Quality-Adjusted Coverage of Nutrition Interventions Across the Continuum of Care: Insights from Household and Health Facility Data in Bangladesh

Abstract Objectives Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjust crude health coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, across the continuum of care in Bangladesh. Methods We used data from Bangladesh Demographic and Health Surveys 2014 to assess use of maternal and child health services and Service Provision Assessments 2014 to determine facility readiness to deliver nutrition interventions during antenatal (ANC), institutional delivery, and postnatal care (PNC). Service readiness was computed as the mean availability of four nutrition-specific inputs, capturing human resources and training, equipment, diagnostics, and medicines. Crude coverage was combined with service readiness to create a measure of input-adjusted nutrition coverage at the national and regional levels, across place of residence, and by maternal educational and household socio-economic quintiles. Results Crude coverage varied, with greater use of any ANC (79%) and postnatal care (61–81%), than institutional delivery (37%). Nutrition service readiness was lower than crude coverage at each time point, such that nutrition input-adjusted coverage was 45% for ANC, 25% for institutional delivery, and 38–49% for preventive and sick child postnatal care, respectively. Input-adjusted coverage varied by 10–22 percentage points (pp) between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (12–17 pp between urban and rural areas, ∼17pp between low and high education, and 30–36pp between highest and lowest wealth quintiles), and less variable for postnatal care (<10%). Conclusions Nutrition input-adjusted coverage was suboptimal and varied sub-nationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals. Funding Sources Bill & Melinda Gates Foundation through A4NH.

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Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys

BMJ Open ◽

10.1136/bmjopen-2020-040109 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040109

Author(s):

Phuong Hong Nguyen ◽

Long Quỳnh Khương ◽

Priyanjana Pramanik ◽

Sk Masum Billah ◽

Purnima Menon ◽

...

Keyword(s):

Child Care ◽

Sick Child ◽

Institutional Delivery ◽

Continuum Of Care ◽

Child Growth ◽

Growth Monitoring ◽

Nutrition Interventions ◽

Nutrition Services ◽

Service Readiness ◽

The Continuum

IntroductionImproving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh.MethodsWe used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles.ResultsContact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14–17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp).ConclusionNutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.

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Sequential impact of components of maternal and child health care services on the continuum of care in India

Journal of Biosocial Science ◽

10.1017/s002193202100016x ◽

2021 ◽

pp. 1-23

Author(s):

K. S. James ◽

Udaya S. Mishra ◽

Rinju ◽

Saseendran Pallikadavath

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Postnatal Care ◽

Institutional Delivery ◽

National Level ◽

Continuum Of Care ◽

Child Health Care ◽

Institutional Deliveries ◽

And Child Health ◽

The Continuum

Abstract This paper examines the sequential impact of components of maternal and child health care on the continuum of care in India using data from the Indian National Family Health Surveys conducted in 2005–06 and 2015–16. Continuum of care (CoC) for maternal and child health is defined in this paper as the sequential uptake of three key maternal services (antenatal care, institutional delivery and postnatal care for the mother). Women who received all three services were classified as full CoC recipients. Characteristics odd ratios for achieving CoC were estimated by mother’s place of residence, household wealth status, mother’s education, birth order and child full vaccination. Odds ratios were computed to understand the relative impact of each preceding service utilization on the odds of subsequent service uptake. At national level, 30.5% and 55.5% of women achieved full CoC in 2005–06 and 2015–16, respectively, and the overall progress of CoC over the 10-year period was 25.5 percentage points, with significant variation across states and socioeconomic groups. Full CoC improved from 7.5% to 32.4% among the poorest women, whereas among the richest women it improved from 70.5% to 75.1%. Similarly, among uneducated women full CoC improved from 11.7% to 35.9% as against 75.1% to 80.5% among educated mothers over the same period. Furthermore, greater CoC was observed among parity one women. The conditionality between various components of CoC indicated that at national level the odds of having an institutional delivery with antenatal care were 9 times higher in the earlier period as against 4.5 times higher in the more recent period. Furthermore, women who had institutional deliveries complied more with mother’s postnatal care compared with women who did not have institutional deliveries. This again helps increase the likelihood of a child receiving full vaccination.

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Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

BMJ Open ◽

10.1136/bmjopen-2019-032161 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032161

Author(s):

Neha Batura ◽

Jolene Skordis ◽

Tom Palmer ◽

Aloyce Odiambo ◽

Andrew Copas ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Care Facility ◽

Continuum Of Care ◽

Postnatal Period ◽

Cash Transfers ◽

Conditional Cash Transfers ◽

Sensitivity Analyses ◽

The Impact ◽

The Continuum

IntroductionA wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.Methods and analysisThe economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.Ethics and disseminationThe study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberNCT03021070

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Dietary Service Staffing Impact Nutritional Quality in Nursing Homes

Journal of Applied Gerontology ◽

10.1177/0733464816688309 ◽

2017 ◽

Vol 38 (5) ◽

pp. 639-655 ◽

Cited By ~ 3

Author(s):

Kelly M. Smith ◽

Kali S. Thomas ◽

Shanthi Johnson ◽

Hongdao Meng ◽

Kathryn Hyer

Keyword(s):

Nursing Homes ◽

Online Survey ◽

Certified Nursing Assistants ◽

Staffing Levels ◽

Nutrition Services ◽

Service Staff ◽

Food And Nutrition ◽

The Impact ◽

The Relationship

Objective: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). Method: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service–related deficiency citation. An unconditional logit model with random effects was employed. Results: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. Conclusion: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services’ proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.

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The Effect of A Demand Side Financing Program on the Continuum of Maternal and Child Health Care in India

10.21203/rs.3.rs-124406/v1 ◽

2020 ◽

Author(s):

Saseendran Pallikadavath ◽

William Stones ◽

Sumit Mazumdar ◽

Ngianga Kandala ◽

Rahman Mohammad Mahbubur

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Institutional Delivery ◽

Continuum Of Care ◽

Average Treatment Effect ◽

Demand Side ◽

Care Services ◽

Demand Side Financing ◽

And Child Health ◽

The Continuum

Abstract Background The Indian Government launched a demand-side financing program, ‘Janani Suraksha Yojana’ (JSY) in 2005 with the aim of reducing maternal and neonatal mortality through increased access to institutional delivery care service. This paper analyses the effects of the JSY on the uptake of maternal and child health (MNCH) care services intending to understand the overall impact of the program on the continuum of care. Methods Using the 2013-14 round of the District-level Household Survey (DLHS) surveyed in high performing states, the average treatment effect on the treated (ATT) was estimated by using the Propensity Score Matching (PSM). Results are reported regarding both ATTs and deviations from the theoretical continuum of care line, which represents 100% uptake, i.e., all women availing all the MNCH services. Results Overall, JSY effects on MNCH components ranged between 0.7% and 12%. As expected, the highest impact of the JSY was on institutional delivery (ATT: 0.12; 95% CI: 0.104-0.131) and the lowest for breastfeeding more than six months (ATT: 0.007; 95% CI: -0.014-0.027). Deviation from the complete continuum of care line ranged from 2.3% to 80.9%. The highest deviation was for three or more Tetanus Toxoid (100%-19.1%=80.9%) injections and the lowest for Polio given at any time (100%-97.7%=2.3%). Conclusions The program had high effects on those MNCH care services, the uptakes of which were already high without the program (low deviations from the continuum of care line), and the program had low effects on those MNCH care services, which had low uptakes in the absence of the program (high deviations from the continuum of care line). The program should also incentivize the utilization of those MNCH care services, which have low uptakes in the absence of the program.

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Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia

PLoS ONE ◽

10.1371/journal.pone.0198829 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0198829 ◽

Cited By ~ 9

Author(s):

Kimiyo Kikuchi ◽

Junko Yasuoka ◽

Keiko Nanishi ◽

Ashir Ahmed ◽

Yasunobu Nohara ◽

...

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Postnatal Care ◽

Continuum Of Care ◽

And Child Health ◽

The Continuum

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Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

PLoS ONE ◽

10.1371/journal.pone.0250060 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0250060

Author(s):

Ana Paula Loch ◽

Simone Queiroz Rocha ◽

Mylva Fonsi ◽

Joselita Maria de Magalhães Caraciolo ◽

Artur Olhovetchi Kalichman ◽

...

Keyword(s):

Implementation Science ◽

Virologic Failure ◽

Healthcare Services ◽

Continuum Of Care ◽

Public Healthcare ◽

Treatment Gap ◽

Positive Effects ◽

Number Of Patients ◽

The Impact ◽

The Continuum

Objective To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.

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Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

BMJ Open ◽

10.1136/bmjopen-2021-055921 ◽

2022 ◽

Vol 12 (1) ◽

pp. e055921

Author(s):

Fedra Vanhuyse ◽

Oliver Stirrup ◽

Aloyce Odhiambo ◽

Tom Palmer ◽

Sarah Dickin ◽

...

Keyword(s):

Controlled Trial ◽

Randomised Trial ◽

Electronic System ◽

Continuum Of Care ◽

Cash Transfers ◽

Conditional Cash Transfers ◽

Cluster Randomised Trial ◽

Cluster Randomised ◽

The Impact ◽

The Continuum

ObjectivesGiven high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation).DesignWe conducted an unblinded 1:1 cluster-randomised controlled trial.Setting48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019.Participants2922 women were recruited to the control and 2522 to the intervention arm.InterventionsAn electronic system recorded attendance and triggered payments to the participant’s mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone.Primary outcomesPrimary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data.ResultsWe found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10).ConclusionsDemand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe.Trial registrationNCT03021070.

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Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

10.21203/rs.2.22005/v2 ◽

2020 ◽

Author(s):

Mamothena Mothupi ◽

Lucia Knight ◽

Hanani Tabana

Keyword(s):

Quality Of Care ◽

Maternal Health ◽

Health System ◽

Service Provision ◽

Health Sector ◽

Continuum Of Care ◽

Care Utilization ◽

District Health ◽

The Continuum

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

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The Continuum of Care in Cross-Border Health Travel

Journal of Healthcare Management Standards ◽

10.4018/jhms.2021010101 ◽

2021 ◽

Vol 1 (1) ◽

pp. 1-13

Author(s):

David G. Vequist IV

Keyword(s):

Statistical Analysis ◽

Large Population ◽

Continuum Of Care ◽

Healthcare Outcomes ◽

Moderate Amount ◽

Cross Border ◽

Before And After ◽

International Boundary ◽

The Impact ◽

The Continuum

There are several studies showing that a breakdown in the continuum of care occurs when a person crosses an international boundary for healthcare, such as migrants and medical tourists. This study attempted to measure the impact of a lack of standard continuity on the healthcare outcomes by comparing self-reported perceptions of health among a large population of people that traveled across borders. These travelers, without a discernible continuum of care, were surveyed before and after travel. A statistical analysis of self-reported perception data about general health before and after cross-border travel shows a significant decrease in overall health after cross-border travel. Despite some limitations, a moderate amount of the decline can be attributed to the breakdown of the continuum of care between providers on both sides of the border. The development of standards for cross-border healthcare could potentially improve the healthcare received by migrants and medical travelers.

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