scholarly journals Maternity waiting home as a potential intervention for reducing the maternal mortality ratio in El Salvador: an observational case study

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Hee sang Yoon ◽  
Chong-Sup Kim
Keyword(s):  
El Salvador ◽  
Maternal Mortality Ratio ◽  
Health Indicators ◽  
Skilled Birth Attendance ◽  
Fertility Rate ◽  
Birth Attendance ◽  
Maternity Waiting Homes ◽  
Health Factors ◽  
Mortality Ratio

Abstract Background El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Methods We ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country. Results El Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes. Conclusions The reason for the unexplained reduction in El Salvador’s MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes.

scholarly journals Maternity Waiting Home and Maternal Mortality Ratio in EI Salvador

2020 ◽  
Author(s):  
Heesang Yoon ◽  
Chong-sup Kim
Keyword(s):  
Maternal Mortality ◽  
El Salvador ◽  
Maternal Mortality Ratio ◽  
Health Indicators ◽  
Skilled Birth Attendance ◽  
Fertility Rate ◽  
Birth Attendance ◽  
Health Factors ◽  
Mortality Ratio ◽  
Maternity Waiting Home

Abstract Background: El Salvador is recognized as a country which could effectively reduce the maternal mortality ratio (MMR). In El Salvador, there was an improvement in health indicators, such as fertility rate, adolescent fertility rate, skilled birth attendance, health expenditures, but this improvement was not extraordinary compared with other developing countries. The reason El Salvador could achieve an outstanding decrease in MMR in spite of a not so special improvement in health or non-health indicators, deserves a deep research.Methods: We used quantitative as well as qualitative methods to show that the reason El Salvador could reduce maternal mortality ratio more than expected is the health policy that not only aimed at reducing the (adolescent) fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home. As quantitative methods we ran regressions using maternal mortality ratio as dependent variable, health and non-health factors as independent variables. As qualitative methods, we carried out a case study of maternal waiting home in El Salvador.Results: El Salvador could reduce maternal mortality ratio through the improvement of health factors, such as fertility rate, skilled birth attendance, and non-health factors, such as GDP per capita and woman empowerment. However, even considering these factors, maternal mortality ratio of El Salvador decreased more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is more than expected from the regression results, can be attributed partly to the government measures, such as maternity waiting home.Conclusions: The reason of the unexplained reduction in El Salvador’s maternal mortality ratio seems to be attributable to the health policy that not only aimed at reducing the fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home.

Effectiveness of Official Development Assistance in the Health Sector in Africa: A Case Study of Uganda

2020 ◽  
pp. 0272684X2091804
Author(s):  
Cyriaque Rene Sobtafo Nguefack
Keyword(s):  
Infant Mortality ◽  
Maternal Mortality ◽  
Development Assistance ◽  
Maternal Mortality Ratio ◽  
Health Sector ◽  
Health Indicators ◽  
Mortality Rates ◽  
Official Development Assistance ◽  
Mortality Ratio

This qualitative explanatory case study assessed the influence of Official Development Assistance on selected health development indicators in Uganda between 2005 and 2013 by reviewing development partners’ perceptions. Key health indicators included the following: (a) under 5-year-old mortality rates, (b) infant mortality rates, and (c) maternal mortality ratio. Results indicated slow progress in reducing infant mortality and under-5 mortality rates and almost no progress in the maternal mortality ratio despite the disbursement of a yearly average of nearly $400 million USD in the last 7 years to the health sector in Uganda. Five bottlenecks in the influence of development assistance on health indicators were identified: (a) poor governance and accountability framework in the country, (b) ineffective supply chain of health commodities, (c) negative cultural beliefs, (d) insufficient government funding to health care, and (e) insufficient alignment of development assistance to the National Development Plan and noncompliance with the Paris Declaration on Aid Effectiveness.

scholarly journals Stakeholders’ Perspectives on the Implementation of Maternity Waiting Homes in Rural Ethiopia: A Qualitative Study

2021 ◽  
Author(s):  
Mekdes Kondale Gurara ◽  
Jean-Pierre Geertruyden ◽  
Yves Jacquemyn ◽  
Veerle Draulans
Keyword(s):  
Geographic Area ◽  
Skilled Birth Attendance ◽  
Cultural Barriers ◽  
Group Discussions ◽  
Healthcare Facilities ◽  
Rural Ethiopia ◽  
Guide Field ◽  
Birth Attendance ◽  
Maternity Waiting Homes ◽  
Field Notes

Abstract Background The rural community in Ethiopia is scattered over a wide geographic area, some regions with difficult mountains, making access to healthcare facilities a great challenge. To overcome geographical barriers and improve access to skilled childbirth care, maternity waiting homes (MWHs), shelters built nearby health facilities, where pregnant women are lodged until labour begins, were introduced decades ago. This study identifies the demand and supply-side determinants of access to MWH services in rural Ethiopia. Methods This descriptive, exploratory study included five focus group discussions and eight in-depth interviews using a semistructured interviewer guide. Field notes were collected, and interviews were audio-recorded. Using Quirkois®, data were coded, transcribed verbatim, translated into English, and analyzed following Penchansky and Thomas’s modified framework of access. Results The study identified several challenges of the implementation of the MWH program in the study area. Subthemes that emerged from the discussions were lack of awareness about the MWH services, geographic inaccessibility, inadequacy of facilities and unaffordability-related issues, substandard and culturally insensitive care at MWHs, and logistic barriers. Most participants rated the MWH quality as poor and requested better MWH services to promote access to skilled birth attendance. Conclusions Several contextual, structural and socio-cultural barriers have been hindering the implementation of MWHs in the study area. To improve women’s access to skilled childbirth, it is crucial to tailor context-based MWH messages, upgrade existing MWHs and ensure that the services are culturally sensitive.

scholarly journals Implementing the skilled birth attendance strategy in Uganda: a policy analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Susan Munabi-Babigumira ◽  
Harriet Nabudere ◽  
Delius Asiimwe ◽  
Atle Fretheim ◽  
Kristin Sandberg
Keyword(s):  
Human Resources ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Obstetric Care ◽  
Skilled Birth Attendance ◽  
Decision Makers ◽  
Birth Attendance ◽  
Nurse Midwife ◽  
Physical Infrastructure ◽  
Attendance Policy

Abstract Background Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda’s skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. Methods This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. Results The skilled birth attendance policy was an important priority on Uganda’s maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. Conclusion Uganda’s skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

scholarly journals Childbirth Experiences and Delivery Care During Times of War: Testimonies of Syrian Women and Doctors

2021 ◽  
Vol 2 ◽  
Author(s):  
Hyam Bashour ◽  
Mayada Kharouf ◽  
Jocelyn DeJong
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Secondary Analysis ◽  
Health Indicators ◽  
Lessons Learned ◽  
Delivery Care ◽  
Care Providers ◽  
Near Misses ◽  
Birth Attendance ◽  
Depth Interviews

Background: Until the eruption of violence in 2011, Syria made good progress in improving maternal health indicators including reducing the maternal mortality ratio and increasing the level of skilled birth attendance. The war in Syria has been described as one of the worst humanitarian crises in recent times. Damascus Maternity Teaching Hospital is the largest maternity public hospital in the country that survived the war and continued to provide its services even during periods of pronounced instability. The main aim of this paper is to highlight the experience of childbirth and delivery care as described by women and doctors at times of severe violence affecting Damascus.Methods: This paper is based on secondary analysis of qualitative data collected between 2012 and 2014 for a WHO-funded implementation research project introducing clinical audits for maternal near-misses. This analysis specifically looked at the effects of violence on the childbirth experience and delivery care from the perspective of both women and physicians. A total of 13 in-depth interviews with women who had recently delivered and survived a complication and 13 in-depth interviews with consultant obstetricians were reviewed and analyzed, in addition to three focus group discussions with 31 junior care providers.Results: Three themes emerged concerning the experiences of women and doctors in these times of war. First, both women and doctors experienced difficulty reaching the hospital and accessing and providing the services, respectively; second, quality of care was challenged at that time as perceived by both women and doctors; and third, women and doctors expressed their psychological suffering in times of hardship and uncertainty and how this affected them.Conclusions: Efforts to safeguard the safety of delivery and prevent maternal mortality in Syria continued despite very violent and stressful conditions. Both women and providers developed strategies to navigate the challenges posed by conflict to the provision of delivery care. Lessons learned from the experiences of both women and doctors should be considered in any plans to improve maternal healthcare in a country like Syria that remains committed to achieving the Sustainable Development Goals in 2030 in the aftermath of nearly 10 years of war.

scholarly journals The influence of quality and respectful care on the uptake of skilled birth attendance in Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Myrrith Hulsbergen ◽  
Anke van der Kwaak
Keyword(s):  
Quality Of Care ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Healthcare Providers ◽  
Skilled Birth Attendance ◽  
Birth Preparedness ◽  
Disrespectful Care ◽  
Birth Attendance ◽  
Respectful Care

Abstract Background An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. Methods This narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included. Results Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels. Conclusions To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.

scholarly journals Maternal Mortality: Paradigm Shift in Nepal

2014 ◽  
Vol 7 (2) ◽  
pp. 3-8 ◽  
Author(s):  
TR Bhadari ◽  
G Dangal
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Health Indicators ◽  
Millennium Development Goal ◽  
Care Providers ◽  
Continuous Assessment ◽  
Development Goal ◽  
Quality Health ◽  
Mortality Ratio

Achieving Millennium Development Goal (MDG) 5 still remains a challenge to Nepal. It is necessary to collect reliable evidence on maternal health for tackling MDG 5 with limited resources. A continuous assessment of maternal mortality is required to assure the progress towards the MDG 5. This study aims to assess the results of the different studies on maternal mortality in Nepal.The results published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2012 have been utilized to prepare this paper. In spite of the low proportion of births attended by skilled persons and institutional delivery, the maternal mortality ratio (MMR) in Nepal has declined drastically between the years 1990 and 2011, from 850 to 229 deaths per 100,000 live births. In recent years, Nepal is also reaching progress in different maternal health indicators such as mothers receiving antenatal care from skilled providers (60%- up from 24% in 1996). More than one-third births in the past five years have been assisted by skilled care providers. Nearly, 45% of women received postnatal care for their last birth in the first two days after delivery, 38% of women is aware of abortion which has been legalized since 2003.Though maternal health is a priority agenda of Nepal among the policy makers and the country is likely to achieve Millennium Development Goal 5 by the year 2015, there is still a wide gap between policies and charted targets, and the real accessibility and availability of the quality health services. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11132   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 3-8

The Genesis and Internal Dynamics of El Salvador's People's Revolutionary Army, 1970–1976

2014 ◽  
Vol 38 (01) ◽  
pp. 102-129
Author(s):  
ALBERTO MARTÍN ÁLVAREZ ◽  
EUDALD CORTINA ORERO
Keyword(s):  
Latin America ◽  
El Salvador ◽  
Early Years ◽  
Left Wing ◽  
Internal Dynamics ◽  
Internal Coherence ◽  
The 1960S

AbstractUsing interviews with former militants and previously unpublished documents, this article traces the genesis and internal dynamics of the Ejército Revolucionario del Pueblo (People's Revolutionary Army, ERP) in El Salvador during the early years of its existence (1970–6). This period was marked by the inability of the ERP to maintain internal coherence or any consensus on revolutionary strategy, which led to a series of splits and internal fights over control of the organisation. The evidence marshalled in this case study sheds new light on the origins of the armed Salvadorean Left and thus contributes to a wider understanding of the processes of formation and internal dynamics of armed left-wing groups that emerged from the 1960s onwards in Latin America.

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