Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies

Dynamics of factors associated with neonatal death in Madagascar: A comparative analysis of the 2003, 2008, 2021 DHS

Neonatal mortality remains a major public health challenge, as reductions have stagnated worldwide despite cost-effective interventions in recent years. The temporal evolution of its determinants is insufficiently studied. This study aimed to analyze the dynamics of factors associated with neonatal death in Madagascar between 2003 and 2021. A secondary analysis was conducted using data from the 2003, 2008, and 2021 Demographic and Health Surveys (DHS) of Madagascar. The study population is focused on children under the age of 5 years at the time of these surveys. The death of a newborn within 30 days after birth constitutes the outcome variable. A multilevel binomial logistic regression was performed. The number of children under 5 included in the analysis were 5,415 in 2003, 12,448 in 2008 and 12,399 in 2021. The prevalence of neonatal deaths was 3.1% in 2003, 2.4% in 2008, and 2.6% in 2021. Persistent significant associations with neonatal death were observed for low birth weight, lack of breastfeeding, medium-sized households, large households, and high birth weight. A loss of statistical significance of the association with neonatal death over time was observed for a birth interval of 2-3 years and 4 years and more, mother's age 40-49 years, and use of mosquito net by the mother. In 2021, new significant associations with neonatal mortality were identified in the province of Toliara, absence of geographic barriers to healthcare access, 4-7 ANC visits, and supervised delivery. The factors associated with neonatal mortality, which have worsened over time in Madagascar, include birth weight abnormalities and delivery in the presence of qualified personnel. This deterioration underscores the urgency of improving the quality of perinatal care in healthcare facilities, beyond mere geographical accessibility.

Barriers to seeking consultation at public service and medical facilities among pregnant and postpartum women in Japan: a cross-sectional study

Background

Pregnant and postpartum women often experience parenting problems which may affect their mental health and children's health and development. However, their ability to seek consultation at public service or medical facilities remains unclear. This study aimed to identify the characteristics associated with women who refrain from visiting these facilities for consultation and their reasons for it.

Methods

This cross-sectional internet-based survey was conducted in Japan between July and August 2021, involving 7,326 women (1,639 pregnant and 5,687 postpartum women). The study outcome was defined as refraining from seeking consultation on family or parenting issues at public service or medical facilities despite a perceived need. We identified women's characteristics associated with refraining from consultation using multivariable logistic regression and conducted a descriptive analysis of 13 listed reasons for refraining from the consultation.

Results

The percentage of women who reported refraining from seeking consultation at public service or medical facilities was 8.6% and 5.1%, respectively. Common factors associated with refraining from seeking consultation at these facilities included having a child(ren) and being in the postpartum period, low health literacy, lack of partner support, and current disability. "Difficulty taking child(ren) to the consultation" and "uncertainty about the seriousness of the problem" were major reasons for refraining from consultation.

Discussion

Healthcare workers at public service and medical facilities should offer prenatal education on the importance of seeking help. An online consultation service and an improved facility environment may mitigate women's perceived barriers to seeking consultation.

Health seeking behaviour of caregivers of children under five and its determinants in Ho West and Adaklu districts, Volta Region, Ghana: a community-based cross-sectional study

BACKGROUND

Despite gains made in child survival, morbidity and mortality remain high in sub-Saharan Africa. Seeking healthcare at health facilities for sick children under-five within 24 h of onset of symptoms is key to mitigating severe morbidity and mortality. However, literature on this outcome is limited and poses challenges for monitoring caregivers' adherence to prompt health seeking behaviour. This study assessed the prevalence and determinants of prompt caregiver health seeking behaviour (HSB) for sick under-fives in two districts in the Volta Region of Ghana.

METHODS

The study was conducted among 770 caregivers/children in the Ho West and Adaklu districts of the Volta Region. Data on caregiver and child characteristics and knowledge of childhood illness symptoms/ signs among others were obtained. Summary statistics were presented as frequencies and percentages. Logistic regression was used to assess for association between prompt HSB and independent variables including caregiver and child socio-demographics. Odds ratios were presented with 95% confidence intervals at a statistical significance of p < 0.05 in the final model.

RESULTS

Almost 93% (714/770) of the caregivers were females while about three-quarters (559/767) were aged 20-39 years. The mean age of the study children was 24.1 months. Of caregivers who sought formal health care the last time their children fell ill, only about 59% (337/573) did so within 24 h of symptoms onset. Less than 10% (52/770) of caregivers had adequate knowledge of childhood danger signs while about 64% (492/770) had decision-making capacity regarding sending a sick child to a health facility. Male children had twice the odds of caregivers' prompt HSB compared to females [AOR 2.02 95% CI: 1.24, 3.27; p = 0.004]. Fourth-born or higher birth order children had 56% reduced odds of prompt HSB [AOR 0.44 95% CI: 0.26, 0.75; p = 0.003].

CONCLUSION

About 60% of those who sought formal care for their sick children did so promptly and this was influenced by the sex and birth order of the child. Public health managers in the study area must promote interventions to improve prompt caregiver HSB, especially for children of higher birth orders. Community education is needed to minimize 'discrimination' against the girl child as far as prompt HSB is concerned.

The impact of interactive text communication on neonatal mortality in Kenya: a randomized controlled trial

Text communication between newborns' caregivers and healthcare workers allows for real-time decisional guidance; however, its impact on neonatal health outcomes is unknown. Mobile WACh NEO (MWACh NEO) was a parallel, unblinded and individually randomized controlled trial at six health facilities across Kenya. Pregnant women at 28-36 weeks gestation were randomized (1:1) to the MWACh NEO intervention or standard of care. MWACh NEO delivered automated maternal and neonatal health text messages to participants up to 6 weeks postpartum and allowed free text communication with a nurse. This trial sought to determine if text communication decreased neonatal mortality. The analysis was intention to treat. From September 2020 until June 2022, 5,020 participants were enrolled and randomized. One hundred and thirty-six participants were excluded because of incomplete mortality data, leaving 2,442 participants in each group for the analysis. Eighty-three neonatal deaths occurred for a neonatal mortality rate of 18.8 per 1,000 live births in the intervention group and 15.2 per 1,000 live births in the control group, with a risk ratio of 1.25 (0.81, 1.91), P = 0.31. No adverse events related to the intervention were reported. Text communication did not decrease neonatal mortality compared to standard of care. Most neonates died before discharge from the facility. ClinicalTrials.gov registration: NCT04598165 .

Fetal outcomes and associated factors of antepartum hemorrhage in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Antepartum hemorrhage (APH) is a significant obstetric complication characterized by bleeding from the genital tract before the onset of labor. It poses serious risks to both maternal and fetal health, with potential outcomes including preterm birth, low birth weight, and increased perinatal mortality. In Ethiopia, where access to comprehensive prenatal care and emergency obstetric services may be limited, the impact of APH on fetal outcomes is a pressing concern. Despite the gravity of this condition, there is a lack of synthesized evidence on its prevalence and the associated risk factors specific to the Ethiopian context. This systematic review and meta-analysis aim to consolidate existing research on the fetal outcomes of APH and identify the key factors contributing to its incidence and severity in Ethiopia.

METHODS

Following the PRISMA checklist guidelines, this study concentrated on research undertaken in Ethiopia. Comprehensive searches across multiple databases Google Scholar, Google, Web of Science, and PubMed yielded six pertinent studies. Data were systematically gathered using a structured checklist and analyzed with STATA version 14. The Cochrane Q test and the I² statistic were utilized to assess heterogeneity. Additionally, publication bias was examined using Egger's weighted regression, a funnel plot, and Begg's test.

RESULTS

This study reviewed 525 research articles that included a total of 22,914 participants. Our meta-analysis revealed that the pooled prevalence of perinatal mortality due to antepartum hemorrhage in Ethiopia is 21.79% (95% CI: 12.32-31.25). Key factors influencing perinatal mortality associated with antepartum hemorrhage included living in rural areas (OR =  1.62, 95% CI: 1.33-1.98), delays in seeking medical care for over 12 hours (OR =  5.43, 95% CI: 1.01-29.14), prematurity (OR =  9.00, 95% CI: 5.39-15.03), and experiencing severe vaginal bleeding prior to arrival at a medical facility (OR =  7.04, 95% CI: 2.14-23.13).

CONCLUSION

The study reveals a high perinatal mortality rate of 21.79% associated with antepartum hemorrhage in Ethiopia. Contributing factors include rural residence, delays in seeking care, prematurity, and severe vaginal bleeding. To reduce mortality, improve rural healthcare, strengthen emergency systems, and enhance prenatal care. Public education on early intervention and specialized care for premature infants are also essential. Collaboration among healthcare providers, government, and NGOs is crucial for effective, sustainable solutions.

Mixed-methods study assessing the accuracy of verbal autopsy and sociocultural determinants of infant mortality in Gujarat, India

BACKGROUND

Accurate determination of infant mortality causes and understanding sociocultural factors influencing care-seeking behaviors are crucial for targeted interventions in resource-limited settings. This mixed-methods study aimed to assess the accuracy of verbal autopsy (VA) in ascertaining infant death causes and explore sociocultural determinants of infant mortality in Gujarat, India.

MATERIALS AND METHODS

It was a mixed-method study with a retrospective cohort component for which data from 661 infant records were extracted from the main health office's database, with a subset of 328 infant deaths selected for verbal autopsy analysis. Delivery characteristics, care-seeking behaviors, access to healthcare, and risk factors were evaluated. Bivariate and multivariate analyses were conducted to identify factors associated with infant mortality. VA diagnostic accuracy was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic curve analysis, with death certificates as the reference standard. Qualitative methods, including in-depth interviews, and focus group discussions were used to explore the sociocultural influences, health system challenges, and stakeholder experiences related to infant deaths and VA implementation. Findings were integrated through triangulation.

RESULTS

Institutional deliveries were 583/661 (88%), and the skilled birth attendance was 397/661 (60%). Care-seeking from health facilities was low at 264/661 (40%), with a mean time of 12 hours. Home deaths accounted for 328/661 (49.6%) cases. Low birth weight (aOR 1.81, 95% CI 1.3-2.4, P = 0.002), home delivery (aOR 1.72, 95% CI 1.1-2.8, P = 0.01), early complementary feeding (aOR 1.48, 95% CI 1.1-2.0, P = 0.01), and acute malnutrition (aOR 1.91, 95% CI 1.3-2.6, P = 0.001) were independent risk factors for mortality. Verbal autopsy showed high specificity (87%) but variable sensitivity (70%) in determining causes of death. Qualitative findings revealed barriers to timely care (lack of danger sign recognition, financial constraints, traditional healer reliance), cultural beliefs impacting care practices, gender discrimination, health system constraints (staff shortages, diagnostic limitations), and challenges with VA implementation (recall bias, desire for feedback).

CONCLUSION

Enhancing antenatal care, skilled birth attendance, optimal breastfeeding, complementary feeding practices, addressing acute malnutrition, overcoming sociocultural barriers through community engagement, health system strengthening, and culturally sensitive interventions could potentially reduce infant mortality rates. While a verbal autopsy is practical for the cause of death determination in resource-limited settings, its effectiveness relies on addressing the identified challenges through policy measures focused on community participation, health system improvements, and culturally appropriate strategies.

Factors influencing early postnatal care use among postpartum women in Afghanistan

Using postnatal care (PNC) within the first week following childbirth is crucial, as both the mother and her baby are particularly vulnerable to infections and mortality during this period. In this study, we examined the factors associated with early postnatal care (EPNC) use in Afghanistan. We used data from the multiple indicator cluster survey (MICS) 2022-2023. The study population was ever-married women who delivered a live child during their recent pregnancy within the 2 years preceding MICS 2022-23. The outcome was EPNC and defined as the first check of the mother within the first week of delivery. A binary logistic regression was used, and odds ratio (OR) and 95% CI were obtained. Out of 12,578 women, 16.0% received EPNC. EPNC was lower in women who delivered at home [AOR 0.35 (95% CI 0.28-0.44)] compared with women who delivered at public clinics. EPNC was higher in women with ≥ 4 antenatal care (ANC) visits [1.29 (1.02-162)], in women in the highest quintile of wealth status [1.70 (1.25-2.32)], and in women with access to radio [1.76 (1.45-2.15)]. EPNC use among Afghan women remains low (16.0%). Key factors associated with ENPC utilization include place of delivery, ANC utilization, wealth status, and radio access.

Mothers' health-seeking practices and associated factors towards neonatal danger signs in Ethiopia: a systematic review and meta-analysis

BACKGROUND

A decrease in obtaining quality healthcare is a major cause of maternal and newborn deaths in low-income and middle-income countries. Ethiopia has one of the highest neonatal mortality rates. Increasing mothers' health-seeking practices related to neonatal danger signs is an essential strategy for reducing the death rate of newborns. However, the pooled prevalence of mothers' health-seeking practices related to neonatal danger signs is not well known in Ethiopia.

OBJECTIVE

The main aim of this systematic review and meta-analysis is to assess the mothers' health-seeking practices and associated factors towards neonatal danger signs in Ethiopia.

DESIGN

Systematic review and meta-analysis.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was to assess the mothers' health-seeking practices towards neonatal danger signs and the secondary outcome was to identify factors associated with health-seeking practices.

METHODS

In total, comprehensive literature was searched in the PubMed, Google Scholar, HINARI, Embase and CINAHL databases published up to 30 December 2023. A random effect model was used to estimate the pooled prevalence and adjusted OR (AOR). Stata (V.17.0) was used to analyse the data. I2 statistics were computed to assess heterogeneity among studies. To minimise the underlying heterogeneity, a subgroup analysis was conducted based on the study region and year of publication. To assess publication bias, Egger's test and funnel plots were used.

RESULTS

Overall, 1011 articles were retrieved, and 11 cross-sectional studies, with a total of 5066 study participants, were included in this systematic review. The overall pooled prevalence of mothers' health-seeking practices for neonatal danger signs in Ethiopia was 52.15%. Postnatal care follow-up (AOR 2.72; 95% CI 1.62 to 4.56), good maternal knowledge (AOR 3.20, 95% CI 2.24 to 4.56), educational status of secondary school and above (AOR 4.17, 95% CI 2.04 to 8.55), women's decision-making autonomy (AOR 3.59, 95% CI 1.60 to 8.06) and place of delivery (AOR 2.71, 95% CI 1.21 to 6.04) were significantly associated with mothers' health-seeking practices for neonatal danger signs.

CONCLUSION

The maternal health-seeking practices of women towards neonatal danger signs were found to be low in Ethiopia. When barriers to seeking care for newborn danger signs are successfully removed, women's practices for seeking care for neonatal danger signs could decrease perinatal mortality.

Delays in the decision to seek care and associated factors among mothers who delivered in rural health centers in Wolaita Zone, Southern Ethiopia

Background

Delays in seeking care in health facilities during pregnancy and childbirth can potentially lead to adverse outcomes for women with obstetric complications. These complications lead to maternal mortality and morbidity in developing countries such as Ethiopia. The magnitude and underlying causes of maternal first delay in Ethiopia, particularly in rural areas of the country, are not well documented. This study aims to assess the magnitude of delay in the decision to seek care and associated factors among mothers who gave birth in rural health centers in Wolaita Zone, Southern Ethiopia.

Method and materials

A facility-based cross-sectional study was undertaken among mothers who gave birth in rural health centers of Wolaita Zone, Southern Ethiopia, from 30 June 2020 to 30 July 2022. A sample size of 410 study participants was selected from each public health center using the systematic random sampling method. Data were collected from a pretested and structured questionnaire using an Open Data Kit; analysis was carried out using SPSS version 25. The determining factors for the first delay were identified using binary logistic regression. Variables with a p-value of less than 0.25 in binary analysis were selected for a multivariable analysis. Variables with a p-value of less than 0.05 were considered statistically significant.

Results

The magnitude of delay in the decision to seek care in health facilities was 42.1% among mothers who gave birth in rural health centers in the Wolaita Zone, Southern Ethiopia. Unemployed mothers (Adjusted Odd Ratio, 2,529; 95% CI, 1.546, 4.136), husbands with no formal education (Adjusted Odd Ratio, 1.290; 95% CI, 1.029, 1.616), mothers who had negative attitudes towards seeking care in health facilities, and (Adjusted Odd Ratio; 1.695; 95% CI, 1.061, 2.709) were significantly associated with a delay in the decision to seek care at a health facility.

Conclusion

The magnitude of the first maternal decision to seek care at health facilities among mothers was high in the study area. Efforts should be made to strengthen the literacy level of the husbands of mothers and increase household income through various income-generating approaches. In addition, the dissemination of health information could effectively raise community awareness of the importance of institutional delivery.

Factors Contributing to Delays to Accessing Appendectomy in Low- and Middle-Income Countries: A Scoping Review

BACKGROUND

Appendicitis is one of the most common emergency surgical conditions worldwide. Delays in accessing appendectomy can lead to complications. Evidence on these delays in low- and middle-income countries (LMICs) is lacking. The aim of this review was to identify and synthesise the available evidence on delays to accessing appendectomy in LMICs.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews framework. The delays and their interconnectivity in LMICs were synthesised and interpreted using the Three Delays framework. We reviewed Africa Wide EBSCOhost, PubMed-Medline, Scopus, Web of Science, African Journals Online (AJOL), and Bioline databases.

RESULTS

Our search identified 21 893 studies, of which 78 were included in the final analysis. All of the studies were quantitative. Fifty per cent of the studies included all three types of delays. Delays in seeking care were influenced by a lack of awareness of appendicitis symptoms, and the use of self and alternative medication, which could be linked to delays in receiving care, and the barrier refusal of medical treatment due to fear. Financial concerns were a barrier observed throughout the care pathway.

CONCLUSION

This review highlighted the need for additional studies on delays to accessing appendectomy in additional LMICs. Our review demonstrates that in LMICs, persons seeking appendectomy present late to health-care facilities due to several patient-related factors. After reaching a health-care facility, accessing appendectomy can further be delayed owing to a lack of adequate hospital resources.

Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda

Background: Women in low-resource settings will likely develop late surgical site infections (SSIs), diagnosed after post-operative day (POD) 10. We measured SSI prevalence and predictors of late and persistent SSIs-suggestive symptoms among women who delivered via cesarean section (c-section). Patients and Methods: Women who underwent c-sections at Kirehe District Hospital (KDH) between September 2019 and February 2020 were prospectively enrolled. Data were collected on POD1, POD11, and POD30. Logistic regression identified factors associated with persistent and late SSI symptoms. Results: In total, 808 women were study enrolled. Of these, 646 women physically attended the POD11 clinic visit follow-up, while 671 received the POD30 telephone-based follow-up review. Thirty-three (5.0%) women were diagnosed with an SSI on POD11, and 39 (5.3%) had an SSI diagnosis during POD11 to POD30, giving a cumulative prevalence of 10.3% late SSI rate. Of 671, 400 (59.9%) reported at least one SSI-associated symptom between POD11 and POD30. The reported symptoms included pain (56.6%), fever (19.4%), or incision drainage (16.6%). Of these, 200 women reported still having at least one of these symptoms on POD30. Of the 400 women with late SSI symptoms, 232 (58.0%) did not seek care, and of these, 80 (48.5%), 59 (35.8%), and 15 (8.9%) could not afford transport fare, did not believe symptoms were severe for a medical visit, and were not able to travel, respectively. Lower odds of late SSI-suggestive symptoms were reported among women with health insurance (adjusted odds ratio [aOR], 0.06; p = 0.013), whereas higher late SSI-suggestive symptoms odds were among women with wealthier socioeconomic status (aOR, 2.88; p = 0.004). Conclusions: Women in rural Rwanda are at risk of late and persistent SSI-suggestive symptoms. Financial barriers and the perception that their symptoms were not serious enough for the medical visit need education on early care seeking and interventions to mitigate financial barriers for optimizing perinatal care.

Health care seeking behaviors of pregnant women in rural Amhara, Ethiopia: a qualitative study of perceptions of pregnant women, community members, and health care providers

Introduction

in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia.

Methods

the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from October 3rd through October 14th, 2018. A phenomenological qualitative study design was used to understand participants' perceptions and experiences about pregnant women's health care seeking behaviors.

Results

early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers.

Conclusion

despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women's health care seeking practices.

Population health and sociodemographic variables as predictors of access to cardiac medicine and surgery in Haiti

BACKGROUND

In Haiti, cardiovascular disease is a leading cause of morbidity and mortality, with congenital and rheumatic heart disease comprising a large portion of disease burden. However, domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood. We analyzed population-level sociodemographic variables to predict cardiac care outcomes across the 10 Haitian administrative departments.

METHODS

This cross-sectional study combined data from a 2016-17 Haitian national survey with aggregate outcomes from the Haiti Cardiac Alliance (HCA) database (n = 1817 patients). Using univariate and multivariable regression analyses, the proportion of HCA patients belonging to each of three clinical categories (active treatment, lost to follow-up, deceased preoperatively) was modeled in relation to six population-level variables selected from national survey data at the level of the administrative department.

RESULTS

In univariate analysis, higher department rates of childhood growth retardation were associated with a lower proportion of patients in active care (OR = 0.979 [0.969, 0.989], p = 0.002) and a higher proportion of patients lost to follow-up (OR = 1.016 [1.006, 1.026], p = 0.009). In multivariable analysis, the proportion of department patients in active care was inversely associated with qualified prenatal care (OR = 0.980 [0.971, 0.989], p = 0.005), and child growth retardation (OR = 0.977 [0.972, 0.983]), p = 0.00019). Similar multivariable results were obtained for department rates of loss to follow-up (child growth retardation: OR = 1.018 [1.011, 1.025], p = 0.002; time to nearest healthcare facility in an emergency: OR = 1.004 [1.000, 1.008, p = 0.065) and for preoperative mortality (prenatal care: OR = 0.989 [0.981, 0.997], p = 0.037; economic index: OR = 0.996 [0.995, 0.998], p = 0.007; time to nearest healthcare facility in an emergency: OR = 0.992 [0.988, 0.996], p = 0.0046).

CONCLUSIONS

Population-level survey data on multiple variables predicted domestic disparities in HCA clinical outcomes by region. These findings may help to identify underserved areas in Haiti, where increased cardiac care resources are required to improve health equity. This approach to analyzing clinical outcomes through the lens of population-level survey data may inform future health policies and interventions designed to increase cardiac care access in Haiti and other low-income countries.

Knowledge and practices of home caregivers on neonatal danger signs pre-admission to tamale teaching hospital, Ghana: an explorative descriptive study

INTRODUCTION

Neonatal illnesses can prove to be fatal if not identified early and treated. This suggests that death occasioned as result of neonatal illness could be prevented. However, it has been observed that most mothers report to the hospital late with their newborns in critical state, making it difficult for professionals to salvage the problem often than not. This study sought to explore the knowledge and practices of home caregivers on neonatal danger signs pre-admission to Tamale Teaching Hospital a tertiary hospital in northern Ghana.

METHODS

An explorative descriptive qualitative design was used in this study. Purposive sampling technique was used to select fifteen caregivers of neonates on admission at the Neonatal Intensive Care Unit of Tamale Teaching Hospital. Data was collected using semi-structured interview guide. As part of data collection, audio recordings were used to audio tape interviews. All data collected were transcribed verbatim and subsequently analyzed manually using thematic content analysis.

RESULTS

Thematic analysis in the study demonstrated that caregivers had basic knowledge, describing neonatal illness with danger signs such as lethargy, convulsion, fever, fast breathing, poor feeding, vomiting and diarrhea. The study further found that the predominant practice to care seeking by caregivers was home/traditional herbal remedies. It also indicated that inexperience caring for neonates, severity of illness and non-availability of finances were factors that informed caregivers choice of treatment of neonatal illness.

CONCLUSION

The study concludes that inexperience caring for neonate, severity of illness and non-availability of finances were factors that informed caregivers choice of treatment. There is a pressing need for health workers to strengthen the education of caregivers/mothers on neonatal danger signs and the need for prompt care seeking from skilled health care providers prior to discharge from the hospital.

Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature

BACKGROUND

Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs.

METHODS

This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed.

RESULTS

Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure.

CONCLUSION

This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

Home based postpartum care and determinants in Ethiopia: A multilevel analysis

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.

The Impact of Delayed Surgical Care on Patient Outcomes With Alimentary Tract Perforation: Insight From a Low-Middle Income Country

Introduction

In-patient delay is associated with increased mortality in patients with alimentary tract perforations. Access to surgical care is a glaring health issue in low-middle income countries (LMICs), where patient presentation is also delayed for a myriad of reasons, which can be broadly categorized as social/cultural, financial, and structural in their nature. The impact these delays have on surgical outcomes in low-middle income countries is not known.

Methods

A retrospective cohort study of patients who underwent emergency laparotomy for alimentary tract perforation from July 2015 to June 2018 was conducted at a tertiary care hospital in Karachi, Pakistan. Time was recorded in two variables: symptom onset to emergency room presentation (ERT) and emergency room to operation room time (ORT).

Results

Overall, 80 patients were included in the study. The 12 (15%) patients who expired were significantly older (57 ± 17.7 years of age), had a higher Charlson Comorbidity Index and had longer ORT [median ORT in hours-discharged vs expired: 8.2 (IQR 5-15) vs 16 (IQR 12-28) p=0.02]. ERT was also longer but lacked statistical significance [median ERT in hours-discharged vs expired: 24 (IQR 22-72) vs 48 (IQR 24-120) p=0.19]. Multivariable logistic regression analysis revealed ORT to be significantly associated with mortality [odds ratio (OR): 1.02, 95% confidence interval (CI): 1.003-1.041; p=0.02]. Adjusted Cox regression analysis showed that each hour of ORT increased the risk of mortality by 1.5% [hazard ratio (HR) 1.015, 95% CI 1.001-1.030].

Conclusion

Inpatient delays increased the risk of mortality for patients undergoing emergency laparotomy for alimentary tract perforation. Larger sample sizes and prospective studies are needed to better understand this relationship and the impact pre-hospital delays have on outcomes.

Level of Postnatal Checkup in Ethiopia - Implications for Child Health Services

Background

High neonatal mortality rates continue to be a major public health issue in Ethiopia. Despite different maternal and neonatal care interventions, neonatal mortality in Ethiopia is at a steady state. This could be due to the low utilization of neonatal checkups. Thus, nationally assessing the level and predictors of postnatal checkups could provide important information for further improving neonatal healthcare services.

Materials and Methods

A secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) was performed on 7,586 women who had live births in the 2 years before the survey. All variables with a p-value of ≤0.25 in the bivariable analysis were entered into the final model for multivariable analysis, and the level of statistical significance was declared at a P-value of <0.05.

Results

According to the national survey, only 8.3% [95% CI: 8.19, 8.41] of neonates received postnatal checkups. About two-thirds of women, 62.8% had antenatal care visits, 67.9%, gave birth at home, and 95.7% were unaware of neonatal danger signs. Distance from health care institutions [AOR = 1.42; 95% CI: 1.06, 1.89], giving birth in a healthcare facility [AOR = 1.55; 95% CI: 1.12, 2.15], antenatal care visit [AOR = 3.0; 95% CI: 1.99, 4.53], and neonatal danger signs awareness [AOR = 3.06; 95% CI: 2.09, 4.5] were all associated with postnatal care visits.

Conclusion

The number of neonates who had a postnatal checkup was low. Increasing antenatal care visit utilization, improving institutional delivery, raising awareness about neonatal danger signs, increasing access to health care facilities, and implementing home-based neonatal care visits by healthcare providers could all help to improve postnatal checkups.

[Evidence synthesis: evidence-based clinical practice guidelines for monitoring at-risk newbornsSíntese de evidência: diretrizes de prática clínica baseada em evidência para o acompanhamento de recém-nascidos em risco]

Introducción.

La Organización Mundial de la Salud recomienda focalizar la atención en el período neonatal, eliminar la mortalidad de causa prevenible y brindar cuidados de calidad. Es esencial conocer cuáles son las condiciones con alta probabilidad de ocurrencia en esa población para monitorearlos de forma sistemática, de modo que se logre su detección temprana; y el abordaje terapéutico y rehabilitación oportunos.

Objetivos.

Sintetizar las recomendaciones incluidas en las Directrices de práctica clínica basadas en la evidencia para el seguimiento de recién nacidos en riesgo, publicada por la Centro Latinoamericano de Peri­natología/Salud de la Mujer y Reproductiva de la Organización Panamericana de la Salud en el 2020, con el fin de presentar las estrategias para el seguimiento de los niños recién nacidos con condiciones de riesgo desde su nacimiento hasta los 2 años.

Métodos.

Se llevó a cabo una síntesis de la guía y sus recomendaciones. Además, se realizó una búsqueda sistemática en Pubmed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en la Región de las Américas, con el fin de identificar barreras, facilitadores y estrategias de implementación.

Resultados.

Se formularon 21 recomendaciones y 14 puntos de buena práctica que aplican a los recién nacidos con condiciones de riesgo hasta los dos años (prematuros y aquellos con alteraciones adquiridas o congénitas). Se identificaron barreras como la disponibilidad de pruebas de tamización, deficiencias en el sistema de referencia y conocimiento de las recomendaciones para su implementación.

Conclusiones.

La guía brinda recomendaciones sobre los criterios de egreso, incluidas pruebas de tamizaje; información y apoyo para padres y cuidadores; tamizaje y frecuencia de seguimiento de los niños en riesgo hasta los dos años en la Región de las Américas.

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

INTRODUCTION

Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan.

METHODS

We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care.

RESULTS

We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women's empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44-2.43) and 2.78 (95% CI 2.04-3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60-2.44) and 1.56 (95% CI 2.17-1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making.

CONCLUSION

The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women's empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

Is quality maternal healthcare all about successful childbirth? Views of mothers in the Wa Municipality, Ghana

Introduction

In spite of the countless initiatives of the Ghana government to improve the quality of maternal healthcare, Upper West Region still records poor childbirth outcomes. This study, therefore, explored women’s perception of the quality of maternal healthcare they receive in the Wa Municipality of the Upper West Region of Ghana.

Materials and methods

This is a qualitative cross-sectional study of 62 women who accessed maternal healthcare in the Wa Municipality of Ghana. We analysed the transcripts using the analytic inductive technique. An inter-coding technique (testing for inter-coding agreement) was employed. The iterative coding process resulted in a coding scheme with four main themes. We used peer-debriefing technique in ensuring credibility and trustworthiness.

Results

Logistics and equipment; referral service; empathic service delivery; inadequacy of care providers; affordability of service; satisfaction with services received; as well as experience and service delivery were the parameters used by the women in assessing quality maternity care. A number of gaps were reported in the healthcare system including limited healthcare providers, limited beds and inefficient referral system. Conversely, some of them reported that some healthcare providers offered empathetic healthcare. Contrary views were expressed with respect to satisfaction with maternity care.

Conclusion

Government and all stakeholders seeking to enhance quality of maternal health and accelerate the attainment of the third Sustainable Development Goal need to reconsider the financing of service delivery at health institutions. Indeed, our findings have illustrated that routine workshops on empathetic healthcare are required in efforts to increase the rate of facility-based childbirth, and thereby subside maternal mortality and all adverse pregnancy outcomes.

Understanding the financial burden of incomplete abortion: An analysis of the out-of-pocket expenditure on postabortion care in eight public-sector health care facilities in Dakar, Senegal

Timely access to treatment is essential for women when they experience abortion complications. Out-of-pocket (OOP) expenditure is a known barrier to health care access. In 2018, we assessed the financial burden of accessing postabortion care (PAC) borne by women in Dakar, Senegal, where studies estimate that half of poor women with complications obtain PAC. We interviewed 729 women following discharge from PAC. Women reported expenditures on transportation, admission, treatment, family planning, hospitalisation, complementary tests, prescriptions, other medicines and materials. We compare women's OOP on PAC by expenditure category, type of treatment and facility type, and use multiple generalised linear regression analysis to explain variation in overall OOP and forecast it under alternate scenarios. The average OOP was USD $93.84. At health centres it was $65.47 and at hospitals it was $120.47. The average cost of PAC using dilation and curettage was $112.37, manual vacuum aspiration was $99.84, and misoprostol $61.80. Overall OOP on PAC amounts, on average, to 15% of the average monthly salary for women living in Dakar. Strategies that emphasise timely access to misoprostol for treating complications in primary care settings will address the contribution of OOP costs to Senegal's appreciable unmet need for PAC among the poor.

Causes of preterm and low birth weight neonatal mortality in a rural community in Kenya: evidence from verbal and social autopsy

Background

Under-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.

Methods

Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10).

Results

Between January 2017 to December 2018, 3175 babies were born preterm or LBW, and

164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths.

Conclusion

Deaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04012-z.

Antimicrobial Resistance and Predictors of Adverse Outcomes in Neonates with Bacterial Meningitis: a Retrospective Study from a Tertiary Care Hospital of Northern India

This study aimed to determine antimicrobial resistance pattern and predictors of adverse outcome in neonatal meningitis. A retrospective study by analyzing case files of 134 cases of neonatal meningitis. We noted an alarming degree of multidrug resistance (MDR) among both gram-negative (Klebsiella spp., 50%; Escherichia coli, 100%; and and Acinetobacter spp., 50%), as well as positive (Enterococcus, 100%) isolates in cerebrospinal fluid (CSF) culture. The incidence rate of adverse outcome (i.e., mortality and abnormal neurological examination at discharge) was 8.2 and 17.2%, respectively. On univariate analysis, delayed seeking of medical care, bulging anterior fontanelle, vomiting, positive sepsis screen, shock during hospital course, ventriculitis, diversion procedures for raised intracranial pressure, central line placement, low CSF sugar, and failed hearing screening test at discharge were associated with increased risk of adverse outcome. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MDR infections were independently found to be associated with adverse outcomes. An alarming degree of antimicrobial resistance among the CSF isolates necessitates the need to understand the pathogenesis of resistance and curtail the irrational prescription of antibiotics in neonatal meningitis. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MRD infection may have prognostic value in neonatal meningitis

Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight

BACKGROUND

Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes.

AIM

To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya.

METHODS

This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data.

RESULTS

At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers.

CONCLUSION

Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..

Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

BACKGROUND

The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.

METHODS

We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.

RESULTS

Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.

CONCLUSIONS

Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

Perspectives on implementing a quality improvement collaborative to improve person-centered care for maternal and reproductive health in Kenya

OBJECTIVE

To understand perspectives and experiences related to participation in a quality improvement collaborative (QIC) to improve person-centered care (PCC) for maternal health and family planning (FP) in Kenya.

DESIGN AND SETTING

Semi-structured qualitative interviews were conducted with members of the QIC in four public health facilities in Kenya.

PARTICIPANTS

Clinical and nonclinical public health facility staff who had participated in the QIC were purposively sampled to participate in the semi-structured interviews.

INTERVENTION

A QIC was implemented across four public health facilities in Nairobi and Kiambu Counties in Kenya to improve PCC experiences for women seeking maternity or FP services.

MAIN OUTCOME MEASURE

Semi-structured interviews with participants of the QIC to understand perspectives and experiences associated with sensitization to and implementation of PCC behaviors in maternity and FP services.

RESULTS

Respondents reported that sensitization to PCC principles resulted in multiple perceived benefits for staff and patients alike, including improved interactions with patients and clients, deeper awareness of patient and client preferences, and improved interpersonal skills and greater job satisfaction. Respondents also highlighted system-level challenges that impeded their ability to consistently provide high-quality PCC to women, namely staff shortages and frequent turnover, high patient volumes and lack of space in their respective health facilities.

CONCLUSION

Respondents were easily able to articulate perceived benefits derived from participation in this QIC, although they were equally able to identify challenges that hindered their ability to consistently provide high-quality PCC to women seeking maternity or FP services.

Management of fast breathing pneumonia in young infants aged 7 to 59 days by community level health workers: protocol for a multi-centre cluster randomized controlled trial

Background:

WHO does not recommend community-level health workers (CLHWs) using integrated community case management (iCCM) to treat 7–59 days old infants with fast breathing with oral amoxicillin, whereas World Health Organization (WHO) integrated management of childhood illness (IMCI) recommends it. We want to collect evidence to help harmonization of both protocols.

Methods:

A cluster, randomized, open-label trial will be conducted in Africa and Asia (Ethiopia, Malawi, Bangladesh and India) using a common protocol with the same study design, inclusion criteria, intervention, comparison, and outcomes to contribute to the overall sample size. This trial will also identify hypoxaemia in young infants with fast breathing. CLHWs will assess infants for fast breathing, which will be confirmed by a study supervisor. Enrolled infants in the intervention clusters will be treated with oral amoxicillin, whereas in the control clusters they will be managed as per existing iCCM protocol. An independent outcome assessor will assess all enrolled infants on days 6 and 14 of enrolment for the study outcomes in both intervention and control clusters. Primary outcome will be clinical treatment failure by day 6. This trial will obtain approval from the WHO and site institutional ethics committees.

Conclusions:

If the research shows that CLHWs can effectively and safely treat fast breathing pneumonia in 7–59 days old young infants, it will increase access to pneumonia treatment substantially for infants living in communities with poor access to health facilities. Additionally, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with IMCI protocol.

Trial Registration:

The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303.

Care-seeking behavior for neonatal jaundice in rural northern Nigeria

Objective

This study determined the predictors of maternal knowledge and health-seeking behavior for neonatal jaundice in rural Kumbotso, northern Nigeria.

Study design

Cross-sectional survey.

Method

A total of 361 mothers were interviewed using structured questionnaires. Knowledge scores and care-seeking practices were determined. Adjusted odds ratios were generated from logistic regression models.

Results

The proportion of respondents with good, fair and poor knowledge of neonatal jaundice were (46.0%, n ​= ​166), (24.1%, n ​= ​87) and (30.0%, n ​= ​108), respectively. Of the 117 mothers with a jaundiced child, (67.5%, n ​= ​79) and (20.5%, n ​= ​24) received treatment from health facilities and traditional healers, respectively, whereas (12.0%, n ​= ​14) resorted to home remedies. Maternal education Adjusted Odds Ratio (AOR) ​= ​2.39; 95% Confidence Interval (CI): 1.16–4.91) (secondary school versus no formal), source of information on neonatal jaundice (AOR ​= ​11.3; 95%CI: 5.84–21.93) (health worker versus ‘others’), recent delivery in a health facility (AOR ​= ​1.83; 95%CI: 1.06–3.14) and having a previously jaundiced child (AOR ​= ​5.06; 95%CI: 2.76–9.27) predicted knowledge. Preference for health facility treatment was predicted by a previously jaundiced child (AOR ​= ​10.04; 95%CI: 5.73–17.60), antenatal care (AOR ​= ​2.97; 95%CI: 1.43–6.15) (≥4 versus 0 visits), source of information on neonatal jaundice (AOR ​= ​2.33; 95%CI: 1.30–4.17) (health worker versus ‘others’), and maternal ethnicity (AOR ​= ​0.36; 95%CI: 0.14–0.96) (Hausa-Fulani versus ‘others’).

Conclusion

Maternal knowledge of neonatal jaundice was sub-optimal. Being educated, health facility delivery, having had a jaundiced child, and receiving information from health workers predicted good knowledge. Having a previously jaundiced child, antenatal care, obtaining information from health workers and maternal ethnicity predicted preference for health facility treatment. Policies and programs should be strengthened to focus on prevention, early detection and prompt management of neonatal jaundice.

Determinants of care-seeking practice for neonatal illnesses in rural Bangladesh: A community-based cross-sectional study

Background

Proper utilization of skilled care services in neonatal illnesses is crucial to reduce neonatal morbidity and mortality. The study aimed to evaluate the level and factors associated with seeking care from skilled healthcare service providers for reported neonatal illnesses in rural Matlab, Bangladesh.

Methods

This community based cross-sectional study was based on data from a randomly selected sample comprised of 2223 women who delivered live-born babies in 2014. Data were collected from June to October 2015 through a structured questionnaire. We used a multivariable logistic regression model and presented the results by adjusted odds ratios (AOR) with 95% confidence intervals (CI).

Results

Of the neonates, 1361 (61.2%) suffered from at least one complication, and among these, 479 (35.2%) sought care from skilled healthcare service providers. In the multivariable logistic regression analysis, the participants’ husbands’ educational level, number of antenatal care visits, and place of childbirth were significantly associated with seeking skilled care for reported neonatal illnesses. The care-seeking from skilled healthcare service providers for neonatal illness was more than two times higher (AOR = 2.26, 95% CI = 1.51–3.39) in the group in which the participants’ husband had attended school for more than 10 years as compared to the group in which they had attended school for less than six years. The AORs of seeking skilled care were 1.93 (95% CI = 1.42–2.62) and 2.26 (95% CI = 1.51–3.39) with the mothers receiving two to three and four or more antenatal care services, respectively, compared to the mothers with no or one antenatal care visit. Women who gave birth at a health facility were three times (AOR = 3.24, 95% CI = 2.50–4.19) more likely to seek skilled care for sick neonates compared to those who gave birth at home.

Conclusion

The utilization of skilled care for neonatal sicknesses was low in this rural setting in Bangladesh. The participants' husbands’ higher school attendance, increased number of ANC visits, and facility delivery were positively associated with care-seeking from skilled healthcare providers for neonatal illness. The husbands with low school attendance should be targeted for intervention, and continue efforts to increase ANC coverage and facility delivery to improve neonatal health in this country’s rural area.

Health care seeking behaviour among rural women in Telangana: A cross sectional study

Background:

The health of women is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. Women need to breach many social barriers to empower and to get access for quality health care services. Health seeking behavior is one of the important determinants of women health.

Objectives:

To assess healthcare seeking behavior among rural women in Telangana.

Methods:

Cross-sectional study with sample size of 200 was conducted in three villages attached to a medical college. Women of aged 20 years and above were included in the study. Data was collected by predesigned pretested semi-structured questionnaire. Data was presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23.

Results:

Only 34.5% [95% CI: 27.9, 41.5] of the subjects seek medical care as soon as symptoms appear and 69% [95% CI: 62.1, 75.3] of the participants were aware of nearby functioning health centres. Majority (60.5%) of the subjects Visits qualified medical practitioner during illness.

Conclusions:

The present study found that there is still a need to create awareness about the importance of healthcare and available health centers as significant proportion of women population approached unqualified medical practitioners and seeking home remedies as first consultancy source for their health remedies.

RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe

Background

Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe.

Methods

We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12.

Results

Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge.

Conclusion

Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be a challenge because of maternal health care barriers such as poor road network, poor phone network, and the high cost of transport. There is a need to investigate the social determinants of access to maternity services to inform RoadMApp implementation.

Pain in low-income older women with disabilities: a qualitative descriptive study

The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management.