scholarly journals Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts’ perspectives

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mamothena Carol Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Thematic Analysis ◽  
Continuum Of Care ◽  
The Continuum

Indicators and gaps for monitoring service provision along the continuum of care for maternal health in South Africa

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective This study assesses indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the emerging construct of adequacy of the continuum of care to assess multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results We found indicators along the adequacy dimensions of care utilization and access, linkages of care, and quality of care in the routine district health information system. The General Household Survey contained indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

scholarly journals Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

2020 ◽  
Author(s):  
Mamothena Carol Mothupi ◽  
Jeroen De Man ◽  
Hanani Tabana ◽  
Lucia Knight
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Service Delivery ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Health Service Delivery ◽  
Continuum Of Care ◽  
Determinants Of Health ◽  
The Continuum

Abstract Introduction: The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in South Africa. Materials and Methods: The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results: The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs=-0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r=0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions: This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

scholarly journals Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252182
Author(s):  
Mamothena Carol Mothupi ◽  
Jeroen De Man ◽  
Hanani Tabana ◽  
Lucia Knight
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Service Delivery ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Health Service Delivery ◽  
Continuum Of Care ◽  
Determinants Of Health ◽  
The Continuum

Introduction The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. Materials and methods The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013–2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

scholarly journals Hospitalization and post-discharge care in South Africa: A critical event in the continuum of care

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0208429 ◽  
Author(s):  
Cody Cichowitz ◽  
Rachael Pellegrino ◽  
Katlego Motlhaoleng ◽  
Neil A. Martinson ◽  
Ebrahim Variava ◽  
...  
Keyword(s):  
South Africa ◽  
Continuum Of Care ◽  
Critical Event ◽  
Post Discharge ◽  
Discharge Care ◽  
The Continuum

scholarly journals Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project

PLoS ONE ◽  
2018 ◽  
Vol 13 (3) ◽  
pp. e0192603 ◽  
Author(s):  
Alexandra Wollum ◽  
Rose Gabert ◽  
Claire R. McNellan ◽  
Jessica M. Daly ◽  
Priscilla Reddy ◽  
...  
Keyword(s):  
South Africa ◽  
Cardiovascular Disease ◽  
Continuum Of Care ◽  
The Continuum

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Health Sector ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

scholarly journals Women’s retention on the Continuum of Maternal Care Pathway in West Gojjam Zone, Ethiopia: Multilevel Analysis

2020 ◽  
Author(s):  
Amanu Aragaw Emiru ◽  
Getu Degu Alene ◽  
Gurmesa Tura Debelew
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Antenatal Care ◽  
Service Utilization ◽  
Maternal Care ◽  
Health Service Utilization ◽  
Continuum Of Care ◽  
Maternal Health Service ◽  
West Gojjam ◽  
The Continuum

Abstract Background: The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. Methods: A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95 % confidence interval. Results: The study revealed that only 12.1% of women completed the continuum of care (ANC4+, SBA, PNC within 48 hours after birth); while 25.1% reported not having care at any stage for their most recent birth. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR=7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR=3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. Conclusions: The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality

Continuum of maternal health care services and its impact on child immunization in India: an application of the propensity score matching approach

2020 ◽  
pp. 1-20
Author(s):  
Mohd Usman ◽  
Enu Anand ◽  
Laeek Siddiqui ◽  
Sayeed Unisa
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Services ◽  
Continuum Of Care ◽  
Maternal Health Care ◽  
Child Immunization ◽  
Care Services ◽  
Care Approach ◽  
Maternal Health Care Services ◽  
The Continuum

Abstract Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015–16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15–49 were included in the analysis of maternal health care indicators, and 8246 children aged 12–23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Health Sector ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results: We found 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

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