Readiness for implementation of preconception care in Uganda; a review on the current policy, health system barriers, opportunities and way forward

2021 ◽  
Vol 7 (3) ◽  
pp. 68-72
Author(s):  
Isabirye Nathan ◽  
Agnes Nyabigambo ◽  
Agnes Kayego ◽  
Peter Waiswa ◽  
Kele Moley ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Preconception Care ◽  
Service Integration ◽  
Health Indicators ◽  
Preconception Health ◽  
Low Income Countries ◽  
Health Seeking ◽  
Related Factors ◽  
Short Baseline

Background: Uganda like other low-income countries, preconception health has received no attention. Communications in this article are derived from preliminary findings of an ongoing preconception baseline pilot in Luuka-a rural eastern district of Uganda. This is a phased study, including a desk review of literature and a short baseline pilot. Methods: The review followed the methodology of systematic reviews. Key electronic databases were searched including PUBMED/MEDLINE and google scholar. Also, reports from ministries/academic institution libraries and views from experts were done. English articles published post 2000, covering preconception care, barriers, facilitators and policies were included in the review. Out of 110 shortlisted abstracts, 28 were included. Studies were extracted onto structured formats and analysed using the narrative synthesis approach. Results: There exist unstructured preconception health and service guidelines in Uganda. Barriers to preconception service integration into the district’s health system include; lack of a clear policy, careworn health system and care seeker related factors. Opportunities for preconception service integration include; poor maternal and neonatal health indicators, positive change in health seeking behaviour, existence of a gap in the care continuum, functional VHT system to link the community to services, anticipated roll out of key family care practises by Ministry of Health Uganda, and improved access to radio & mobile phones. Conclusion: Formulation of clear preconception guidelines, testing health system integration approaches, stakeholders’ engagement, awareness creation and strengthening the supply side is recommended as a way forward

scholarly journals Global Surgery, Obstetric, and Anesthesia Indicator Definitions and Reporting: An Utstein Consensus Report

2021 ◽  
Author(s):  
Justine Ina Davies ◽  
Adrian W. Gelb ◽  
Julian Gore-Booth ◽  
Janet Martin ◽  
Jannicke Mellin-Olsen ◽  
...  
Keyword(s):  
Low Income ◽  
Data Science ◽  
Health Indicators ◽  
Obstetric Care ◽  
Global Surgery ◽  
Low Income Countries ◽  
Financial Risk Protection ◽  
Current Time ◽  
Timely Access ◽  
Data Points

Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define - for the first time - the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a two day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high, middle, and low income countries. Considering each of the six indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2-5 (intermediate) and >5 year (full) timeframes. We removed one of the original six indicators (one of two financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. Conclusions To track global progress toward timely access to quality SAO care, these indicators – at the basic level - should be implemented universally. Intermediate and full evolutions will assist in developing national surgical plans, and collecting data for research studies.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

Reducing the distance to walk: establishing a remote maternity facility in Runga, Hoima District, Uganda

2020 ◽  
Vol 14 (2) ◽  
pp. 1-8
Author(s):  
Rhiannon Grindle ◽  
Sofia Giannopoulou ◽  
Harriet Jacobs ◽  
Jerome Barongo ◽  
Alexandra Elspeth Cairns
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Local Level ◽  
Substantial Reduction ◽  
Care Quality ◽  
Low Income Countries ◽  
Health Seeking ◽  
Birth Attendance

Despite a substantial reduction in global maternal mortality, rates in low-income countries remain unacceptably high. Multiple contributing factors exist, grouped into three delays: health-seeking behaviour; accessibility of care; quality of care. In the Hoima District, rates of health facility delivery and skilled birth attendance remain low and maternal mortality exceeds the national average. Establishing the Midwives At Maternity Azur Clinic (February 2017) has addressed these issues at a local level. Health education and antenatal care are provided at the clinic, encouraging women to seek timely, appropriate intrapartum care. Access from surrounding villages is facilitated by a waiting home and weekly transport for antenatal care, alongside transport to a health facility with a staffed operating theatre, when required. It is run by a resident midwife, with regular training updates, and is stocked with the necessary resources for quality healthcare. Since its advent, village leaders report all-cause burials have reduced from one a day to one a week.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

2019 ◽  
Vol 34 (8) ◽  
pp. 618-624
Author(s):  
Anatole Manzi ◽  
Alyssa Ierardo ◽  
Jean Claude Mugunga ◽  
Cate Oswald ◽  
Patrick Ulysse ◽  
...  
Keyword(s):  
Global Health ◽  
Health System ◽  
Low Income ◽  
Program Implementation ◽  
Quality Care ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Global Movement ◽  
Active Implementation

Abstract The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

scholarly journals Out-of-Pocket Expenditures on Health: A Global Stocktake

2020 ◽  
Vol 35 (2) ◽  
pp. 123-157 ◽  
Author(s):  
Adam Wagstaff ◽  
Patrick Eozenou ◽  
Marc Smitz
Keyword(s):  
Health System ◽  
Low Income ◽  
Poverty Line ◽  
Low Income Countries ◽  
Two Measures ◽  
Per Capita ◽  
Summary Measures ◽  
The Rich ◽  
Catastrophic Expenditures ◽  
Highly Correlated

Abstract This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals Epidemiology and determinant factors of neural tube defect: Narrative review

2020 ◽  
Vol 11 ◽  
pp. 81
Author(s):  
Melese Linger Endalifer ◽  
Gedefaw Diress
Keyword(s):  
Neural Tube ◽  
Neural Tube Defect ◽  
Low Income ◽  
Low Income Countries ◽  
Medical Illness ◽  
Related Factors ◽  
Mortality And Morbidity ◽  
Determinant Factors ◽  
Geographical Regions ◽  
Behavioral Nutrition

Background: The epidemiology of neural tube defect (NTD) is face ignorance from the global community. However, the problem is complex and it is a cause for child mortality and morbidity. We provide the latest insights with respect to determinant factors of NTD. Methods: Google Scholar and PubMed were systematically searched to identify potential research articles concerning the epidemiology and its determinant factors of NTD. Results: The epidemiology of Neural tube defects increased in some countries. The epidemiology and determinant factors were varies across countries,geographical regions and socioeconomic status of the populations. In general, the determinant factors of NTD were summarized as behavioral, nutrition-related, environmental, medical illness, and health service-related factors. Conclusion: Birth defect is fatal which affects the new generation; specifically, NTD is the problem of middle- and low-income countries. It is a direct cause for neonatal and perinatal mortality rate globally. Even if little factors identified, yet conducting experimental and clinical trial researches are a better approach to slow down the progress.

scholarly journals Health Literacy and Health Behavior Among Women in Ghazni, Afghanistan

2021 ◽  
Vol 9 ◽  
Author(s):  
Stefanie Harsch ◽  
Asadullah Jawid ◽  
Ebrahim Jawid ◽  
Luis Saboga-Nunes ◽  
Kristine Sørensen ◽  
...  
Keyword(s):  
Health Literacy ◽  
Health Behavior ◽  
Low Income ◽  
Help Seeking ◽  
Health Indicators ◽  
Low Income Countries ◽  
Health Related ◽  
Public Health Challenge ◽  
The Relationship ◽  
Voluntary Basis

Background:Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors.Methods:From May to June 2017, we randomly recruited 7–10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15–61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior.Results:Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior.Conclusion:This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.

scholarly journals Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

2021 ◽  
Vol 15 ◽  
pp. 135-141
Author(s):  
Mayssa A. Traboulsi ◽  
Zainab. El Alaoui Talibi ◽  
Abdellatif Boussaid
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Low Income ◽  
Health Indicators ◽  
Penalized Regression ◽  
Low Income Countries ◽  
Medical Surveillance ◽  
Spontaneous Preterm Birth ◽  
Multiparous Women ◽  
Low Prevalence

Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Machine learning methods have been used to predict PTB but the low prevalence of this pregnancy complication led to rather low prediction values. The objective of this study was to produce a nomogram based on improved prediction for low prevalence PTB using up sampling and lasso penalized regression. We used data from a cohort study in Northern Lebanon of 922 multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. The improved Positive Predictive Value for PTB reached around 88%. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. The physicians can use this tool to screen for women at high risk for spontaneous preterm birth to improve medical surveillance that can reduce PTB incidence.

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