Erratum: Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review

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.

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

PLoS ONE ◽

10.1371/journal.pone.0243034 ◽

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.

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

BMJ Open ◽

10.1136/bmjopen-2020-042952 ◽

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.

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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

BMJ Global Health ◽

10.1136/bmjgh-2018-001011 ◽

2018 ◽

Vol 3 (6) ◽

pp. e001011 ◽

Cited By ~ 12

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.

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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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Systematic Review and Meta-Analysis of Cost-effectiveness of Rotavirus Vaccine in Low-Income and Lower-Middle-Income Countries

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz117 ◽

2019 ◽

Vol 6 (4) ◽

Cited By ~ 8

Author(s):

Sabbir Haider ◽

Usa Chaikledkaew ◽

Montarat Thavorncharoensap ◽

Sitaporn Youngkong ◽

Md Ashadul Islam ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Low Income ◽

Meta Analysis ◽

Rotavirus Vaccine ◽

Middle Income ◽

Middle Income Countries

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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/v1 ◽

2020 ◽

Author(s):

Columba Mbekenga ◽

Eunice Pallangyo ◽

Tumbwene 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 BackgroundHealthcare 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 education and training of health care providers (HCPs) is reported worldwide and contributes to the critical shortages, and lack of adequate knowledge and skills among HCPs. The aim of this study was to assess the training needs among HCPs of RMNH care in selected health facilities of Mwanza, Tanzania. MethodsA cross-sectional descriptive and analytic survey using a self- administered questionnaire was conducted in 36 out of 80 health care facilities included in the Government of Canada and Aga Khan Foundation Canada funded 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) instrument was used for data collection. The HCPs provided ratings 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. ResultsOut of 153 HCPs 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).ConclusionsThe study highlights 16 (out of 49) training gaps as perceived by HCPs working 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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Accessibility of primary healthcare in low and middle income countries: a systematic review

Medical & Clinical Research ◽

10.33140/mcr.06.08.04 ◽

2021 ◽

Vol 6 (8) ◽

Keyword(s):

Systematic Review ◽

Health Care ◽

Low Income ◽

Primary Healthcare ◽

Spatial Accessibility ◽

Low Income Countries ◽

Middle Income ◽

Middle Income Countries ◽

Rural Africa ◽

Low And Middle Income

Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas.] Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.

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