Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. The study identified individual, sociocultural, and structural-level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included mistrust towards public health facilities and inadequate symptom recognition. The three identified sociocultural barriers were aversion to biomedical interventions, gendered imbalances in decision making, and women’s restricted mobility. The structural barriers included ineffective referral systems and prohibitively expensive transportation services. Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers.

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Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

BMC Health Services Research ◽

10.1186/s12913-019-4871-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Tsering P. Lama ◽

Melinda K. Munos ◽

Joanne Katz ◽

Subarna K. Khatry ◽

Steven C. LeClerq ◽

...

Keyword(s):

Health Worker ◽

District Hospital ◽

Newborn Care ◽

Active Management ◽

Major Barrier ◽

Significant Difference ◽

Facility Type ◽

Maternal And Newborn Care ◽

Facility Readiness ◽

Maternal And Newborn

Abstract Background Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods Using an audit tool and interviews, respectively, facility readiness and health providers’ knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. Results Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. Conclusions Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.

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Effect of Village Health Team Home Visits and Mobile Phone Consultations on Maternal and Newborn Care Practices in Masindi and Kiryandongo, Uganda: A Community-Intervention Trial

PLoS ONE ◽

10.1371/journal.pone.0153051 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153051 ◽

Cited By ~ 11

Author(s):

Richard Mangwi Ayiasi ◽

Patrick Kolsteren ◽

Vincent Batwala ◽

Bart Criel ◽

Christopher Garimoi Orach

Keyword(s):

Mobile Phone ◽

Community Intervention ◽

Newborn Care ◽

Intervention Trial ◽

Health Team ◽

Village Health Team ◽

Care Practices ◽

Maternal And Newborn Care ◽

Village Health ◽

Maternal And Newborn

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Barriers to accessing maternal and newborn care: a qualitative study in district Thatta, Pakistan

10.21203/rs.3.rs-124358/v1 ◽

2020 ◽

Author(s):

Muhammad Asim ◽

Sarah Saleem ◽

Zarak Hussain Ahmad ◽

Imran Naeem ◽

Farina Abrejo ◽

...

Keyword(s):

Health Care ◽

Health Workers ◽

Newborn Care ◽

Structured Interview ◽

Maternal And Newborn Health ◽

Structural Level ◽

Care Seeking ◽

Structural Barriers ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Abstract Background: Accessibility and utilization of health care play a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing pregnancy and neonatal care. The aim of this study was to explore the multifaceted barriers that inhibit women to seek maternal and newborn health care in Thatta, Sindh, Pakistan.Methods: This study employed an interpretive research design using purposive sampling approach. Pre-tested semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. Findings: The study identified individual, socio-cultural, and structural level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included: mistrust towards public health facilities, and inadequate symptom recognition. The two identified socio-cultural barriers were: aversion to biomedical interventions, and gendered imbalances in decision making. The structural barriers included: prohibitively expensive transportation services, and ineffective referral systems. Conclusion and Suggestions: Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers.

Download Full-text