scholarly journals Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Resham B Khatri ◽  
Rajendra Karkee ◽  
Jo Durham ◽  
Yibeltal Assefa
Keyword(s):  
Antenatal Care ◽  
Maternity Care ◽  
Institutional Delivery ◽  
Health Workers ◽  
Multinomial Logistic Regression ◽  
Newborn Health ◽  
Postnatal Period ◽  
Outcome Variable ◽  
Maternal And Newborn Health ◽  
Maternal And Newborn

Abstract Background Routine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period. Methods We conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05. Results Approximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers. Conclusions Routine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces.

scholarly journals Continuity of care and its determinants of routine maternal and newborn health visits in Nepal: Evidence from a nationally representative household survey

2021 ◽  
Author(s):  
Resham Bahadur Khatri ◽  
Rajendra Karkee ◽  
Jo Durham ◽  
Yibeltal Assefa
Keyword(s):  
Continuity Of Care ◽  
Agricultural Sector ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Newborn Health ◽  
Outcome Variable ◽  
Maternal And Newborn Health ◽  
Health Management Information System ◽  
Neonatal Deaths ◽  
Maternal And Newborn

Abstract Background Maternal and newborn health (MNH) is a priority health issue in Nepal, has high maternal and neonatal deaths. Maternal and neonatal deaths can be prevented through uptake of essential antenatal, intrapartum, and postnatal interventions received during routine MNH visits. Not all women, however, receive all recommended routine visits across the MNH Continuum of Care (CoC) in Nepal. This study examined the patterns and determinants of (dis)continuity of care across the MNH continuum. Methods The study included 1,978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The outcome variable was (dis)continuity of care at different stages of MNH visits (at least four antenatal care (4ANC) visits, institutional delivery, and postnatal care (PNC) visit). Several structural, intermediary and health system explanatory variables were included in the analysis. Multinomial logistic regression analysis was conducted, and the magnitude of (dis)continuity of care was reported as relative risk ratios (RR) with 95% confidence intervals (CIs). The statistical significance level was set p<0.05. Results More than two-in-five (41%) women in Nepal received all three MNH visits across the CoC. There was high risk of discontinuity of care during months or weeks prior to childbirth or around childbirth. Higher risk of discontinuation across the CoC was reported among women of disadvantaged ethnic groups, lower wealth status and illiterate. Similarly, women who speak Bhojpuri, provinces six and seven, who had higher birth order (≥4), who involved in agricultural sector, had unwanted last birth had higher risk of discontinuation of MNH visits. Women did not complete all MNH visits if they had poor awareness on health mother groups and if they perceived problem of not having female healthcare providers. Conclusions Women had poor completion of all routine MNH visits. High discontinuation was observed among disadvantaged groups across the COC. Regular monitoring using the composite indicator of continuity of care through routine health management information system is required. Program approaches should focus on disadvantaged women to improve the completion of routine MNH visits and uptake of essential interventions.

scholarly journals Women’s experiences of maternal and newborn health care services and support systems in Buikwe District, Uganda: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261414
Author(s):  
Marte Bodil Roed ◽  
Ingunn Marie Stadskleiv Engebretsen ◽  
Robert Mangeni ◽  
Irene Namata
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Services ◽  
Health Workers ◽  
Newborn Health ◽  
Postnatal Period ◽  
Maternal And Newborn Health ◽  
Care Services ◽  
Professional Health ◽  
Maternal And Newborn

Background Uganda continues to have a high neonatal mortality rate, with 20 deaths per 1000 live births reported in 2018. A measure to reverse this trend is to fully implement the Uganda Clinical Guidelines on care for mothers and newborns during pregnancy, delivery and the postnatal period. This study aimed to describe women’s experiences of maternal and newborn health care services and support systems, focusing on antenatal care, delivery and the postnatal period. Methods We used triangulation of qualitative methods including participant observations, semi-structured interviews with key informants and focus group discussions with mothers. Audio-recorded data were transcribed word by word in the local language and translated into English. All collected data material were stored using two-level password protection or stored in a locked cabinet. Malterud’s Systematic text condensation was used for analysis, and NVivo software was used to structure the data. Findings Antenatal care was valued by mothers although not always accessible due to transport cost and distance. Mothers relied on professional health workers and traditional birth attendants for basic maternal services but expressed general discontentment with spousal support in maternal issues. Financial dependency, gender disparities, and lack of autonomy in decision making on maternal issues, prohibited women from receiving optimal help and support. Postnatal follow-ups were found unsatisfactory, with no scheduled follow-ups from professional health workers during the first six weeks. Conclusions Further focus on gender equity, involving women’s right to own decision making in maternity issues, higher recognition of male involvement in maternity care and improved postnatal follow-ups are suggestions to policy makers for improved maternal care and newborn health in Buikwe District, Uganda.

scholarly journals Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Resham B. Khatri ◽  
Yibeltal Alemu ◽  
Melinda M. Protani ◽  
Rajendra Karkee ◽  
Jo Durham
Keyword(s):  
Institutional Delivery ◽  
Secondary Analysis ◽  
Newborn Health ◽  
Household Survey ◽  
Universal Coverage ◽  
Maternal And Newborn Health ◽  
Multiple Forms ◽  
Wealth Status ◽  
Cross Sectional ◽  
Maternal And Newborn

Abstract Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.

Training health workers to provide person-centred maternal and newborn health care in Burkina Faso

2013 ◽  
Vol 3 (2) ◽  
pp. 154-159
Author(s):  
Janet Perkins ◽  
Aminata Bargo ◽  
Cecilia Capello ◽  
Carlo Santarelli
Keyword(s):  
Health Care ◽  
Burkina Faso ◽  
Health Care Providers ◽  
Health Workers ◽  
Healthcare Providers ◽  
Newborn Health ◽  
World Health ◽  
Maternal And Newborn Health ◽  
Care Providers ◽  
Maternal And Newborn

Assuring the provision of person-centred care is critical in maternal and newborn health (MNH). As a component of the national strategy to improve MNH, Burkina Faso Ministry of Health, supported by Enfants du Monde, La Fondation pour le Développement Communautaire/Burkina Faso and UNFPA, is implementing the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH. As a first step in district implementation, participatory community assessments were conducted. These assessments consistently revealed that poor interactions with healthcare providers posed one important barrier preventing women from seeking MNH services. In order to address this barrier, healthcare providers were trained to improve their interpersonal skills and in counselling women. During 2011-12 a total of 175 personnel were trained over a 5-day course developed using a WHO manual. The course was met with enthusiasm as providers expressed their need and desire for such training. Immediate post-test results revealed an impressive increase in knowledge and anecdotal evidence suggests that training has influenced provider’s behaviours in their interactions with women. In addition, health care providers are taking concrete action to build the capabilities of women to experience pregnancy and birth safely by engaging directly with communities.  While early findings are promising, an evaluation will be necessary to measure how the training has influenced practices, whether this translates into a shift of perceptions at community level and ultimately its contribution toward promoting person-centred care in Burkina Faso.

scholarly journals Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

2022 ◽  
Vol 5 (1) ◽  
pp. 1-18
Author(s):  
Lucy Natecho Namusonge ◽  
Maximilla N. Wanzala ◽  
Edwin K. Wamukoya
Keyword(s):  
Maternity Care ◽  
Newborn Health ◽  
Health Facilities ◽  
Respectful Maternity Care ◽  
Maternal And Newborn Health ◽  
Disrespect And Abuse ◽  
Live Births ◽  
Experience Of Care ◽  
Maternal And Newborn

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

scholarly journals “That’s a woman’s problem”: a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Vandana Sharma ◽  
Jessica Leight ◽  
Nadège Giroux ◽  
Fatima AbdulAziz ◽  
Martina Bjorkman Nyqvist
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Health ◽  
Male Involvement ◽  
Maternal And Newborn Health ◽  
Northern Nigeria ◽  
Care Seeking ◽  
Health Providers ◽  
Post Partum Period ◽  
Maternal And Newborn

Abstract Background Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria. Methods This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori. Results This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members. Conclusion These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women’s autonomy and avoiding reinforcement of gender inequitable roles and behaviors.

Combined clinical audits and low-dose, high-frequency, in-service training of health care providers and community health workers to improve maternal and newborn health in Mali: protocol for a pragmatic cluster randomized trial (Preprint)

2021 ◽  
Author(s):  
David Zombre ◽  
Diego Bassani ◽  
Farhana Zareef ◽  
Moussa Doumbia ◽  
Sekou Doumbia ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Classroom Setting ◽  
Care Providers ◽  
Mortality And Morbidity ◽  
Hands On ◽  
Service Training ◽  
Maternal And Newborn

BACKGROUND Despite most births in Mali occurring in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly due to existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. OBJECTIVE This trial aims to assess the effectiveness, and cost-effectiveness, of an intervention combining clinical audits and low-dose high-frequency (LDHF) in-service training of health care providers and community health workers in reducing perinatal mortality. METHODS The study is a three-arm cluster RCT in the Koulikoro region, in Mali. The unit of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits followed by one-day LDHF training biweekly, for 6 months. The health workers in second intervention arm (28 facilities), will receive a refresher course in Maternal, Newborn and Child Health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcome are perinatal deaths in the intervention arms compared to the control arm. A final sample of approximately 600 deliveries per cluster is expected, for a total of 30,000 newborns over 14 months. Data sources include both routine health records and follow-up household surveys of all women who recently gave birth in study facility 7 days post-delivery. Data collection tools will capture perinatal deaths, complications and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. RESULTS NA CONCLUSIONS The results will provide policy makers and practitioners crucial information on both the impact of different healthcare provider training modalities on maternal and newborn health outcomes, and how to successfully implement these strategies in resource-limited settings. CLINICALTRIAL Trial registration: ClinicalTrials.gov NCT03656237, registered on September 4, 2018.

scholarly journals Maternal and newborn health priority setting partnership in rural Uganda in association with the James Lind Alliance: a study protocol

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
James Ditai ◽  
Monicah Nakyazze ◽  
Deborah Andrinar Namutebi ◽  
Proscovia Auma ◽  
Martin Chebet ◽  
...  
Keyword(s):  
Health Workers ◽  
Newborn Health ◽  
Adverse Outcomes ◽  
Maternal And Newborn Health ◽  
Face To Face ◽  
The Public ◽  
James Lind Alliance ◽  
Research Questions ◽  
Eastern Uganda ◽  
Maternal And Newborn

Abstract Background Maternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore ‘why maternal and newborn adverse outcomes continue to occur. The objectives of the study include; To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural Uganda To establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in Uganda To support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda. Methods The present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers’ group and partners’ group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops. The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations. We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda. Discussion The current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys. This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting.

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