Seizing the Big Missed Opportunity: Linking HIV and Maternity Care Services in Sub-Saharan Africa

2007 ◽  
Vol 15 (30) ◽  
pp. 190-201 ◽  
Author(s):  
Nel Druce ◽  
Anne Nolan
Keyword(s):  
Maternity Care ◽  
Sub Saharan Africa ◽  
Care Services ◽  
Sub Saharan ◽  
Missed Opportunity

scholarly journals Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Quraish Sserwanja ◽  
Lilian Nuwabaine ◽  
Kassim Kamara ◽  
Milton W. Musaba
Keyword(s):  
Sierra Leone ◽  
Maternity Care ◽  
Postnatal Care ◽  
Tertiary Education ◽  
Sub Saharan Africa ◽  
Government Interventions ◽  
Factors Associated ◽  
Care Services ◽  
Field Worker ◽  
Sub Saharan

Abstract Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

scholarly journals Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity?

2021 ◽  
Vol 6 (12) ◽  
pp. e007682
Author(s):  
Helen M Nabwera ◽  
Osayame A Ekhaguere ◽  
Haresh Kirpalani ◽  
Kathy Burgoine ◽  
Chinyere V Ezeaka ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Missed Opportunity

scholarly journals Midwifery workforce profile in Limpopo Province referral hospitals

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Sam T. Ntuli ◽  
Gboyega A. Ogunbanjo
Keyword(s):  
Maternal Mortality ◽  
Registered Nurses ◽  
Maternity Care ◽  
Work Experience ◽  
Limpopo Province ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Referral Hospitals ◽  
Negative Effect ◽  
Sub Saharan

Background: In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas.Objective: To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa.Method: A cross-sectional descriptive study was conducted in all maternity units of Limpopo’s public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0.Results: The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study.Conclusion: This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province.

scholarly journals Planning universal accessibility to public health care in sub-Saharan Africa

2020 ◽  
Vol 117 (50) ◽  
pp. 31760-31769
Author(s):  
Giacomo Falchetta ◽  
Ahmed T. Hammad ◽  
Soheil Shayegh
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Services ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Public Health Care ◽  
Care Services ◽  
Universal Accessibility ◽  
Care Facilities ◽  
Sub Saharan

Achieving universal health care coverage—a key target of the United Nations Sustainable Development Goal number 3—requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., Sci. Data 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.

scholarly journals Strengths and weaknesses of eye care services in sub-Saharan Africa: a meta-synthesis of eye health system assessments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stevens Bechange ◽  
Emma Jolley ◽  
Bhavisha Virendrakumar ◽  
Vladimir Pente ◽  
Juliet Milgate ◽  
...  
Keyword(s):  
Health System ◽  
Sub Saharan Africa ◽  
Eye Care ◽  
Care Services ◽  
Eye Health ◽  
Sub Saharan

scholarly journals ‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216123
Author(s):  
Brenda Nyambura Mungai ◽  
Elizabeth Joekes ◽  
Enos Masini ◽  
Angela Obasi ◽  
Veronica Manduku ◽  
...  
Keyword(s):  
Population Based ◽  
Sub Saharan Africa ◽  
Radiological Findings ◽  
Prevalence Survey ◽  
X Ray ◽  
Chest X Ray ◽  
Sub Saharan ◽  
Significant Disease ◽  
Tuberculosis Prevalence ◽  
Missed Opportunity

BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

scholarly journals A qualitative study to explore the experience of parents of newborns admitted to neonatal care unit in rural Rwanda

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252776
Author(s):  
Samuel Byiringiro ◽  
Rex Wong ◽  
Jenae Logan ◽  
Deogratias Kaneza ◽  
Joseph Gitera ◽  
...  
Keyword(s):  
Qualitative Study ◽  
District Hospital ◽  
Healthcare Providers ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Traumatic Experience ◽  
Environment Interaction ◽  
Care Services ◽  
Sub Saharan ◽  
Neonatal Care Unit

Background Neonatal Care Units (NCUs) provide special care to sick and small newborns and help reduce neonatal mortality. For parents, having a hospitalized newborn can be a traumatic experience. In sub-Saharan Africa, there is limited literature about the parents’ experience in NCUs. Objective Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda. Methods A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. Interviews were conducted using a semi-structured guide in the participants’ homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data were organized using Dedoose software for analysis. Results Twenty-one interviews were conducted primarily with mothers (90.5%, n = 19) among newborns who were most often discharged home alive (90.5%, n = 19). Four themes emerged from the interviews. These were the parental adaptation to having a sick neonate in NCU, adaptation to the NCU environment, interaction with people (healthcare providers and fellow parents) in the NCU, and financial stressors. Conclusion The admission of a newborn to the NCU is a source of stress for parents and caregivers in rural Rwanda, however, there were several positive aspects which helped mothers adapt to the NCU. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for parents and families in general.

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