Unqualified Health Care Providers in Rural Health Care System in Bangladesh: Quality of services and effects on Maternal and Child Health

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.

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Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A theory-driven scoping review

10.21203/rs.2.19606/v1 ◽

2019 ◽

Author(s):

Eveline Muika Kabongo ◽

Ferdinand Mukumbang ◽

Peter N/A Delobelle ◽

Edward N/A Nicol

Keyword(s):

Health Care ◽

Child Health ◽

Community Health ◽

Community Health Workers ◽

Health Care Providers ◽

Maternal And Child Health ◽

Health Workers ◽

Child Health Services ◽

Care Providers ◽

And Child Health

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.

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Impact of COVID-19 Pandemic on Utilization of Facility-Based Essential Maternal and Child Health Services in North Shewa Zone, Ethiopia

10.1101/2022.01.10.22268794 ◽

2022 ◽

Author(s):

Chalachew Bekele ◽

Delayehu Bekele ◽

Bezawit Hunegnaw ◽

Kimiko Van Wickle ◽

Fanos Ashenafi ◽

...

Keyword(s):

Health Care ◽

Family Planning ◽

Child Health ◽

Service Utilization ◽

Health Care Providers ◽

Maternal And Child Health ◽

Child Health Services ◽

Care Providers ◽

New Family ◽

And Child Health

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.

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

International Journal of Medical and Health Sciences Research ◽

10.18488/journal.9/2015.2.9/9.9.158.170 ◽

2015 ◽

Vol 2 (9) ◽

pp. 158-170 ◽

Cited By ~ 3

Author(s):

Uzochukwu Benjamin ◽

Okwuosa Chinenye ◽

Ezeoke Ogochukwu ◽

Onwujekwe Obinna

Keyword(s):

Health Care ◽

Child Health ◽

Health Services ◽

Health Care Providers ◽

Maternal And Child Health ◽

Child Health Services ◽

Care Providers ◽

Enugu State ◽

And Child Health

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Provision and Utilization of Health and Nutrition Services During the COVID-19 Pandemic in Urban Bangladesh

Current Developments in Nutrition ◽

10.1093/cdn/nzab045_072 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 690-690

Author(s):

Celeste Sununtnasuk ◽

Phuong Nguyen ◽

Anjali Pant ◽

Lan Mai Tran ◽

Shivani Kachwaha ◽

...

Keyword(s):

Health Care ◽

Child Health ◽

Pregnant Women ◽

Health Care Providers ◽

Maternal And Child Health ◽

Child Health Services ◽

Care Providers ◽

Health And Nutrition ◽

Gates Foundation ◽

And Child Health

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.

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Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A theory-driven scoping review

10.21203/rs.2.19606/v2 ◽

2020 ◽

Author(s):

Eveline Muika Kabongo ◽

Ferdinand Mukumbang ◽

Peter N/A Delobelle ◽

Edward N/A Nicol

Keyword(s):

Health Care ◽

Child Health ◽

Community Health ◽

Community Health Workers ◽

Health Care Providers ◽

Maternal And Child Health ◽

Health Workers ◽

Child Health Services ◽

Care Providers ◽

And Child Health

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.

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Assessment of the Quality of Prenatal Care: The Transmission of Information to Pregnant Women in Maternal and Child Health Centers in Jordan

International Quarterly of Community Health Education ◽

10.2190/113k-4ab7-x2jr-rxme ◽

1992 ◽

Vol 13 (1) ◽

pp. 47-62 ◽

Cited By ~ 5

Author(s):

Ra'Eda Al-Qutob ◽

Salah Mawajdeh

Keyword(s):

Child Health ◽

Prenatal Care ◽

Pregnant Women ◽

Health Care Providers ◽

Maternal And Child Health ◽

Information Provision ◽

Care Providers ◽

Quality Of Information ◽

And Child Health

The quality of information provided to pregnant women seeking prenatal care from public maternal and child health (MCH) facilities was assessed in Irbid, the principal city in the North of Jordan. The structural setup of the settings, as well as the process of information transmission, were examined using interviews of the managing physicians and recipients, as well as observation of encounters between pregnant women and health care providers (physicians and midwives) at the health facility. The results of the study showed that pregnant women's needs for health information were not being adequately met Women were dissatisfied with the quality of information delivered. Inadequacies in both the structure and the process of information provision are discussed.

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Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03684-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eveline M. Kabongo ◽

Ferdinand C. Mukumbang ◽

Peter Delobelle ◽

Edward Nicol

Keyword(s):

Health Care ◽

Child Health ◽

Health System ◽

Health Care Providers ◽

Maternal And Child Health ◽

Child Health Care ◽

Care Providers ◽

Middle Income ◽

Middle Income Countries ◽

And Child Health

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 five online databases (PubMed/Medline, 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 implementation and uptake of maternal and child health care. 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 are 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 are 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 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.

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