scholarly journals Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis

2021 ◽  
Vol 6 (12) ◽  
pp. e006453
Author(s):  
Muhammad Ashar Malik ◽  
Lara Riedige Rohm ◽  
Pieter van Baal ◽  
Eddy van Doorslaer van Doorslaer
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Maternal Care ◽  
Care Seeking ◽  
Difference In Difference ◽  
Maternal Healthcare ◽  
Healthcare Seeking ◽  
Birth Attendance ◽  
And Child Health ◽  
Care Seeking Behaviour

IntroductionPakistan is a country with high maternal and infant mortality. Several large foreign funded projects were targeted at improving maternal, neonatal and child health. The Norway-Pakistan Partnership Initiative (NPPI) was one of these projects. This study aims to evaluate whether NPPI was successful in improving access and use of skilled maternal healthcare.MethodsWe used data from three rounds (2009–2010, 2011–2012 and 2013–2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM). A difference-in-difference regression framework was used to estimate the effectiveness of NPPI and its different programme components with respect to maternal healthcare seeking behaviour of pregnant women. Various parts of the PSLM were combined to examine the healthcare seeking behaviour response of pregnant women to exposure to NPPI.ResultsTrends in maternal care seeking behaviour of pregnant women were similar in districts exposed to NPPI and control districts. Consequently, only a weak and insignificant impact of NPPI on maternal care seeking behaviour was found. However, women in districts which used vouchers or which implemented contracting were more likely to seek skilled assistance with their delivery.ConclusionWe conclude that the objective to improve access to and use of skilled care was not achieved by NPPI. The small effects identified for vouchers and contracts on skilled birth attendance hold some promise for further experimentation.

scholarly journals Equity and Coverage in the Continuum of Reproductive, Maternal, Newborn and Child Health Services in Nepal-Projecting the Estimates on Death Averted Using the LiST Tool

2019 ◽  
Vol 24 (S1) ◽  
pp. 22-30 ◽  
Author(s):  
Jeevan Thapa ◽  
Shyam Sundar Budhathoki ◽  
Rejina Gurung ◽  
Prajwal Paudel ◽  
Bijay Jha ◽  
...  
Keyword(s):  
Child Health ◽  
Antenatal Care ◽  
Rate Of Change ◽  
Childhood Mortality ◽  
Child Health Services ◽  
Care Seeking ◽  
Newborn And Child Health ◽  
Under Five ◽  
Birth Attendance ◽  
And Child Health

Abstract Introduction The third Sustainable Development Goal, focused on health, includes two targets related to the reduction in maternal, newborn and under-five childhood mortality. We found it imperative to examine the equity and coverage of reproductive, maternal, newborn and child health (RMNCH) interventions from 2001 to 2016 in Nepal; and the death aversion that will take place during the SDG period. Methods We used the datasets from the Nepal Demographic Health Surveys (NDHS) 2001, 2006, 2011 and 2016. We calculated the coverage and equity for RMNCH interventions and the composite coverage index (CCI). Based on the Annualized Rate of Change (ARC) in the coverage for selected RMNCH indicators, we projected the trend for the RMNCH interventions by 2030. We used the Lives Saved Tools (LiST) tool to estimate the maternal, newborn, under-five childhood deaths and stillbirths averted. We categorised the interventions into four different patterns based on coverage and inequity gap. Results Between 2001 and 2016, a significant improvement is seen in the overall RMNCH intervention coverage-CCI increasing from 46 to 75%. The ARC was highest for skilled attendance at birth (11.7%) followed by care seeking for pneumonia (8.2%) between the same period. In 2016, the highest inequity existed for utilization of the skilled birth attendance services (51%), followed by antenatal care (18%). The inequity gap for basic immunization services reduced significantly from 27.4% in 2001 to 5% in 2016. If the current ARC continues, then an additional 3783 maternal deaths, 36,443 neonatal deaths, 66,883 under-five childhood deaths and 24,024 stillbirths is expected to be averted by the year 2030. Conclusion Nepal has experienced an improvement in the coverage and equity in RMNCH interventions. Reducing inequities will improve coverage for skilled birth attendants and antenatal care. The current annual rate of change in RMNCH coverage will further reduce the maternal, neonatal, under-five childhood deaths and stillbirths.

scholarly journals Utilization of preconception care and its impacts on health behavior changes among expectant couples in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Li Du ◽  
Xuena La ◽  
Liping Zhu ◽  
Hong Jiang ◽  
Biao Xu ◽  
...  
Keyword(s):  
Folic Acid ◽  
Child Health ◽  
Health Behavior ◽  
Pregnant Women ◽  
Preconception Care ◽  
Behavior Changes ◽  
Care Services ◽  
Folic Acid Supplements ◽  
Health Behavior Changes ◽  
And Child Health

Abstract Background Preconception care is an opportunity for detecting potential health risks in future parents and providing health behavior education to reduce morbidity and mortality for women and their offspring. Preconception care has been established in maternal and child health hospitals in Shanghai, China, which consists of health checkups, health education and counseling. This study investigated factors associated with the utilization of preconception care, and the role of preconception care on health behavior changes before conception among pregnant women and their partners. Methods A cross-sectional study was conducted among pregnant women at three maternal and child health hospitals in Shanghai. The participants were invited to complete a self-administered questionnaire on the utilization of preconception care and health behavioral changes before conception. Results Of the 948 recruited pregnant women, less than half (42.2%) reported that they had utilized preconception care before the current pregnancy. Unplanned pregnancy, unawareness of preconception care and already having a general physical examination were the main reasons for not attending preconception care. The two main sources of information about preconception care were local community workers and health professionals. Younger women and the multipara were less likely to utilize preconception care. Women who utilized preconception care were more likely to take folic acid supplements before conception [Adjusted Odds Ration (aOR) 3.27, 95% Confidence Interval (CI) 2.45–4.36, P < 0.0001]. The partners of pregnant women who had attended preconception care services were more likely to stop smoking [aOR 2.76, 95%CI 1.48–5.17, P = 0.002] and to stop drinking [aOR 2.13, 95%CI 1.03–4.39, P = 0.041] before conception. Conclusions Utilization of preconception care was demonstrated to be positively associated with preconception health behavior changes such as women taking folic acid supplements before pregnancy, their male partner stopping smoking and drinking before conception. Future studies are needed to explore barriers to utilizing preconception care services and understand the quality of the services. Strategies of promoting preconception care to expectant couples, especially to young and multipara women, should be developed to further improve the utilization of the services at the community level.

scholarly journals Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. K. Okemo ◽  
D. Kamya ◽  
A. M. Mwaniki ◽  
M. Temmerman
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Preconception Care ◽  
Healthcare Providers ◽  
Preventive Health Care ◽  
Structured Interview ◽  
University Hospital ◽  
Rural Setting ◽  
Rural Settings ◽  
And Child Health

Abstract Background Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya. Methods A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically. Findings A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH). Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy. The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC. Conclusion From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later.

scholarly journals Global Disease Outbreaks and Effects on Maternal, Newborn & Child Health in Global South, a Systematic Review

2020 ◽  
pp. 47-58
Author(s):  
O. Orjingene ◽  
N. L. Akondeng ◽  
A. Kone-Coulibaly ◽  
T. Ogojah ◽  
M. Ganama
Keyword(s):  
Health Care ◽  
Child Health ◽  
Pregnant Women ◽  
Low Income ◽  
Hospital Admissions ◽  
Disease Outbreaks ◽  
Global South ◽  
Hiv Positive ◽  
Newborn And Child Health ◽  
And Child Health

Background/Aim: The world has witnessed several disease outbreaks both in the past and in recent times. Apart from loss of lives as a result of such outbreaks, there are also disruptions in health care provision and utilization due to certain measures aimed at curtailing the spread of such outbreaks. This study aimed to seek evidence from existing literature on the effects of disease outbreaks on maternal, newborn and child health care in Global South. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used and 14 literatures met the inclusion criteria. Results: HIV/AIDS pandemic affected the Maternal Newborn and Child Health since increased cases of anaemia, hospital admissions, still births in HIV positive pregnant and cases of foetal anaemia reported in infants born from HIV positive pregnant women were reported. No COVID-19 pandemic related-effects on MNCH observed since no maternal deaths and transmission from infected pregnant women to their newborns reported. Indirect effects of pandemics on MNHC include reduced service delivery and demand/utilization as well as inaccessibility due to diverse reasons. Discussion: The Government should put in place palliative measures for low-income citizens; engage and sensitize women, pregnant women and their children on available health care services and mitigation measures in place to access with minimal or no risk of being infected in a secure environment.

scholarly journals Utilization of preconception care and associated factors in Hosanna Town, Southern Ethiopia

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261895
Author(s):  
Meron Admasu Wegene ◽  
Negeso Gebeyehu Gejo ◽  
Daniel Yohannes Bedecha ◽  
Amene Abebe Kerbo ◽  
Shemsu Nuriye Hagisso ◽  
...  
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Preconception Care ◽  
Previous History ◽  
Care Utilization ◽  
Adverse Birth Outcomes ◽  
Care Services ◽  
History Of ◽  
And Child Health

Introduction There is substantial body of evidence that portrays gap in the existing maternal and child health continuum of care; one is less attention given to adolescent girls and young women until they get pregnant. Besides, antenatal care is too late to reduce the harmful effects that a woman’s may have on the fetus during the critical period of organogenesis. Fortunately, preconception care can fill these gaps, enhance well-being of women and couples and improve subsequent pregnancy and child health outcomes. Therefore, the main aim of the current study was to assess preconception care utilization and associated factors among pregnant women attending antenatal care clinics of public health facilities in Hosanna town. Methods A facility based cross-sectional study design was carried out from July 30, 2020 to August 30, 2020. Data were collected through face-to-face interview among 400 eligible pregnant women through systematic sampling technique. Epi-data version 3.1 and SPSS version 24 was used for data entry and analysis respectively. Both bivariable and multivariable logistic regression analysis was conducted to identify association between dependent and independent variables. Crude and adjusted odds ratio with respective 95% confidence intervals was computed and statistical significance was declared at p-value <0.05. Result This study revealed that 76 (19%, 95% Cl (15.3, 23.2) study participants had utilized preconception care. History of family planning use before the current pregnancy (AOR = 2.45; 95% Cl (1.270, 4.741), previous history of adverse birth outcomes (AOR = 3.15; 95% Cl (1.650, 6.005), poor knowledge on preconception care (AOR = 0.18; 95% Cl (0.084, 0.379) and receiving counseling on preconception care previously (AOR = 2.82; 95% Cl (1.221, 6.493) were significantly associated with preconception care utilization. Conclusions The present study revealed that nearly one-fifth of pregnant women have utilized preconception care services. History of family planning use before the current pregnancy, previous history of adverse birth outcomes, poor knowledge on preconception care and receiving counseling on preconception care previously were significantly associated with preconception care utilization. Integrating preconception care services with other maternal neonatal child health, improving women’s/couples knowledge & strengthening counseling services is pivotal.

scholarly journals Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2020 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Health Behaviors ◽  
Pregnant Women ◽  
Evidence Based ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
And Child Health

Abstract Background: We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and uptake of evidence-based, maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared the uptake of MNCH behaviors between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at health facilities in Busia County to participate in Chamas . Women enrolled in Chamas agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We collected baseline sociodemographic data at study enrollment for each cohort. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions: Chamas participation was associated with increased practice of evidence-based MNCH health behaviors among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Increasing uptake of maternal, newborn, and child health interventions through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2019 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Pregnant Women ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
Matched Cohort Study ◽  
Significant Difference ◽  
And Child Health

Abstract Background We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated Chamas’ impact on improving uptake of evidence-based maternal, newborn and child health (MNCH) interventions. Methods We prospectively compared MNCH intervention uptake between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women in Busia county attending their first antenatal care (ANC) visit to participate in Chamas and enroll in this study. Upon joining, women agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We selected controls among non-Chamas participants who attended the same ANC clinics. We collected baseline sociodemographic and reproductive health data at study enrollment. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced fewer stillbirths than non-participants (n=2 vs. n=6, p=0.083). Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions Chamas participation was associated with increased uptake of MNCH interventions among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level maternal and infant health benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Determinants of Preconception care among Pregnant Women In an Urban and a Rural Health Facility In Kenya: A Qualitative Study

2021 ◽  
Author(s):  
Joan Khavugwi Okemo ◽  
Dorothy Kamya ◽  
Abraham Mukaindo Mwaniki ◽  
Marleen Temmerman
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Preconception Care ◽  
Healthcare Providers ◽  
Preventive Health Care ◽  
Structured Interview ◽  
University Hospital ◽  
Rural Setting ◽  
Rural Settings ◽  
And Child Health

Abstract BACKGROUNDPreconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in the rural areas. Little is known regarding PCC use in Kenya that could help in bridging this gap. This study aimed to assess the determinants of PCC in urban and rural settings in Kenya.METHODSSelected pregnant women seeking antenatal care (ANC) were recruited by purposive sampling at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed thematically.RESULTS A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred after 13 interviews (7 at AKUH and 6 at MLFH).Transcription, coding and thematic analysis of the IDIs yielded 12 main themes. Eleven of the main themes were identified as determinants of PCC while the twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy.The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC.CONCLUSIONFrom this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of nurses and doctors.

scholarly journals Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

2018 ◽  
Vol 3 (3) ◽  
pp. e000466 ◽  
Author(s):  
Iryna Postolovska ◽  
Stéphane Helleringer ◽  
Margaret E Kruk ◽  
Stéphane Verguet
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Low Income ◽  
Child Health Services ◽  
Demographic And Health Surveys ◽  
Care Seeking ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health

BackgroundMeasles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services.MethodsWe analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000–2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough).ResultsSIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country.ConclusionThe paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

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