COVID-19 and Health Sector Development Plans in Africa: The Impact on Maternal and Child Health Outcomes in Uganda

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that the low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfers (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. In 2014 we conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visits, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers' knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of rural health facilities.

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Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

BMC Public Health ◽

10.1186/s12889-020-09468-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Karl W. le Roux ◽

Ellen Almirol ◽

Panteha Hayati Rezvan ◽

Ingrid M. le Roux ◽

Nokwanele Mbewu ◽

...

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Home Visiting ◽

Health Workers ◽

Group Comparison ◽

Comparison Study ◽

Child Health Outcomes ◽

The Impact ◽

And Child Health

Abstract Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3–0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

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The Impact of Panel Composition and Topic on Stakeholder Perspectives: Generating Hypotheses from Online Maternal and Child Health Modified-Delphi Panels

10.21203/rs.3.rs-415307/v1 ◽

2021 ◽

Author(s):

Dmitry Khodyakov ◽

Sujeong Park ◽

Jennifer Hutcheon ◽

Sara Parisi ◽

Lisa Bodnar

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Stakeholder Engagement ◽

Child Health Outcomes ◽

Modified Delphi ◽

Multi Stakeholder ◽

The Impact ◽

And Child Health ◽

Do So

Abstract Background: Multi-stakeholder engagement is crucial for conducting health services research. Delphi-based methodologies combining iterative rounds of questions with feedback on and discussion of group results are a well-documented approach to multi-stakeholder engagement. The aim of this study is to develop hypotheses about the impact of panel composition and topic on the propensity and meaningfulness of response changes in multi-stakeholder modified-Delphi panels.Methods: We conducted three online modified-Delphi multi-stakeholder panels using the same protocol. We assigned 60 maternal and child health professionals to a homogeneous (professionals-only) panel, 60 pregnant or postpartum women (patients) to a homogeneous panel, and 30 professionals and 30 patients to a mixed panel. In Round 1, participants rated seriousness of 11 maternal and child health outcomes using 0-100 scale and explained their ratings. In Round 2, participants saw Round 1 results and discussed them using anonymous, moderated online discussion boards. In Round 3, participants revised their original ratings. Our outcome measures included binary indicators of response changes to ratings of low, medium, and high severity maternal and child health outcomes and their meaningfulness, measured by a change of 10 or more points on a 0-100 scale.Results: Participants changed 55% of responses; the majority of response changes were meaningful. We developed three main hypotheses. First, stakeholders may be more likely to change their responses on preference-sensitive topics where there is a range of viable alternatives or perspectives. Second, patients may be more likely to change their responses and to do so meaningfully in mixed panels, whereas professionals may be more likely to do so in homogeneous panels. Third, the association between panel composition and response change may vary according to the topic.Conclusions: Results of our work not only helped generate empirically-derived hypotheses to be tested in future research, but also offer practical recommendations for designing multi-stakeholder online modified-Delphi panels.Registration: International Registered Report Identifier: DERR1-10.2196/16478

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Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study

BMC Health Services Research ◽

10.1186/s12913-021-07292-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Janak Kumar Thapa ◽

Doris Stöckl ◽

Raj Kumar Sangroula ◽

Dip Narayan Thakur ◽

Suresh Mehata ◽

...

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Regression Coefficient ◽

Control Area ◽

Child Health Outcomes ◽

Intervention Area ◽

Quasi Experimental ◽

The Impact ◽

And Child Health

Abstract Background Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal. Methods The study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05. Results The results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group. Conclusion The IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.

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Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China: A cluster controlled design

10.21203/rs.2.13107/v1 ◽

2019 ◽

Author(s):

Huan Zhou ◽

Yuju Wu ◽

Chengfang Liu ◽

Chang Sun ◽

Yaojiang Shi ◽

...

Keyword(s):

Child Health ◽

Health Outcomes ◽

Breast Feeding ◽

Maternal And Child Health ◽

Rural Areas ◽

Western China ◽

Child Health Services ◽

Child Health Outcomes ◽

The Impact ◽

And Child Health

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfer (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services and health outcomes among children in poor rural areas of western China. Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. We conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China in 2014. In each village, 21 households were selected based on their eligibility status for the CCT program. Propensity score matching analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visit, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages was significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of the rural health facilities.

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Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural ChinaConditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

10.21203/rs.2.13107/v3 ◽

2020 ◽

Author(s):

Huan Zhou ◽

Yuju Wu ◽

Chengfang Liu ◽

Chang Sun ◽

Yaojiang Shi ◽

...

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Rural Areas ◽

Cash Transfers ◽

Western China ◽

Child Health Services ◽

Child Health Outcomes ◽

The Impact ◽

And Child Health

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that the low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfers (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. In 2014 we conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visits, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of rural health facilities.

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The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis

10.21203/rs.3.rs-25287/v1 ◽

2020 ◽

Author(s):

Arif Mohammed ◽

Duah Dwomoh ◽

Justice Nonvignon

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Interrupted Time Series ◽

P Value ◽

Interrupted Time Series Analysis ◽

Improvement Project ◽

Child Health Outcomes ◽

The Impact ◽

And Child Health

Abstract Background Improving maternal and child health outcomes (MCH) continues to be a major public health concern to governments in sub-Saharan Africa and the international development community. The Maternal and Child Health and Nutrition Improvement Project (MCHNP) was a nationwide project that sought to improve the utilization of maternal and child health services in Ghana through financial incentive packages. The objective of this study was to determine the differential impact of MCHNP on maternal and child health outcomes. Methods A retrospective longitudinal pre-test post-test study design was employed. The study used monthly data from the District Health Information Management System between January 2014 to December 2018. Interrupted time series analysis was applied to estimate the impact of MCHNP on MCH for each region of the country. Results Neonatal mortality rate increased significantly in the Western,Upper East and Upper West regions with impact estimates of 0.144 (95% CI: 0.100, 0.188; p-value < 0.001), 0.124 (95% CI: 0.076, 0.172; p-value < 0.001) and 0.082 (95% CI: 0.048, 0.117; p-value < 0.001) respectively. The proportion of women who had four ANC visits decreased significantly in the Volta region with an impact of -0.011 (95% CI: -0.020, -0.002; p-value < 0.01), but increased in the Central, Western, Eastern, Upper East, and Upper West with estimated impacts of 0.004 (95% CI: -0.003, 0.011), 0.003 (95% CI: -0.003, 0.008), 0.002 (95% CI: -0.004, 0.008), 0.011 (95% CI: -0.004, 0.026) and 0.007 (95% CI: -0.012, 0.026) respectively though none of the increase was statistically significant. Skilled deliveries reduced in the Greater Accra, Volta, Ashanti and Brong-Ahafo regions with statistically insignificant estimated impacts of 0.006 (95% CI: -0.019, 0.007), 0.005 (95% CI: -0.015, 0.006), 0.005 (95% CI: -0.011, 0.002) and 0.004 (95% CI: -0.010, 0.002) respectively. Maternal mortality rate declined in Greater Accra by; 0.001 (95% CI: -0.018, 0.017), Volta; -0.010 (95% CI: -0.035, 0.016), Western; -0.009 (95% CI: -0.031, 0.013), Brong-Ahafo; -0.018 (95% CI: -0.052, 0.017), Eastern; -0.025 (95% CI: -0.064, 0.013) and Northern − 0.024 (95% CI: -0.060, 0.011) regions. Conclusion The nationwide implementation of MCHNP produced mixed results as some regions recorded positive (significant) impacts whereas others had no significant impacts on the outcome variables as expected following the implementation of the intervention, therefore the need for further studies to understand why the intervention failed to produce positive impacts in some regions.

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Dietary and lifestyle behaviours in the preconception period

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.853 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Schoenaker

Keyword(s):

Child Health ◽

Health Outcomes ◽

Maternal And Child Health ◽

Observational Studies ◽

Health Behaviours ◽

Preconception Health ◽

Lifestyle Behaviours ◽

Child Health Outcomes ◽

The Impact ◽

And Child Health

Abstract Observational studies have shown strong associations of preconception nutrition and lifestyle behaviours with maternal and child health outcomes; however, awareness of these links among lay people, policy makers and health professionals is very limited. Poor nutrition and obesity are common among women of reproductive age, and the preconception period therefore has underutilised potential as a point of intervention. Intervention studies to improve dietary intake and physical activity during pregnancy have not been successful in reducing adverse maternal and newborn health outcomes, but relatively few interventions have examined effects of modifying diet and lifestyle prior to pregnancy. Despite limited evidence from human clinical trials, increasing evidence from observational studies and from animal trials for the benefits of optimal preconception health suggests public health efforts to increase awareness and improve preconception health behaviours are needed as strategies for disease prevention across generations. This presentation will provide an overview of the evidence for the impact of nutrition and lifestyle behaviours on short and long-term maternal and child health outcomes. This will provide workshop participants with an understanding of health behaviours across the life course that should be considered when building preconception care into existing health services.

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