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McKellar L, Fleet JA, Adelson P. 'There is no other option': Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia. Aust J Rural Health 2024; 32:67-79. [PMID: 37983900 DOI: 10.1111/ajr.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. OBJECTIVE The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. DESIGN The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. FINDINGS The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option - it has to work'. DISCUSSION All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. CONCLUSION This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option-it has to work'.
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Affiliation(s)
- Lois McKellar
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Julie-Anne Fleet
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Pamela Adelson
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Benzie CA, Newton MS, McLachlan HL, Forster DA. Identifying women with a disability in Australian maternity services: Time for a change. Aust N Z J Obstet Gynaecol 2023. [PMID: 37964405 DOI: 10.1111/ajo.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
It is estimated that over 1 billion people worldwide have a disability. In Australia, 9% of women of childbearing age have a disability, but data on disability status for women accessing maternity services are not routinely collected and data collection processes are inconsistent. Maternal disability may affect perinatal outcomes, but to understand what factors might be amenable to interventions to improve outcomes, accurate data collection on disability status is essential. This opinion piece reflects on disability identification within maternity services in Australia, identifying areas for policy and practice change.
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Affiliation(s)
- Charlie A Benzie
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Michelle S Newton
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helen L McLachlan
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Melbourne, Victoria, Australia
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Obionu IM, Onyedinma CA, Mielewczyk F, Boyle E. UK maternity care experiences of ethnic minority and migrant women: Systematic review. Public Health Nurs 2023; 40:846-856. [PMID: 37548036 DOI: 10.1111/phn.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. METHODS A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. RESULTS Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. CONCLUSION This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.
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Affiliation(s)
- Ifeoma Maureen Obionu
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Chioma Amarachi Onyedinma
- Department of Community Medicine University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Frances Mielewczyk
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Kelly K, Leitao S, Meaney S, O'Donoghue K. Pregnant people's views and knowledge on prenatal screening for fetal trisomy in the absence of a national screening program. J Genet Couns 2023. [PMID: 37723939 DOI: 10.1002/jgc4.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/20/2023] [Accepted: 08/06/2023] [Indexed: 09/20/2023]
Abstract
Multiple non-invasive prenatal tests (NIPT) are available to screen for risk of fetal trisomy, however, there is no national prenatal screening program in Republic of Ireland. This study aimed to analyze pregnant people's opinions on availability, cost, and knowledge of NIPT for fetal aneuploidy. An anonymous questionnaire on prenatal screening tests and termination of pregnancy was distributed to patients attending antenatal clinics at a tertiary hospital. Descriptive analyses and chi-squared tests were completed. Among respondents, 62% (200/321) understood the scope of prenatal screening tests, with 77% (251/326) and 76% (245/323) correctly interpreting low- and high-risk test results, respectively. Only 26% (83/319) of participants had heard of NIPT. Chi-square tests showed a higher proportion of these people were ≥40 years old (p-value, <0.001), had post-graduate education (p-value, <0.001), or attended private clinics (p-value <0.001). Over 91% (303/331) of participants said every pregnant person should be offered prenatal screening tests for aneuploidy and 88% (263/299) believed these should be free. While pregnant Irish individuals have reasonable understanding of screening test interpretation, most were unaware of screening options. Additionally, participants' views on availability and associated cost of tests show the need for a national prenatal screening program, including education on fetal aneuploidy. These findings have relevance for countries without screening policies and are pertinent for broader maternity services.
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Affiliation(s)
- Kristin Kelly
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Andreeva D, Gill C, Brockbank A, Hejmej J, Conti‐Ramsden F, Doores KJ, Seed PT, Poston L. Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and vaccine antibody prevalence in a multi-ethnic inner-city antenatal population: A cross-sectional surveillance study. BJOG 2023; 130:1135-1144. [PMID: 37113111 PMCID: PMC10718194 DOI: 10.1111/1471-0528.17508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in pregnancy in an inner-city setting and assess associations with demographic factors and vaccination timing. DESIGN Repeated cross-sectional surveillance study. SETTING London maternity centre. SAMPLE A total of 906 pregnant women attending nuchal scans, July 2020-January 2022. METHODS Blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid (N) and spike (S) proteins. Self-reported vaccination status and coronavirus disease 2019 (COVID-19) infection were recorded. Multivariable regression models determined demographic factors associated with seroprevalence and antibody titres. MAIN OUTCOME MEASURES Immunoglobulin G N- and S-protein antibody titres. RESULTS Of the 960 women, 196 (20.4%) were SARS-CoV-2 seropositive from previous infection. Of these, 70 (35.7%) self-reported previous infection. Among unvaccinated women, women of black ethnic backgrounds were most likely to be SARS-CoV-2 seropositive (versus white adjusted risk ratio [aRR] 1.88, 95% CI 1.35-2.61, p < 0.001). Women from black and mixed ethnic backgrounds were least likely to have a history of vaccination with seropositivity to S-protein (versus white aRR 0.58, 95% CI 0.40-0.84, p = 0.004; aRR 0.56, 95% CI 0.34-0.92, p = 0.021, respectively). Double vaccinated, previously infected women had higher IgG S-protein antibody titres than unvaccinated, previously infected women (mean difference 4.76 fold-change, 95% CI 2.65-6.86, p < 0.001). Vaccination timing before versus during pregnancy did not affect IgG S-antibody titres (mean difference -0.28 fold-change, 95% CI -2.61 to 2.04, p = 0.785). CONCLUSIONS This cross-sectional study demonstrates high rates of asymptomatic SARS-CoV-2 infection with women of black ethnic backgrounds having higher infection risk and lower vaccine uptake. SARS-CoV-2 antibody titres were highest among double-vaccinated, infected women.
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Affiliation(s)
- Daria Andreeva
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Carolyn Gill
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Anna Brockbank
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Joanna Hejmej
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Fran Conti‐Ramsden
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Katie J. Doores
- Department of Infectious Diseases, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - Paul T. Seed
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population SciencesKing's College LondonLondonUK
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Moniz S, Karia A, Khalid AF, Vindrola-Padros C. Stories for Change: The impact of Public Narrative on the co-production process. Health Expect 2023; 26:919-930. [PMID: 36707932 PMCID: PMC10010083 DOI: 10.1111/hex.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/07/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Involving service users in health service design and delivery is considered important to improve the quality of healthcare because it ensures that the delivery of healthcare is adapted to the needs of the users. Co-production is a process used to involve service users, but multiple papers have highlighted the need for the mechanisms and values guiding co-production to be more clearly stated. The aim of this paper was to evaluate the mechanisms and values that guided the co-production approach of the Stories for Change project, which used Public Narrative as part of the co-design process to create change in National Health Service maternity services. METHODS This study was conducted using a rapid feedback evaluation approach. Semistructured interviews (n = 16) were the main source of data, six of which were maternity service users, with observations (5 h) and documentary analysis also carried out in parallel. RREAL sheets were used for data analysis to organize data based on key topics of interest. RESULTS This study identified three broad mechanisms and values underpinning the co-production approach: creating an open and safe space to share ideas, learning how to tell stories using Public Narrative and having service providers who play a key role in strengthening the health system listen to stories compelling them to action. This study identified the main areas for improvement of the Stories for Change project related to recruitment, the inclusion of participants, the co-design process, the Skills Session and the Learning Event. CONCLUSION Our study provided a deeper understanding of the co-production approach that addresses the need to uncover the mechanism and values underlying co-production and co-design approaches. This study expands on the literature pertaining to the influence of storytelling in creating meaningful change in health care. We propose a co-design methodology that uses Public Narrative as a model for service user engagement to help inform future healthcare development processes. PATIENT OR PUBLIC CONTRIBUTION The experiences and perceptions of maternity service users and health professionals informed this evaluation. The project organizers were involved in the manuscript preparation stage by providing feedback, and service users wrote a commentary on the project from the lived experience perspective.
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Affiliation(s)
- Sophie Moniz
- Department of Targeted Intervention, Rapid Research Evaluation and Appraisal Lab (RREAL), UCL, London, UK
| | - Amelia Karia
- Department of Targeted Intervention, Rapid Research Evaluation and Appraisal Lab (RREAL), UCL, London, UK
| | - Ahmad Firas Khalid
- Centre for Implementation Research, Canadian Institutes of Health Research Health System Impact Fellowship, Centre for Implementation Research, Hospital Research Institute, Ottawa, Ontario, Canada.,Health in Emerrgencies, The Canadian Red Cross, Ottawa, Ontario, Canada
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention, Rapid Research Evaluation and Appraisal Lab (RREAL), UCL, London, UK
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Panko TL, Cuculick J, Albert S, Smith LD, Cooley MM, Herschel M, Mitra M, McKee M. Experiences of pregnancy and perinatal healthcare access of women who are deaf: a qualitative study. BJOG 2023; 130:514-521. [PMID: 36156842 PMCID: PMC9992236 DOI: 10.1111/1471-0528.17300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women who are deaf experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared with their peers who can hear. This study explores the pregnancy experiences of women who are deaf to better understand their barriers to and facilitators of optimal pregnancy-related health care. DESIGN Qualitative study using thematic analysis. SETTING Semi-structured, individual, remote or in-person interviews conducted in the USA. SAMPLE Forty-five women who are deaf and communicate using American Sign Language (ASL) and gave birth in the USA within the past 5 years participated in the interviews. METHODS Semi-structured interviews explored how mothers who are deaf experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. MAIN OUTCOME MEASURES Barriers and facilitators related to a positive experience of perinatal care access among women who are deaf. RESULTS Three major themes emerged: (1) communication accessibility; (2) communication satisfaction; and (3) healthcare provider and team support. Common barriers included choosing healthcare providers, inconsistent communication access and difficulty accessing health information. However, when women who are deaf were able to use ASL interpreters, they had more positive pregnancy and birth experiences. Self-advocacy served as a common facilitator for more positive pregnancy and healthcare experiences. CONCLUSIONS Healthcare providers need to be more aware of the communication and support needs of their patients who are deaf, especially how to communicate effectively. Increased cultural awareness and consistent provision of on-site interpreters can improve pregnancy and birth experiences for women who are deaf.
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Affiliation(s)
- Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, New York, USA
| | - Jess Cuculick
- NTID Department of Liberal Studies, Rochester Institute of Technology, Rochester, New York, USA
| | - Sasha Albert
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Margarita M Cooley
- Independent Consultant to Brandeis University, Waltham, Massachusetts, USA
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Peeters H, Oldenhof LE, van der Scheer W, Putters K. Bedtime negotiations: Unravelling normative complexity in hospital-based prevention. Sociol Health Illn 2023. [PMID: 36967487 DOI: 10.1111/1467-9566.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
This study explores how actors deal with normative complexity in the design and implementation of practices of preventative care. Previous studies have identified conflicting (e)valuations of prevention within health care at large, but little empirical research describes how these conflicts are resolved in day-to-day interactions. Zooming in on the work of a single actor, our ethnographic study describes a Dutch psychiatrist developing a novel type of hospital bed that provides preventative psychiatric care for women in the post-partum period. Drawing on pragmatic sociology of justification, we construe 'beds'-and the time, people and resources they represent-as points of convergence between conflicting valuations of care. The results show that embedded modes of valuation in a curative hospital setting generate significant normative complexity during implementation. We identify three main strategies through which normative complexity is managed: (a) translating between different modes of valuing prevention, (b) compromising in (material) design of care beds and (c) transcending embedded valuations through moral appeals. By showing the normative complexity of prevention in practice, our study highlights the need for a diverse and situated accounting for preventative care.
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Affiliation(s)
- Hugo Peeters
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lieke E Oldenhof
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wilma van der Scheer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kim Putters
- Tilburg University, Tilburg, The Netherlands
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Mallick LM, Thoma ME, Shenassa ED. The role of doulas in respectful care for communities of color and Medicaid recipients. Birth 2022; 49:823-832. [PMID: 35652195 PMCID: PMC9796025 DOI: 10.1111/birt.12655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. METHODS We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed. RESULTS Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance. CONCLUSIONS Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.
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Affiliation(s)
- Lindsay M. Mallick
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA,Avenir HealthGlastonburyConnecticutUSA
| | - Marie E. Thoma
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA
| | - Edmond D. Shenassa
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA,Department of Epidemiology and BiostatisticsSchool of Public Health, University of MarylandCollege ParkMarylandUSA,School of MedicineUniversity of MarylandBaltimoreMarylandUSA,Department of EpidemiologySchool of Public Health, Brown UniversityProvidenceRhode IslandUSA
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de Labrusse C, Abderhalden‐Zellweger A, Mariani I, Pfund A, Gemperle M, Grylka‐Baeschlin S, Mueller AN, Valente E, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards. Int J Gynaecol Obstet 2022; 159 Suppl 1:70-84. [PMID: 36530005 PMCID: PMC9877813 DOI: 10.1002/ijgo.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.
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Affiliation(s)
- Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Alessia Abderhalden‐Zellweger
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Anouck Pfund
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Michael Gemperle
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | | | - Antonia N. Mueller
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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O'Byrne LJ, Bodunde EO, Maher GM, Khashan AS, Greene RM, Browne JP, McCarthy FP. Patient-reported outcome measures evaluating postpartum maternal health and well-being: a systematic review and evaluation of measurement properties. Am J Obstet Gynecol MFM 2022; 4:100743. [PMID: 36087713 DOI: 10.1016/j.ajogmf.2022.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to systematically review and evaluate postpartum health and well-being using patient-reported outcome measures across all domains of postpartum health using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. DATA SOURCES Based on a preprepared published protocol, a systematic search of PubMed, Embase, and CINAHL was undertaken to identify patient-reported outcome tools. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42021283472), and this work followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines for systematic reviews. STUDY ELIGIBILITY CRITERIA Studies eligible for inclusion included those that assessed a patient-reported outcome measure examining postpartum women's health and well-being with no limitation on the domain. The included studies aimed to evaluate one or more measurement properties of the patient-reported outcome measure. METHODS Data extraction and the methodological assessment of the quality of the patient-reported outcome measure were assessed by 2 reviewers independently based on content validity, structural validity, internal consistency, cross-cultural validity or measurement invariance, reliability, measurement error, hypotheses testing for construct validity, and responsiveness, as defined by the COnsensus-based Standards for the selection of health Measurement INstruments. The standard used for content validity were the domains of importance to women in postpartum health and well-being proposed by the International Consortium for Health Outcomes Measurement. The outcome domains for patient-reported health status include mental health, health-related quality of life, incontinence, pain with intercourse, breastfeeding, and motherhood role transition. The quality of the methods was rated an overall rating of results, awarded a level of evidence, and assessed using the Grading of Recommendations, Assessment, Development, and Evaluations assessment tool, and a level of recommendation was awarded for each tool. RESULTS There were 10,324 studies identified in the initial search, of which 29 tools were identified from 41 eligible studies included in the review. Moreover, 21 tools were awarded an "A" grading of recommendation for use as a patient-reported outcome measure in postpartum women following the COnsensus-based Standards for the selection of health Measurement Instruments standards. Of the "A"-rated tools, 17 (80%) examined the domain of mental health, 5 examined health-related quality of life, 4 examined breastfeeding, and 6 represented role transition. No "A"-recommended tool examined postpartum incontinence or pain with intercourse. Of note, 3 tools did not cover domains as recommended by the International Consortium for Health Outcomes Measurement, and 5 tools were awarded a "B" rating, requiring more research before their recommendation for use. Here, most tools were awarded very low-moderate Recommendations, Assessment, Development, and Evaluations level of evidence. Moreover, the highest quality tool identified that covered multiple domains of postpartum health and well-being was the women's Postpartum Quality-of-Life Questionnaire. CONCLUSION This systematic review identified the best performing patient-reported outcome measures to assess postpartum health and well-being. No individual tool covers all 6 domains of postpartum health and well-being. Here, the highest quality tool found that covered multiple domains of postpartum health and well-being was the Postpartum Quality-of-Life Questionnaire. The Postpartum Quality-of-Life Questionnaire captures 4 of 6 domains of importance to women, with domains of incontinence and sexual health unevaluated. The domain of urinary incontinence was represented by the International Consultation on Incontinence Questionnaire Short Form, which requires further psychometric analysis before its recommended use. Postpartum sexual health, not represented by any tool, necessitates the development of a patient-reported outcome measure. A postpartum patient-reported outcome measure would be best provided by a combination of tools; however, further research is required before its implementation.
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Affiliation(s)
- Laura J O'Byrne
- National Perinatal Epidemiological Centre (NPEC), University College Cork, Ireland (Drs O'Byrne, Maher and Greene); Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Ireland (Drs O'Byrne, Greene and McCarthy); INFANT Research Centre, University College Cork, Ireland (Drs O'Byrne, Maher and McCarthy).
| | - Elizabeth O Bodunde
- Department of Public Health, University College Cork, Cork, Ireland (Ms Bodunde Drs Khashan and Browne)
| | - Gillian M Maher
- National Perinatal Epidemiological Centre (NPEC), University College Cork, Ireland (Drs O'Byrne, Maher and Greene); INFANT Research Centre, University College Cork, Ireland (Drs O'Byrne, Maher and McCarthy)
| | - Ali S Khashan
- Department of Public Health, University College Cork, Cork, Ireland (Ms Bodunde Drs Khashan and Browne)
| | - Richard M Greene
- National Perinatal Epidemiological Centre (NPEC), University College Cork, Ireland (Drs O'Byrne, Maher and Greene); Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Ireland (Drs O'Byrne, Greene and McCarthy)
| | - John P Browne
- Department of Public Health, University College Cork, Cork, Ireland (Ms Bodunde Drs Khashan and Browne)
| | - Fergus P McCarthy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Ireland (Drs O'Byrne, Greene and McCarthy); INFANT Research Centre, University College Cork, Ireland (Drs O'Byrne, Maher and McCarthy)
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Hargreaves S, Young S, Prior SJ, Ayton J. Exploring Women's Experiences of Maternity Service Delivery in Regional Tasmania: A Descriptive Qualitative Study. Healthcare (Basel) 2022; 10. [PMID: 36292330 DOI: 10.3390/healthcare10101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to explore and understand the experiences of women who receive antenatal, birthing, and postnatal care from an integrated maternity services model in a regional area in Tasmania, Australia. This descriptive qualitative study included semi-structured, one-on-one interviews with 14 mothers aged >18 years, who were living in a regional area of Tasmania and had accessed maternity health services. Thematic analysis revealed three key themes: (i) talking about me, (ii) is this normal? and (iii) care practices. Overall, women cited mostly negative experiences from a poorly implemented fragmented service. These experiences included feelings of isolation, frustration over receiving conflicting advice, feeling ignored, and minimal to no continuity of care. In contrast, women also experienced the euphoric feelings of birth, immense support, guidance, and encouragement. Regional women’s experiences of maternity care may be improved if health services work towards place-based continuity of care models. These models should be informed by the local women’s experiences and needs in order to achieve better communication, reduce feelings of isolation, and promote positive breastfeeding experiences.
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Aiello E, Perera K, Ade M, Sordé-Martí T. A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service. Front Public Health 2022; 10:926599. [PMID: 36187684 PMCID: PMC9521407 DOI: 10.3389/fpubh.2022.926599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background In 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme. Methods Qualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis. Results The study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others ("shared purpose"), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as "healthcare leaders," both individually and collectively. Conclusions The Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.
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Affiliation(s)
- Emilia Aiello
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain,*Correspondence: Emilia Aiello
| | - Kathryn Perera
- National Health Service (NHS) Horizons, London, United Kingdom
| | - Mo Ade
- Maternity Voices Partnership (MVP) Chair and Patient Public Voice, National Health Service, Ashford, United Kingdom
| | - Teresa Sordé-Martí
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain
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Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
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Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
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Shen X, Lin S, Li H, Amaerjiang N, Shu W, Li M, Xiao H, Segura-Pérez S, Pérez-Escamilla R, Fan X, Hu Y. Timing of Breastfeeding Initiation Mediates the Association between Delivery Mode, Source of Breastfeeding Education, and Postpartum Depression Symptoms. Nutrients 2022; 14:nu14142959. [PMID: 35889915 PMCID: PMC9324203 DOI: 10.3390/nu14142959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03−2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30−3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47−0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34−0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29−0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85−25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80−30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.
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Affiliation(s)
- Xinran Shen
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Shunna Lin
- Department of Pediatrics, Tianhe District Maternal and Child Hospital of Guangzhou, Guangzhou 510620, China;
| | - Hui Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Nubiya Amaerjiang
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Wen Shu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Menglong Li
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Huidi Xiao
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
| | - Sofia Segura-Pérez
- Chief Program Officer, Hispanic Health Council, 175 Main St., Hartford, CT 06106, USA;
| | | | - Xin Fan
- Department of Pediatrics, Women and Children’s Hospital of Chongqing Medical University, No. 120, Longshan Road, Yubei District, Chongqin 400042, China
- Correspondence: (X.F.); (Y.H.)
| | - Yifei Hu
- Department of Child and Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No. 10 You’anmenwai Xitoutiao, Fengtai District, Beijing 100069, China; (X.S.); (H.L.); (N.A.); (W.S.); (M.L.); (H.X.)
- Correspondence: (X.F.); (Y.H.)
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Oosthuizen SJ, Bergh AM, Silver A, Malatji RE, Mfolo V, Botha T. The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme. S Afr Fam Pract (2004) 2022; 64:e1-e12. [PMID: 35384679 PMCID: PMC8990513 DOI: 10.4102/safp.v64i1.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. METHODS This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. RESULTS Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers' response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. CONCLUSION Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.
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Affiliation(s)
- Sarie J Oosthuizen
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, SAMRC Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Pilav S, Easter A, Silverio SA, De Backer K, Sundaresh S, Roberts S, Howard LM. Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study. Int J Environ Res Public Health 2022; 19:1975. [PMID: 35206163 DOI: 10.3390/ijerph19041975] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023]
Abstract
(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.
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Madaj B, Gopalakrishnan S, Quach A, Filiaci S, Traore A, Bakusa D, Mdegela M, Yousofzai AW, Rahmanzai AJ, Kodindo G, Gami JP, Rostand ND, Kessely H, Addo SA, Abbey M, Sapali M, Omar A, Ernest A, Mtandu R, Agossou A, Ketoh GK, Furtado N, Mangiaterra V, van den Broek N. Where is the 'C' in antenatal care and postnatal care: A multi-country survey of availability of antenatal and postnatal care in low- and middle-income settings. BJOG 2022; 129:1546-1557. [PMID: 35106907 PMCID: PMC9541911 DOI: 10.1111/1471-0528.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Objective Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy‐related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care. Design Cross‐sectional survey. Setting Afghanistan, Chad, Ghana, Tanzania, Togo. Sample Three hundred and twenty‐one healthcare facilities. Methods Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component. Main outcome measure Availability of ANC PNC components. Results Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3–17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub‐Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7–86.5% of facilities. Prevention and management of TB; assessment of pre‐ or post‐term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities. Conclusions Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced. Tweetable abstract ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings. ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings. Linked article: This article is commented on by Carolyn Paul, pp. 1558–1559 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17113.
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Affiliation(s)
- Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Alexandre Quach
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Simone Filiaci
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adama Traore
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | - Hamit Kessely
- Centre de Support en Santé Internationale - Centre de Recherche en Anthropologie et Sciences Humaines (CSSI-CRASH), N'Jamena, Chad
| | | | - Mercy Abbey
- Research and Development Division, Ghana Health Services, Accra, Ghana
| | - Mary Sapali
- Ministry of Health Tanzania Mainland, Dar- es- Salaam, Tanzania
| | - Ali Omar
- Ministry of Health, Zanzibar, Tanzania
| | | | - Rugola Mtandu
- Centre for Maternal and Newborn Health, Dar-es-Salaam, Tanzania
| | | | | | - Nicholas Furtado
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), Geneva, Switzerland
| | - Viviana Mangiaterra
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), Geneva, Switzerland
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Lefèvre M, Bouckaert N, Camberlin C, Van de Voorde C. Economies of scale and optimal size of maternity services in Belgium: A Data Envelopment Analysis. Int J Health Plann Manage 2022; 37:1421-1438. [PMID: 34981849 DOI: 10.1002/hpm.3408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/07/2022] Open
Abstract
This article uses a Data Envelopment Analysis to measure scale efficiency of maternity services in Belgium and estimate the minimum efficient scale in this context. Using administrative data for all maternity services in Belgium in 2016, the minimum efficient scale is estimated at 557 deliveries per year, which is above the currently prevailing norm of 400 deliveries per year. In particular, the closure of 17 small maternity services could improve efficiency without reducing accessibility. In addition to that, further efficiency gains could be attained by increasing the scale of maternity services up to at least 900 deliveries per year. Although most services are close to scale efficiency, the mean scale inefficiency level is 13% and low scores are mainly concentrated among the smallest services. These results are robust to changes in model specifications, bootstrapping and removal of outliers. In the current context of reform of the hospital and maternity landscape in Belgium, this study shows room for improvement and the possibility to generate substantial efficiency gains that could be reinvested in the healthcare system.
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Affiliation(s)
- Mélanie Lefèvre
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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20
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Oluoch-Aridi J, Chelagat T, Nyikuri MM, Onyango J, Guzman D, Makanga C, Miller-Graff L, Dowd R. COVID-19 Effect on Access to Maternal Health Services in Kenya. Front Glob Womens Health 2021; 1:599267. [PMID: 34816169 PMCID: PMC8593959 DOI: 10.3389/fgwh.2020.599267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements. Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed. Results: Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services. Conclusion: The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.
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Affiliation(s)
- Jackline Oluoch-Aridi
- The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States.,Strathmore Business School, Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Tecla Chelagat
- Strathmore Business School, Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Mary M Nyikuri
- Strathmore Business School, Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Joseph Onyango
- Strathmore Business School, Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Danice Guzman
- The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States
| | - Cindy Makanga
- The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States
| | - Laura Miller-Graff
- The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States.,Department of Psychology, The Kroc Institute of Peace Studies, University of Notre Dame, Notre Dame, IN, United States
| | - Robert Dowd
- The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States
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21
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Roxburgh C, Moore S, McCulloch C, Valli K, Zuidersma D, Pikora T, Ngo H. Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia. Aust J Rural Health 2021; 30:135-148. [PMID: 34514661 DOI: 10.1111/ajr.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. SETTING Nine general practitioner obstetrician practices located in regional Western Australia. PARTICIPANTS 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. MAIN OUTCOME MEASURES We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. RESULTS 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. CONCLUSION General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.
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Affiliation(s)
- Carly Roxburgh
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Sarah Moore
- Rural Clinical School of Western Australia, University of Western Australia, Busselton, WA, Australia
| | - Claudia McCulloch
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Kelsey Valli
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Danika Zuidersma
- Rural Clinical School of Western Australia, University of Western Australia, Bunbury, WA, Australia
| | - Terri Pikora
- Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Hanh Ngo
- Rural Clinical School of Western Australia, University of Western Australia, Perth, WA, Australia
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Kane S, Jiang H, Tian Y, Mukhopadhyay M, Qian X. Making effective referrals happen: a theory-informed policy analysis. Health Policy Plan 2021; 35:1309-1317. [PMID: 33141176 DOI: 10.1093/heapol/czaa091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
Effective referral is a critical element of a well-functioning health system. While having a good referral policy in place is important, equally important is its effective implementation. Using the implementation of a policy on referral of obstetric emergencies in Shanghai as a case, we illustrate the application of the 'Inhabited Institutions' analytical approach for studying policy implementation. In doing so, our study highlights how 'referral' is a quintessential systems process embedded in institutional, social and historical contexts. We show that multiple institutional logics, in the form of explicit and tacit organizing principles and assumptions, intersect to influence and shape actors' actions, sometimes with good outcomes and sometimes with poor outcomes. We reveal the embedded agency of frontline healthcare managers and providers across different levels of care. We show how frontline managers and providers, operating under conditions of uncertainties and ambiguities in organizational processes, actively draw upon their experience and network capital to creatively adapt to get referrals done in a timely manner to save lives of critically ill pregnant women. From our findings, two sets of linked implications emerge for strengthening referral systems. Given that referral often involves ill and complicated cases, getting referrals right depends on the exercise of discretion and judgement by those at the frontline to arrive at timely and workable solutions-health systems need to recognize this. We also conclude that to get referrals right, while one needs clearly defined policies and implementation processes that are locally appropriate, well understood by all concerned and easy to follow, this is not enough. In addition, explicit measures that enable the exercise of discretion and judgement at the frontline need to be locally identified and adopted.
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Affiliation(s)
- Sumit Kane
- Nossal Institute For Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Parkville, VIC 3010, Australia.,KIT Royal Tropical Institute, Mauritskade 64, 1092 AD Amsterdam, The Netherlands
| | - Hong Jiang
- School of Public Health, Global Health Institute, Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai 200032, China
| | - Yuan Tian
- Department of Child Health Management, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | - Xu Qian
- School of Public Health, Global Health Institute, Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai 200032, China
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23
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McRae DN, Bergen N, Portela AG, Muhajarine N. A systematic review and meta-analysis of the effectiveness of maternity waiting homes in low- and middle-income countries. Health Policy Plan 2021; 36:1215-1235. [PMID: 34179952 DOI: 10.1093/heapol/czab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
Maternity waiting homes (MWHs) in low- and middle-income countries (LMICs) provide women with accommodation close to a health facility to enable timely access to skilled care at birth. We examined whether MWH use and availability compared with non-use/unavailability were associated with facility birth, birth with a skilled health professional, attendance at postnatal visit(s) and/or improved maternal and newborn health, in LMICs. We included (non-)randomized controlled, interrupted time series, controlled before-after, cohort and case-control studies published since 1990. Thirteen databases were searched with no language restrictions. Included studies (1991-2020) were assessed as either moderate (n = 9) or weak (n = 10) on individual quality using the Effective Public Health Practice Project tool. Quality was most frequently compromised by selection bias, confounding and blinding. Only moderate quality studies were analyzed; no studies examining maternal morbidity/mortality met this criterion. MWH users had less relative risk (RR) of perinatal mortality [RR 0.65, 95% confidence intervals (CIs): 0.48, 0.87] (3 studies) and low birthweight (RR 0.34, 95% CI: 0.20, 0.59) (2 studies) compared with non-users. There were no significant differences between MWH use and non-use for stillbirth (RR 0.75, 95% CI: 0.47, 1.18) (3 studies) or neonatal mortality (RR 0.51, 95% CI: 0.25, 1.02) (2 studies). Single study results demonstrated higher adjusted odds ratios (aOR) for facility birth (aOR 5.8, 95% CI: 2.6, 13.0) and attendance at all recommended postnatal visits within 6 weeks of birth (aOR 1.99, 95% CI: 1.30, 3.07) for MWH users vs. non-users. The presence vs. absence of an MWH was associated with a 19% increase in facility birth (aOR 1.19, 95% CI: 1.10, 1.29). The presence vs. absence of a hospital-affiliated MWH predicted a 47% lower perinatal mortality rate (P < 0.01), but at a healthcare centre-level a 13 higher perinatal mortality rate (P < 0.01). Currently, there remains a lack of robust evidence supporting MWH effectiveness. We outline a six-point strategy for strengthening the evidence base.
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Affiliation(s)
- Daphne N McRae
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 104 Clinic Place, Saskatoon SK, S7N 2Z4, Canada
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Montpetit Hall, 125 University, Ottawa ON, K1N 6N5, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202 Genève, Switzerland
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 104 Clinic Place, Saskatoon SK, S7N 2Z4, Canada.,Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon SK, S7N 5E5, Canada
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24
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Diniz CSG, Bussadori JCDC, Lemes LB, Moisés ECD, Prado CADC, McCourt C. A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative. Med Teach 2021; 43:19-26. [PMID: 32672483 DOI: 10.1080/0142159x.2020.1791319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients' experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.
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Affiliation(s)
| | | | | | - Elaine Christine Dantas Moisés
- Department of Gynecology & Obstetrics, Ribeirão Preto School of Medicine (FMRP), University of São Paulo, Ribeirão Preto, Brazil
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25
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Murewanhema G, Nyakanda MI, Madziyire MG. Restoring and maintaining robust maternity services in the COVID-19 era: a public health dilemma in Zimbabwe. Pan Afr Med J 2020; 37:32. [PMID: 33456656 DOI: 10.11604/pamj.supp.2020.37.32.26798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/11/2022] Open
Abstract
Lockdown policies, travel restrictions and reduced provision of healthcare in Zimbabwe in response to the COVID-19 pandemic have brought unprecedented challenges for healthcare delivery. Maternity services, including antenatal care, labour and delivery as well as postnatal care have been affected directly and indirectly by the pandemic and resultant control interventions, with delays introduced at several points across the continuum of care. Unfortunately, maternity conditions are time-sensitive, and delays can negatively impact feto-maternal outcomes, with increased maternal, fetal or neonatal morbidity and mortality. An audit at central hospitals revealed reduced utilisation of maternity services and a trend towards an increase in maternal mortality. A formal evaluation is required; however, mitigating public health interventions are required, especially as the burden of COVID-19 in the country has considerably come down. The World Health Organisation offers useful technical guidance for maintaining essential health services in pandemic times in low-resources settings, and rationalising the use of personal protective equipment, which can be contextualised and adopted to restore and maintain essential health services. Restoration of essential maternity services is urgently required in an environment that protects healthcare workers and their clients, minimising their risk of contracting COVID-19 whilst optimising fetomaternal outcomes. Thus, the various stakeholders involved in maternity care must urgently come together and find ways of achieving this goal.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe
| | - Munyaradzi Innocent Nyakanda
- Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe.,Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mugove Gerald Madziyire
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe.,Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
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26
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Abstract
Lockdown policies, travel restrictions and reduced provision of healthcare in Zimbabwe in response to the COVID-19 pandemic have brought unprecedented challenges for healthcare delivery. Maternity services, including antenatal care, labour and delivery as well as postnatal care have been affected directly and indirectly by the pandemic and resultant control interventions, with delays introduced at several points across the continuum of care. Unfortunately, maternity conditions are time-sensitive, and delays can negatively impact feto-maternal outcomes, with increased maternal, fetal or neonatal morbidity and mortality. An audit at central hospitals revealed reduced utilisation of maternity services and a trend towards an increase in maternal mortality. A formal evaluation is required; however, mitigating public health interventions are required, especially as the burden of COVID-19 in the country has considerably come down. The World Health Organisation offers useful technical guidance for maintaining essential health services in pandemic times in low-resources settings, and rationalising the use of personal protective equipment, which can be contextualised and adopted to restore and maintain essential health services. Restoration of essential maternity services is urgently required in an environment that protects healthcare workers and their clients, minimising their risk of contracting COVID-19 whilst optimising fetomaternal outcomes. Thus, the various stakeholders involved in maternity care must urgently come together and find ways of achieving this goal.
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Affiliation(s)
- Grant Murewanhema
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe
| | - Munyaradzi Innocent Nyakanda
- Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe.,Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mugove Gerald Madziyire
- Unit of Obstetrics and Gynaecology, Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Zimbabwe Society of Obstetricians and Gynaecologists, Harare, Zimbabwe.,Sally Mugabe Hospital, Ministry of Health and Child Care, Harare, Zimbabwe
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27
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Power S, Meaney S, O'Donoghue K. Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study. BJOG 2020; 128:676-684. [PMID: 32935467 DOI: 10.1111/1471-0528.16502] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore fetal medicine specialists' experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. DESIGN Qualitative study. SETTING Fetal medicine units in the Republic of Ireland. POPULATION Ten fetal medicine specialists from five of the six fetal medicine units. METHODS nvivo 12 assisted in the thematic analysis of semi-structured in-depth face-to-face interviews. MAIN OUTCOME MEASURES Fetal medicine specialists' experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. RESULTS Four themes were identified: 'not fatal enough', 'interactions with colleagues', 'supporting pregnant women' and 'internal conflict and emotional challenges'. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and 'restrictive' legislation were identified that 'ostracised' severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and 'stretched' resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to 'provide full care for women'. CONCLUSIONS Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. TWEETABLE ABSTRACT The implementation of termination services for fatal fetal anomaly is complex and requires institutional support.
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Affiliation(s)
- S Power
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - S Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - K O'Donoghue
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Abstract
PURPOSE Coronavirus Disease-2019 (COVID-19) is a rapidly evolving pandemic. It is well-known that pregnant women are more susceptible to viral infection due to immune and anatomic factors. Therefore, the viral pandemic might affect the reproductive health and maternity services especially in low-resource countries. MATERIALS AND METHODS In this article, we tried to highlight the impact of COVID-19 on reproductive health and maternity health services in low resource countries with emphasis on adapting some of the published best practice recommendations to suit a struggling environment. CONCLUSION Pregnant women residing in low resource countries represent a uniquely vulnerable group in epidemics due to several factors. Maternity services in low resource countries are adapting to provide antenatal and postnatal care amidst a rapidly shifting health system environment due to the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Y Abdelbadee
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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29
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Ugwu IA, Itua I. Utilization of Maternity Services and Its Relationship with Postpartum Use of Modern Contraceptives Among Women of Reproductive Age Group in Nigeria. Open Access J Contracept 2020; 11:1-13. [PMID: 32021499 PMCID: PMC6955809 DOI: 10.2147/oajc.s215619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Utilization of maternity services (UMS) exposes mothers to family planning (FP) counseling and other FP promotional activities. Uptake of postpartum modern contraceptives (PPMC) reduces both infant and maternal mortalities by reducing unwanted pregnancies and promoting good child spacing. Understanding the relationship between UMS and uptake of PPMC was therefore very important. Purpose To determine the association between UMS and uptake of PPMC among women of the reproductive age group in Nigeria taking into consideration the influence of the place of access to the maternity services. Patients and Methods This study was a descriptive epidemiological study design. Secondary data obtained from the 2013 Nigerian Demographic Health Survey (NDHS) was analyzed to achieve the above aim. The uptake of PPMC was the dependent variable (DV). The independent variables (IDV) selected were the number of antenatal care (ANC) visits, place of access of ANC, place of delivery, timing of postnatal care (PNC) and place of access of PNC. Other control variables include socio-demographic factors. Descriptive statistics, chi-square testing, and logistic regression analyses were conducted to determine the association between the PPMC uptake and the IDV/other control variables. Statistical significance was claimed at p<0.05. Results Utilization of maternity services was associated with higher uptake of PPMC among the women (>/= 4 ANC visits OR = 2.08, 95% CI=1.65–2.62, P<0.001; public facility delivery OR= 1.80, 95% CI= 1.54–2.10, P< 0.001; private facility delivery OR =1.54, 95% CI 1.28–1.85, P< 0.001; PNC OR=1.21, 95% CI= 1.02–1.43, P=0.029). Accessing postnatal care in private health facilities was associated with increased uptake of PPMC (OR= 1.46, 95% CI =1.05–2.02, P= 0.024). The number of children alive, educational attainment, wealth index and having information about FP remained significant predictors of PPMC uptake. Conclusion The utilization of maternity services was positively associated with postpartum use of modern contraceptives among women of reproductive age in Nigeria. There was increased uptake of PPMC among women who utilized maternity service compared to their counterparts who did not. Regarding the place of access, accessing antenatal care as well as delivering in either private or public health facilities was not a significant predictor of PPMC use. However, accessing postnatal care in private facilities was associated with higher uptake of PPMC.
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Affiliation(s)
- Innocent Anayochukwu Ugwu
- Department of Obstetrics & Gynecology, College of Medicine, Enugu State University of Science & Technology (ESUT) and ESUT Teaching Hospital, Enugu, Nigeria
| | - Imose Itua
- Department of Public Health and Healthcare Management, University of Liverpool/Laureate Online Education, Liverpool, UK
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30
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Salmon VE, Hay-Smith EJC, Jarvie R, Dean S, Terry R, Frawley H, Oborn E, Bayliss SE, Bick D, Davenport C, MacArthur C, Pearson M. Implementing pelvic floor muscle training in women's childbearing years: A critical interpretive synthesis of individual, professional, and service issues. Neurourol Urodyn 2019; 39:863-870. [PMID: 31845393 PMCID: PMC7079154 DOI: 10.1002/nau.24256] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
AIMS Antenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations. METHODS Critical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT. RESULTS Fifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over-arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers. CONCLUSION Numerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low-risk, low-cost, and proven strategies as part of women's reproductive health.
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Affiliation(s)
| | - E J C Hay-Smith
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachel Jarvie
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Dean
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rohini Terry
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Helena Frawley
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Eivor Oborn
- Warwick Business School, University of Warwick, Coventry, UK
| | - Susan E Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Institute for Clinical & Applied Health Research, Hull York Medical School, University of Hull, Heslington, UK
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Rayment‐Jones H, Harris J, Harden A, Khan Z, Sandall J. How do women with social risk factors experience United Kingdom maternity care? A realist synthesis. Birth 2019; 46:461-474. [PMID: 31385354 PMCID: PMC6771833 DOI: 10.1111/birt.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. METHODS Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). RESULTS Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. CONCLUSIONS The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.
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Affiliation(s)
- Hannah Rayment‐Jones
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
| | - James Harris
- Elizabeth Garrett Anderson Wing, University College HospitalLondonUK
| | - Angela Harden
- Institute for Health and Human Development, University of East LondonLondonUK
| | - Zahra Khan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
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Khatri RB, Karkee R. Social determinants of health affecting utilisation of routine maternity services in Nepal: a narrative review of the evidence. Reprod Health Matters 2018; 26:32-46. [PMID: 30403932 DOI: 10.1080/09688080.2018.1535686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Nepal has one of the highest maternal and neonatal mortality rates among low- and middle-income countries. Nepal's health system focuses on life-saving interventions provided during the antenatal to postpartum period. However, the inequality in the uptake of maternity services is of major concern. This study aimed to synthesise evidence from the literature regarding the social determinants of health on the use of maternity services in Nepal. We conducted a structured narrative review of studies published from 1994 to 2016. We searched five databases: PubMed; CINAHL; EMBASE; ProQuest and Global Index Medicus using search terms covering four domains: access and use; equity determinants; routine maternity services and Nepal. The findings of the studies were summarised using the World Health Organization's Social Determinants of Health framework. A total of 59 studies were reviewed. A range of socio-structural and intermediary-level determinants was identified, either as facilitating factors, or as barriers, to the uptake of maternity services. These determinants were higher socioeconomic status; education; privileged ethnicities such as Brahmins/Chhetris, people following the Hindu religion; accessible geography; access to transportation; family support; women's autonomy and empowerment; and a birth preparedness plan. Findings indicate the need for health and non-health sector interventions, including education linked to job opportunities; mainstreaming of marginalised communities in economic activities and provision of skilled providers, equipment and medicines. Interventions to improve maternal health should be viewed using a broad 'social determinants of health' framework.
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Affiliation(s)
- Resham Bahadur Khatri
- a PhD Candidate, School of Public Health, Faculty of Medicine , The University of Queensland , Brisbane, Australia; Centers for Research and Development, Kathmandu , Nepal
| | - Rajendra Karkee
- b Associate Professor, School of Public Health and Community Medicine , BP Koirala Institute of Health Sciences , Dharan , Nepal
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Darley S, Walshe K, Boaden R, Proudlove N, Goff M. Improvement capability and performance: a qualitative study of maternity services providers in the UK. Int J Qual Health Care 2018; 30:692-700. [PMID: 29669040 PMCID: PMC6307332 DOI: 10.1093/intqhc/mzy081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/13/2018] [Accepted: 04/03/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We explore variations in service performance and quality improvement across healthcare organisations using the concept of improvement capability. We draw upon a theoretically informed framework comprising eight dimensions of improvement capability, firstly to describe and compare quality improvement within healthcare organisations and, secondly to investigate the interactions between organisational performance and improvement capability. DESIGN A multiple qualitative case study using semi-structured interviews guided by the improvement capability framework. SETTING Five National Health Service maternity services sites across the UK. We focused on maternity services due to high levels of variation in quality and the availability of performance metrics which enabled us to select organisations from across the performance spectrum. PARTICIPANTS About 52 hospital staff members across the five case studies in positions relevant to the research questions, including midwives, obstetricians and clinical managers/leaders. MAIN OUTCOME MEASURE A qualitative analysis of narratives of quality improvement and performance in the five case studies, using the improvement capability framework as an analytic device to compare and contrast cases. RESULTS The improvement capability framework has utility in analysing quality improvement within and across organisations. Qualitative differences in the configurations of improvement capability were identified across all providers but were particularly striking between higher and lower performing organisations. CONCLUSIONS The improvement capability framework is a useful tool for healthcare organisations to assess, manage and develop their own improvement capabilities. We identified an interaction between performance and improvement capability; higher performing organisations appeared to have more developed improvement capabilities, though the meaning of this relationship requires further research.
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Affiliation(s)
- Sarah Darley
- Centre for Primary Care, School of Health Sciences, Oxford Road, Manchester, UK
| | - Kieran Walshe
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ruth Boaden
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Alliance Manchester Business School, Booth Street West, Manchester, UK
| | - Nathan Proudlove
- Health Management Group, Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Mhorag Goff
- Health Services Research Centre, Alliance Manchester Business School, University of Manchester, Manchester, UK
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Hutchinson AM, Nagle C, Kent B, Bick D, Lindberg R. Organisational interventions designed to reduce caesarean section rates: a systematic review protocol. BMJ Open 2018; 8:e021120. [PMID: 30002008 PMCID: PMC6082465 DOI: 10.1136/bmjopen-2017-021120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/10/2018] [Accepted: 06/01/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a growing body of evidence to indicate that both primary and subsequent caesarean sections are associated with increased maternal and perinatal morbidity. Efforts to reduce the number of clinically unnecessary caesarean sections are urgently required. Our objective is to systematically review published evidence on the effectiveness of maternity service organisational interventions, such as models of maternity care, that aim to reduce caesarean section rates. METHODS AND ANALYSIS Databases will be searched, including the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS. Search terms related to caesarean section and organisational intervention will be used. Research published before 1980 will be excluded and only randomised controlled trials, cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies will be included. Data extraction and quality assessments will be undertaken by two authors. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences. PROSPERO REGISTRATION NUMBER CRD42016039458.
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Affiliation(s)
- Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Deakin University, Geelong, Victoria, Australia
- Deakin Centre for Quality and Patient Safety Research, Monash Health, Clayton, Victoria, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Bridie Kent
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK
| | - Debra Bick
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Rebecca Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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35
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Banks KP, Karim AM, Ratcliffe HL, Betemariam W, Langer A. Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia. Health Policy Plan 2018; 33:317-327. [PMID: 29309598 PMCID: PMC5886294 DOI: 10.1093/heapol/czx180] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01-0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women's experiences as part of quality of care initiatives.
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Affiliation(s)
- Kathleen P Banks
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building, 3rd Floor, Boston, MA 02118, USA
| | - Ali M Karim
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Hannah L Ratcliffe
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
- Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - Wuleta Betemariam
- JSI Research & Training Institute Inc., The Last Ten Kilometers Project, 44 Farnsworth St, Boston, MA 02210, USA, and
| | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB 7th Floor, Boston, MA 02115, USA
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36
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Hernandez B, Colombara DV, Gagnier MC, Desai SS, Haakenstad A, Johanns C, McNellan CR, Nelson J, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study. Health Policy Plan 2017; 32:769-780. [PMID: 28335004 DOI: 10.1093/heapol/czx010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
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Affiliation(s)
- Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA and
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer Nelson
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Zúñiga-Brenes
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Emma Iriarte
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Abstract
OBJECTIVES More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities. DESIGN Secondary analysis was conducted on data from a 2015 national survey of women's experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women. SETTING Survey data were collected on women's experience of primary and secondary care in all trusts providing maternity care in England. PARTICIPANTS Women who had given birth 3 months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth. RESULTS Overall, 20 094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding. CONCLUSION While access to care was generally satisfactory for disabled women, women's emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women's sense of control to build trusting relationships with healthcare providers.
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Affiliation(s)
- Reem Malouf
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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38
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Abstract
This article discusses practices of parental support in the maternity healthcare provided by the welfare state. Drawing on ethnographic material from clinics in Finland, I discuss maternity healthcare practices and processes as the specific contexts of subjectification to parenthood in the Nordic welfare state. The analysis shows that in both nurses' (work) experience-based knowledge and population-statistical knowledge, parental competence is achieved largely through the 'natural' process of experiencing pregnant life. Care practices can be seen as enabling parenthood through respect for this process. Clinics encourage parents-to-be to self-reflect and be self-reliant. Emphasis on self-reflection and self-reliance has previously been interpreted as the state adoption of therapy culture, and as a response to market demands for the welfare state to offer to and require of its citizens more autonomy and choice. I argue, however, that the parental subject emerging from the practices of this welfare service cannot be reduced to a neoliberal reflexive individual for whom parenthood is an individual project and who is to blame for individual shortcomings. Equally, they are no mere disciplined product of governmentality being pushed to conform to an idealised parent figure derived from collective ideas of good parenthood.
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Affiliation(s)
- Riikka Homanen
- Gender Studies and Research Centre for Knowledge, Science, Technology and Innovation, School of Social Sciences and Humanities, University of Tampere, Finland
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39
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Rudrum S, Brown H, Oliffe JL. Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: 'The help they give when they've seen how different you are'. Sociol Health Illn 2016; 38:1318-1335. [PMID: 27554163 DOI: 10.1111/1467-9566.12456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post-conflict northern Uganda found that gift-giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift-giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health.
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Affiliation(s)
- Sarah Rudrum
- Institute for Gender Race Sexuality and Social Justice, University of British Columbia, Canada.
| | - Helen Brown
- School of Nursing, University of British Columbia, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Canada
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40
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Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Cuembelo F, Quembo T, Afonso P, Gloyd S, Lambdin BH, Micek MA, Porthé V, Sherr K. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study. Glob Health Action 2016; 9:31980. [PMID: 27580822 PMCID: PMC5007246 DOI: 10.3402/gha.v9.31980] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/19/2016] [Accepted: 08/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA;
| | - Sarah Gimbel
- Health Alliance International, Seattle, WA, USA.,Department of Family Child Nursing, University of Washington, Seattle, WA, USA
| | - Roxanne Hoek
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Cathy Michel
- Health Alliance International, Beira, Mozambique
| | - Fatima Cuembelo
- Community Health Department, School of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Titos Quembo
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Pires Afonso
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Stephen Gloyd
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Barrot H Lambdin
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Pangea Global AIDS, Oakland, CA, USA
| | - Mark A Micek
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Victoria Porthé
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
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41
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Abstract
Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future.
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Affiliation(s)
- Laura A Magee
- Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK; Department of Obstetrics and Gynaecology, St. George's Hospital and NHS Foundation Trust, London, UK
| | - Anne-Marie Cote
- Department of Medicine, Université de Sherbrooke, Québec, Canada
| | - Geena Joseph
- Department of Medicine, McMaster University, Ontario, Canada
| | - Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Winnie Sia
- Department of Medicine, University of Alberta, Alberta, Canada
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42
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Manthalu G, Yi D, Farrar S, Nkhoma D. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi. Health Policy Plan 2016; 31:1184-92. [PMID: 27175033 PMCID: PMC5035778 DOI: 10.1093/heapol/czw050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
Abstract
The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P < 0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important.
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Affiliation(s)
- Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health, P.O Box 30377, Lilongwe 3, Malawi
| | - Deokhee Yi
- Department of Palliative Care, Policy and Rehabilitation, Kings College London, Bessemer Road, Denmark Hill, SE5 9PJ, UK
| | - Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Dominic Nkhoma
- Department of Planning and Policy Development, Ministry of Health, P.O Box 30377, Lilongwe 3, Malawi
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Riggs E, Yelland J, Szwarc J, Wahidi S, Casey S, Chesters D, Fouladi F, Duell-Piening P, Giallo R, Brown S. Fatherhood in a New Country: A Qualitative Study Exploring the Experiences of Afghan Men and Implications for Health Services. Birth 2016; 43:86-92. [PMID: 26616739 DOI: 10.1111/birt.12208] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fathers of refugee background are dealing with multiple, interrelated stressors associated with forced migration and establishing their lives in a new country. This has implications for the role of men in promoting the health and well-being of their families. METHODS Afghan community researchers conducted interviews with 30 Afghan women and men who had recently had a baby in Australia. Interviews and focus groups were conducted with health professionals working with families of refugee background. RESULTS Fourteen men, 16 women, and 34 health professionals participated. Afghan men reported playing a major role in supporting their wives during pregnancy and postnatal care, accompanying their wives to appointments, and providing language and transport support. Although men embraced these roles, they were rarely asked by health professionals about their own concerns related to their wife's pregnancy, or about their social circumstances. Perinatal health professionals queried whether it was their role to meet the needs of men. CONCLUSION There are many challenges for families of refugee background navigating maternity services while dealing with the challenges of settlement. There is a need to move beyond a narrow conceptualization of antenatal and postnatal care to encompass a broader preventive and primary care approach to supporting refugee families through the period of pregnancy and early years of parenting. Pregnancy and postnatal care needs to be tailored to the social and psychological needs of families of refugee background, including men, and incorporate appropriate language support, in order to improve child and family health outcomes.
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Affiliation(s)
- Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Sayed Wahidi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Fatema Fouladi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | | | - Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia.,School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
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44
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Mackintosh N, Sandall J. The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings. Sociol Health Illn 2016; 38:252-69. [PMID: 26382089 PMCID: PMC4949570 DOI: 10.1111/1467-9566.12339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice.
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Affiliation(s)
| | - Jane Sandall
- Division of Women's HealthKing's College LondonLondonUK
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Sharma B, Ramani KV, Mavalankar D, Kanguru L, Hussein J. Using 'appreciative inquiry' in India to improve infection control practices in maternity care: a qualitative study. Glob Health Action 2015; 8:26693. [PMID: 26119249 PMCID: PMC4483369 DOI: 10.3402/gha.v8.26693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/06/2015] [Accepted: 05/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. OBJECTIVE To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. DESIGN An organisational change process called 'appreciative inquiry' (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. RESULTS Challenges which emerged included management processes (e.g. decision-making and problem-solving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. CONCLUSION Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.
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Affiliation(s)
- Bharati Sharma
- Department of women's and children's health, Karolinska Institute, Stockholm, Sweden.,Indian Institute of Management, Ahmedabad, India.,Indian Institute of Public Health, Gandhinagar, India;
| | - K V Ramani
- Indian Institute of Management, Ahmedabad, India
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Pilcher J, Kruske S, Barclay L. A review of rural and remote health service indexes: are they relevant for the development of an Australian rural birth index? BMC Health Serv Res 2014; 14:548. [PMID: 25491346 PMCID: PMC4265404 DOI: 10.1186/s12913-014-0548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communities in Australia. To address this, the Australian government has prioritised the development of a rigorous methodology in the Australian National Maternity Services Plan to inform the planning of rural and remote maternity services. METHODS A review of the literature was undertaken to identify planning indexes with component variables as outlined in the Australian National Maternity Services Plan. The indexes were also relevant if they described need associated with a specific type and level of health service in rural and remote areas of high income countries. Only indexes that modelled a range of socioeconomic and or geographical variables, identified access or need for a specific service type in rural and remote communities were included in the review. RESULTS Four indexes, two Australian and two Canadian met the inclusion criteria. They used combinations of variables including: geographical placement of services; isolation from services and socioeconomic vulnerability to identify access to a type and level of health service in rural and remote areas within 60 minutes. Where geographic isolation reduces access to services for high needs populations, additional measures of disadvantage including indigeneity could strengthen vulnerability scores. CONCLUSION Current planning indexes are applicable for the development of an Australian rural birthing index. The variables in each of the indexes were relevant, however use of flexible sized catchments to accurately account for population births and weighting for extreme geographic isolation needs to be considered. Additionally, socioeconomic variables are required that will reflect need for services particularly for isolated high needs populations. These variables could be used with Australian data and appropriate cut-off points to confirm applicability for maternity services. All of the indexes used similar types of variables and are relevant for the development of an Australian Rural Birth Index.
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Affiliation(s)
- Jennifer Pilcher
- University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia.
| | - Sue Kruske
- University Centre for Mothers and Babies, University of Queensland, St Lucia, Brisbane, Australia.
| | - Lesley Barclay
- University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia.
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Psaila K, Kruske S, Fowler C, Homer C, Schmied V. Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives'. BMC Pregnancy Childbirth 2014; 14:151. [PMID: 24766674 PMCID: PMC4016663 DOI: 10.1186/1471-2393-14-151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/14/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In Australia, women who give birth are transitioned from maternity services to child and health services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from the perspective of Australian midwives and child and family health (CFH) nurses. METHOD This paper reports findings from phase two of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of qualitative responses. RESULTS Respondents described the ToC between maternity services and CFH services as problematic. Key problems identified included communication between professionals and services and transfer of client information. Issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these issues were more difficult for families with identified social and emotional health concerns. Strategies identified by respondents to improve ToC included improving electronic transfer of information, regular meetings between maternity and CFH services, and establishment of liaison roles. CONCLUSION Significant problems exist around the ToC for all families but particularly for families with identified risks. Improved ToC will require substantial changes in information transfer processes and in the professional relationships which currently exist between maternity and CFH services.
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Affiliation(s)
- Kim Psaila
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia
| | - Sue Kruske
- Director Queensland Centre for Mothers & Babies, The University of Queensland, Brisbane, Queensland, Australia
| | - Cathrine Fowler
- Tresillian Chair for Child & Family Health, Centre for Midwifery, Child & Family Health, Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Australia
| | - Caroline Homer
- Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Sydney, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery & the Family and Community Health Research Group, University of Western Sydney, Sydney, Australia
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Abstract
BACKGROUND Young motherhood is commonly associated with vulnerabilities, stereotyping of young women's behavior, and poor outcomes for them and their children. The objective was to understand how maternity care is experienced by this group in the transition to parenthood. METHODS Data from a large-scale 2010 survey of women's experience of maternity care were analyzed using qualitative methods with open text responses. RESULTS Overall, 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: "being a consumer," "the quality of care," "needing support," and "pride in parenthood" whereas subthemes included "being young" and "how staff made me feel," "testimonials for staff," "not being left," and "it is all worthwhile." CONCLUSION Many young women responding described a positive experience. For many first-time mothers this feeling marked a change in their identity. Nevertheless, staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women is offered, supporting and reinforcing their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known.
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Affiliation(s)
- Maggie Redshaw
- Policy Research Unit for Maternal Health and Care, National Perinatal and Epidemiological Unit, University of Oxford, Oxford, UK; Queensland Centre for Mothers & Babies, School of Psychology, The University of Queensland, Brisbane, Qld, Australia
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Alfonso YN, Bishai D, Bua J, Mutebi A, Mayora C, Ekirapa-Kiracho E. Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda. Health Policy Plan 2013; 30:88-99. [PMID: 24371219 DOI: 10.1093/heapol/czt100] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The maternal mortality ratio (MMR) in Uganda has declined significantly during the last 20 years, but Uganda is not on track to reach the millennium development goal of reducing MMR by 75% by 2015. More evidence on the cost-effectiveness of supply- and demand-side financing programs to reduce maternal mortality could inform future strategies. This study analyses the cost-effectiveness of a voucher scheme (VS) combined with health system strengthening in rural Uganda against the status quo. The VS, implemented in 2010, provided vouchers for delivery services at public and private health facilities (HF), as well as round-trip transportation provided by private sector workers (bicycles or motorcycles generally). The VS was part of a quasi-experimental non-randomized control trial. Improvements in institutional delivery coverage (IDC) rates can be estimated using a difference-in-difference impact evaluation method and the number of maternal lives saved is modelled using the evidence-based Lives Saved Tool. Costs were estimated from primary and secondary data. Results show that the demand for births at HFs enrolled in the VS increased by 52.3 percentage points. Out of this value, conservative estimates indicate that at least 9.4 percentage points are new HF users. This 9.4% bump in IDC implies 20 deaths averted, which is equivalent to 1356 disability-adjusted-life years (DALYs) averted. Cost-effectiveness analysis comparing the status quo and VS's most conservative effectiveness estimates shows that the VS had an incremental cost-effectiveness ratio per DALY averted of US$302 and per death averted of US$20 756. Although there are limitations in the data measures, a favourable cost-effectiveness ratio persists even under extreme assumptions. Demand-side vouchers combined with supply-side financing programs can increase attended deliveries and reduce maternal mortality at a cost that is acceptable.
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Affiliation(s)
- Y Natalia Alfonso
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - John Bua
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - Crispus Mayora
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
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Bellows B, Kyobutungi C, Mutua MK, Warren C, Ezeh A. Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya. Health Policy Plan 2013; 28:134-42. [PMID: 22437506 PMCID: PMC3584990 DOI: 10.1093/heapol/czs030] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements. DATA SOURCES Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08. METHODS Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother's place of delivery, NUHDSS-MCH recorded the use of the voucher. FINDINGS There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme. CONCLUSIONS A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations.
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Affiliation(s)
- Ben Bellows
- Population Council, Ralph Bunche Rd, General Accident House, PO Box 17643-00500, Nairobi, Kenya.
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