Demand Side Financing and Healthcare Seeking of Pregnant Women

Demand-side financing (DSF) scheme is popularly known as the maternal health voucher program, which is launched in many developing countries of the world including Bangladesh as an intervention of developing overall health status. Maternal mortality ratio is a strong indicator of health profile of any country and pregnant women are prone to fall vulnerable situation. This review was aimed to find gap/missing of existing literature in order to make foundation of new research on healthcare seeking of pregnant women along with financing coverage. After repeated critical review of number original articles, some gaps have been found. Almost every article they focused on outcome and mildly highlighted input variables but did not consider all possible variables and missed to show interlink between those variables.

WIDOWER’S AGE AND NUMBER OF CHILDREN AFFECT PARENTING STYLE AND REMARRIAGE DECISION

Highlight:1. The widow will outsource childcare to other people, such as the widow's mother, stepmother, aunt, or other relatives who believe they know more about childcare after the wife's death.3. There was a significant relationship between widower’s age and the number of children affecting parenting style and remarriage decision.Abstract:Background: The high maternal mortality ratio automatically represents the highest number of widowers in Indonesia. The change of status from a husband to a widower does not rule out the possibility of being able to change his role and function in the family. Objective: To describe that the widower’s age and the number of children have an impact on the parenting style and the desire to remarry. Materials and Methods: This study was an observational study with a cross-sectional design. Husbands who had been left by their wives for two years or more owing to maternal death and had one or more children before the wife's maternal death were the subjects of this study. Widower’s age, as well as kid’s parenting patterns before the death of the mother were recorded. This study was likewise subjected to an ethics review and relied on informed consent. Results: Widowers who had one child before their wife's death and decided to remarry accounted for 7 subjects (87.5%), while those who did not remarry accounted for 5 (31.3%). On the association between a widower’s age and child-rearing practices, there were two respondents (40%) who chose to entrust their children’s care to someone else or not to be cared by themselves. Conclusion: There was a significant relationship between widower’s age and the number of children and the parenting style and remarriage decision. Single parents who decided to remarry were single parents at a relatively younger age.

Maternal mortality in the city of Berlin: consequences for perinatal healthcare

Objectives The fifth of the United Nations’ Millennium Development Goals proposed for 2000–2015 was to improve maternal health, which has only partially been achieved. Worldwide, the maternal mortality ratio is currently estimated at 216/100.000 livebirths, compared to 380/100,000 in 1990. As yet, there has been no published comprehensive analysis of maternal mortality data as it pertains to Berlin and by extension Germany. Aim of the study was to evaluate and analyze the maternal mortality rate of Berlin as a result of shortcomings in healthcare provision and identify possible solutions. Methods The Institute for Quality and Transparency in the Healthcare Sector sourced external quality control from the Qualitätsbüro Berlin to provide maternal mortality data from Berlin hospitals from 2007 to 2020. Results Nineteen maternal deaths were registered between 2007 and 2020 in total. Case analysis shows that two main events occur: thrombosis and hemorrhage at 31.6%, respectively, followed by hypertensive disorder (15.8%), and sepsis (15.8%). After detailed analysis of each case report, we determined 8/19 (42.1%) maternal deaths as being potentially preventable given slightly altered circumstances. Consequences The system of registration of perinatal data in Germany does not allow for a comprehensive recording of maternal death and requires alteration to provide a more accurate picture of the phenomenon of maternal mortality; presumably, there exist twice as many unreported cases. Conclusions Symptoms, risks, and primary prevention tactics of thromboembolism during pregnancy and birth should be imparted to every licensed professional in individual hospital settings, along with evidence-based simulation training for the event of obstetric or prepartum hemorrhage.

A retrospective analysis of maternal mortality in an urban tertiary care hospital

Background: The aims of the study were to generate information regarding causes and complications leading to maternal deaths in an urban tertiary care centre and to find if any of the causes are preventable.Methods: The medical records of all maternal deaths occurring over a period of 4 years between January 2015 and December 2018 were reviewed.Results: Maternal mortality ratio ranged between 127 and 48 per 1, 00,000 births in the study. The causes of deaths were haemorrhage (29.47%), pregnancy-induced hypertension (PIH) (28.42%), anaemia (12.63%), sepsis (9.47%), thromboembolism (6.31%), hepatic causes (5.26%), blood reactions (3.15%), heart diseases (2.10%), central nervous system (CNS) related (1.05%) and others (2.10%). Maximum deaths occurred in women between 21-30 years of age. Mortality was highest in post-natal mothers (70.52%).Conclusions: Overall maternal mortality due to direct obstetric causes was (73.68%), indirect obstetric causes (22.10%) and unrelated causes (4.2%).

Determinants for Postpartum Care of Women in Rakhine State, Myanmar: A Descriptive Cross- sectional Study

Background – The maternal mortality ratio of Rakhine State is cited as being the highest level among the states of Myanmar. In contrast, the usage of healthcare providers for the delivery process is at the lowest rate in the Union. Therefore, this study sought to discover the factors influencing women from Rakhine State in receiving postpartum care from healthcare providers.Methodology – All in all, 278 women from the 15- to 49-year-old age group collected from the Myanmar Demographic Health Survey (2015-2016) were used for this study. Binary logistic regression was likewise employed. Results –Among the 104 cases receiving postpartum care, only 42 cases were home deliveries. Maternal health knowledge status, the role of healthcare providers, and places of delivery, rather than socioeconomic status and social structure, were the most essential factors in promoting postpartum care status. The occupation status of women also influenced their postpartum care receiving status.Conclusion – By strengthening the health care system setting and promoting the job efficacy of women, the postdelivery care status of Rakhine state can be increased and the maternal death after child birth can be reduced to reach the SDGs.

The Current Status in Obstetrics in North Korea and Strategies for Establishing a Better Healthcare System

The women's healthcare in North Korea is in poor condition. The present study explored the current state of women's healthcare, especially in the field of obstetrics, in the region with a number of considerations in regards to establishing a better healthcare system. Peer-reviewed journal articles and reports from intergovernmental organizations were reviewed. Data show that many healthcare facilities suffer from shortages of basic amenities. The maternal mortality ratio was 82 deaths per 100,000 live births. The leading cause of maternal death was postpartum hemorrhage. It was also found that many hospitals were unable to provide adequate obstetrical emergency care such as anticonvulsants, antibiotics, and blood products. A long-term roadmap that is sustainable with clear principles and that is not disturbed by political tensions should be established.

Tatalaksana Penggunaan Forceps pada Posisi Oksiput Posterior Persisten

Maternal health is the health of women during pregnancy, childbirth and the postnatal period. World Health Organization (WHO) record every day in 2017 about 810 women died from preventable causes related to pregnancy and childbirth. Between 2000-2017, the maternal mortality ratio dropped by about 38% worldwide, but 4% of all maternal deaths occur in low and lower middle-income countries. Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Cesarean delivery is higher (3 times greater risk of death) maternal morbidity and mortality than vaginal delivery and also costs more than normal childbirth. Forceps extraction is one of the operative obstetric actions that aims to help childbirth through normal childbirth. This is done for all conditions that threaten the mother and fetus that have indications to undergo childbirth. the use of forceps techniques, will assure successful, safe, and steady performance of forced delivery. Therefore, obstetric forceps should be inherited of skills to the trainee at this time. Therefore, it is reasonable for the standards establishing the proper position for forceps delivery to vary between experienced and inexperienced operators. The first priority is safe and secure implementation of the procedure.

Maternity waiting home as a potential intervention for reducing the maternal mortality ratio in El Salvador: an observational case study

Background El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Methods We ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country. Results El Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes. Conclusions The reason for the unexplained reduction in El Salvador’s MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes.

Influencing factors of unmet needs for child spacing among selected countries experiencing high maternal-mortality in sub-Saharan Africa

Background: Maternal complication and death has been implicated in unintended pregnancy. The indicator for measuring the risk of unintended pregnancy is unmet need for family planning (FP). It is necessary to explore the current situation of unmet need for child spacing (UNCS) as well as its influencing factors among countries that are experiencing high maternal mortality ratio. We aimed to unveil the prevalence of UNCS and its associated factors in Nigeria, Liberia and Sierra Leone.Methods: We analysed the data from DHS phase VII survey, a cross- sectional study conducted from year 2017 to 2018 across several countries. Total records of 25,539, 5,553, and 10,050 were extracted for Nigeria, Liberia and Sierra Leone respectively. Explored variables were UNCS, demographic characteristics and husband’s partners profile. Data was analysed using SPSS version 25. Descriptive statistics, test of association (chi-square) and binary logistic regression were used during the data analysis (α0.05).Results: UNCS was high in Nigeria (15.9%), Liberia (22.5%) and Sierra Leone (21.9%). In Nigeria, Liberia and Sierra Leone, 40%, 37% and 49.1% were uneducated respectively. The proportion of married women were 89% in Nigeria, 32% in Liberia and 70.2% in Sierra Leone. Also, female headship of household (OR: 1.29, 95%CI: 1.09-1.54) was associated with UNCS relative to male headship of household.Conclusions: UNCS was high in the three countries. Factors like educational status of women, age, as well as women as head of the households should be given much attention in the efforts to reduce UNCS as identified in this study.

Politics of Childbirth in Nepal

Nepal has been hailed as a global success in reducing the maternal mortality ratio from around 540 women dying per 100,000 births in 1996 to about 240 in 2016. The chapter will critically analyse two interventions implemented around 2005. First, we will look at the USAID-funded Nepal Family Health Program, through which oral misoprostol (to control bleeding after delivery) was launched across Nepal. Second, we will look at Aama Surakshya Karyakram (or mother programme), which was implemented to promote institutional delivery. These two programmes, despite aiming to address high maternal mortality ratio in Nepal, adopted very different approaches, reflecting ideological struggles on women’s agency and the politics of childbirth. The chapter concludes that the costs of these changes (such as the lack of resources or the commercialization of healthcare) have been overlooked in the claims of Nepal’s ‘success’.