454 results
Search Results
2. Overcoming the constraints of competitive clientelism? Explaining the success of Ghana's poorest region in reducing maternal mortality.
- Author
-
Abdulai AG
- Subjects
- Female, Humans, Pregnancy, Ghana epidemiology, Maternal Health, Delivery of Health Care, Maternal Mortality, Maternal Health Services
- Abstract
Maternal mortality remains a health challenge that many developing countries struggle to address. Drawing on 64 key informant interviews, this article shows how Ghana's most impoverished administrative region, the Upper East, emerged as a bureaucratic 'pocket of effectiveness' in reducing maternal mortality in a context where national political settlement dynamics are undermining progress in improving maternal health. At the national level, Ghana's progress in reducing maternal mortality has been disappointing because public investments are disproportionately directed to reforms that contribute to the short-term political survival of ruling elites. Competitive electoral pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating resources to interventions that are necessary for enhancing the quality of health. The relatively better performance of the Upper East Region in reducing maternal mortality has been driven by a hybrid form of accountability that combines top-down pressures from the regional health directorate with horizontal forms of accountability that result in a competitive spirit among health workers. These findings show that even in contexts where resources are limited, the capacity of sub-national leaders in devising local solutions to local problems can lead to improved performance of health systems at the sub-national level. The findings also suggest the need for academic debates to go beyond the binary distinctions regarding the usefulness of top-down versus bottom-up accountability measures and focus on building effective and legitimate forms of accountability that run both top-down and bottom-up when seeking to improve health service delivery., (© 2023 John Wiley & Sons Ltd.)
- Published
- 2024
- Full Text
- View/download PDF
3. Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries.
- Author
-
Nove A, Boyce M, Neal S, Homer CSE, Lavender T, Matthews Z, and Downe S
- Subjects
- Humans, Female, Pregnancy, Infant, Newborn, Infant, Cesarean Section statistics & numerical data, Global Health, Workplace, Health Services Accessibility, Working Conditions, Midwifery statistics & numerical data, Developing Countries, Maternal Mortality trends, Infant Mortality trends, Maternal Health Services
- Abstract
Background: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration., Methods: Using the most recent available data from publicly available global databases for the period 2000-2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality., Results: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10-15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country., Conclusions: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
4. Increased utilisation and quality: a focus on inequality and a learning health system approach-explaining Nepal's success in reducing maternal and newborn mortality 2000-2020.
- Author
-
Sharma S, Campbell OMR, Oswald WE, Adhikari D, Paudel P, Lal B, and Penn-Kekana L
- Subjects
- Humans, Nepal, Female, Infant, Newborn, Pregnancy, Infant, Healthcare Disparities, Quality of Health Care, Health Services Accessibility, Maternal Mortality trends, Infant Mortality trends, Maternal Health Services
- Abstract
Introduction: Maternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000-2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000-2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000-2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a 'success'. Our study describes mechanisms which contributed to these achievements., Methods: A mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops., Results: Despite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities., Conclusion: Policies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns., Competing Interests: Competing interests: Dr Punya and Dr Bibek are currently employed by the Government of Nepal. Dr Sharma was previously employed there. Their participation and insights have been invaluable to this report., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
5. Alliance for Innovation on Maternal Health: Evolution of a program to address maternal morbidity and mortality.
- Author
-
Allen C, Taylor I, and Ushry A
- Subjects
- Humans, Female, Pregnancy, United States epidemiology, Patient Safety, Program Development, Patient Care Bundles, Maternal Mortality trends, Quality Improvement, Maternal Health Services organization & administration, Maternal Health
- Abstract
The Alliance for Innovation on Maternal Health program is a national investment in promoting safe care for every birth in the United States and lowering rates of preventable maternal mortality and severe maternal morbidity. Through its work with state and jurisdiction-based teams on patient safety bundle implementation, the program supports data-driven quality improvement. This paper details key aspects of the Alliance for Innovation on Maternal Health including patient safety bundles, technical assistance, implementation resource development, data support, and partnerships while providing an overview of the program's evolution, reach, impact, and future opportunities., Competing Interests: Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2024. Published by Elsevier Inc.)
- Published
- 2024
- Full Text
- View/download PDF
6. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67
- Author
-
Jane Hirst, Georgina Jones, Dilly Anumba, and Caroline Mitchell
- Subjects
Male ,Maternal Mortality ,Pregnancy ,Social Determinants of Health ,Infant, Newborn ,Obstetrics and Gynecology ,Gender Identity ,Humans ,Women's Health ,Female ,Maternal Health Services - Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.
- Published
- 2022
7. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group.
- Author
-
Eapen, Doncy, Mbango, Catherine, Daniels, Glenda, Mathew Joseph, Nitha, Mary, Annapoorna, Mathews, Nisha, Carr, Kathryn Kravetz, Wells, Cheryl, Suriaga, Armiel, and Saint Fleur, Angeline
- Subjects
MATERNAL health services ,MEDICAL quality control ,HEALTH services accessibility ,MINORITIES ,BLACK people ,WOMEN ,QUALITY assurance ,NURSING research ,PREGNANCY complications ,HEALTH care teams ,PROFESSIONAL associations ,MATERNAL mortality - Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non‐Hispanic Black women is 3.5 times that of non‐Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy‐related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
8. Narratives of responsibility: Maternal mortality, reproductive governance, and midwifery in Mexico.
- Author
-
Williams SA
- Subjects
- Female, Humans, Mexico epidemiology, Pregnancy, Maternal Health Services organization & administration, Maternal Mortality, Midwifery, Narration, Social Responsibility
- Abstract
This research highlights the malleability of Maternal Mortality Ratios (MMR) and the ways in which they accommodate a variety of narratives via their claims about women's access to reproductive health services. MMR plays an important role in determining fiscal and legislative priorities for women's health in Mexico and in the discursive practices that shape societal beliefs about appropriate birthing practices and birth attendants. This paper is based on ethnographic fieldwork conducted in Yucatán and Quintana Roo between 2009 and 2017 during Ministry of Health midwifery workshops and approximately fifty interviews with midwives, doctors, public health officials, and parents. It explores the mutability of MMR within the context of political struggles for midwifery in Mexico-both for and against its legality and existence. In Mexico, MMR is often used by bureaucrats and public health workers to reinforce the importance of biomedical obstetric services over midwifery. However, the same metrics are also employed by midwives in critiques of underfunded and often structurally-violent maternal health care services. While doctors attempt to use MMR to prove that birth is inherently dangerous and must take place in hospitals with access to obstetric technologies and interventions, midwives use MMR to demonstrate that birth in hospitals is risky precisely because of those technologies and their inappropriate use, and to draw international attention and funding in support of midwifery. In addition to examining the strategic use of MMR in health-related discourses, this paper interrogates techniques employed by the state to limit midwives' access to births in the name of monitoring and improving MMR. I contend that while discursive uses of MMR to advance professional and political goals are common in both midwifery and biomedicine, the asymmetric power relations of biomedicine vis-à-vis the Mexican state privilege interpretations of MMR that justify and legitimate enhanced bureaucratic surveillance of midwives., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
9. Monitoring maternal near miss/severe maternal morbidity: A systematic review of global practices.
- Author
-
England N, Madill J, Metcalfe A, Magee L, Cooper S, Salmon C, and Adhikari K
- Subjects
- Adult, Canada epidemiology, Female, Humans, Pregnancy, United States epidemiology, Eclampsia mortality, Eclampsia therapy, Hospitalization, Maternal Health Services, Maternal Mortality, Near Miss, Healthcare
- Abstract
There is international interest in monitoring severe events in the obstetrical population, commonly referred to as maternal near miss or severe maternal morbidity. These events can have significant consequences for individuals in this population and further study can inform practices to reduce both maternal morbidity and mortality. Numerous surveillance systems exist but we lack a standardized approach. Given the current inconsistencies and the importance in monitoring these events, this study aimed to identify and compare commonly used surveillance methods. In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and maternal near miss/severe maternal morbidity. We included papers that used at least three indicators to monitor for these events and collected data on specific surveillance methods. We calculated the rate of maternal near miss/severe maternal morbidity in hospitalization data obtained from the 2016 US National Inpatient Sample using five common surveillance methods. Of 18,832 abstracts, 178 papers were included in our review. 198 indicators were used in studies included in our review; 71.2% (n = 141) of these were used in <10% of included studies and only 6.1% (n = 12) were used in >50% of studies included in our review. Eclampsia was the only indicator that was assessed in >80% of included studies. The rate of these events in American hospitalization data varied depending on the criteria used, ranging from 5.07% (95% CI = 5.02, 5.11) with the Centers for Disease Control criteria and 7.85% (95% CI = 7.79, 7.91) using the Canadian Perinatal Surveillance System. Our review highlights inconsistencies in monitoring practices within and between developed and developing countries. Given the wide variation in monitoring approaches observed and the likely contributing factors for these differences, it may be more feasible for clinical and academic efforts to focus on standardizing approaches in developed and developing countries independently at this time. PROSPERO Registration: CRD42018096858., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
- Full Text
- View/download PDF
10. Challenges and Successes of Distributing Birth Kits with Misoprostol to Reduce Maternal Mortality in Rural Tanzania.
- Author
-
Webber GC, Chirangi BM, and Magatti NJ
- Subjects
- Adult, Cell Phone, Female, Humans, Misoprostol administration & dosage, Mobile Applications, Oxytocics administration & dosage, Practice Guidelines as Topic, Pregnancy, Pregnancy Outcome, Pregnant Women, Prenatal Care, Rural Population, Tanzania, Young Adult, Community Health Workers education, Health Services Accessibility, Maternal Health Services organization & administration, Maternal Mortality, Midwifery education, Misoprostol supply & distribution, Oxytocics supply & distribution, Postpartum Hemorrhage prevention & control
- Abstract
The Saving Mothers Project was conducted from September 2015 to March 2017 in Bunda and Tarime Districts, Mara Region, Tanzania. The purpose of this project was to train community health workers (CHWs) to use mobile phones applications to register and educate pregnant women about safe deliveries and encourage them to access skilled health care providers for antenatal care and delivery, and to provide nurses and CHWs with clean birth kits with misoprostol to distribute to women. The birth kits were for use in case women could not access the health facility, or if the health facility was lacking supplies at the time of delivery. The overall goal of the study was to reduce the maternal mortality rate by increasing women's access to health services where possible, and to clean supplies when a non-facility birth was unavoidable. This paper reports on a mixed methods evaluation of the project including a survey of over two thousand four hundred women, and focus groups with women, community health workers, and nurses participating in the project. The results of the survey and focus groups demonstrate a high degree of satisfaction with the birth kits and misoprostol and an increase in facility birth rates where the project was implemented. Differences between the two districts illustrate that policy maker support is key to successful implementation.
- Published
- 2019
- Full Text
- View/download PDF
11. The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach.
- Author
-
Rieger M, Wagner N, Mebratie A, Alemu G, and Bedi A
- Subjects
- Ethiopia epidemiology, Female, Humans, Military Personnel, Pregnancy, Program Evaluation, Government Programs, Health Services Accessibility organization & administration, Maternal Health Services organization & administration, Maternal Mortality trends
- Abstract
The Ethiopian government has implemented nationwide strategies to improve access to basic health services and enhance health outcomes. The Health Extension Program (HEP) launched in 2003, expanded basic health infrastructure and local human resources. In 2011, the government introduced the Health Development Army (HDA). HDA is a women-centered community movement inspired by military structures and discipline. Its special objective is to improve maternal health outcomes. This paper uses a synthetic control approach to assess the effects of HEP and HDA on maternal mortality ratios (MMR). The MMR data are from the Global Burden of Diseases (GBD) database. A pool of 42 Sub-Saharan African countries, covering the period 1990 to 2016, is used to construct a synthetic comparator which displays a mortality trajectory similar to Ethiopia prior to the interventions. On average, since 2004, maternal mortality in the control countries exhibits a moderate downward trend. In Ethiopia, the downward trend is considerably steeper as compared to its synthetic control. By 2016, maternal mortality in Ethiopia was lower by 171 (p-value 0.048) maternal deaths per 100,000 live births as compared to its synthetic control. Between 2003 and 2016, Ethiopia's maternal mortality ratio declined from 728 to 357. These estimates suggest that a substantial proportion of this decline may be attributed to HEP/HDA. The Ethiopian experience of enhancing nation-wide access to and use of maternal health services in a short time-span is remarkable. Whether such a model may be transplanted is an open question., (Copyright © 2019. Published by Elsevier Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
12. Between orchestrated and organic: Accountability for loss and the moral landscape of childbearing in Malawi.
- Author
-
de Kok BC
- Subjects
- Female, Humans, Pregnancy, Culture, Malawi epidemiology, Infant, Newborn, Maternal Health Services standards, Maternal Mortality, Perinatal Mortality, Quality of Health Care standards, Social Responsibility
- Abstract
This paper explores loss in childbearing in Malawi (miscarriages, perinatal deaths and maternal mortality) as a lens to understand accountability and health system functioning. In low-income countries, maternal and perinatal mortality reflects poor health system functioning, to be improved in part through accountability. Understanding how accountability plays out on the ground requires examination of the existing, 'organic' accountability relationships and mechanisms. Thematic and discourse analysis of interviews and observations illuminates vocabularies of responsibility and practices of accountability concerning loss. Women are especially held accountable for loss, by a range of social actors. They use existing 'organic' accountability relationships and mechanisms to manage their own interests, but arguably also to care for pregnant women, even though negative birth experiences may ensue. Instances of disrespectful care appear a by-product of the convergence of organic and orchestrated, policy-driven accountability for numeric outcomes (deaths averted) rather than process (quality of care). Moreover, in the absence of essential physical resources, providers and relatives mobilize the social resources at their disposal to keep women and babies alive. Improving quality of care requires acknowledgment that providers' actions are both systemic and situational, and embedded in local moral landscapes and uneven webs of accountability., (Copyright © 2018 Elsevier Ltd. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
13. Ending preventable maternal mortality: phase II of a multi-step process to develop a monitoring framework, 2016-2030.
- Author
-
Jolivet RR, Moran AC, O'Connor M, Chou D, Bhardwaj N, Newby H, Requejo J, Schaaf M, Say L, and Langer A
- Subjects
- Consensus, Delivery of Health Care, Female, Humans, Pregnancy, World Health Organization, Maternal Health, Maternal Health Services standards, Maternal Mortality, Quality Indicators, Health Care organization & administration
- Abstract
Background: In February 2015, the World Health Organization (WHO) released "Strategies toward ending preventable maternal mortality (EPMM)" (EPMM Strategies), a direction-setting report outlining global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period. In May 2015, the EPMM Working Group outlined a plan to develop a comprehensive monitoring framework to track progress toward the achievement of these targets and priorities. This monitoring framework was developed in two phases. Phase I, which focused on identifying indicators related to the proximal causes of maternal mortality, was completed in October 2015. This paper describes the process and results of Phase II, which was completed in November 2016 and aimed to build consensus on a set of indicators that capture information on the social, political, and economic determinants of maternal health and mortality., Findings: A total of 150 experts from more than 78 organizations worldwide participated in this second phase of the process to develop a comprehensive monitoring framework for EPMM. The experts considered a total of 118 indicators grouped into the 11 key themes outlined in the EPMM report, ultimately reaching consensus on a set of 25 indicators, five equity stratifiers, and one transparency stratifier., Conclusion: The indicators identified in Phase II will be used along with the Phase I indicators to monitor progress towards ending preventable maternal deaths. Together, they provide a means for monitoring not only the essential clinical interventions needed to save lives but also the equally important political, social, economic and health system determinants of maternal health and survival. These distal factors are essential to creating the enabling environment and high-performing health systems needed to ensure high-quality clinical care at the point of service for every woman, her fetus and newborn. They complement and support other monitoring efforts, in particular the "Survive, Thrive, and Transform" agenda laid out by the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) and the SDG3 global target on maternal mortality.
- Published
- 2018
- Full Text
- View/download PDF
14. The effect of Kenya's free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities.
- Author
-
Gitobu CM, Gichangi PB, and Mwanda WO
- Subjects
- Adult, Delivery, Obstetric economics, Delivery, Obstetric legislation & jurisprudence, Female, Health Facilities statistics & numerical data, Health Plan Implementation statistics & numerical data, Health Policy economics, Health Policy legislation & jurisprudence, Humans, Infant, Infant, Newborn, Kenya, Maternal Health Services economics, Maternal Health Services legislation & jurisprudence, Pregnancy, Delivery, Obstetric statistics & numerical data, Infant Mortality trends, Maternal Health Services statistics & numerical data, Maternal Mortality trends, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Background: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy's effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities., Methods: A time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya., Results: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality., Conclusion: The findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths.
- Published
- 2018
- Full Text
- View/download PDF
15. Medical provision and urban-rural differences in maternal mortality in late nineteenth century Scotland.
- Author
-
Reid A and Garrett E
- Subjects
- Death Certificates history, Female, History, 19th Century, Humans, Maternal Health Services statistics & numerical data, Pregnancy, Rural Population statistics & numerical data, Scotland epidemiology, Urban Population statistics & numerical data, Health Status Disparities, Maternal Health Services history, Maternal Mortality history, Rural Population history, Urban Population history
- Abstract
This paper examines the effect of variable reporting and coding practices on the measurement of maternal mortality in urban and rural Scotland, 1861-1901, using recorded causes of death and women who died within six weeks of childbirth. This setting provides data (n = 604 maternal deaths) to compare maternal mortality identified by cause of death with maternal mortality identified by record linkage and to contrast urban and rural settings with different certification practices. We find that underreporting was most significant for indirect causes, and that indirect causes accounted for a high proportion of maternal mortality where the infectious disease load was high. However, distinguishing between indirect and direct maternal mortality can be problematic even where cause of death reporting appears accurate. Paradoxically, underreporting of maternal deaths was higher in urban areas where deaths were routinely certified by doctors, and we argue that where there are significant differences in medical provision and reported deaths, differences in maternal mortality may reflect certification practices as much as true differences. Better health services might therefore give the impression that maternal mortality was lower than it actually was. We end with reflections on the interpretation of maternal mortality statistics and implications for the concept of the obstetric transition., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
16. The Midwifery services framework: What is it, and why is it needed?
- Author
-
Nove A, Hoope-Bender PT, Moyo NT, and Bokosi M
- Subjects
- Adult, Developing Countries statistics & numerical data, Female, Global Health trends, Humans, Infant, Infant, Newborn, Pregnancy, Infant Mortality trends, Maternal Health Services standards, Maternal Mortality trends
- Abstract
Most low- and middle-income countries failed to meet the Millennium Development Goal targets for maternal, newborn and child health, and even more ambitious targets have been set under the Sustainable Development Goals and the Ending Preventable Maternal Mortality initiative. This means that many countries will need to accelerate progress on sexual, reproductive, maternal and newborn health over the next few years. Recent years have seen the publication of a large and convincing body of evidence about the potential of midwifery to make a significant contribution to this acceleration, but little practical guidance has emerged to help countries invest in midwifery services so that their health systems can meet the increasing need for sexual, reproductive, maternal and newborn health care. To help fill this gap, the International Confederation of Midwives designed and launched the Midwifery Services Framework, a new tool to guide countries through the process of strengthening and developing their midwifery services. This first of a series of three papers introduces the MSF, explains why it is needed, how it was developed, its guiding principles and its anticipated outcomes and impact. The other two papers explain the process of implementing the Midwifery Services Framework, and lessons learned in the first countries to start implementation., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
17. The magnitude and factors related to facility-based maternal mortality in Mozambique.
- Author
-
Chavane L, Dgedge M, Degomme O, Loquiha O, Aerts M, and Temmerman M
- Subjects
- Emergency Medical Services, Female, Hospitals statistics & numerical data, Humans, Maternal Health Services statistics & numerical data, Maternal-Child Health Centers statistics & numerical data, Mozambique epidemiology, Pregnancy, Quality of Health Care, Risk Factors, Surveys and Questionnaires, Health Services Accessibility, Maternal Health Services organization & administration, Maternal Mortality, Nurse Midwives statistics & numerical data
- Abstract
Facility-based maternal mortality remains an important public health problem in Mozambique. A number of factors associated with health system functioning can be described behind the occurrence of these deaths. This paper aimed to evaluate the magnitude of the health facility-based maternal mortality, its geographical distribution and to assess the health facility factors implicated in the occurrence of these deaths. A secondary analysis was done on data from the survey on maternal health needs performed by the Ministry of Health of Mozambique in 2008. During the study period 2.198 maternal deaths occurred out of 312.537 deliveries. According to the applied model the availability of Maternal and Child Health (MCH) nurses performing Emergency Obstetric Care functions was related to the reduction of facility-based maternal mortality by 40%. No significant effects were observed for the availability of medical doctors, surgical technicians and critical delivery room equipment. Impact statement Is largely known that the availability of skilled attendants assisting every delivery and providing Emergency Obstetric Care services during the pregnancy, labor and Childbirth is key for maternal mortality reduction. This study add the differentiation on the impact of different cadres of health services providers working on maternal and child health services on the facility based maternal mortality. In this setting the study proven the high impact of the midlevel skilled maternal and child health nurses on the reduction of maternal mortality. Another important add from this study is the use of facility based maternal mortality data to inform the management process of maternal healthcare services. The findings from this study have potential to impact on the decision of staffing prioritization in setting like the study setting. The findings support the policy choice to improve the availability of maternal and child health nurses.
- Published
- 2017
- Full Text
- View/download PDF
18. Ideal citizens: the birthing of state truths and fictions in Quintana Roo.
- Author
-
Williams SA
- Subjects
- Anthropology, Medical, Data Interpretation, Statistical, Delivery, Obstetric ethics, Delivery, Obstetric methods, Delivery, Obstetric psychology, Delivery, Obstetric statistics & numerical data, Female, Health Knowledge, Attitudes, Practice ethnology, Health Policy, Humans, Interviews as Topic, Mexico, Midwifery methods, Midwifery statistics & numerical data, Patient Acceptance of Health Care psychology, Maternal Health Services statistics & numerical data, Maternal Mortality ethnology, Parturition ethnology, Parturition psychology, Patient Acceptance of Health Care ethnology, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Reducing the maternal mortality rate (MMR) is an important part of Mexico's commitment to the Millennium Development Goals, and the country has made great strides towards achieving this goal. However, researchers have questioned to what extent the focus on improved MMR and other indices of maternal health has contributed to an emphasis on improved statistics rather than quality care, and the effect this has had on the quality of reporting. While public health officials and hospital administrators alike agree that improved obstetric reporting is necessary, there is little discussion regarding the accuracy of the data that are submitted and the institutional pressures that may contribute to the production of inaccurate data. Using ethnographic research collected in Tulum, Quintana Roo, this paper explores how biomedical childbirth functions as a source of legitimization for the state while simultaneously providing the means for the presentation of an ideal subjecthood, one that situates birthing women and healthcare personnel as properly attenuated to the norms and needs of the modern Mexican state. By highlighting the point of disjuncture between women's experiences and the formal 'reality' created through hospital texts, this paper explores the place of biomedical birth as a producer of and legitimization for Mexican public health policy.
- Published
- 2016
- Full Text
- View/download PDF
19. Maternal mortality in New York--Looking back, looking forward.
- Author
-
Chazotte C and D'Alton ME
- Subjects
- Female, History, 20th Century, History, 21st Century, Hospitals, Maternity standards, Humans, Hypertension, Pregnancy-Induced diagnosis, Hypertension, Pregnancy-Induced epidemiology, Hypertension, Pregnancy-Induced history, Hypertension, Pregnancy-Induced therapy, Maternal Health Services standards, Maternal Mortality ethnology, Maternal Mortality trends, New York epidemiology, Patient Care Bundles standards, Patient Safety history, Patient Safety standards, Postpartum Hemorrhage diagnosis, Postpartum Hemorrhage epidemiology, Postpartum Hemorrhage history, Postpartum Hemorrhage therapy, Pregnancy, Venous Thromboembolism diagnosis, Venous Thromboembolism epidemiology, Venous Thromboembolism history, Venous Thromboembolism therapy, Hospitals, Maternity history, Maternal Health Services history, Maternal Mortality history, Patient Care Bundles history
- Abstract
New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
20. Demand-side interventions for maternal care: evidence of more use, not better outcomes.
- Author
-
Hurst TE, Semrau K, Patna M, Gawande A, and Hirschhorn LR
- Subjects
- Female, Humans, Infant, Infant, Newborn, Pregnancy, Quality Improvement, Infant Mortality, Maternal Health Services supply & distribution, Maternal Mortality, Perinatal Mortality, Prenatal Care statistics & numerical data, Stillbirth epidemiology
- Abstract
Background: Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children., Methods: We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University's Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP)., Results: Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures., Conclusions: We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.
- Published
- 2015
- Full Text
- View/download PDF
21. Shaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam.
- Author
-
Ha BT, Mirzoev T, and Mukhopadhyay M
- Subjects
- Female, Humans, Politics, Pregnancy, Reproductive Health, Vietnam, Health Policy, Health Priorities, Maternal Death prevention & control, Maternal Health Services, Maternal Mortality
- Abstract
Background: Maternal health remains a central policy concern in Vietnam. With a commitment to achieving the Millennium Development Goal (MDG) 5 target of maternal mortality rate (MMR) of 70/100 000 by 2015, the Ministry of Health (MoH) issued the National Plan for Safe Motherhood (NPSM) 2003-2010. In 2008, reproductive health, including safe motherhood (SM) became a national health target program with annual government funding., Methods: A case study of how SM emerged as a political priority in Vietnam over the period 2001-2008, drawing on Kingdon's theory of agenda-setting was conducted. A mixed method was adopted for this study of the NPSM., Results: Three related streams contributed to SM priority in Vietnam: (1) the problem of high MMR was officially recognized from high-quality research, (2) the strong roles of policy champion from MoH in advocating for the needs to reducing MMR as well as support from government and donors, and (3) the national and international events, providing favorable context for this issue to emerge on policy agenda., Conclusion: This paper draws on the theory of agenda-setting to analyze the Vietnam experience and to develop guidance for SM a political priority in other high maternal mortality communities., (© 2015 by Kerman University of Medical Sciences.)
- Published
- 2015
- Full Text
- View/download PDF
22. Research results from a registry supporting efforts to improve maternal and child health in low and middle income countries.
- Author
-
Goldenberg RL, McClure EM, Bose CL, Jobe AH, and Belizán JM
- Subjects
- Adolescent, Female, Humans, Infant, Pregnancy, Registries, Socioeconomic Factors, Infant Mortality trends, Maternal Health Services standards, Maternal Mortality trends, Quality of Health Care
- Abstract
The National Institute of Child Health and Human Development created and continues to support the Global Network for Women's and Children's Health Research, a partnership between research institutions in the US and low-middle income countries. This commentary describes a series of 15 papers emanating from the Global Network's Maternal and Newborn Health Registry. Using data from 2010 to 2013, the series of papers describe nearly 300,000 pregnancies in 7 sites in 6 countries - India (2 sites), Pakistan, Kenya, Zambia, Guatemala and Argentina. These papers cover a wide range of topics including several dealing with efforts made to ensure data quality, and others reporting on specific pregnancy outcomes including maternal mortality, stillbirth and neonatal mortality. Topics ranging from antenatal care, adolescent pregnancy, obstructed labor, factors associated with early initiation of breast feeding and maintenance of exclusive breast feeding and contraceptive usage are presented. In addition, case studies evaluating changes in mortality over time in 3 countries - India, Pakistan and Guatemala - are presented. In order to make progress in improving pregnancy outcomes in low-income countries, data of this quality are needed.
- Published
- 2015
- Full Text
- View/download PDF
23. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales).
- Author
-
Olivas, Elijah T., Valdez, Mario, Muffoletto, Barbara, Wallace, Jacqueline, Stollak, Ira, and Perry, Henry B.
- Subjects
MATERNAL health services ,RURAL health services ,HEALTH services accessibility ,RESEARCH methodology ,BIRTHING centers ,COMMUNITY health services ,ACQUISITION of data ,INTERVIEWING ,PREGNANCY complications ,PSYCHOSOCIAL factors ,MEDICAL referrals ,MEDICAL records ,RESEARCH funding ,DESCRIPTIVE statistics ,INTERPROFESSIONAL relations ,INDIGENOUS peoples ,DECISION making in clinical medicine ,MATERNAL mortality ,CORPORATE culture - Abstract
Background: In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. Methods: We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. Results: During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. Conclusion: The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
24. The struggle to deliver in squatters: a qualitative study on inter-state migrant women in Aligarh.
- Author
-
Iqrar, Sanoobia and Musavi, Azra
- Subjects
DISEASE risk factors ,INFANT mortality ,QUALITATIVE research ,MATERNAL health services ,VIOLENCE ,NOMADS ,STATISTICAL sampling ,INTERVIEWING ,ATTITUDES of mothers ,POVERTY areas ,MATERNAL mortality ,JUDGMENT sampling ,HYGIENE ,THEMATIC analysis ,PREGNANCY complications ,CHILDBIRTH ,PSYCHOLOGICAL vulnerability ,PREGNANCY - Abstract
Purpose: This paper aims to understand the maternal health vulnerabilities of migrant women in slums and explore their challenges during and after childbirth. Design/methodology/approach: The study used a qualitative approach, including in-depth interviews through purposive and snowball sampling techniques. Thematic analysis was used for analysing data. The consolidated criteria for reporting qualitative studies (COREQ)-32 items were followed for reporting this study. Findings: The study found that migrant women were highly susceptible to adverse birthing outcomes due to risks involved in birthing, lack of care and hygiene, lack of skilled care in dealing with complicated pregnancies and exposure to domestic and obstetric violence. Originality/value: The study intends to highlight the narratives of female migrants' birthing and maternal health challenges. The entire process of childbirth in slums with consequences can result in maternal and infant morbidities and mortalities. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
25. Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania.
- Author
-
Kamala, Benjamin Anathory, Ersdal, Hege, Moshiro, Robert, Mduma, Estomih, Baker, Ulrika, Guga, Godfrey, Kvaløy, Jan Terje, Bishanga, Dunstan R., Bundala, Felix, Marwa, Boniphace, Rutachunzibwa, Thomas, Simeo, Japhet, Rutatinisibwa, Honoratha Faustine, Ndungile, Yudas, Kayera, Damas, Kalabamu, Florence Salvatory, and Mdoe, Paschal
- Subjects
MATERNAL health services ,CHILDBIRTH ,MEDICAL quality control ,DATA quality ,EVALUATION of human services programs ,SCIENTIFIC observation ,HEALTH facilities ,PREGNANT women ,GESTATIONAL age ,MENTORING ,POPULATION geography ,DOCUMENTATION ,HUMAN services programs ,PERINATAL death ,RANDOMIZED controlled trials ,PRE-tests & post-tests ,PEARSON correlation (Statistics) ,COMPARATIVE studies ,QUALITY assurance ,DESCRIPTIVE statistics ,CHI-squared test ,RESEARCH funding ,MATERNAL mortality ,INFANT mortality ,LABOR (Obstetrics) ,STATISTICAL sampling ,PATIENT safety - Abstract
This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project's implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
26. Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster‐randomised study in rural Tanzania
- Author
-
Larson, Elysia, Gage, Anna D., Mbaruku, Godfrey M., Mbatia, Redempta, Haneuse, Sebastien, and Kruk, Margaret E.
- Subjects
Adult ,Rural Population ,Tanzanie ,essai contrôlé randomisé en grappes ,évaluation ,cluster‐randomised controlled trial ,maternal and newborn health ,Tanzania ,Pregnancy ,Infant Mortality ,Humans ,Maternal Health Services ,Home Childbirth ,Quality of Health Care ,evaluation ,qualité ,Infant, Newborn ,Parturition ,Infant ,Prenatal Care ,Patient Acceptance of Health Care ,utilisation ,Delivery, Obstetric ,Quality Improvement ,santé maternelle et néonatale ,Maternal Mortality ,quality ,Original Article ,Female ,Health Facilities ,Original Research Papers ,Delivery of Health Care ,Program Evaluation - Abstract
Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub-optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.In this cluster-randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in-service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference-in-differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.La réduction de la mortalité maternelle et néonatale exige que les femmes accouchent dans des établissements de santé de haute qualité. Cependant, de nombreux établissements offrent une qualité de soins sous-optimale, ce qui peut expliquer l'utilisation moins généralisée des établissements. Nous avons évalué l'impact d'un projet d'amélioration de la qualité sur l'utilisation des établissements pour l'accouchement. MÉTHODES: Dans cet essai randomisé en grappes mené dans quatre districts ruraux de Tanzanie, 12 cliniques de soins primaires et leurs zones de recrutement ont bénéficié d'une intervention d'amélioration de la qualité consistant en une formation au cours du service, une supervision par un encadrement et un accompagnement, un appui en infrastructure et des relations avec les pairs tandis que 12 établissements et leur zone de recrutement ont servi de contrôles. Nous avons procédé à un recensement de tous les accouchements dans la zone de recrutement et utilisé une analyse de la différence des différences pour déterminer l'effet de l'intervention sur l'utilisation des établissements pour l'accouchement. Nous avons effectué une analyse secondaire de l'utilisation chez les femmes dont l'accouchement précédent avait eu lieu à domicile. Nous avons également investigué les mécanismes permettant d'accroître l'utilisation des établissements. RÉSULTATS: L'intervention a entraîné une augmentation du nombre de naissances dans les établissements de 6,7 points de pourcentage par rapport à une de référence base de 72% (intervalle de confiance à 95%: 0.6-12.8). L'intervention a augmenté de 18.3 points de pourcentage l'accouchement dans un établissement pour les femmes ayant accouché à domicile précédemment (IC 95%: 10.1-26.6). La qualité prénatale a augmenté dans les établissements d'intervention, les prestataires effectuant 0.5 action supplémentaire sur l'ensemble de la population et 0.8 action pour le sous-groupe des accouchements à domicile.Nous attribuons l'utilisation accrue des établissements à une meilleure qualité prénatale. Cette utilisation accrue ne ferait baisser la mortalité maternelle que si la qualité des soins s'améliorait.
- Published
- 2019
27. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho
- Author
-
Jesper Brix, Hartini Sugianto, Gilles van Cutsem, Sarah Jane Steele, Kristal Duncan, Mit Philips, Aline Aurore Niyibizi, Sandra Sedlimaier, Julia Hill, Quentin Baglione, and Amir Shroufi
- Subjects
Adult ,neonatal mortality ,retrospective study ,030231 tropical medicine ,mortalité néonatale ,maternal health ,Health Services Accessibility ,User fee ,03 medical and health sciences ,Maternity care ,0302 clinical medicine ,Pregnancy ,District hospital ,Chart review ,Infant Mortality ,Per capita ,Humans ,utilisation des soins obstétricaux ,Medicine ,Maternal Health Services ,obstetric care utilisation ,access to care ,maternal mortality ,business.industry ,Neonatal mortality ,Mortality rate ,Public Health, Environmental and Occupational Health ,Infant ,Retrospective cohort study ,Delivery, Obstetric ,medicine.disease ,Hospital Charges ,Lesotho ,Infectious Diseases ,suppression des frais d'utilisation ,user fee removal ,Female ,Original Article ,étude rétrospective ,Parasitology ,Medical emergency ,business ,Original Research Papers - Abstract
Objective Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho. Methods We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives. Results Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital. Conclusion Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.
- Published
- 2018
28. Population cause of death estimation using verbal autopsy methods in large-scale field trials of maternal and child health: lessons learned from a 20-year research collaboration in Central Ghana.
- Author
-
Danso, Samuel O., Manu, Alexander, Fenty, Justin, Amanga-Etego, Seeba, Avan, Bilal Iqbal, Newton, Sam, Soremekun, Seyi, and Kirkwood, Betty
- Subjects
CAUSES of death ,MATERNAL health services ,DATA quality ,MIDDLE-income countries ,AUTOPSY ,VITAL statistics ,CHILDREN'S health ,INTERPROFESSIONAL relations ,LOW-income countries ,RESEARCH funding ,MATERNAL mortality ,INFANT mortality ,DEATH certificates - Abstract
Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
29. Improving Tanzanian childbirth service quality
- Author
-
Joanna Schellenberg, Suzanne Penfold, Jennie Jaribu, Fatuma Manzi, and Cathy Green
- Subjects
Rural Population ,Quality management ,Decision Making ,Collaborative model ,Tanzania ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Health facility delivery ,Nursing ,Health facility ,Pregnancy ,Primary health ,Infant Mortality ,Birth plan ,Humans ,Medicine ,Childbirth ,Maternal Health Services ,030212 general & internal medicine ,Program Development ,Partograph ,Pregnancy danger signs ,Service quality ,biology ,business.industry ,030503 health policy & services ,Health Policy ,Pregnancy Outcome ,Infant ,Rural district ,Delivery, Obstetric ,biology.organism_classification ,Quality Improvement ,General Business, Management and Accounting ,Pregnancy Complications ,Maternal Mortality ,Female ,0305 other medical science ,business ,Program Evaluation ,Research Paper - Abstract
PurposeThe purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.Design/methodology/approachA QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.FindingsMedian monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.Research limitations/implicationsThe time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.Originality/valueHealthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.
- Published
- 2018
30. Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR
- Author
-
Chankham, Tengbriacheu, Yamamoto, Eiko, Reyer, Joshua A., Arafat, Rahman, Khonemany, Innoukham, Panome, Sayamoungkhoun, Hongkham, Dalavong, Bounfeng, Phommalaysith, Anonh, Xeuthvongsa, and Hamajima, Nobuyuki
- Subjects
Adult ,Original Paper ,knowledge ,Adolescent ,free delivery policy ,health facility ,Young Adult ,Cross-Sectional Studies ,Logistic Models ,Maternal Mortality ,Laos ,Odds Ratio ,maternal care ,Humans ,Female ,Maternal Health Services ,Health Facilities - Abstract
To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its “Free Maternal Health Services Policy” in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P
- Published
- 2017
31. A Mobile Health Wallet for Pregnancy-Related Health Care in Madagascar: Mixed-Methods Study on Opportunities and Challenges
- Author
-
Muller, Nadine, Emmrich, Peter Martin Ferdinand, Rajemison, Elsa Niritiana, De Neve, Jan-Walter, Bärnighausen, Till, Knauss, Samuel, and Emmrich, Julius Valentin
- Subjects
Original Paper ,cell phone ,maternal mortality ,maternal health services ,Information technology ,developing countries ,T58.5-58.64 ,marketing of health services ,mobile applications ,healthcare financing ,Madagascar ,pregnancy ,telemedicine ,health expenditures ,Public aspects of medicine ,RA1-1270 ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit - Abstract
BackgroundMobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services—which commonly require large 1-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings. ObjectiveThe aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone–based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar. MethodsWe used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population. Results59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support. ConclusionsFinancial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service.
- Published
- 2019
32. A realist review of interventions targeting maternal health in low- and middle-income countries.
- Author
-
Abraham, Julie Mariam and Melendez-Torres, GJ
- Subjects
MATERNAL health services ,CULTURE ,MIDDLE-income countries ,HEALTH services accessibility ,MEDICAL information storage & retrieval systems ,SYSTEMATIC reviews ,SOCIAL norms ,EVIDENCE-based medicine ,HELP-seeking behavior ,TREATMENT effectiveness ,CHILD health services ,LOW-income countries ,RESEARCH funding ,MATERNAL mortality ,THEMATIC analysis ,SUSTAINABLE development ,MEDLINE - Abstract
Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
33. Respectful Maternal Care Experience in Low- and Middle-Income Countries: A Systematic Review.
- Author
-
Kawish, Ayesha Babar, Umer, Muhammad Farooq, Arshed, Muhammad, Khan, Shahzad Ali, Hafeez, Assad, and Waqar, Saman
- Subjects
MIDDLE-income countries ,MATERNAL health services ,INFANT care ,HIGH-income countries ,WOMEN'S hospitals ,DATABASES - Abstract
Background and Objectives: Respectful maternity care promotes practices that acknowledge women's preferences and women and newborns' needs. It is an individual-centered strategy founded on ethical and human rights principles. The objective of this systematic review is to identify the impact of income on maternal care and respectful maternity care in low- and middle-income countries. Materials and Methods: Data were searched from Google Scholar, PubMed, Web of Science, NCBI, CINAHL, National Library of Medicine, ResearchGate, MEDLINE, EMBASE database, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Maternity and Infant Care database. This review followed PRISMA guidelines. The initial search for publications comparing low- and middle-income countries with respectful maternity care yielded 6000 papers, from which 700 were selected. The review articles were further analyzed to ensure they were pertinent to the comparative impact of income on maternal care. A total of 24 articles were included, with preference given to those published from 2010 to 2023 during the last fourteen years. Results: Considering this study's findings, respectful maternity care is a crucial component of high-quality care and human rights. It can be estimated that there is a direct association between income and maternity care in LMICs, and maternity care is substandard compared to high-income countries. Moreover, it is determined that the evidence for medical tools that can enhance respectful maternity care is sparse. Conclusions: This review highlights the significance of improving maternal care experiences, emphasizing the importance of promoting respectful practices and addressing disparities in low- and middle-income countries. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
34. Power of partnerships: What makes a difference in reducing maternal mortality and how can Canadians contribute?
- Author
-
Shroff, Farah, Minhas, Jasmit S., and Laugen, Christian
- Subjects
MATERNAL mortality ,COMMUNITY health services ,HEALTH care teams ,INTERPROFESSIONAL relations ,INTERVIEWING ,MATERNAL health services ,MATHEMATICAL models ,SURVIVAL ,TEAMS in the workplace ,WORLD health ,THEORY ,MIDDLE-income countries ,LOW-income countries ,PREVENTION - Abstract
Purpose: Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates. Design/methodology/approach: Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates. Findings: Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women's literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad. Research limitations/implications: Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality. Practical implications: All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of "tied aid", thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative. Social implications: Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women's health are valuable. Canada's midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women's lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/. Originality/value: There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
35. Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study.
- Author
-
Sørensen, Jane Brandt, Housseine, Natasha, Maaløe, Nanna, Bygbjerg, Ib Christian, Pinkowski Tersbøl, Britt, Konradsen, Flemming, Sequeira Dmello, Brenda, van Den Akker, Thomas, van Roosmalen, Jos, Mookherji, Sangeeta, Siaity, Eunice, Osaki, Haika, Khamis, Rashid Saleh, Kujabi, Monica Lauridsen, John, Thomas Wiswa, Wolf Meyrowitsch, Dan, Mbekenga, Columba, Skovdal, Morten, and L. Kidanto, Hussein
- Subjects
MATERNAL health services ,CHILDBIRTH ,PILOT projects ,EVALUATION of human services programs ,MIDDLE-income countries ,ATTITUDES of mothers ,DISEASES ,MEDICAL protocols ,QUALITATIVE research ,EXPERIENCE ,QUALITY assurance ,RESEARCH funding ,LOW-income countries ,INFANT mortality ,MATERNAL mortality - Abstract
Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study's programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants' motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
36. PROFESSIONAL MIDWIFERY EDUCATION IN BULGARIA AT THE TURN OF XX CENTURY: A HISTORICAL PERSPECTIVE.
- Author
-
Gospodinova, P. and Dimitrova, S.
- Subjects
- *
MIDWIFERY education , *MATERNAL health services , *INFANT mortality , *MATERNAL mortality , *HISTORICAL source material - Abstract
The goal of this article is to recount the birth and development of midwifery and maternal care education in Bulgaria after the Bulgarian Liberation at the end of XIX and the beginning of the XX century. The researchers set the following tasks: 1) to present the main reasons for the emergence of professional midwifery education in post-Liberation Bulgaria; 2) to show the place and role of the first professionally trained midwives in Bulgaria; 3) to outline the seminal work of notable personalities for the development of professional midwifery care. Historical method was used, secondary historical sources, documents and scientific papers were reviewed. Conclusions: Professional midwifery education helped the introduction and spread of modern Obstetrics/Gynecology medicine, which lead to decrease in maternal and infant mortality and slowly improved quality of life for Bulgarian women and children. Bulgarian nationals educated abroad brought to the country the scientific foundation and best practices in maternal health care. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
37. How does COVID-19 affect maternal and neonatal outcomes?
- Author
-
Koç, Esin and Dilli, Dilek
- Subjects
MATERNAL health services ,COVID-19 ,IMMUNIZATION ,SYSTEMATIC reviews ,PREGNANT women ,CATASTROPHIC illness ,PREGNANCY complications ,BREASTFEEDING ,INFANT mortality ,MATERNAL mortality ,VERTICAL transmission (Communicable diseases) ,DISEASE risk factors ,CHILDREN ,PREGNANCY - Abstract
In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
38. Rheumatic heart disease in pregnancy: Maternal and neonatal outcomes in the Top End of Australia.
- Author
-
Lam, Chor Kiu, Thorn, Jane, Lyon, Xylyss, Waugh, Edith, Piper, Ben, and Wing‐Lun, Edwina
- Subjects
MATERNAL health services ,INDIGENOUS Australians ,RHEUMATIC heart disease ,SCIENTIFIC observation ,PREGNANT women ,RETROSPECTIVE studies ,PREGNANCY outcomes ,PERINATAL death ,SEVERITY of illness index ,HEALTH care teams ,CESAREAN section ,MATERNAL mortality - Abstract
Background: Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature. Aims: The primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status. Methods: A retrospective observational study was conducted over a 9.5‐year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis. Results: One hundred and twenty‐nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated. Conclusion: We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
39. Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme
- Author
-
Obare, Francis, Okwero, Peter, Villegas, Leslie, Mills, Samuel, and Bellows, Ben
- Subjects
SOCIAL SCIENCE ,ADOLESCENT REPRODUCTIVE HEALTH ,LOCAL POPULATION ,COMMERCIAL SEX ,ACCESS TO FAMILY PLANNING ,SAFE MOTHERHOOD ,IMPROVING HEALTH CARE ,MATERNAL HEALTH SERVICES ,CHILDREN ,CHILD HEALTH ,MEASUREMENT ,CONTRACEPTION ,HEALTH SYSTEM ,SEX WORKERS ,ADOLESCENTS ,IMPLEMENTATION ,SERVICE UTILIZATION ,EMERGENCY OBSTETRIC CARE ,POLICY MAKERS ,EMPOWERMENT OF WOMEN ,POOR MATERNAL HEALTH ,POPULATION ,IMMUNODEFICIENCY ,COMPLICATIONS ,REFERRAL FACILITY ,NUMBER OF CHILDREN ,WOMEN ,ACQUIRED IMMUNODEFICIENCY SYNDROME ,WORKERS ,REDUCING MATERNAL MORTALITY ,STIS ,MORTALITY RATIO ,SERVICE PROVIDERS ,FAMILY PLANNING PROGRAM ,DISEASES ,HEALTH OUTCOMES ,IMPROVEMENTS IN QUALITY OF CARE ,POPULATIONS ,HEALTH ,INTERVENTION ,HEALTH CARE SERVICES ,SEXUALLY TRANSMITTED DISEASES ,VIOLENCE ,BULLETIN ,SERVICE DELIVERY ,POLICY DISCUSSIONS ,NEONATAL MORTALITY ,PATIENT ,PUBLIC SERVICES ,SERVICE QUALITY ,LIVE BIRTHS ,MALARIA ,BABIES ,RURAL AREAS ,PURCHASING POWER ,FERTILITY ,NATIONAL HEALTH SYSTEMS ,HEALTH FACILITIES ,SERVICE PROVIDER ,PROGRESS ,MILLENNIUM DEVELOPMENT GOAL ,HYPERTENSION ,MORTALITY ,HEALTH-SECTOR ,LOW-INCOME COUNTRY ,DELIVERY CARE ,SOCIAL COHESION ,NATIONAL FAMILY PLANNING PROGRAMS ,DEVELOPMENT POLICY ,MATERNAL HEALTH ,RISKS ,INTERVIEW ,RISK GROUPS ,MATERNAL MORTALITY ,HEALTH SECTOR ,LEVEL OF EDUCATION ,QUALITY SERVICES ,DELIVERY COSTS ,HOUSEHOLD SURVEYS ,MARKETING ,PREGNANT WOMEN ,SKILLED HEALTH PERSONNEL ,NEWBORN ,INFORMED CONSENT ,COMMERCIAL SEX WORKERS ,ADOLESCENT HEALTH ,QUALITY OF HEALTH CARE ,WORLD HEALTH ORGANIZATION ,ANTENATAL CARE ,ABORTION ,HOME DELIVERIES ,HOUSEHOLD ASSETS ,LIFE EXPECTANCY ,MIDWIVES ,OBSTETRIC CARE ,HUMAN DEVELOPMENT ,MINISTRY OF HEALTH ,POPULATION COUNCIL ,REPRODUCTIVE HEALTH COMMODITIES ,WOMAN ,HEALTH POLICY ,NATIONAL FAMILY PLANNING ,FAMILY PLANNING PROGRAMS ,FOOD SECURITY ,POLICY ,HEALTH INDICATORS ,FAMILY PLANNING ,HEALTH PROBLEMS ,AIDS ,SEXUALLY TRANSMITTED INFECTIONS ,PREGNANCY ,NORMAL DELIVERIES ,HEALTH CARE ,HEALTH SYSTEMS ,MATERNAL HEALTH CARE ,NUTRITION ,SEX ,PUBLIC HEALTH ,SEXUAL PARTNER ,RESPECT ,CHILDBIRTH ,MATERNAL DEATHS ,EMERGENCY CARE ,NURSING ,REPRODUCTIVE HEALTH SERVICES ,TRAINING ,SERVICE PROVISION ,MATERNAL HEALTH OUTCOMES ,POPULATION STRATEGY ,LOW-INCOME POPULATIONS ,STERILIZATION ,POLICY RESEARCH ,DISEASE SYMPTOMS ,QUALITY OF SERVICES ,MORBIDITY ,DEVELOPING COUNTRIES ,FEMALE STERILIZATION ,CHILDBEARING ,PREGNANCY COMPLICATIONS ,FAMILY PLANNING SERVICES ,PREGNANCIES ,DRUGS ,INEQUITIES ,KNOWLEDGE ,CHILD HEALTH SERVICES ,STRATEGY ,POLICY RESEARCH WORKING PAPER ,MATERNAL MORTALITY RATIO ,REPRODUCTIVE HEALTH INDICATORS ,REPRODUCTIVE HEALTH CARE ,ACCESS TO HEALTH SERVICES ,SKILLED ATTENDANT ,USE OF MATERNAL HEALTH SERVICES ,RADIO ,MARITAL STATUS ,GENDER EQUALITY ,POLICY ANALYSIS ,PHARMACIES ,HIV ,MATERNAL MORBIDITY ,POSTNATAL CARE ,HEALTH SERVICES ,QUALITY OF CARE ,OBSERVATION ,CHILD MORTALITY ,CAESAREAN SECTION ,NEWBORN CARE ,INJURIES ,NURSES ,WEIGHT ,REPRODUCTIVE HEALTH ,PROVISION OF SERVICES ,HOSPITAL ,C-SECTION - Abstract
Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities’ claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.
- Published
- 2016
40. Maternal and Child Health Inequalities in Ethiopia
- Author
-
Ambel, Alemayehu, Andrews, Colin, Bakilana, Anne, Foster, Elizabeth, Khan, Qaiser, and Wang, Huihui
- Subjects
MODERN CONTRACEPTIVE USE ,LEVELS OF MORTALITY ,MIGRANT ,NUMBER OF DEATHS ,MATERNAL HEALTH SERVICES ,METHOD OF CONTRACEPTION ,CHILDREN ,OWNERSHIP OF LAND ,CHILD HEALTH ,MEASUREMENT ,CONTRACEPTION ,HEALTH SYSTEM ,MORTALITY LEVELS ,IMPLEMENTATION ,SERVICE UTILIZATION ,MODERN CONTRACEPTIVES ,EMERGENCY OBSTETRIC CARE ,POPULATION ,NATIONAL LEVEL ,NUMBER OF CHILDREN ,PLACE OF RESIDENCE ,WOMEN ,WORKERS ,NUTRITIONAL STATUS ,MOTHER ,HEALTH OUTCOMES ,VACCINATION ,HEALTH ,ILL HEALTH ,INTERVENTION ,AGED ,BULLETIN ,FAMILY SIZE ,IMMUNIZATIONS ,MEASLES ,NEONATAL MORTALITY ,LOW-INCOME COUNTRIES ,LIVE BIRTHS ,SANITATION ,ACCESS TO HEALTH CARE ,RURAL AREAS ,SECONDARY EDUCATION ,MARRIED WOMEN ,HEALTH FACILITIES ,NUMBER OF BIRTHS ,PROGRESS ,HEALTH RISKS ,MORTALITY ,DRINKING WATER ,MATERNAL HEALTH ,RISKS ,MATERNAL MORTALITY ,HEALTH SECTOR ,SUSTAINABLE DEVELOPMENT ,INFANT ,INFANT MORTALITY ,MILLENNIUM DEVELOPMENT GOALS ,SANITATION FACILITIES ,WORLD HEALTH ORGANIZATION ,ANTENATAL CARE ,CONTRACEPTIVE PREVALENCE ,GLOBAL HEALTH ,POLIO ,SOCIOECONOMIC INEQUALITIES ,DEVELOPMENT GOALS ,LIFE EXPECTANCY ,OBSTETRIC CARE ,RURAL RESIDENTS ,MINISTRY OF HEALTH ,FOOD SECURITY ,DISSEMINATION ,SKILLED CARE ,CHILD NUTRITION ,POLICY ,IMMUNIZATION ,HEALTH INDICATORS ,FAMILY PLANNING ,PREGNANCY ,INFANT DEATHS ,HEALTH CARE ,NUTRITION ,SEX ,PUBLIC HEALTH ,CHILDBIRTH ,MORALITY ,INFANT MORTALITY RATE ,SKILLED PERSONNEL ,CONTRACEPTIVES ,POLICY RESEARCH ,QUALITY OF SERVICES ,SKILLED BIRTH ATTENDANTS ,DEVELOPING COUNTRIES ,LEGAL STATUS ,HOUSEHOLD SIZE ,PEOPLE ,FAMILY PLANNING SERVICES ,CHILD MORTALITY RATES ,INEQUITIES ,CHILD HEALTH SERVICES ,MEASLES IMMUNIZATION ,POLICY RESEARCH WORKING PAPER ,REPRODUCTIVE HEALTH INDICATORS ,HOUSEHOLD LEVEL ,MORTALITY RATE ,CONTRACEPTIVE USE ,SKILLED PROFESSIONALS ,BIRTH ATTENDANTS ,ANTENATAL VISITS ,LIVE BIRTH ,GLOBAL DEVELOPMENT ,FACT SHEET ,SKILLED BIRTH ATTENDANCE ,HEALTH SERVICES ,SOCIOECONOMIC DIFFERENCES ,OBSERVATION ,URBAN AREAS ,CHILD MORTALITY ,MODERN CONTRACEPTION ,BIRTH ATTENDANT ,RURAL WOMEN ,WEIGHT ,REPRODUCTIVE HEALTH ,HOSPITAL ,HEALTH INTERVENTIONS - Abstract
Recent surveys show considerable progress in maternal and child health in Ethiopia. The improvement has been in health outcomes and health services coverage. The study examines how different groups have fared in this progress. It tracked 11 health outcome indicators and health interventions related to millennium development goals one, four, and five. These are stunting, underweight, wasting, neonatal mortality, infant mortality, under -five mortality, measles vaccination, and full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. Trends in rate differences and rate ratios are analyzed. The study also investigates the dynamics of inequalities, using concentration curves for different years. In addition, a decomposition analysis is conducted to identify the role of proximate determinants. The study finds substantial improvements in health outcomes and health services. Although there still exists a considerable gap between the rich and the poor, the study finds some reductions in inequalities of health services. However, some of the improvements in selected health outcomes appear to be pro-rich.
- Published
- 2015
41. New politics, an opportunity for maternal health advancement in eastern myanmar: an integrative review
- Author
-
Adam B, Loyer, Mohammed, Ali, and Diana, Loyer
- Subjects
Maternal mortality ,International aid ,Maternal Health ,Politics ,Myanmar ,Armed Conflicts ,Original Papers ,MMR ,humanities ,Policy ,Pregnancy ,Government ,Ethnicity ,Humans ,Female ,Maternal Health Services ,Human rights violations ,Burma/Myanmar ,Liberalization - Abstract
Myanmar (formerly Burma) is a southeast Asian country, with a long history of military dictatorship, human rights violations, and poor health indicators. The health situation is particularly dire among pregnant women in the ethnic minorities of the eastern provinces (Kachin, Shan, Mon, Karen and Karenni regions). This integrative review investigates the current status of maternal mortality in eastern Myanmar in the context of armed conflict between various separatist groups and the military regime. The review examines the underlying factors contributing to high maternal mortality in eastern Myanmar and assesses gaps in the existing research, suggesting areas for further research and policy response. Uncovered were a number of underlying factors uniquely contributing to maternal mortality in eastern Myanmar. These could be grouped into the following analytical themes: ongoing conflict, health system deficits, and political and socioeconomic influences. Abortion was interestingly not identified as an important contributor to maternal mortality. Recent political liberalization may provide space to act upon identified roles and opportunities for the Myanmar Government, the international community, and non-governmental organizations (NGOs) in a manner that positively impacts on maternal healthcare in the eastern regions of Myanmar. This review makes a number of recommendations to this effect.
- Published
- 2014
42. Maternal health research outputs and gaps in Latin America: reflections from the mapping study.
- Author
-
Vargas-Riaño, Emily, Becerril-Montekio, Víctor, Becerra-Posada, Francisco, and Tristán, Mario
- Subjects
MATERNAL health ,MATERNAL health services ,MATERNAL mortality ,DECISION making ,PUBLIC health ,DEVELOPING countries ,MENTAL health surveys ,QUESTIONNAIRES ,RESEARCH - Abstract
As part of the MASCOT/WOTRO multinational team conducting the maternal health literature mapping, four Latin American researchers were particularly interested in analysing information specific to their region. The mapping started with 45,959 papers uploaded from MEDLINE, CINAHL, Embase, LILACAS, PopLINE, PsycINFO and Web of Knowledge. From these, 4175 full texts were reviewed and 2295 papers were subsequently included. Latin America experienced an average maternal mortality decline of 40% between 1990 and 2013. Nevertheless, the region's performance was below the global average and short of the 75% reduction set in Millennium Development Goal 5 for 2015. The main outcomes show that research on maternal health in the countries where the most impoverished populations of the world are living is not always aligned with their compelling needs. From another perspective, the review made it possible to recognize that research funding as well as the amount of scientific literature produced concentrate on issues that are not necessarily among the main causes of maternal deaths. Even though research on maternal health in Latin America has grown from an average of 92.5 publications per year in 2000-2003 to 236.7 between 2008 and 2012, it's not satisfactorily keeping pace with other regions. In conclusion, it is critical to effectively orient research funding and production to respond to the health needs of the population. At the same time, there is a need for innovative mechanisms to strengthen the production and uptake of scientific evidence that can properly inform public health decision making. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
43. The contribution of district prioritization on maternal and newborn health interventions coverage in rural India.
- Author
-
Ramesh, B. M., Dehury, Bidyadhar, Isac, Shajy, Gothalwal, Vikas, Prakash, Ravi, Namasivayam, Vasanthakumar, Halli, Shivalingappa, Blanchard, James, and Boerma, Ties
- Subjects
CHILD health services ,CONFIDENCE intervals ,INFANT mortality ,MATERNAL health services ,EVALUATION of medical care ,MATERNAL mortality ,NATIONAL health insurance ,QUESTIONNAIRES ,REGRESSION analysis ,RURAL conditions ,EDUCATIONAL attainment ,DESCRIPTIVE statistics - Abstract
Background: In 2001, India prioritized eight most socioeconomically disadvantaged states known as Empowered Action Group (EAG) states and in 2013, it prioritized 190 of the 718 as high priority districts (HPDs) to accelerate the decline in maternal and newborn mortality. This paper assesses whether the HPDs achieved a greater coverage of maternal and newborn health interventions than the non-HPDs and HPDs in EAG states achieved greater coverage than those in non-EAG states.Methods: We used data from the Sample Registration System to assess rural neonatal mortality trends in EAG states and all India. We computed a co-coverage index based on seven maternal and newborn health interventions from the 2015/16 National Family Health Survey. Difference in differences (DID) analyses were used to examine the contribution of district prioritization, considering the HPDs and the illiterate as treatment groups and 2013 as the time cut-off for the pre- and post-treatment.Results: Neonatal mortality declined in rural India from 36 to 27 per 1000 live births during 2010-2016 at 4.5% per year. Four EAG states experienced faster rates of decline than the national rate. From 2013, the co-coverage index increased significantly more in the HPDs compared to non-HPDs (DID = 0.11, P ≤ 0.005). The district prioritization effect on co-coverage was statistically significant in only EAG states (DID = 0.13, P ≤ 0.05). The coverage gains for illiterate mothers were greater than for literate mothers, especially in the HPDs.Conclusions: The district prioritization in India is associated with greater improvements in the coverage of maternal and newborn health services in EAG states and the HPDs, including reductions in inequalities within those states and districts. There are however still large gaps between states and districts and within districts by the mother's literacy status that need further prioritization to make progress towards the SDG targets by 2030. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
44. Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis.
- Author
-
Actis Danna, Valentina, Bedwell, Carol, Wakasiaka, Sabina, and Lavender, Tina
- Subjects
CINAHL database ,HEALTH services accessibility ,MEDICAL information storage & retrieval systems ,PSYCHOLOGY information storage & retrieval systems ,MATERNAL health services ,MEDLINE ,MATERNAL mortality ,SYSTEMATIC reviews ,DATA analysis software ,DESCRIPTIVE statistics ,MIDDLE-income countries ,LOW-income countries ,TREATMENT delay (Medicine) ,INTRAPARTUM care - Abstract
The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care. To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care. We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the 'best-fit framework approach'. This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model's structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay's definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women's individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach. This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women's Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women's empowerment during pregnancy and childbirth. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
45. Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis.
- Author
-
Pavalagantharajah, Sureka, Negrin, Atziri Ramirez, Bouzanis, Katrina, Joan Lee, Tin-Suet, Miller, Peter, Jones, Rebecca, Sinnott, Will, and Alvarez, Elizabeth
- Subjects
- *
MATERNAL health services , *MEDICAL quality control , *ONLINE information services , *PSYCHOLOGY information storage & retrieval systems , *HEALTH facilities , *MEDICAL information storage & retrieval systems , *HOSPITAL building design & construction , *EQUIPMENT & supplies , *SOCIAL support , *HEALTH services accessibility , *SYSTEMATIC reviews , *LEADERSHIP , *MEDICAL personnel , *EVIDENCE-based medicine , *COGNITION , *CONCEPTUAL structures , *DRUGS , *HEALTH , *INFORMATION resources , *MEDICAL referrals , *CULTURAL competence , *MEDLINE , *MEDICAL practice , *ENDOWMENTS , *RESPECT , *DIGNITY , *EMPLOYEE participation in management - Abstract
Objectives: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. Methods: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. Results: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support. Significance: Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
46. Potential influence of nurses' implicit racial bias on maternal mortality.
- Author
-
Rattan, Jesse and Bartlett, T. Robin
- Subjects
- *
IMPLICIT bias , *RACISM , *MATERNAL health services , *PSYCHOLOGY of Black people , *NURSES' attitudes , *HEALTH services accessibility , *RACE , *NURSES , *MATERNAL mortality , *WHITE people , *HEALTH equity - Abstract
Stark disparities persist in maternal mortality and perinatal outcomes for Black and other birthing people of color, such as Native Americans, and their newborns compared to White people in the United States. An increasing body of research describes the phenomenon of implicit racial bias among providers and how it may affect communication, treatment decisions, the patient care experience, and health outcomes. This synthesis of literature reviews and distills current research on the presence and influence of implicit racial bias among nurses as it may relate to maternal and pregnancy‐related care and outcomes. In this paper, we also summarize what is known about implicit racial bias among other types of healthcare providers and interventions that can mitigate its effects, identify a gap in research, and recommend next steps for nurses and nurse researchers. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
47. Safe Childbirth: A Call to Action.
- Author
-
Lothian, Judith A.
- Subjects
CHILDBIRTH & psychology ,MATERNAL mortality ,CESAREAN section ,CONTINUING education ,MATERNAL health services ,EVALUATION of medical care ,MEDICAL protocols ,MIDWIVES ,PATIENT advocacy ,PREGNANCY ,PROFESSIONAL associations ,EVIDENCE-based medicine ,PROFESSIONAL practice ,LAW - Abstract
Since the publication of Lamaze's Six Healthy Birth Practice papers in 2014, there has been increasing concern with the safety of the current maternity care system. A doubling of the maternal mortality rate in the United States and the continued high cesarean rate, as well as ongoing research that supports physiologic birth and identifies the risks of interfering with the physiologic process, has resulted in updated guidelines for care and has spurred advocacy efforts to transform maternity care. This article presents a number of these advocacy efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
48. Obstetric complications and delays in seeking emergency care in poor settings of northern India.
- Author
-
Khan, Nizamuddin
- Subjects
AUDITING ,COGNITION ,DECISION making ,EMERGENCY medical services ,HEALTH services accessibility ,HELP-seeking behavior ,INTERVIEWING ,MATERNAL health services ,MEDICAL needs assessment ,MATERNAL mortality ,OBSTETRICAL emergencies ,PREGNANCY complications ,PRENATAL care ,QUESTIONNAIRES ,RURAL conditions ,STATISTICAL sampling ,WOMEN'S health ,SOCIOECONOMIC factors ,DISEASE prevalence ,DATA analysis software ,TREATMENT delay (Medicine) - Abstract
Purpose - Huge gap exists between demand and supply of seeking health care leads to remain high maternal mortality in rural areas of Uttar Pradesh, India. The purpose of this paper is to make an effort in this direction. Design/methodology/approach - This paper draws on Three Delays Model to understand the reasons behind poor maternal health outcomes among 964 currently married women aged 15-34, given birth in last two years preceding the survey including six case studies in poor settings of Northern India. Findings - Receiving minimum four antenatal care and identifying the severity of obstetric complications during pregnancy was quite low (7 and 34 per cent, respectively). Major delay in seeking care in district was decision delay (average four days) followed by arranging transportation (average 4 hours) and start treatment within an hour after reaching health facility. Health services and trained human resources are mainly concentrated at towns and poor supply of drugs and equipment in labour room is always in demand at primary level in the district in area. Delays in decision making, travel and treatment compounded by ignorance of obstetric complications and poor healthcare infrastructure are the major contributing factors of maternal deaths in the district in area. Originality/value - Interventions to improve timely seeking of medical care for obstetric complications may need to more effectively target husbands and family members rather than women. Strengthening of primary and secondary level facilities and timely referral to tertiary level care can play a crucial role in improving obstetric care in the district in rural areas. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
49. A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health.
- Author
-
Glazer, Kimberly B. and Howell, Elizabeth A.
- Subjects
MATERNAL health services ,MEDICAL quality control ,SUICIDE ,HEALTH services accessibility ,SUBSTANCE abuse ,DRUG overdose ,HEALTH status indicators ,MENTAL health ,RACE ,DISEASES ,QUALITY assurance ,MATERNAL mortality ,HEALTH equity ,SELF-mutilation - Abstract
Our objective was to review the role of maternal health disparities and mental health in the maternal mortality crisis in the USA, and discuss how perinatal care quality improvement in these areas is a critical lever for reducing maternal death. This paper summarizes content from a plenary talk delivered at the 2020 Biennial Meeting of the International Marcé Society for Perinatal Mental Health, in commemoration of the Society's 40th anniversary. The talk synthesized literature on two characteristics of the maternal mortality crisis in the US: (1) wide racial and ethnic disparities in maternal mortality and severe morbidity and (2) the impact of mental health and substance use disorders on maternal death, and introduced a framework for how health care quality gaps contribute to both of these issues. The US remains an outlier among similar nations in its alarmingly high rates of maternal mortality. Achieving significant progress on this measure will require confronting longstanding racial and ethnic disparities that exist throughout the pregnancy-postpartum continuum, as well as addressing the under-reported issue of maternal self-harm. Suicide and overdose are leading but under-recognized causes of death among pregnant and postpartum women in some states. Health care delivery failures, including inadequate risk assessment, care coordination, and communication, are identified in the literature on drivers of maternal health disparities and self-harm. Many of the same steps to improve quality of perinatal care can help to reduce health disparities and address the essential role of mental health in maternal well-being. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
50. Indirect cost of maternal mortality in the WHO African Region, 2013.
- Author
-
Kirigia, Joses M., Mwabu, Germano M., Orem, Juliet N., and Muthuri, Rosenabi Karimi
- Subjects
MATERNAL mortality ,GROSS domestic product ,MATERNAL health services - Abstract
Purpose – The purpose of this paper is to estimate discounted value of potential non-health gross domestic product (GDP) losses attributable to the 167,913 maternal deaths that occurred among 45 countries in the WHO African Region in 2013. Design/methodology/approach – A cost-of-illness method was used to estimate non-health GDP losses related to maternal deaths. Future non-health GDP losses were discounted at 3 per cent. The analysis was undertaken for countries categorized under three income groups. Findings – The discounted value of future non-health GDP loss due to maternal deaths in 2013 is in the order of Int$5.53 billion. About 17.6 per cent of that occurred in countries in the high and upper income group, 45.7 per cent in the middle income group and 36.7 per cent in the lower middle income group, and the average non-health GDP loss per maternal death was Int$136,799, Int$43,304 and Int$19,822, respectively. Research limitations/implications – This study omitted costs related to direct health care, direct non-health care treatment, patient time for treatment, informal caregivers’ time, intangible costs such as pain and grief, lost output due to morbidity, and negative externalities on the family and community. Social implications – The study demonstrated that maternal deaths have a sizable negative effect on non-health GDP of the region, implying that maternal mortality is not only a human rights concern but also an economic issue and that universal coverage of maternal health interventions ought to be an imperative goal in all countries. Originality/value – This paper provides new evidence on the impact of maternal deaths on non-health GDP of 45 countries in the WHO African Region. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.