scholarly journals Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries

2018 ◽  
Vol 3 (6) ◽  
pp. e001011 ◽  
Author(s):  
Ashley Sheffel ◽  
Celia Karp ◽  
Andreea A Creanga
Keyword(s):  
Low Income ◽  
Service Provision ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Service Availability ◽  
Middle Income ◽  
Middle Income Countries ◽  
Experience Of Care ◽  
Maternal And Newborn

Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA) are the most widely employed, standardised tools that generate health service delivery data in LMICs. We ascertained the use of SPA/SARA surveys for assessing the quality of MNH services using a two-step approach: a SPA/SARA questionnaire mapping exercise in line with WHO’s Quality of Care (QoC) Framework for pregnant women and newborns and the WHO quality standards for care around the time of childbirth; and a scoping literature review, searching for articles that report SPA/SARA data. SPA/SARA surveys are well suited to assess the WHO Framework’s cross-cutting dimensions (physical and human resources); SPA also captures elements in the provision and experience of care domains for antenatal care and family planning. Only 4 of 31 proposed WHO quality indicators around the time of childbirth can be fully generated using SPA and SARA surveys, while 19 and 23 quality indicators can be partially obtained from SARA and SPA surveys, respectively; most of these are input indicators. Use of SPA/SARA data is growing, but there is considerable variation in methods employed to measure MNH QoC. With SPA/SARA data available in 30 countries, MNH QoC assessments could benefit from guidance for creating standard metrics. Adding questions in SPA/SARA surveys to assess the WHO QoC Framework’s provision and experience of care dimensions would fill significant data gaps in LMICs.

scholarly journals Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

2019 ◽  
Vol 4 (3) ◽  
pp. e001308 ◽  
Author(s):  
Andrea Katryn Blanchard ◽  
Audrey Prost ◽  
Tanja A J Houweling
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Home Visits ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Women's Groups ◽  
Middle Income ◽  
Middle Income Countries ◽  
Women’S Groups ◽  
Maternal And Newborn

IntroductionCommunity health worker (CHW) interventions are promoted to improve maternal and newborn health in low-income and middle-income countries. We reviewed the evidence on their effectiveness in reducing socioeconomic inequities in maternal and newborn health outcomes, how they achieve these effects, and contextual processes that shape these effects.MethodsWe conducted a mixed-methods systematic review of quantitative and qualitative studies published between 1996 and 2017 in Medline, Embase, Web of Science and Scopus databases. We included studies examining the effects of CHW interventions in low-income and middle-income countries on maternal and newborn health outcomes across socioeconomic groups (wealth, occupation, education, class, caste or tribe and religion). We then conducted a narrative synthesis of evidence.ResultsWe identified 1919 articles, of which 22 met the inclusion criteria. CHWs facilitated four types of interventions: home visits, community-based groups, cash transfers or combinations of these. Four studies found that CHWs providing home visits or facilitating women’s groups had equitable coverage. Four others found that home visits and cash transfer interventions had inequitable coverage. Five studies reported equitable effects of CHW interventions on antenatal care, skilled birth attendance and/or essential newborn care. One study found that a CHW home visit intervention did not reduce wealth inequities in skilled birth attendance. A study of women’s groups reported greater reductions in neonatal mortality among lower compared with higher socioeconomic groups. Equity was most improved when CHWs had relevant support for assisting women to improve health practices and access health care within community contexts.ConclusionWhile current evidence remains limited, particularly for mortality, existing studies suggest that CHW interventions involving home visits, cash transfers, participatory women’s groups or multiple components can improve equity in maternal and newborn health. Future mixed-methods research should explore intervention strategies and contextual processes shaping such effects on equity to optimise these efforts.

scholarly journals Assessing the quality of antenatal corticosteroids in low- and middle-income countries: A systematic review

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243034
Author(s):  
Euodia Mosoro ◽  
Alyce N. Wilson ◽  
Caroline S. E. Homer ◽  
Joshua P. Vogel
Keyword(s):  
Systematic Review ◽  
Newborn Health ◽  
Poor Quality ◽  
Maternal And Newborn Health ◽  
Antenatal Corticosteroids ◽  
Middle Income ◽  
Middle Income Countries ◽  
Medicine Quality ◽  
Maternal And Newborn

Background The World Health Organization (WHO) recommends the administration of intramuscular antenatal corticosteroids to women at risk of preterm birth to prevent preterm-associated neonatal mortality and morbidity. Poor quality medicines are a major problem for health services in low- and middle-income countries (LMICs), however the quality of antenatal corticosteroids is not well understood. We aimed to conduct a systematic review of available studies describing the quality of recommended injectable antenatal corticosteroids (dexamethasone or betamethasone) in LMICs. Methods Structured search strategy was applied to six databases (MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, Global Index Medicus, WHO Medicines Quality Database), without year or language restrictions. Any primary study reporting any medicine quality parameter (Active Pharmacological Ingredient, pH and sterility) for injectable dexamethasone or betamethasone was eligible. Two authors independently screened studies for eligibility, extracted data on included studies and applied Medicine Quality Assessment Reporting Guidelines tool to assess study quality. Results were reported narratively, stratified by country of manufacture, organisation type and level of care. Results In total, 15,547 citations were screened with two eligible studies identified that focussed on dexamethasone quality (no studies of betamethasone were identified). One study included 19 samples from 9 LMICs, and the other included “less than 100 samples” from India. The prevalence of failed dexamethasone samples ranged from 3.14% to 32.2% due to inadequate Active Pharmacological Ingredient. A higher prevalence of failed dexamethasone samples were seen at the point of care and the public sector. Conclusions Poor quality maternal and newborn health medicines can endanger women and newborns. Though available evidence on antenatal corticosteroids quality in LMICs is limited, results suggested poor quality dexamethasone may be prevalent in some countries. More primary studies are required to confirm these findings and guide policymakers on procurement of good-quality maternal and newborn health medicines.

scholarly journals Scoping review protocol of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042952
Author(s):  
Solange Mianda ◽  
Olamide O Todowede ◽  
Helen Schneider
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Low Income ◽  
Newborn Health ◽  
Health System Strengthening ◽  
Maternal And Newborn Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Qualitative Phase ◽  
Maternal And Newborn

IntroductionThis review will explore the characteristics of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries, comparing three common framing approaches of these interventions (referred to as archetypes), namely, quality improvement (QI), health system strengthening (HSS) and implementation science (IS), over the last 20 years.Methods and analysisThis study will review the literature on health service interventions from 2000 to 2020. This will be achieved by searching for English peer-reviewed articles in the following electronic databases EBSCOhost, PubMed, Web of Science, MASCOT/Wotro Map of Maternal Health Research and Google scholar. We will develop a systematic search strategy using a combination of keywords and Boolean operators AND/OR. Eligibility screening and data extraction will be conducted by two independent reviewers, and disagreements resolved by a third independent reviewer. Analyses will be conducted in two steps, a quantitative and a qualitative phase. The quantitative phase will provide a descriptive profile of papers, including the category (QI, HSS, IS, mixed or other) of papers. In the follow-up qualitative phase, all three reviewers will independently code for key concepts in a subset of papers, jointly selected as representing each archetype, and analysed in batches until concept saturation is achieved.Ethics and disseminationThis review does not require ethical approval. The results will be published as an article in a peer-reviewed journal and presented to stakeholders involved in implementing health system interventions in maternal and newborn.

scholarly journals Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

2022 ◽  
Vol 5 (1) ◽  
pp. 1-18
Author(s):  
Lucy Natecho Namusonge ◽  
Maximilla N. Wanzala ◽  
Edwin K. Wamukoya
Keyword(s):  
Maternity Care ◽  
Newborn Health ◽  
Health Facilities ◽  
Respectful Maternity Care ◽  
Maternal And Newborn Health ◽  
Disrespect And Abuse ◽  
Live Births ◽  
Experience Of Care ◽  
Maternal And Newborn

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

scholarly journals Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries

2020 ◽  
Vol 17 (S3) ◽  
Author(s):  
Yamini V. Pusdekar ◽  
Archana B. Patel ◽  
Kunal G. Kurhe ◽  
Savita R. Bhargav ◽  
Vanessa Thorsten ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Preterm Birth ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Health Registry ◽  
Maternal And Newborn

Abstract Background Preterm birth continues to be a major public health problem contributing to 75% of the neonatal mortality worldwide. Low birth weight (LBW) is an important but imperfect surrogate for prematurity when accurate assessment of gestational age is not possible. While there is overlap between preterm birth and LBW newborns, those that are both premature and LBW are at the highest risk of adverse neonatal outcomes. Understanding the epidemiology of preterm birth and LBW is important for prevention and improved care for at risk newborns, but in many countries, data are sparse and incomplete. Methods We conducted data analyses using the Global Network’s (GN) population-based registry of pregnant women and their babies in rural communities in six low- and middle-income countries (Democratic Republic of Congo, Kenya, Zambia, Guatemala, India and Pakistan). We analyzed data from January 2014 to December 2018. Trained study staff enrolled all pregnant women in the study catchment area as early as possible during pregnancy and conducted follow-up visits shortly after delivery and at 42 days after delivery. We analyzed the rates of preterm birth, LBW and the combination of preterm birth and LBW and studied risk factors associated with these outcomes across the GN sites. Results A total of 272,192 live births were included in the analysis. The overall preterm birth rate was 12.6% (ranging from 8.6% in Belagavi, India to 21.8% in the Pakistani site). The overall LBW rate was 13.6% (ranging from 2.7% in the Kenyan site to 21.4% in the Pakistani site). The overall rate of both preterm birth and LBW was 5.5% (ranging from 1.2% in the Kenyan site to 11.0% in the Pakistani site). Risk factors associated with preterm birth, LBW and the combination were similar across sites and included nulliparity [RR − 1.27 (95% CI 1.21–1.33)], maternal age under 20 [RR 1.41 (95% CI 1.32–1.49)] years, severe antenatal hemorrhage [RR 5.18 95% CI 4.44–6.04)], hypertensive disorders [RR 2.74 (95% CI − 1.21–1.33], and 1–3 antenatal visits versus four or more [RR 1.68 (95% CI 1.55–1.83)]. Conclusions Preterm birth, LBW and their combination continue to be common public health problems at some of the GN sites, particularly among young, nulliparous women who have received limited antenatal care services. Trial registration The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.Trial registration: The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.

scholarly journals Private sector delivery of maternal and newborn health care in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055600
Author(s):  
Samantha R Lattof ◽  
Blerta Maliqi ◽  
Nuhu Yaqub ◽  
Anne-Sophie Jung
Keyword(s):  
Private Sector ◽  
Scoping Review ◽  
Health Sector ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Private Health Sector ◽  
Review Protocol ◽  
Maternal And Newborn

IntroductionRecent studies have pointed to the substantial role of private health sector delivery of maternal and newborn health (MNH) care in low-/middle-income countries (LMICs). While this role has been partly documented, an evidence synthesis is missing. To analyse opportunities and challenges of private sector delivery of MNH care as they pertain to the new World Health Organization (WHO) strategy on engaging the private health service delivery sector through governance in mixed health systems, a more granular understanding of the private health sector’s role and extent in MNH delivery is imperative. We developed a scoping review protocol to map and conceptualise interventions that were explicitly designed and implemented by formal private health sector providers to deliver MNH care in mixed health systems.Methods and analysisThis protocol details our intended methodological and analytical approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Seven databases (Cumulative Index to Nursing and Allied Health, Excerpta Medica Database, International Bibliography of the Social Sciences, PubMed, ScienceDirect, Web of Science, WHO Institutional Repository for Information Sharing) and two websites will be searched for studies published between 1 January 2002 and 1 June 2021. For inclusion, quantitative and/or qualitative studies in LMICs must report at least one of the following outcomes: maternal morbidity or mortality; newborn morbidity or mortality; experience of care; use of formal private sector care during pregnancy, childbirth, and postpartum; and stillbirth. Analyses will synthesise the evidence base and gaps on private sector MNH service delivery interventions for each of the six governance behaviours.Ethics and disseminationEthical approval is not required. Findings will be used to develop a menu of private sector interventions for MNH care by governance behaviour. This study will be disseminated through a peer-reviewed publication, working groups, webinars and partners.

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