and child mortality situation. J Glob Health 2016; 6:010602. [PMID: 26955472 PMCID: PMC4766792 DOI: 10.7189/jogh.06.010602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence–based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country’s progress toward achieving Millennium Development Goal 4. A follow–up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub–Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners.
Collapse
Affiliation(s)
| | | | - Henry D Kalter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Abdou Maina
- Institute National des Statistics, Niamey, Niger
| | - Narjis Kazmi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
28
|
Infection Surveillance Protocol for a Multicountry Population-based Study in South Asia to Determine the Incidence, Etiology and Risk Factors for Infections Among Young Infants of 0 to 59 Days Old. Pediatr Infect Dis J 2016; 35:S9-15. [PMID: 27070072 DOI: 10.1097/inf.0000000000001100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insufficient knowledge of the etiology and risk factors for community-acquired neonatal infection in low-income countries is a barrier to designing appropriate intervention strategies for these settings to reduce the burden and treatment of young infant infection. To address these gaps, we are conducting the Aetiology of Neonatal Infection in South Asia (ANISA) study among young infants in Bangladesh, India and Pakistan. The objectives of ANISA are to establish a comprehensive surveillance system for registering newborns in study catchment areas and collecting data on bacterial and viral etiology and associated risk factors for infections among young infants aged 0-59 days. METHODS We are conducting active surveillance in 1 peri-urban and 4 rural communities. During 2 years of surveillance, we expect to enroll an estimated 66,000 newborns within 7 days of their birth and to follow-up them until 59 days of age. Community health workers visit each young infant in the study area 3 times in the first week of life and once a week thereafter. During these visits, community health workers assess the newborns using a clinical algorithm and refer young infants with signs of suspected infection to health care facilities where study physicians reassess them and provide care if needed. On physician confirmation of suspected infection, blood and respiratory specimens are collected and tested to identify the etiologic agent. CONCLUSIONS ANISA is one of the largest initiatives ever undertaken to understand the etiology of young infant infection in low-income countries. The data generated from this surveillance will help guide evidence-based decision making to improve health care in similar settings.
Collapse
|
29
|
Bergh AM, de Graft-Johnson J, Khadka N, Om'Iniabohs A, Udani R, Pratomo H, De Leon-Mendoza S. The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:4. [PMID: 26818943 PMCID: PMC4730627 DOI: 10.1186/s12914-016-0080-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/22/2016] [Indexed: 12/02/2022]
Abstract
Background Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. Methods Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. Results The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998–2006); the newborn-care phase (2007–2012); and lastly the current phase where small babies are also included in action plans. Conclusions This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.
Collapse
Affiliation(s)
- Anne-Marie Bergh
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa.
| | | | - Neena Khadka
- Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA.
| | - Alyssa Om'Iniabohs
- Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA.
| | - Rekha Udani
- D Y Patil University, School of Medicine, Nerul, Navi Mumbai, India.
| | - Hadi Pratomo
- Faculty of Public Health, Universitas Indonesia, Depok Campus, Depok 16424, West Java, Indonesia.
| | - Socorro De Leon-Mendoza
- Bless-Tetada Kangaroo Mother Care Foundation Phil., Inc., 7431 P. Burgos Street, San Dionisio Paranaque City Metro, Manila, Philippines.
| |
Collapse
|
30
|
Payne BA, Groen H, Ukah UV, Ansermino JM, Bhutta Z, Grobman W, Hall DR, Hutcheon JA, Magee LA, von Dadelszen P. Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension. Pregnancy Hypertens 2015; 5:315-21. [DOI: 10.1016/j.preghy.2015.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/26/2015] [Indexed: 11/29/2022]
|
31
|
Elmusharaf K, Byrne E, O'Donovan D. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed. BMC Public Health 2015; 15:870. [PMID: 26350731 PMCID: PMC4562346 DOI: 10.1186/s12889-015-2222-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Discussion Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. Summary We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.
Collapse
Affiliation(s)
- Khalifa Elmusharaf
- Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan. .,Royal College of Surgeons in Ireland, Manama, Bahrain. .,National University of Ireland, Galway, Ireland.
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | |
Collapse
|
32
|
Mangwi Ayiasi R, Atuyambe LM, Kiguli J, Garimoi Orach C, Kolsteren P, Criel B. Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda. BMC Public Health 2015; 15:560. [PMID: 26084369 PMCID: PMC4471930 DOI: 10.1186/s12889-015-1939-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022] Open
Abstract
Background Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice. Methods A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques. Results Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns. Conclusions Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of combining home visits with phone consultations between VHTs and professional health workers. However, the challenge of attitudinal change among VHTs towards certain strongly culturally-embedded behavioural post-partum practices, resistance from part of the professional health workforce to collaborate with VHTs and the problematic availability of professional health workers are important systemic problems that need to be addressed. Trial registration Current Controlled Trials NCT02084680.Registered 14 March 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1939-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Richard Mangwi Ayiasi
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Lynn Muhimbuura Atuyambe
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Patrick Kolsteren
- Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium.
| | - Bart Criel
- Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium.
| |
Collapse
|
33
|
Adding content to contacts: measurement of high quality contacts for maternal and newborn health in Ethiopia, north east Nigeria, and Uttar Pradesh, India. PLoS One 2015; 10:e0126840. [PMID: 26000829 PMCID: PMC4441429 DOI: 10.1371/journal.pone.0126840] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 04/08/2015] [Indexed: 11/28/2022] Open
Abstract
Background Families in high mortality settings need regular contact with high quality services, but existing population-based measurements of contacts do not reflect quality. To address this, in 2012, we designed linked household and frontline worker surveys for Gombe State, Nigeria, Ethiopia, and Uttar Pradesh, India. Using reported frequency and content of contacts, we present a method for estimating the population level coverage of high quality contacts. Methods and Findings Linked cluster-based household and frontline health worker surveys were performed. Interviews were conducted in 40, 80 and 80 clusters in Gombe, Ethiopia, and Uttar Pradesh, respectively, including 348, 533, and 604 eligible women and 20, 76, and 55 skilled birth attendants. High quality contacts were defined as contacts during which recommended set of processes for routine health care were met. In Gombe, 61% (95% confidence interval 50-72) of women had at least one antenatal contact, 22% (14-29) delivered with a skilled birth attendant, 7% (4-9) had a post-partum check and 4% (2-8) of newborns had a post-natal check. Coverage of high quality contacts was reduced to 11% (6-16), 8% (5-11), 0%, and 0% respectively. In Ethiopia, 56% (49-63) had at least one antenatal contact, 15% (11-22) delivered with a skilled birth attendant, 3% (2-6) had a post-partum check and 4% (2-6) of newborns had a post-natal check. Coverage of high quality contacts was 4% (2-6), 4% (2-6), 0%, and 0%, respectively. In Uttar Pradesh 74% (69-79) had at least one antenatal contact, 76% (71-80) delivered with a skilled birth attendant, 54% (48-59) had a post-partum check and 19% (15-23) of newborns had a post-natal check. Coverage of high quality contacts was 6% (4-8), 4% (2-6), 0%, and 0% respectively. Conclusions Measuring content of care to reflect the quality of contacts can reveal missed opportunities to deliver best possible health care.
Collapse
|
34
|
Abstract
Nearly a decade ago, The Lancet published the Neonatal Survival Series, with an ambitious call for integration of newborn care across the continuum of reproductive, maternal, newborn, and child health and nutrition (RMNCH). In this first of five papers in the Every Newborn Series, we consider what has changed during this decade, assessing progress on the basis of a systematic policy heuristic including agenda-setting, policy formulation and adoption, leadership and partnership, implementation, and evaluation of effect. Substantial progress has been made in agenda setting and policy formulation for newborn health, as witnessed by the shift from maternal and child health to maternal, newborn, and child health as a standard. However, investment and large-scale implementation have been disappointingly small, especially in view of the size of the burden and potential for rapid change and synergies throughout the RMNCH continuum. Moreover, stillbirths remain invisible on the global health agenda. Hence that progress in improvement of newborn survival and reduction of stillbirths lags behind that of maternal mortality and deaths for children aged 1-59 months is not surprising. Faster progress is possible, but with several requirements: clear communication of the interventions with the greatest effect and how to overcome bottlenecks for scale-up; national leadership, and technical capacity to integrate and implement these interventions; global coordination of partners, especially within countries, in provision of technical assistance and increased funding; increased domestic investment in newborn health, and access to specific commodities and equipment where needed; better data to monitor progress, with local data used for programme improvement; and accountability for results at all levels, including demand from communities and mortality targets in the post-2015 framework. Who will step up during the next decade to ensure decision making in countries leads to implementation of stillbirth and newborn health interventions within RMNCH programmes?
Collapse
Affiliation(s)
- Gary L Darmstadt
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA, USA.
| | - Mary V Kinney
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
| | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lily Kak
- United States Agency for International Development, Washington, DC, USA
| | - Vinod K Paul
- All India Institute of Medical Sciences, New Delhi, India
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland; Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Research and Evidence Division, Department for International Development, London, UK
| |
Collapse
|