Narrative Case study: The most essential determinants to child and maternal health in Sierra Leone

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Sheriff ◽  
G A Barzyk
Keyword(s):  
Maternal Health ◽  
Child Health ◽  
Maternal Mortality ◽  
Health Outcomes ◽  
Sierra Leone ◽  
Maternal And Child Health ◽  
Maternal Mortality Ratio ◽  
Live Births ◽  
Child And Maternal Health ◽  
And Child Health

Abstract Background Sierra Leone is one of the poorest countries in the world, suffering from some of the worst maternal and child health outcomes. In 2013, it had a maternal mortality ratio of 1165/10000 live births and an under-five mortality of 156/1000 live births. The country has introduced a number of policies and interventions to tackle maternal and child health issues but still retains one of the highest global mortality rates. The purpose of this study is to determine the most essential determinants to infant, child and maternal health and recommend some interventions and policy changes to improve their health outcomes. Methods A small review of relevant policies and papers and analysis of relevant maternal and child health data and statistics was conducted to inform questions for Key Informant Interviews. Interviews were then conducted with relevant stakeholders to child and maternal health from UN Organisations, international NGOs and the Ministry of Health and Sanitation (MoHS). Results Analysis of transcribed Interview data with NVIVO showed that the most essential determinants were the lack of effective coordination between the MoHS and partners due to the emergency mindset, systematic problems with the attitude of the healthcare workforce especially towards women and socio-cultural restriction on women restricting their ability to make choices about their own health and lives Conclusions The study found that there was a focus on policies and interventions targeted at improving clinical determinants and health statistics while consideration of socio-cultural context were negligible. An inclusion of interventions focused on women's empowerment and increasing their voices will help to tackle some of these most essential determinants. Key messages Sierra Leone has the policy environment, political will, and technical expertise to continue making improvements to their high maternal and child mortality problem. An emergency mindset approach, and interventions targeted only at reducing clinical determinants of maternal mortality are missing out on addressing wider socio-cultural issues to improving health.

scholarly journals Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005–2010

2018 ◽  
Vol 3 (2) ◽  
pp. e000674 ◽  
Author(s):  
Dana R Thomson ◽  
Cheryl Amoroso ◽  
Sidney Atwood ◽  
Matthew H Bonds ◽  
Felix Cyamatare Rwabukwisi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Health System ◽  
Population Health ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Health System Strengthening ◽  
Live Births ◽  
Intervention Area ◽  
And Child Health

IntroductionAlthough Rwanda’s health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators.MethodsCombining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables.ResultsOverall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households.ConclusionWe observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically.

scholarly journals 1421Effects of the Colombian armed conflict on reproductive, maternal and child health

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Isabel Garcés-palacio ◽  
Mary Salazar-Barrientos ◽  
Edison Bedoya Bedoya ◽  
Ana Langer
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Maternal And Child Health ◽  
Armed Conflict ◽  
Maternal Mortality Ratio ◽  
Secondary Analysis ◽  
Health Indicators ◽  
Internally Displaced ◽  
And Child Health ◽  
Victimization Rates

Abstract Background Colombia has been affected by internal armed conflict for 70 years. About 7.3 million people have been internally displaced and nearly 50% of them were women. In conflict-afflicted areas, pregnant women and newborns have higher rates of adverse health outcomes. Methods Secondary analysis of public databases. We examined sixteen indicators from the Countdown to 2030 initiative, for which data from Colombia were available and reliable between 1998 and 2016. We also constructed a variable (victimization rate) to measure the intensity of the conflict for each municipality/year and grouped them into quintiles. We compared relative differences and confidence intervals using the Rothman and Greenland method. Results Across time, most indicators improved in all municipalities. However, four indicators were significantly different between municipalities with high versus low victimization rates. The maternal mortality ratio was higher in the municipalities with higher victimization rates in the periods 1998-2004, 2005-2011 and 2012-2016. The percentages of caesarean births and women who received four or more antenatal care visits were lower in settings with highest levels of victimization (1998-2000,) while the fertility rate among women 15-19 years old was higher in those municipalities between 2012 and 2016. Conclusions In Colombia, several maternal and child health indicators have improved during the years of the conflict; however, municipalities most affected by the armed conflict had poorer reproductive and maternal health outcomes. Key messages Maternal and reproductive health were negatively affected by protracted armed conflict in Colombia.

scholarly journals Assessing Access and Healthcare Quality of Maternal and Child Health Services in Facilities of Kasai Province in the Democratic Republic of the Congo (DRC)

2021 ◽  
Author(s):  
Britou Ndela ◽  
Philippe Ngwala ◽  
Adrien N’siala ◽  
Albert Kalonji ◽  
Felix Minuku ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Democratic Republic ◽  
Maternal Mortality Ratio ◽  
Child Health Services ◽  
Geographical Access ◽  
Republic Of The Congo ◽  
And Child Health

Abstract Background: The Democratic Republic of the Congo (DRC) is classified among the 5 countries with the highest global maternal mortality ratio (MMR) and highest under-five mortality rate (U5MR) in the world. Kasai is one of 14 provinces of the DRC, which have a high U5MR and MMR. Despite this overriding concern, almost no studies have been conducted to assess maternal et child situation in this province. The aim of this study was to assess access, availability, and quality of maternal and child health services in Kasai Province in the DRC. Methods: A cross-sectional survey of 49 Health Facilities (HFs) integrating quantitative and qualitative data collection was conducted in 18 Health Zones in Kasai Province in the DRC. Documentary review, interviews and direct observation of HFs were performed to collect data. Pearson’s chi-squared test was performed to establish the relation between variables.Results: Nearly 54 % of visited HFs population had a geographical access to maternal and child health services and the majority of medical acts were unaffordable. Basic and comprehensive emergency obstetric care (EmOC) were offered respectively by only 11.8% and 7.6% of HF and none provided high quality basic or comprehensive EmOC. This low availability and quality of EmOC are due to the insufficiency of necessary inputs and personal for maternal and child health services in the majority of HFs. Conclusion: The situation of maternal and child health services is very precarious in Kasai Province. The improvement of EmOC coverage will require rehabilitation of infrastructure, dotation of equipment, regular supply of medicines and strengthening of human resource capacity.

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