Assessment of knowledge of evidence-based maternal and newborn care practices among midwives and nurses in six provinces in Indonesia

AbstractObjectiveTo prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic.DesignCross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs).Setting81 countries, between March 24 and April 10, 2020.Participants714 maternal and newborn healthcare providers.Main outcome measuresPreparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic.ResultsOnly one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based.ConclusionsSubstantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses.Key MessagesWhat is already knownIn addition to lack of healthcare worker protection, staffing shortages, heightened risk of nosocomial transmission and decreased healthcare use described in previous infectious disease outbreaks, maternal and newborn care during the COVID-19 pandemic has also been affected by large-scale lockdowns/curfews.The two studies assessing the indirect effects of COVID-19 on maternal and child health have used models to estimate mortality impacts.Experiences of frontline health professionals providing maternal and newborn care during the COVID-19 pandemic have not been empirically documented to date.What this study addsRespondents in high-income countries more commonly reported available/updated guidelines, access to COVID-19 testing, and dedicated isolation rooms for confirmed/suspected COVID-19 maternity patients.Levels of stress increased among health professionals globally, including due to changed working hours, difficulties in reaching health facilities, and staff shortages.Healthcare providers were worried about the impact of rapidly changing care practices on health outcomes: reduced access to antenatal care, fewer outpatient visits, shorter length-of-stay in facilities after birth, banning birth companions, separating newborns from COVID-19 positive mothers, and postponing routine immunisations.COVID-19 illustrates the susceptibility of maternity care services to emergencies, including by reversing hard-won gains in healthcare utilisation and use of evidence-based practices. These rapid findings can inform countries of the main issues emerging and help develop effective responses.

Download Full-text

Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study

BMC Medicine ◽

10.1186/s12916-018-1092-9 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 12

Author(s):

Karen M. Edmond ◽

Khaksar Yousufi ◽

Zelaikha Anwari ◽

Sayed Masoud Sadat ◽

Shah Mansoor Staniczai ◽

...

Keyword(s):

Health Worker ◽

Home Visiting ◽

Intervention Study ◽

Newborn Care ◽

Population Based ◽

Care Seeking ◽

Fragile States ◽

Care Practices ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Download Full-text

Effect of Village Health Team Home Visits and Mobile Phone Consultations on Maternal and Newborn Care Practices in Masindi and Kiryandongo, Uganda: A Community-Intervention Trial

PLoS ONE ◽

10.1371/journal.pone.0153051 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153051 ◽

Cited By ~ 11

Author(s):

Richard Mangwi Ayiasi ◽

Patrick Kolsteren ◽

Vincent Batwala ◽

Bart Criel ◽

Christopher Garimoi Orach

Keyword(s):

Mobile Phone ◽

Community Intervention ◽

Newborn Care ◽

Intervention Trial ◽

Health Team ◽

Village Health Team ◽

Care Practices ◽

Maternal And Newborn Care ◽

Village Health ◽

Maternal And Newborn

Download Full-text

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03516-4 ◽

2021 ◽

Vol 21 (S1) ◽

Author(s):

Rejina Gurung ◽

◽

Harriet Ruysen ◽

Avinash K. Sunny ◽

Louise T. Day ◽

...

Keyword(s):

Newborn Care ◽

Verbal Abuse ◽

Standards Of Care ◽

Skin Contact ◽

Mode Of Birth ◽

Survey Interviews ◽

Maternal And Newborn Care ◽

Poor Care ◽

Respectful Care ◽

Maternal And Newborn

Abstract Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = − 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01–0.05) of receiving skin-to-skin contact than those with vaginal births. Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

Download Full-text

Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

Implementation Science ◽

10.1186/s13012-020-01058-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Karen Zamboni ◽

Samiksha Singh ◽

Mukta Tyagi ◽

Zelee Hill ◽

Claudia Hanson ◽

...

Keyword(s):

Quality Improvement ◽

Neonatal Mortality ◽

Process Evaluation ◽

Andhra Pradesh ◽

Newborn Care ◽

Mechanisms Of Change ◽

Evidence Based ◽

Programme Implementation ◽

Quasi Experimental ◽

Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

Download Full-text

Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03534-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ebenezer Oduro-Mensah ◽

Irene Akua Agyepong ◽

Edith Frimpong ◽

Marjolein Zweekhorst ◽

Linda Amarkai Vanotoo

Keyword(s):

Decision Making ◽

Call Center ◽

Clinical Decision Making ◽

Newborn Care ◽

Clinical Decision ◽

Series Data ◽

Maternal And Newborn Care ◽

Greater Accra Region ◽

Maternal And Newborn ◽

Decision Making Support

Abstract Background Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. This paper presents analysis of the use of a pilot referral and decision making support call center for mothers and newborns in the Greater Accra region of Ghana, and challenges encountered in implementing such an intervention. Methods We analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel. Results During the first seventeen months of operation, the Information Communication Technology (ICT) platform was provided by the private telecommunication network MTN. The focus of the referral system was on maternal and newborn care. In this first phase, a total of 372 calls were handled by the center. 93% of the calls were requests for referral assistance (87% obstetric and 6% neonatal). The most frequent clinical reasons for maternal referral were prolonged labor (25%), hypertensive diseases in pregnancy (17%) and post-partum hemorrhage (7%). Birth asphyxia (58%) was the most common reason for neonatal referral. Inadequate bed space in referral facilities resulted in only 81% of referrals securing beds. The national ambulance service was able to handle only 61% of the requests for assistance with transportation because of its resource challenges. Resources could only be mobilized for the recurrent cost of running the center for 12 h (8.00 pm – 8.00 am) daily. During the second phase of the intervention we switched the use of the ICT platform to a free government platform operated by the National Security. In the next sixteen-month period when the focus was expanded to include all clinical cases, 390 calls were received with 51% being for medical emergency referrals and 30% for obstetrics and gynaecology emergencies. Request for bed space was honoured in 69% of cases. Conclusions The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the LMIC context of this study. However, health systems challenges such inadequacy of human resources, unavailability of referral beds, poor health infrastructure, lack of recurrent financing and emergency transportation need to be addressed for optimal functioning.

Download Full-text