Uganda Newborn Survival Study: improving newborn health and survival through a community based intervention linked to health facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: A quasi-experimental study

10.21203/rs.3.rs-27919/v3 ◽

2020 ◽

Author(s):

Duncan Ndombi Shikuku ◽

Geofrey Tanui ◽

Mercy Wabomba ◽

Dennis Wanjala ◽

Josephine Friday ◽

...

Keyword(s):

Health Service ◽

Health Service Utilization ◽

Newborn Health ◽

Significant Decline ◽

Health Facilities ◽

Maternal And Newborn Health ◽

Monthly Average ◽

Quasi Experimental ◽

Time Periods ◽

Maternal And Newborn

Abstract Background: Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers' strikes in rural Kenya. Methods: The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. Results: The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p<0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p<0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p>0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p<0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p<0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. Conclusions: The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

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How a Communication Intervention in Zambia Re-Oriented Health Services to the Needs of the Least-Supported

Healthcare ◽

10.3390/healthcare6030114 ◽

2018 ◽

Vol 6 (3) ◽

pp. 114 ◽

Cited By ~ 1

Author(s):

Tony Klouda ◽

Cathy Green ◽

Miniratu Soyoola ◽

Paula Quigley ◽

Tendayi Kureya ◽

...

Keyword(s):

Health Services ◽

Health Workers ◽

Newborn Health ◽

Maternal Health Services ◽

Global Strategy ◽

Health Facilities ◽

Maternal And Newborn Health ◽

Small Scale ◽

Structured Interviews ◽

Experiential Training

Despite decades of training health workers in communication, complaints from clients and communities about poor health worker attitudes abound. This was found to be so in Zambia where the More Mobilizing Access to Maternal Health Services in Zambia (MORE MAMaZ) program was trying to ensure the inclusion of under-supported women in a community-based maternal and newborn health program in five intervention districts. Under-supported women suffer a disproportionate burden of child mortality and are poor users of health services. An exploratory small-scale qualitative survey involving nurses from training schools and health facilities found that nurses knew how to communicate well, but were selective with whom and in what circumstances they did this. In general, those who received the worst communication were under-supported and had low confidence—the very people who needed the best communication. An experiential training program was started to help health workers reflect on the reasons for their poor communication. The training was evaluated after 14 months using semi-structured interviews and focus group discussions with staff at participating health facilities. The results showed improved inclusion of under-supported women but also increased attendance generally for ante-natal clinics, deliveries and under-five clinics. Another outcome was improved communication between, and a sense of job satisfaction among, the health workers themselves. The program demonstrated an effective way to improve the inclusion and involvement of the least-supported women and girls. There are important lessons for other health programs that aim to operationalize the goals of the Global Strategy for Women’s, Children’s and Adolescent’s Health, which include an emphasis on reaching every woman.

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Community-based maternal and newborn care: A concept analysis

Curationis ◽

10.4102/curationis.v41i1.1922 ◽

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.

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A Causal Model of Attitudes toward Mental Health Facilities

Environment and Planning A Economy and Space ◽

10.1068/a150525 ◽

1983 ◽

Vol 15 (4) ◽

pp. 525-542 ◽

Cited By ~ 12

Author(s):

G B Hall ◽

S M Taylor

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Mentally Ill ◽

Causal Model ◽

Health Facilities ◽

Community Mental Health Care ◽

Community Based ◽

Mental Health Facilities ◽

Perceived Impacts ◽

Community Facilities

Nonuser responses to community facilities are recognised as among the most important factors determining the success or failure of community-based systems of service delivery. A causal model of individual attitudes to community mental health care is defined and tested with survey data collected in Toronto, Ontario. The results from a path analysis show the strong antecedent influence of attitudes toward facility users and of perceived impacts of facilities on facility desirability. The importance of personal nonattitudinal characteristics on reactions to facilities is also revealed. The implications of familiarity with mental illness and of attitudes toward the mentally ill for the acceptance of community mental health facilities are considered.

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Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia: A Community Based Cross Sectional Study

PLoS ONE ◽

10.1371/journal.pone.0033564 ◽

2012 ◽

Vol 7 (3) ◽

pp. e33564 ◽

Cited By ~ 60

Author(s):

Yemisrach B. Okwaraji ◽

Simon Cousens ◽

Yemane Berhane ◽

Kim Mulholland ◽

Karen Edmond

Keyword(s):

Child Mortality ◽

Cross Sectional Study ◽

Health Facilities ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Rural Ethiopia ◽

Geographical Access ◽

Access To Health

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Book Review: Community-Based Mental Health Facilities

British Journal of Occupational Therapy ◽

10.1177/030802269906201210 ◽

1999 ◽

Vol 62 (12) ◽

pp. 566-566

Author(s):

Sue Dunn

Keyword(s):

Mental Health ◽

Health Facilities ◽

Community Based ◽

Mental Health Facilities

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Quality of Maternal and Newborn Health Care in Ethiopia: A Cross-Sectional Study

10.21203/rs.3.rs-141660/v1 ◽

2021 ◽

Author(s):

Abera Biadgo ◽

Aynalem Legesse ◽

Abiy Seifu ◽

Kavita Singh ◽

Zewdie Mulissa ◽

...

Keyword(s):

Health Care ◽

Quality Of Care ◽

Newborn Health ◽

Health Facilities ◽

Maternal And Newborn Health ◽

Neonatal Health ◽

Input Process ◽

Maternal And Neonatal Health ◽

Maternal And Newborn

Abstract Background: Despite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.Methodology: This study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.Result: The study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.Conclusion: This study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.

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

10.21203/rs.3.rs-115748/v2 ◽

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.

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