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Mespreuve AS, Apers L, Moller AB, Galle A. Postnatal quality of care measures for mothers and newborns at home: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003498. [PMID: 39163315 PMCID: PMC11335102 DOI: 10.1371/journal.pgph.0003498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/30/2024] [Indexed: 08/22/2024]
Abstract
The postnatal period is one of the most critical periods in the lives of mothers and newborns. Yet, the postnatal period remains the most neglected period along the maternal health care continuum. Globally, measures assessing quality of postnatal care (PNC) often focus on care at health facility level, the provision of home-based PNC and associated quality of care measures seem largely overlooked. This scoping review aims to give an overview of the literature on measures assessing quality of PNC for mothers and newborns in a home-based setting. This review was conducted according to the Arksey and O'Malley's methodology for scoping reviews. Three electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened the identified articles. All data on home-based PNC measures were extracted and mapped according to the 2022 World Health Organization PNC Guideline recommendations in three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. Several additional quality of care domains, characterizing home-based PNC, were identified: i) social and emotional empowerment, ii) assessment of the home setting, iii) early breastfeeding, iv) health education and counseling, v) personal hygiene and prevention of infections, vi) referral to health facility when necessary, vii) thermal care, viii) parent-child relationship and ix) promote economic self-sufficiency. This review illustrates that home-based PNC has a very broad spectrum of care and plays a vital role in improving maternal and newborn health and well-being. In addition, there is a clear need for more research on the optimal timing and content of home-based care in the postnatal period for maximizing its potential.
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Affiliation(s)
- Ann-Sofie Mespreuve
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Lise Apers
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Galle
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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Habte A, Tamene A, Sewalem ZW. The receipt of health information on neonatal dangers signs during the immediate postpartum period and its determinants in Ethiopia: a multilevel mixed-effects logistic regression analysis of the 2016 Ethiopian demographic health survey report. BMC Pregnancy Childbirth 2024; 24:408. [PMID: 38844856 PMCID: PMC11154997 DOI: 10.1186/s12884-024-06605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/24/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Identification of neonatal danger signs and immediate access to health care are two global efforts aimed at enhancing newborn and child survival by preventing 75% of neonatal deaths. Despite various small-scale studies on women's awareness of neonatal danger signs in Ethiopia, little is known about the level of receiving health information on those danger signs during the immediate postpartum period at the national level. Hence, this study aimed at assessing the level, and its determinants of the service uptake in Ethiopia. METHODS The data for this study was taken from the Ethiopian Demographic and Health Survey (EDHS), which took place from January to June 2016 and covered all administrative regions of Ethiopia. A weighted sample of 7,589.8 women was analyzed using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was employed to determine the effects of each predictor on the outcome variable. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the explanatory variables. RESULTS The receipt of health information on neonatal danger signs during the immediate postpartum period was 10.70% [95% CI:10.01, 11.40]. Variables namely living in Metropolitans [AOR = 2.06; 95%CI: 1.48, 2.88] and Large central [AOR = 1.83; 95%CI: 1.38, 2.42] regions, being in the highest wealth quintile [AOR = 1.87; 95% CI: 1.23, 2.84], being nulliparous [AOR = 0.27; 95% CI: 0.08, 0.87] and primiparous[AOR = 0.61;95% CI: 0.46, 0.79], getting adequate antenatal visits [AOR = 2.42; 95% CI: 1.75, 3.33], institutional delivery [AOR = 5.91; 95% CI: 4.66, 7.53], and receipt of postnatal visits [AOR = 3.52; 95% CI: 2.84, 4.38] were identified as significant determinants of receiving health information on newborn danger signs. CONCLUSION The findings revealed that unacceptably low uptake of health information on newborn danger signs during the immediate postpartum period in Ethiopia. A concerted effort is needed from all stakeholders in the health sector to enhance the uptake of maternal health services (antenatal care, skilled delivery service, and postnatal care). Healthcare providers should pay special attention to nulliparous and primiparous women during and after delivery, and the government should also focus on women of peripheral regions, who make up a large portion of the low coverage.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.
| | - Aiggan Tamene
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Zablon Wale Sewalem
- Department of Clinical and Psychosocial Epidemiology, University of Groningen, Groningen, Netherlands
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Daalderop LA, de Vries EF, Steegers EAP, Been JV, Struijs JN, Lagendijk J. Socioeconomic inequalities in the uptake of postpartum care at home across Dutch neighbourhoods. Eur J Public Health 2024:ckae089. [PMID: 38783612 DOI: 10.1093/eurpub/ckae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Postpartum care focuses on prevention of health problems by performing medical check-ups and through enhancing maternal empowerment, the parent-infant interaction and knowledge about mother's own health and that of her newborn. We aimed to investigate whether there was significant clustering within neighbourhoods regarding the uptake of postpartum care and to what extent neighbourhood-level differences are explained by individual socio-demographic factors, pregnancy-related factors and neighbourhood-level determinants (i.e. deprivation and urbanization). METHODS A nationwide population-based observational study was carried out using linked routinely collected healthcare data from appropriate-for-gestational-age weight live-born term singleton deliveries (2015-18) in the Netherlands. We performed two-level multivariable logistic regression analyses, using three different models. Model 1 contained no explanatory variables and was used to assess clustering of postpartum care uptake within neighbourhoods. In model 2, individual-level determinants were added one by one and in model 3, neighbourhood-level determinants were added. RESULTS About 520 818 births were included. Multilevel modelling showed that 11% of the total variance in postpartum care uptake could be attributed to the neighbourhood of residence. Individual characteristics explained 38% of the neighbourhood variance, of which income and migration background were the most important contributors. An additional 6% of the variation could be explained by neighbourhood-level determinants. CONCLUSION We found substantial neighbourhood differences in postpartum care uptake. These differences are influenced by a complex interplay between individual-level and neighbourhood-level determinants, highlighting the importance of addressing both individual and neighbourhood-level determinants to improve the uptake of postpartum care and therewith overall community health.
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Affiliation(s)
- Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eline F de Vries
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Kamau IW, Keraka MN, Gitonga E. Effect of post-discharge postnatal educational intervention on postnatal practices among low-income primiparas in Nairobi informal settlements, Kenya: a post-test quasi-experiment. Pan Afr Med J 2024; 48:14. [PMID: 39184849 PMCID: PMC11343503 DOI: 10.11604/pamj.2024.48.14.42194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/09/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction informal settlements exhibit disproportionately worse maternal and newborn outcomes. Postnatal care (PNC) is a high-impact intervention for populations contributing to higher mortalities. Postnatal education is crucial to adopting evidence-based postnatal practices (PNPs) thus its post-discharge reinforcement is vital for low-income primiparas. This study aimed to determine the effect of post-discharge follow-up postnatal education intervention (PNE) on the adoption of recommended PNPs among low-income primiparas. Methods quasi-experimental study in Nairobi informal settlements with 118 primiparas discharged early after normal delivery on each arm. Facility and demographic data collected using an interviewer-administered questionnaire. Study arm received the intervention for 6 weeks in addition to routine PNC while control received routine PNC only. An interviewer-administered exit questionnaire was applied after 6 weeks. Focus group discussions were conducted for qualitative data then analyzed thematically. SPSS used to analyze quantitative data then descriptive statistics, t-tests, Chi-square, Mann-Whitney, and multiple linear or logistic regressions derived. PNPs composed of health-seeking for maternal and newborn danger signs, self and baby care practices, and utilization of PNC contacts. Results the intervention was a positive predictor of adoption of composite PNPs (β=0.26, p=0.00), self-care practices (β=0.39, p=0.00) and mothers' two weeks PNC contact (OR=4.64, p=0.00, 95% CI=1.9-11.2). Neither a significant predictor of health-seeking for maternal (β=-0.11, p=0.31) nor newborns danger signs (β=-0.04, p=0.73) though inversely related. No influence on baby care practices, two weeks of newborn contact and six weeks contact for the dyad. Multi-pronged approaches are appreciated. Conclusion follow-up post-discharge PNE intervention enhances adoption of PNPs among low-income primiparas thus a worthwhile supplement to routine PNC.
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Affiliation(s)
- Immaculate Wambui Kamau
- Department of Environmental and Occupational Health, School of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - Margaret Nyanchoka Keraka
- Department of Environmental and Occupational Health, School of Health Sciences, Kenyatta University, Nairobi, Kenya
| | - Eliphas Gitonga
- Department of Environmental and Occupational Health, School of Health Sciences, Kenyatta University, Nairobi, Kenya
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Giouleka S, Tsakiridis I, Kostakis N, Boureka E, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Postnatal Care: A Comparative Review of Guidelines. Obstet Gynecol Surv 2024; 79:105-121. [PMID: 38377454 DOI: 10.1097/ogx.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Importance Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being. Objective The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices. Evidence Acquisition A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted. Results There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period. Conclusions Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.
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Affiliation(s)
| | | | | | | | | | - Ioannis Kalogiannidis
- Associate Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kahraman S, Havlioğlu S. The effect of home nurse visits on infant weight and breastfeeding: Systematic review and meta-analysis. Int J Nurs Pract 2024; 30:e13150. [PMID: 36967608 DOI: 10.1111/ijn.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/01/2023] [Accepted: 03/04/2023] [Indexed: 03/28/2023]
Abstract
AIMS The primary aim of this systematic review and meta-analysis is to evaluate the effects of home nurse visiting on infant weight and breastfeeding; the secondary aim is to determine the duration, frequency and content of home visits. METHODS A systematic search of the PubMed, CINAHL, Embase (Ovid), Web of Science, Google Scholar and DergiPark databases for publications between September 2000 and January 2019 was conducted using established methods in compliance with the PRISMA-P declaration guideline. Two authors independently evaluated the studies for inclusion and bias, extracted the data and checked their accuracy. RESULTS This meta-analysis includes a total of 34 studies, 28 on breastfeeding and nine on infant weight. The average effect size of the 28 studies investigating the effect on breastfeeding was found to be OR: 2.24; 95% CI: 1.73-2.90; p < 0.001. The average effect size of the nine studies investigating the effect on infant weight was found to be ES: 0.197; 95% CI: 0.027-0.368; p < 0.05. CONCLUSION There is an association between nurse home visits and breastfeeding and infant weight. Home visits by nurses should continue to remain within the nursing role and be analysed appropriately for mother and baby health.
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Affiliation(s)
- Selma Kahraman
- Department of Public Health Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Suzan Havlioğlu
- Health Services Vocational School, Harran University, Şanlıurfa, Turkey
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Cho Y, Awoonor-Williams K, Jun D, Oh C, Cha S. Trial-based economic evaluation of the system-integrated activation of community health volunteers in rural Ghana. Glob Health Action 2023; 16:2203541. [PMID: 37165851 PMCID: PMC10177701 DOI: 10.1080/16549716.2023.2203541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Globally, steps to revitalise programmes deploying community health workers (CHWs) on a national scale have been growing, but few economic evaluations have been done on system-integrated CHW programmes. Ghana has dual cadres of CHWs: community health officers (CHOs) and community health volunteers (CHVs). CHO plays a major role in primary health services but has suffered from chronic staff shortages. We activated CHVs in communities to mitigate the negative impact due to CHO shortages. The CHVs conducted home visits and provided health education to prevent childhood diseases. OBJECTIVE We evaluated the cost-effectiveness and cost-benefit of activating CHVs. METHODS In a cluster-randomised trial with 40 communities in rural Ghana, the changes in disease incidence were inferred from a statistical model using a Bayesian generalised linear multilevel model. We evaluated the total incremental cost, benefit, and effectiveness for the intervention from an economic model. In cost-effectiveness analysis, disability-adjusted life years (DALYs) were estimated using a decision tree model. In the cost-benefit analysis, the cost-benefit ratio and net present value of benefit were estimated using a decision tree model, and a standardised sensitivity analysis was conducted. The decision tree model was a one-year cycle and run over 10-years. Costs, benefits, and effectiveness were discounted at a rate of 3% per year. RESULTS According to the cost-effectiveness analysis, the programme was highly likely to exceed the WHO-CHOICE threshold (1-3 times GDP per capita), but it was unlikely to exceed the conservative threshold (10-50% of GDP per capita). In the cost-benefit analysis, the mean and median cost-benefit ratios were 6.4 and 4.8, respectively. CONCLUSION We found the potential economic strengths in the cost-benefit analysis. To integrate CHW programmes with national health systems, we need more research to find the most effective scope of work for CHWs.
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Affiliation(s)
- Yinseo Cho
- West Africa Division, Korea International Cooperation Agency, Seongnam-si, Korea
| | - Koku Awoonor-Williams
- Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Damin Jun
- Performance Management Team, Korea International Cooperation Agency, Seongnam-si, Korea
| | - Chunghyeon Oh
- Fiji Office, Korea International Cooperation Agency, Suva, Fiji
- Department of Surgery, CWM Hospital, Suva, Fiji
| | - Seungman Cha
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
- Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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Izulla P, Muriuki A, Kiragu M, Yahner M, Fonner V, Nitu SNA, Osir B, Bello F, de Graft-Johnson J. Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries. PLoS One 2023; 18:e0293479. [PMID: 37983214 PMCID: PMC10659187 DOI: 10.1371/journal.pone.0293479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023] Open
Abstract
Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.
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Affiliation(s)
| | - Angela Muriuki
- Save the Children, Kenya Regional Office, Nairobi, Kenya
| | | | - Melanie Yahner
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Virginia Fonner
- Adroitz Consultants Limited, Nairobi, Kenya
- Department of Health and Nutrition, Save the Children, Dhaka, Bangladesh
| | - Syeda Nabin Ara Nitu
- Department of Global Health, Save the Children Federation Inc, Washington DC, United States of America
| | | | - Farahat Bello
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Joseph de Graft-Johnson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
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Iwuagwu AO. "Ọmụgwọ" As Unpaid Labor? The Perceptions of Postpartum Caregiving Among Older Grandmothers in Southeast Nigeria. Innov Aging 2023; 8:igad069. [PMID: 38577519 PMCID: PMC10993719 DOI: 10.1093/geroni/igad069] [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: 03/27/2023] [Indexed: 04/06/2024] Open
Abstract
Background and Objectives In Nigeria and many Sub-Saharan African countries where the majority are poor and cannot afford formal postpartum care, nursing mothers rely primarily on their mothers or older female relatives for postpartum care. Despite their invaluable contributions, such grandmothers often operate in a reality of inadequate social and institutional support. Yet, little is known about how women perceive this form of traditional care in Sub-Saharan Africa. This study explored the views of older grandmothers in Southeast Nigeria about postpartum caregiving, called "Ọmụgwọ." Research Design and Methods Using a qualitative descriptive inquiry, the author employed criterion-purposive sampling and snowballing to recruit 17 older grandmothers who participated in the interviews, and data were analyzed in themes. Results Three themes and eight subthemes emerged. The themes cover perceptions supporting the continuity of Ọmụgwọ practice irrespective, the influence of culture on Ọmụgwọ practice, and the indirect rewards of the practice. Discussion and Implications The findings of this study could potentially influence postpartum caregiving policies for female older adults in Sub-Saharan Africa and further advance the quality of informal care during postpartum periods in Africa.
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Ali S, Thind A, Stranges S, Campbell MK, Sharma I. Investigating Health Inequality Using Trend, Decomposition and Spatial Analyses: A Study of Maternal Health Service Use in Nepal. Int J Public Health 2023; 68:1605457. [PMID: 37332772 PMCID: PMC10272384 DOI: 10.3389/ijph.2023.1605457] [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] [Received: 10/05/2022] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives: (a) To quantify the level and changes in socioeconomic inequality in the utilization of antenatal care (ANC), institutional delivery (ID) and postnatal care (PNC) in Nepal over a 20-year period; (b) identify key drivers of inequality using decomposition analysis; and (c) identify geographical clusters with low service utilization to inform policy. Methods: Data from the most recent five waves of the Demographic Health Survey were used. All outcomes were defined as binary variables: ANC (=1 if ≥4 visits), ID (=1 if place of delivery was a public or private healthcare facility), and PNC (=1 if ≥1 visits). Indices of inequality were computed at national and provincial-level. Inequality was decomposed into explanatory components using Fairile decomposition. Spatial maps identified clusters of low service utilization. Results: During 1996-2016, socioeconomic inequality in ANC and ID reduced by 10 and 23 percentage points, respectively. For PND, the gap remained unchanged at 40 percentage points. Parity, maternal education, and travel time to health facility were the key drivers of inequality. Clusters of low utilization were displayed on spatial maps, alongside deprivation and travel time to health facility. Conclusion: Inequalities in the utilization of ANC, ID and PNC are significant and persistent. Interventions targeting maternal education and distance to health facilities can significantly reduce the gap.
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Affiliation(s)
- Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
- WHO Collaborating Centre for KT and HTA in Health Equity, Ottawa, ON, Canada
- Department of Health Sciences, University of York, York, United Kingdom
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
- Departments of Family Medicine and Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Departments of Family Medicine and Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M. Karen Campbell
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Obstetrics & Gynecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Ishor Sharma
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, Chapman DJ, Grummer-Strawn LM, McCoy D, Menon P, Ribeiro Neves PA, Piwoz E, Rollins N, Victora CG, Richter L. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet 2023; 401:472-485. [PMID: 36764313 DOI: 10.1016/s0140-6736(22)01932-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sonia Hernández-Cordero
- Research Center for Equitable Development (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | | | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Minuye Birhane B, Alebachew Bayih W, Chanie M, Awoke G, Simegn A, Asnakew S, Mamuye M, Yeshambel A, Muche T, Demis A, Munye T, Endalamaw A, Eshetie Y, Kefale D, Chanie ES, Mengesha Yalew Z, Mesfin Belay D. Home based postpartum care and determinants in Ethiopia: A multilevel analysis. PLoS One 2022; 17:e0272489. [PMID: 36007086 PMCID: PMC9409559 DOI: 10.1371/journal.pone.0272489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia. METHODS A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care. CONCLUSION Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother's knowledge about neonatal danger sign.
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Affiliation(s)
| | | | - Muluken Chanie
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Getaneh Awoke
- Debre Tabor Health Science College, Debre Tabor, Ethiopia
| | - Amare Simegn
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebaw Yeshambel
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asmamaw Demis
- College of Health Sciences, Woldia University, Ethiopia
| | - Tigabu Munye
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- School of Health Sciences, College Medicine and Health Sciences, Bahirdar University, Bahirdar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yeshambew Eshetie
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- College Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Zemen Mengesha Yalew
- Department Comprehensive Nursing, College of Health Sciences, Wollo University, Ethiopia
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13
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Tomori C, Hernández-Cordero S, Busath N, Menon P, Pérez-Escamilla R. What works to protect, promote and support breastfeeding on a large scale: A review of reviews. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13344. [PMID: 35315573 PMCID: PMC9113479 DOI: 10.1111/mcn.13344] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023]
Abstract
Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high- or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high-income and upper-middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social-ecological model, including supportive workplace policies; implementation of the Baby-Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper-middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well-established knowledge to scale up breastfeeding protection, promotion and support programmes.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Natalie Busath
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Rhode Island, USA
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Hoyt-Austin AE, Kair LR, Larson IA, Stehel EK. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022. Breastfeed Med 2022; 17:197-206. [PMID: 35302875 PMCID: PMC9206473 DOI: 10.1089/bfm.2022.29203.aeh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Adrienne E Hoyt-Austin
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Laura R Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Ilse A Larson
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth K Stehel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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15
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Tomori C. Overcoming Barriers to Breastfeeding. Best Pract Res Clin Obstet Gynaecol 2022; 83:60-71. [DOI: 10.1016/j.bpobgyn.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
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16
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Schleiff MJ, Aitken I, Alam MA, Damtew ZA, Perry HB. Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Res Policy Syst 2021; 19:113. [PMID: 34641898 PMCID: PMC8506097 DOI: 10.1186/s12961-021-00757-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the sixth of our 11-paper supplement entitled "Community Health Workers at the Dawn of New Era". Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. METHODS We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. RESULTS The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. CONCLUSION Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training-not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.
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Affiliation(s)
- Meike J. Schleiff
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Iain Aitken
- Management Sciences for Health, Ministry of Public Health, Kabul, Afghanistan
| | | | | | - Henry B. Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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17
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Kiross GT, Chojenta C, Barker D, Loxton D. Optimum maternal healthcare service utilization and infant mortality in Ethiopia. BMC Pregnancy Childbirth 2021; 21:390. [PMID: 34011300 PMCID: PMC8136182 DOI: 10.1186/s12884-021-03860-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 01/05/2023] Open
Abstract
Background Ethiopia has one of the highest rates of infant mortality in the world. Utilization of maternal healthcare during pregnancy, at delivery, and after delivery is critical to reducing the risk of infant mortality. Studies in Ethiopia have shown how infant survival is affected by utilization of maternal healthcare services, however, no studies to date have investigated the relationship between optimum utilization of maternal healthcare services utilization and infant mortality. Therefore, this study examined the effect of optimum utilization of maternal healthcare service on infant mortality in Ethiopia based on the World Health Organization (WHO, 2010) guidelines. Methods We used nationally representative cross-sectional data from the Ethiopian Demographic and Health Survey (EDHS). Sampling weights were applied to adjust for the non-proportional allocation of the sample to the nine regions and two city administrations as well as the sample difference across urban and rural areas. A total of 7193 most recent births from mothers who had provided complete information on infant mortality, ANC visits, tetanus injections, place of delivery and skilled birth attendance during pregnancy were included. The EDHS was conducted from January to June 2016. We applied a multivariate logistic regression analysis to estimate the relationship between optimum maternal healthcare service utilization and infant mortality in Ethiopia. Results The findings from this study showed that optimum maternal healthcare service utilization had a significant association with infant mortality after adjusting for other socioeconomic characteristics. This implies that increased maternal healthcare service utilization decreases the rate of infant mortality in Ethiopia. The main finding from this study indicated that infant mortality was reduced by approximately 66% among mothers who had high utilization of maternal healthcare services compared to mothers who had not utilized maternal healthcare services (AOR = 0.34; 95%CI: 0.16–0.75; p-value = 0.007). Furthermore, infant mortality was reduced by approximately 46% among mothers who had low utilization of maternal healthcare services compared to mothers who had not utilized any maternal healthcare services (AOR = 0.54; 95%CI: 0.31–0.97; p-value = 0.040). Conclusions From this study, we concluded that optimum utilization of maternal healthcare services during pregnancy, at delivery and after delivery might reduce the rate of infant mortality in Ethiopia.
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Affiliation(s)
- Girmay Tsegay Kiross
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Kimani RW, Maina R, Shumba C, Shaibu S. Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model. HUMAN RESOURCES FOR HEALTH 2020; 18:75. [PMID: 33028347 PMCID: PMC7539267 DOI: 10.1186/s12960-020-00518-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/02/2020] [Indexed: 05/07/2023]
Abstract
Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.
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Affiliation(s)
- Rachel Wangari Kimani
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Rose Maina
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
- Department of Population Health, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
| | - Sheila Shaibu
- School of Nursing and Midwifery, Aga Khan University, PO Box 39340, Nairobi, 00623 Kenya
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19
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Eidelman AI. The Biopsychosocial Dimension of Breastfeeding. Breastfeed Med 2020; 15:484. [PMID: 32668171 DOI: 10.1089/bfm.2020.29159.aie] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lewkowitz AK, López JD, Carter EB, Duckham H, Strickland T, Macones GA, Cahill AG. Impact of a novel smartphone application on low-income, first-time mothers' breastfeeding rates: a randomized controlled trial. Am J Obstet Gynecol MFM 2020; 2:100143. [PMID: 33345878 DOI: 10.1016/j.ajogmf.2020.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video. OBJECTIVE This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers. STUDY DESIGN This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%. RESULTS A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes. CONCLUSION Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO; Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI.
| | - Julia D López
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - Hillary Duckham
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - Tianta Strickland
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO; Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, TX
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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