Increasing the Level of Knowledge about Stunting and the First 1000 Days of Life in Jember Regency, East Java, Indonesia

Stunting is a developmental disorder experienced by children due to poor nutrition, recurrent infections, and inadequate psychosocial stimulation. In Jember Regency, the number of stunting cases increased from 2018 to 2019. In addition, restrictions on activities during the COVID-19 pandemic, such as nutrition services at Integrated Healthcare Center, can hamper access to consumption and nutrition and child health services. Therefore, education about stunting is urgently needed to implement appropriate parenting patterns in the mids of limited activities during the COVID-19 pandemic. The Jember community service program was carried out online in the form of a webinar activity that was attended by 30 participants. This study is a quantitative analytic research using a one-group pretest-posttest design. Data that have been analyzed are presented descriptively. There is a significant effect on the pretest and posttest scores in the webinar. It means an increase in participants' understanding after online education is carried out. It is hoped that the people of Jember Regency can apply knowledge about the importance of the first 1000 days of life to prevent stunting.

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

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.

Effect of Integrating Maternal and Child Health Services, Nutrition and Family Planning Services on Postpartum Family Planning Uptake at 6 Months Post-partum in Burkina Faso, Cote d’Ivoire and Niger: Protocol of a Longitudinal Quasi-experimental Study

Background : Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action,on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger. Methods: This is a quasi experimental study with one intervention group and one control group of 3-4 health facilities in each country. Each facility was matched to a control facility of the same level of care and that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (with a 6 months pregnancy at maximum) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines.The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women, unevenly distributed at inclusion). Discussion :This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better appreciate the timeline and the factors influencing women's decision-making on the use of post-partum family planning services. The results will help in increasing the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning, taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed.

Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.

COVID-19 and inequities in the Americas: lessons learned and implications for essential health services

The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.

Empowering health cadres in managing maternal and child health in the Covid-19 pandemic era

The covid-19 pandemic has hampered the access of mothers and children to optimal health services. The decreasing number of visits to maternal and child health services has created new nutrition and health problems. However, the Posyandu as one of the health services for mothers and children in several locations were forced to close during the covid-19 pandemic, such as Posyandu RW 07, Cipayung Village. The purpose of this community service is to increase the capacity of the integrated services post (Posyandu) cadres to cadres for maternal and child health responses during the covid-19 pandemic. Service activities are carried out through 3 stages of activity which was starting with discussions with partners about the importance of re-activating the Posyandu for infants and toddlers during the covid-19 pandemic, then increasing the capacity of health cadres for babies and toddlers health services, then handbook creation and evaluation. The method used combines several approaches, such as discussions, socialization, workshop, and evaluation. The result is an increase in the capacity of health cadres and the guidebooks for services and the Posyandu visits during the covid-19 pandemic.

Integration of TB into child health policies in Africa’s high-burden countries: a normative analysis

Integration of paediatric TB care into decentralised child health services has the potential to reduce the large proportion of childhood TB that remains undiagnosed. We performed a review of national guidelines and policies for TB and child health to evaluate the normative integration of paediatric TB into existing child health programmes in 15 high TB burden countries in Africa. While integration is addressed in 80% of the national strategic plans for TB, the child health strategies insufficiently address TB in their plans to reduce child mortality. Emphasis needs to be put on multi-sectoral collaboration among national health programmes.

Prenatal dental care and periodontal health: a concise systematic review

Introduction: Periodontal disease is a chronic infection caused by a bacterium that stimulates the immunoinflammatory response, leading to inflammation of the gingival and tooth support tissue, resulting from the pathogenesis of the microorganism and the host's response. Studies have investigated the association between periodontal conditions and possible complications for pregnant women and newborns. Objective: Analyzed the main consequences of periodontal disease during pregnancy and childbirth, as well as changes involving newborns, in order to elucidate the importance of prenatal dental care. Methods: The present study was followed by a systematic literature review model, according to the PRISMA rules. Clinical studies included case reports, retrospective, prospective and randomized trials. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results: A total of 104 articles were found. A total of 48 articles were evaluated in full, and 20 were included and discussed in this study. The overall assessment did not result in significant risks that could compromise the science of the present study. According to the GRADE classification, the studies were of moderate quality. Gingivitis, periodontitis, and tooth loss were found to be associated with premature birth. Periodontal disease can increase the chance of negative neonatal and maternal outcomes, with fetal growth restriction, vulvovaginitis, and premature rupture of the membrane being the main effects. Conclusion: Oral health should be an important focus in the monitoring of pregnant women in all maternal and child health services, making it necessary to incorporate the diagnosis of maternal oral health and periodontal disease for the health of the mother and newborn.

Neonatal morbidity among African refugee women in Israel: a case–control study

ObjectivesReports on neonatal morbidity (NM) among refugees in developed countries remain inconsistent. We aimed to compare NM among infants of African refugees in Israel to the native population based on a large population sample.DesignA case–control study.SettingA tertiary hospital in Israel.ParticipantsData on hospital-based live births of refugee women and their newborns who were born in 2014 and 2017 were retrieved from medical records. Perinatal and neonatal data were compared between the refugee group and the native residents matched for gestational age and year of birth as well as within the refugee group.Primary outcomePrevalence of NM among African refugees in Israel.ResultsNewborns delivered by 357 refugee women (mean age 30.2 years) and 357 controls (mean age 32.2 years) were analysed. Both groups were similar for the newborns’ weight and gestational age. There were no significant differences in NM between the groups. A within-refugee comparison conducted between 2014 and 2017 yielded significant differences in birth weight (3051.4 vs 3373.6 gr, p<0.001, 95% CI (198.3 to 446.2), d=0.56), the number of twin deliveries (10 vs 4, p=0.002, Φ=0.173), the number of neonates evaluated as small for gestational age (15 vs 10, p=0.003, Φ=0.167) and the use of human milk (71% vs 93%, p<0.001, Φ=−0.298).ConclusionsWe conclude that NM among neonates born to refugee mothers was not higher than that of neonates born to native Israeli mothers. We suggest that successful implementation of health policies for refugees has improved their accessibility to mother–child health services.