scholarly journals Free Maternal and Child Health Services in Enugu State, South East Nigeria: Experiences of the Community and Health Care Providers

Author(s):  
Uzochukwu Benjamin ◽  
Okwuosa Chinenye ◽  
Ezeoke Ogochukwu ◽  
Onwujekwe Obinna
2019 ◽  
Author(s):  
Eveline Muika Kabongo ◽  
Ferdinand Mukumbang ◽  
Peter N/A Delobelle ◽  
Edward N/A Nicol

Abstract Introduction Despite the growing global application of mobile health (mHealth) technology in maternal and child health, the contextual factors and mechanisms by which interventional outcomes are generated have not been subjected to extensive review. In this study, we sought to identify context, mechanisms and outcome elements from implementation and evaluation studies of mHealth interventions to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and new mothers.Method An electronic search of six online databases (Medline, Pubmed, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate MeSH terms and selection procedure, 32 articles were considered for analysis. A theory-driven approach, narrative synthesis, was applied to synthesise the data. Thematic content analysis was used to delineate the elements of the intervention, including its context, actors, mechanism and outcomes. Retroduction was applied to link these elements using a realist evaluation heuristic to form generative theories.Results Mechanisms that promote the implementation of mHealth by community health workers/health care providers include motivation, perceived skill and knowledge improvement, improved self-efficacy, improved confidence, improved relationship between community health workers and clients, perceived support of community health workers, perceived ease of use and usefulness of mHealth, For pregnant women and new mothers, mechanisms that trigger the uptake of mHealth and use of maternal and child health services included: perceived service satisfaction, perceived knowledge acquisition, support and confidence, improved self-efficacy, encouragement, empowerment and motivation. Information overload was identified as a potential negative mechanism for the uptake of maternal and child health services.Conclusion The models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how they improve maternal and child health services in low and middle income countries. These models provide a foundation for the ‘white box’ or theory-driven evaluation of mHealth intervention and can improve the rollout and implementation where required.


2022 ◽  
Author(s):  
Chalachew Bekele ◽  
Delayehu Bekele ◽  
Bezawit Hunegnaw ◽  
Kimiko Van Wickle ◽  
Fanos Ashenafi ◽  
...  

Introduction: Ethiopia registered its first case of COVID-19 on March 13, 2020. We aimed to assess maternal, newborn, and child health care (MNCH) utilization during the first six months of the COVID-19 pandemic, as well as potential barriers and enablers of service utilization from health care providers and clients. Methods: Mixed study design was conducted as part of the Birhan Health and Demographic Surveillance System in Ethiopia. The trend of service utilization during the first six months of COVID-19 was compared to corresponding time and data points of the preceding year. Result: Service utilization of new family planning visits (43.2 to 28.5/month, p = 0.014) and sick under five child visits (225.0 to 139.8/month, P = 007) declined during the initial six months of the pandemic compared to the same period in the preceding year. Antenatal and postnatal care visits, facility delivery rates, and child routine immunization visits also decreased although this did not reach statistical significance. Interviews with health care providers and clients highlighted several barriers to service utilization during COVID-19, including fear of disease transmission, economic hardship, and transport service disruptions and restrictions. Enablers of service utilization included communities' decreased fear of COVID-19, and awareness-raising activities. Conclusion: Provision of essential MNCH services is crucial to ascertain favorable maternal and child health outcomes. In low- and middle-income country settings like Ethiopia, health systems might be fragile to withstand the caseloads and priority setting due to the pandemic. Our study presents early findings on the utilization of MNCH services that were maintained except sick child and new family planning visits. Government leaders, policy makers, and clinicians who wish to improve the resilience of their health system will need to continuously monitor service utilization and clients' evolving concerns during the pandemic to prevent increases in maternal and child morbidity and mortality.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 690-690
Author(s):  
Celeste Sununtnasuk ◽  
Phuong Nguyen ◽  
Anjali Pant ◽  
Lan Mai Tran ◽  
Shivani Kachwaha ◽  
...  

Abstract Objectives The COVID-19 pandemic is expected to have extensive effects on healthcare systems. The Government of Bangladesh has concerns about diminished coverage and quality of maternal and child health services, but little published information exists on service provision, utilization, and adaptations. We examined changes to maternal and child health and nutrition service delivery and utilization in urban Bangladesh during and after the enforcement of COVID-19 restrictions and identified adaptations and potential solutions to strengthen service delivery and uptake. Methods We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children < 2 years (n = 387) in February 2020 (in-person) and September 2020 (by phone). We used Wilcoxon matched-pairs signed-rank tests to compare the changes before and during the pandemic. Results Most services for pregnant women remained available during COVID-19 restrictions, with the provision of antenatal care (ANC) services falling by 6.6 percentage points (pp). Services for women and children which require proximity, however, were more severely affected; weight and height measurements fell by 20–29pp for pregnant women and 37–57pp for children, and child immunizations fell by 38pp. Declines in service utilization were large, including drops in facility visitations (35pp among pregnant women and 67pp among mothers), health and nutrition counseling (up to 73pp), child weight measurements (50pp), and immunizations (61pp). The primary method of adaptation was provision of services over phone (37% for ANC services and 44–49% for counselling of pregnant women or mothers with young children). Conclusions Despite adaptations to service provisions, continued availability of routine maternal and child health services did not translate into service utilization. Further investments are needed to provide timely and accurate information on COVID-19 to the public, improve COVID-19 training and provide incentives for health care providers, and ensure availability of personal protective equipment for both providers and beneficiaries. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI Solutions.


2020 ◽  
Author(s):  
Eveline Muika Kabongo ◽  
Ferdinand Mukumbang ◽  
Peter N/A Delobelle ◽  
Edward N/A Nicol

Abstract Introduction Despite the growing global application of mobile health (mHealth) technology in maternal and child health, the contextual factors and mechanisms by which interventional outcomes are generated have not been subjected to extensive review. In this study, we sought to identify context, mechanisms and outcome elements from implementation and evaluation studies of mHealth interventions to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and new mothers.Method An electronic search of six online databases (Medline, Pubmed, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate MeSH terms and selection procedure, 32 articles were considered for analysis. A theory-driven approach, narrative synthesis, was applied to synthesise the data. Thematic content analysis was used to delineate the elements of the intervention, including its context, actors, mechanism and outcomes. Retroduction was applied to link these elements using a realist evaluation heuristic to form generative theories.Results Mechanisms that promote the implementation of mHealth by community health workers/health care providers include motivation, perceived skill and knowledge improvement, improved self-efficacy, improved confidence, improved relationship between community health workers and clients, perceived support of community health workers, perceived ease of use and usefulness of mHealth, For pregnant women and new mothers, mechanisms that trigger the uptake of mHealth and use of maternal and child health services included: perceived service satisfaction, perceived knowledge acquisition, support and confidence, improved self-efficacy, encouragement, empowerment and motivation. Information overload was identified as a potential negative mechanism for the uptake of maternal and child health services.Conclusion The models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how they improve maternal and child health services in low and middle income countries. These models provide a foundation for the ‘white box’ or theory-driven evaluation of mHealth intervention and can improve the rollout and implementation where required.


Author(s):  
Pat U. Okpala ◽  
Chinwendu L. Okoye ◽  
Florence O. Adeyemo ◽  
Peace N. Iheanacho ◽  
Anthonia C. Emesonwu ◽  
...  

Background: Nigeria continues to have one of the highest rates of maternal mortality in the world at 814 deaths per 100,000 live births despite several efforts. Various factors can influence appropriate utilization of services during pregnancy, childbirth and postpartum. This study examined the perceived factors that influence the utilization of maternal and child-health services among mothers in Enugu, South-East Nigeria.Methods: A descriptive survey design was adopted for the study. The study population of 323 pregnant women was determined using the Power Analysis formula. The instrument used for data collection was a self-developed questionnaire. Demographic information of the women was also obtained for the study. The analysis was done with the software statistical package for Social Sciences (SPSS) Version 16.0. Study period was from April 2016 to August 2016.Results: There was high antenatal clinic attendance (93.1%) and utilization of postnatal care services (93.1%). Also, the major factors that influenced the utilization of maternal and child health services were professionally defined needs, accessibility of health care services and economic status.Conclusions: There was high utilization of maternal and child health care services which was influenced by some factors. There is a need for nurses and other health workers to be actively engaged in educating mothers during antenatal visits. Sustainable financial subsidies and community-based initiatives should be developed to encourage early antenatal clinic visits and to provide the necessary information on the importance of facility-based antenatal and postnatal care.


2020 ◽  
Author(s):  
Eveline Muika Kabongo ◽  
Ferdinand Mukumbang ◽  
Peter N/A Delobelle ◽  
Edward N/A Nicol

Abstract Background: Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers.Method: We undertook a realist synthesis. An electronic search of six online databases (Medline, PubMed, Google Scholar, Scopus, Academic Search Premier, and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories.Results: We formulated two configurational models illustrating how and why mHealth impacts the implementation and uptake of maternal and child care services. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation, and perceived ease of use and usefulness. These mechanisms were influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure, and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation, and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms were influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity, and awareness.Conclusion: Models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required.


2021 ◽  
Author(s):  
Senedu Bekele Gebreegziabher ◽  
Solomon Sisay Marrye ◽  
Tsegaye Hailu Kumssa ◽  
Kassa Haile Merga ◽  
Alemu Kibret Feleke ◽  
...  

Abstract Background In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic. Methods A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportions and mean with standard deviations were computed. T-test was used to assess statistically significant differences in services mean performance. Results PNC visit, new contraceptives accepters, safe abortion care and number of under-five years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (P-value < 0.001), respectively during the first eight months of the COVID-19 pandemic compared to the previous eight months’ average performance. The trends in ANC first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline between January-March 2020 when the COVID-19 pandemic began; with accelerated declines between April-June 2020 following national lockdown. The trends for the stated services began to increase during July-September 2020, during the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January-March 2021when this study was completed. Conclusions Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July-September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.


2019 ◽  
Vol 3 (2) ◽  
pp. 43
Author(s):  
Aplonia PALA ◽  
Endang LARASATI ◽  
Sri SUWITRI ◽  
Ngalimun NGALIMUN

Health care is a human right for communities who arranged mandatory organized by government mandate bases on Constitution 1945. Maternal health services include antenatal, childbirth services and parturition. While children's services are, include the ministries of the newborn, baby and toddlers. In North Central Timor Regency (TTU) in the last five years maternal mortality (AKI), infant mortality (AKB) and Mortality Toddler (AKABA) is very fluctuating. This illustrates that the district health degree requires revamping TTU Regency thoroughly of all aspects related to it. The acceleration of the decline in the mortality rate of mothers, babies and toddlers will improve public health degrees in North Central Timor. This done through community empowerment approach in the field of maternal and child health in which the community does not placed as health development destinations but placed as subjects of health development to enhance the knowledge, attitudes and behavior as well as self-reliance community for healthy living. Community empowerment in the health field can be encouraged through the Health Efforts Resource of Community (UKBM) such as the village health post, a postal village, the construction of an integrated, unified service and post maternity huts are scattered in the whole area villages of North Central Timor. Through community empowerment in the health community field, getting involved is active in the health service because the public join the plan, monitor, evaluate and keep maternal and child health services According to applicable minimum service standard. It can also increase public awareness in the mindset and behave clean living and healthy because of the maternal and child health issues in North Central Timor Regency not only just the responsibility of the Department of Health of North Central Timor, but also be the responsibility of all elements in society. Therefore it takes cooperation of cross-program and cross-sector, i.e. Government Sectors, Private Sector, Community and Health Care in this area so as able to increase the degree of maternal and child health in North Central Timor Regency. Key words: Public Health, North Central Timor Regency,Empowerment, Community HealthHealth Resources.


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