scholarly journals Impact of A Maternal and Newborn Health Results Based Financing Intervention (RBF4MNH) On Stillbirth: A Cross-Sectional Comparison in Four Districts in Malawi.

2020 ◽  
Author(s):  
Regina Makuluni ◽  
William Stones
Keyword(s):  
Positive Impact ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Odds Ratios ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
The Government ◽  
The Impact ◽  
Maternal And Newborn ◽  
Results Based Financing

Abstract Background: A Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” was implemented by the Government of Malawi in four Districts, with the aim of improving health outcomes. We used this setting to examine the impact of this model on antepartum and intrapartum stillbirth, taking women’s risk factors into account. Methods: We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. The result based finance for maternal and newborn health intervention was ongoing in two districts and two non-intervention districts were used for comparison. Data were extracted from the maternity registers and analyzed using STATA version 14. Logistic regression models were developed to determine crude and adjusted odds ratios for fresh and macerated stillbirth. Results: In the study period there were 67 stillbirths among 2,772 deliveries representing 24.1 per 1,000 live births of which 52% (n=35) were fresh (intrapartum) stillbirths and 48% (n=32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P=0.01) and 7.27 (95%CI 2.74 to 19.25 P<0.001) respectively.Gestational age at delivery was significantly associated with stillbirths. Conclusion: The study did not identify a positive impact of result based finance for maternal and newborn health on the reduction of both fresh and macerated stillbirths. There is a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care.

scholarly journals Impact of a maternal and newborn health results-based financing intervention (RBF4MNH) on stillbirth: a cross-sectional comparison in four districts in Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regina Makuluni ◽  
William Stones
Keyword(s):  
Risk Factors ◽  
Positive Impact ◽  
Newborn Health ◽  
Public Hospitals ◽  
Maternal And Newborn Health ◽  
Cross Sectional ◽  
Randomised Study ◽  
The Impact ◽  
Maternal And Newborn ◽  
Results Based Financing

Abstract Background Malawi implemented a Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” at public hospitals in four Districts, with the aim of improving health outcomes. We used this context to seek evidence for the impact of this intervention on rates of antepartum and intrapartum stillbirth, taking women’s risk factors into account. Methods We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. We purposively selected two districts hosting the RBF4MNH intervention and two non-intervention districts for comparison. Data were extracted from the maternity registers and used to develop logistic regression models for variables associated with fresh and macerated stillbirth. Results We identified 67 stillbirths among 2772 deliveries representing 24.1 per 1000 live births of which 52% (n = 35) were fresh (intrapartum) stillbirths and 48% (n = 32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P = 0.01) and 7.27 (95%CI 2.74 to 19.25 P < 0.001) respectively. Among the risk factors examined, gestational age at delivery was significantly associated with increased odds of stillbirth. Conclusion The study did not identify a positive impact of this RBF model on the risk of fresh or macerated stillbirth. Within the scientific limitations of this non-randomised study using routinely collected health service data, the findings point to a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care, in order to reduce the burden of stillbirths.

scholarly journals Protocol for PMA-Ethiopia: A new data source for cross-sectional and longitudinal data of reproductive, maternal, and newborn health

2020 ◽  
Vol 4 ◽  
pp. 126
Author(s):  
Linnea Zimmerman ◽  
Selam Desta ◽  
Mahari Yihdego ◽  
Ann Rogers ◽  
Ayanaw Amogne ◽  
...  
Keyword(s):  
Data Collection ◽  
Longitudinal Data ◽  
Newborn Health ◽  
Quality Data ◽  
Maternal And Newborn Health ◽  
Unique Contribution ◽  
Cross Sectional ◽  
Data Source ◽  
The Impact ◽  
Maternal And Newborn

Background: Performance Monitoring for Action Ethiopia (PMA-Ethiopia) is a survey project that builds on the PMA2020 and PMA Maternal and Newborn Health projects to generate timely and actionable data on a range of reproductive, maternal, and newborn health (RMNH) indicators using a combination of cross-sectional and longitudinal data collection.  Objectives: This manuscript 1) describes the protocol for PMA- Ethiopia, and 2) describes the measures included in PMA Ethiopia and research areas that may be of interest to RMNH stakeholders. Methods: Annual data on family planning are gathered from a nationally representative, cross-sectional survey of women age 15-49. Data on maternal and newborn health are gathered from a cohort of women who were pregnant or recently postpartum at the time of enrollment. Women are followed at 6-weeks, 6-months, and 1-year to understand health seeking behavior, utilization, and quality. Data from service delivery points (SDPs) are gathered annually to assess service quality and availability.  Households and SDPs can be linked at the enumeration area level to improve estimates of effective coverage. Discussion: Data from PMA-Ethiopia will be available at www.pmadata.org.  PMA-Ethiopia is a unique data source that includes multiple, simultaneously fielded data collection activities.  Data are available partner dynamics, experience with contraceptive use, unintended pregnancy, empowerment, and detailed information on components of services that are not available from other large-scale surveys. Additionally, we highlight the unique contribution of PMA Ethiopia data in assessing the impact of coronavirus disease 2019 (COVID-19) on RMNH.

scholarly journals Effect of results-based financing on facility-based maternal mortality at birth: an interrupted time-series analysis with independent controls in Malawi

2019 ◽  
Vol 4 (3) ◽  
pp. e001184
Author(s):  
Manuela De Allegri ◽  
Rachel P Chase ◽  
Julia Lohmann ◽  
Anja Schoeps ◽  
Adamson S Muula ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Newborn Health ◽  
Obstetric Care ◽  
Interrupted Time Series ◽  
Maternal And Newborn Health ◽  
Maternal Deaths ◽  
Care Facilities ◽  
The Impact ◽  
Maternal And Newborn ◽  
Results Based Financing

IntroductionThe aim of this study was to assess the impact of a results-based financing (RBF) programme on the reduction of facility-based maternal mortality at birth. Malawi is a low-income country with high maternal mortality. The Results-Based Financing For Maternal and Newborn Health (RBF4MNH) Initiative was introduced at obstetric care facilities in four districts to improve quality and utilisation of maternal and newborn health services. The RBF4MNH Initiative was launched in April 2013 as a combined supply-side and demand-side RBF. Programme expansion occurred in October 2014.MethodsControlled interrupted time series was used to estimate the effect of the RBF4MNH on reducing facility-based maternal mortality at birth. The study sample consisted of all obstetric care facilities in 4 intervention and 19 control districts, which constituted all non-urban mainland districts in Malawi. Data for obstetric care facilities were extracted from the Malawi Health Management Information System. Facility-based maternal mortality at birth was calculated as the number of maternal deaths per all deliveries at a facility in a given time period.ResultsThe RBF4MNH effectively reduced facility-based maternal mortality by 4.8 (−10.3 to 0.7, p<0.1) maternal deaths/100 000 facility-based deliveries/month after reaching full operational capacity in October 2014. Immediate effects (changes in level rather than slope) attributable to the RBF4MNH were not statistically significant.ConclusionThis is the first study evaluating the effect of a combined supply-side and demand-side RBF on maternal mortality outcomes and demonstrates the positive role financial incentives can play in improving health outcomes. This study further shows that timeframes spanning several years might be necessary to fully evaluate the impact of health-financing programmes on health outcomes. Further research is needed to assess the extent to which the observed reduction in facility-based mortality at birth contributes to all-cause maternal mortality in the country.

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.

scholarly journals Impact of the early stages of the COVID-19 pandemic on coverage of RMNH interventions in Ethiopia

2021 ◽  
Author(s):  
Emily D Carter ◽  
Linnea Zimmerman ◽  
Ellie Qian ◽  
Tim Roberton ◽  
Assefa Seme ◽  
...  
Keyword(s):  
Health Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Addis Ababa ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Early Stages ◽  
The Government ◽  
Negative Impacts ◽  
The Impact

Background: The COVID-19 pandemic and response have the potential to disrupt access and use of reproductive, maternal, and newborn health (RMNH) services. Numerous initiatives aim to gauge the indirect impact of COVID-19 on RMNH. Methods: We assessed the impact of COVID-19 on RMNH coverage in the early stages of the pandemic using panel survey data from PMA-Ethiopia. Enrolled pregnant women were surveyed 6-weeks post-birth. We compared the odds of service receipt, coverage of RMNCH service indicators, and health outcomes within the cohort of women who gave birth prior to the pandemic and the COVID-19 affected cohort. We calculated impacts nationally and by urbanicity. Results: This dataset shows little disruption of RMNH services in Ethiopia in the initial months of the pandemic. There were no significant reductions in women seeking health services or the content of services they received for either preventative or curative interventions. In rural areas, a greater proportion of women in the COVID-19 affected cohort sought care for peripartum complications, ANC, PNC, and care for sick newborns. Significant reductions in coverage of BCG vaccination and chlorohexidine use in urban areas were observed in the COVID-19 affected cohort. An increased proportion of women in Addis Ababa reported postpartum family planning in the COVID-19 affected cohort. Despite the lack of evidence of reduced health services, the data suggest increased stillbirths in the COVID-19 affected cohort. Discussion: The government of Ethiopia's response to control the COVID-19 pandemic and ensure continuity of essential health services appears to have successfully averted most negative impacts on maternal and neonatal care. This analysis cannot address the later effects of the pandemic and may not capture more acute or geographically isolated reductions in coverage. Continued efforts are needed to ensure that essential health services are maintained and even strengthened to prevent indirect loss of life.

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