scholarly journals ‘Who assisted with the delivery of (NAME)?’ Issues in estimating skilled birth attendant coverage through population-based surveys and implications for improving global tracking

2019 ◽  
Vol 4 (2) ◽  
pp. e001367 ◽  
Author(s):  
Emma Radovich ◽  
Lenka Benova ◽  
Loveday Penn-Kekana ◽  
Kerry Wong ◽  
Oona Maeve Renee Campbell
Keyword(s):  
Low Income ◽  
Newborn Health ◽  
Skilled Birth Attendant ◽  
Population Based ◽  
Maternal And Newborn Health ◽  
Demographic And Health Surveys ◽  
High Coverage ◽  
Middle Income ◽  
Definition Of ◽  
Maternal And Newborn

The percentage of live births attended by a skilled birth attendant (SBA) is a key global indicator and proxy for monitoring progress in maternal and newborn health. Yet, the discrepancy between rising SBA coverage and non-commensurate declines in maternal and neonatal mortality in many low-income and middle-income countries has brought increasing attention to the challenge of what the indicator of SBA coverage actually measures, and whether the indicator can be improved. In response to the 2018 revised definition of SBA and the push for improved measurement of progress in maternal and newborn health, this paper examines the evidence on what women can tell us about who assisted them during childbirth and methodological issues in estimating SBA coverage via population-based surveys. We present analyses based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted since 2015 for 23 countries. Our findings show SBA coverage can be reasonably estimated from population-based surveys in settings of high coverage, though women have difficulty reporting specific cadres. We propose improvements in how skilled cadres are classified and documented, how linkages can be made to facility-based data to examine the enabling environment and further ways data can be disaggregated to understand the complexity of delivery care. We also reflect on the limitations of what SBA coverage reveals about the quality and circumstances of childbirth care. While improvements to the indicator are possible, we call for the use of multiple indicators to inform local efforts to improve the health of women and newborns.

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 Survey of women’s report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Shafiqul Ameen ◽  
◽  
Abu Bakkar Siddique ◽  
Kimberly Peven ◽  
Qazi Sadeq-ur Rahman ◽  
...  
Keyword(s):  
Clinical Care ◽  
Newborn Health ◽  
Population Based ◽  
Maternal And Newborn Health ◽  
Demographic And Health Surveys ◽  
Household Surveys ◽  
Exit Survey ◽  
Survey Report ◽  
Clinical Records ◽  
Maternal And Newborn

Abstract Background Population-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report. Methods EN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women’s report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators. Results 33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90–1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04–4.83) while umbilical cord care indicators were massively underestimated (0.14–0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high “don’t know” responses. Conclusions Our study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.

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 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 Community-based maternal and newborn care: A concept analysis

Curationis ◽  
2018 ◽  
Vol 41 (1) ◽  
Author(s):  
Yonas R. Guta ◽  
Patrone R. Risenga ◽  
Mary M. Moleki ◽  
Merertu T. Alemu
Keyword(s):  
Low Income ◽  
Newborn Care ◽  
Newborn Health ◽  
Concept Analysis ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Community Based ◽  
Care Services ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Background: Community-based care can serve as a valuable programme in the provision of essential maternal and newborn care, specifically in communities in low-income countries. However, its application in maternal and newborn care is not clearly documented in relation to the rendering of services by skilled birth attendants.Objectives: The purpose of the analysis was to clarify the meaning of the concept ‘community-based maternal and newborn care and its relationship to maternal and newborn health’.Method: Walker and Avant’s and Rodgers and Knafl’s as well as Chin and Kramer’s approaches to concept analysis were followed to analyse community-based maternal and newborn care.Results: The attributes of community-based care in maternal and newborn health include (1) the provision of home- and/or community-level skilled care, (2) linkages of health services and (3) community participation and mobilisation. These attributes are influenced by antecedents as well as consequences.Conclusion: The provision of good maternal and newborn care to all clients is a crucial aspect in provision of maternal and newborn services. In order for low-income countries to promote maternal and newborn health, community-based care services are the best option to follow.

scholarly journals Training Needs Assessment of Health Care Professionals in Reproductive, Maternal and Newborn Health in a Low-Income Setting in Tanzania

2021 ◽  
Author(s):  
Columba Mbekenga ◽  
Eunice Pallangyo ◽  
Tumbwene E. Mwansisya ◽  
Kahabi Isangula ◽  
Loveluck Mwasha ◽  
...  
Keyword(s):  
Health Care ◽  
Needs Assessment ◽  
Low Income ◽  
Newborn Health ◽  
Training Needs ◽  
Health Facilities ◽  
Maternal And Newborn Health ◽  
Training Needs Assessment ◽  
Low Income Setting ◽  
Maternal And Newborn

Abstract Background: Healthcare delivery globally and particularly in low-income setting is challenged by multiple, complex and dynamic problems. The reproductive, maternal and newborn health (RMNH) care is among the most affected areas resulting into high maternal and neonatal mortality and morbidity across the Sub Saharan region and Tanzania in particular. However, under-investment in adequate training and capacity development among health care workers (HCWs) is reported worldwide and contributes to the critical shortages, and lack of adequate knowledge and skills among HCWs. The aim of this study was to assess the training needs among HCWs of RMNH care in selected health facilities of Mwanza, Tanzania. Methods: A cross-sectional descriptive and analytic survey using a self- administered questionnaire was conducted in 36 out of 80 health care facilities included in Improving Access to Reproductive, Maternal and Newborn Health in Mwanza, Tanzania (IMPACT) project within the 8 councils of Mwanza region in Tanzania. The training needs assessment (TNA) tool adapted from the Hennessy-Hicks’ Training Needs Assessment Questionnaire (TNAQ) was used for data collection. The HCWs rated on the importance of their task and their current performance of the task. The differences in scores were calculated to identify the greatest training needs.Results: Out of 153 HCWs who responded to the TNA questionnaire, majority were registered (n=62) and enrolled (n=43) nurses. Ninety percent (n= 137) were from government-owned health facilities, mostly from hospitals 68 (45%). Training needs were high in 16 areas (out of 49) including cervical cancer screening and care; accessing research resources; basic and comprehensive emergency obstetric and newborn care; and sexual and gender-based violence. The overall perceived importance of the training needs was significantly associated with perceived performance of tasks related to RMNH services (Pearson Correlation (r) = .256; p <001).Conclusions: The study highlights 16 (out of 49) training gaps as perceived by HCWs in RMNH in Tanzania. The utilization of findings from the TNA has great potential to facilitate designing of effective trainings for local RMNH services delivery hence improve the overall quality of care.

scholarly journals “The midwife helped me... Otherwise I could have died” Women’s experience of professional midwifery services in rural Afghanistan.  A qualitative study in the provinces Kunar and Laghman

2020 ◽  
Author(s):  
Trude Thommesen ◽  
Hallgeir Kismul ◽  
Ian Kaplan ◽  
Khadija Safi ◽  
Graziella Van den Berg
Keyword(s):  
Professional Education ◽  
Quality Care ◽  
Emergency Obstetric Care ◽  
Newborn Health ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Maternal And Newborn Health ◽  
Skin Contact ◽  
Birth Attendance ◽  
Maternal And Newborn

Abstract Background Afghanistan has one of the world’s highest maternal mortality ratios, in some areas more than 60% of women have no access to a skilled birth attendant. The main challenges for Afghan childbearing women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, according to the national plan for midwifery education. The aim of this study is to explore women´s experiences with professional midwifery care in four villages in Afghanistan covered by the project, to uncover challenges and improve services in rural and conflict-affected areas of the country. Methods An explorative case study approach was adopted. Fourteen in-depth interviews and four focus group discussions were conducted. Totally, 39 women participated; 25 who had given birth during the last six months, 11 mothers-in-laws and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed through a thematic content analysis. Findings The women reported that the trained midwives’ life-saving competence, skills and care were important reasons for giving birth in a clinic, and the midwives seemed to be appreciated by many of the women, making more women to choose to give birth in the clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence from the midwives. Moreover, disapproval from relatives, shame and problems with transport and security were important obstacles to women giving birth in the clinics. Conclusions Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilization and satisfaction with maternal and newborn health services in rural Afghanistan. Nevertheless, the quality of the services is still wanting, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritized.

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