216 results
Search Results
2. PROFESSIONAL MIDWIFERY EDUCATION IN BULGARIA AT THE TURN OF XX CENTURY: A HISTORICAL PERSPECTIVE.
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Gospodinova, P. and Dimitrova, S.
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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]
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- 2024
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3. The struggle to deliver in squatters: a qualitative study on inter-state migrant women in Aligarh.
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Iqrar, Sanoobia and Musavi, Azra
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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]
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- 2024
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4. Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania.
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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
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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]
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- 2024
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5. 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).
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Olivas, Elijah T., Valdez, Mario, Muffoletto, Barbara, Wallace, Jacqueline, Stollak, Ira, and Perry, Henry B.
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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]
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- 2023
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6. A realist review of interventions targeting maternal health in low- and middle-income countries.
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Abraham, Julie Mariam and Melendez-Torres, GJ
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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]
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- 2023
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7. Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis.
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Pavalagantharajah, Sureka, Negrin, Atziri Ramirez, Bouzanis, Katrina, Joan Lee, Tin-Suet, Miller, Peter, Jones, Rebecca, Sinnott, Will, and Alvarez, Elizabeth
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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]
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- 2023
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8. Respectful Maternal Care Experience in Low- and Middle-Income Countries: A Systematic Review.
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Kawish, Ayesha Babar, Umer, Muhammad Farooq, Arshed, Muhammad, Khan, Shahzad Ali, Hafeez, Assad, and Waqar, Saman
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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]
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- 2023
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9. Potential influence of nurses' implicit racial bias on maternal mortality.
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Rattan, Jesse and Bartlett, T. Robin
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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]
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- 2023
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10. 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.
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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
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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]
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- 2022
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11. 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.
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Danso, Samuel O., Manu, Alexander, Fenty, Justin, Amanga-Etego, Seeba, Avan, Bilal Iqbal, Newton, Sam, Soremekun, Seyi, and Kirkwood, Betty
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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]
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- 2023
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12. Rheumatic heart disease in pregnancy: Maternal and neonatal outcomes in the Top End of Australia.
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Lam, Chor Kiu, Thorn, Jane, Lyon, Xylyss, Waugh, Edith, Piper, Ben, and Wing‐Lun, Edwina
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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]
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- 2023
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13. How does COVID-19 affect maternal and neonatal outcomes?
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Koç, Esin and Dilli, Dilek
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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]
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- 2023
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14. Towards data-driven models for diverging emerging technologies for maternal, neonatal and child health services in Sub-Saharan Africa: a systematic review.
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Batani, John and Maharaj, Manoj Sewak
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DIGITAL technology ,STATISTICAL models ,MEDICAL information storage & retrieval systems ,HEALTH services accessibility ,DATA security ,MATERNAL health services ,INFANT mortality ,MALNUTRITION ,INTERPROFESSIONAL relations ,CHILD health services ,ARTIFICIAL intelligence ,PUBLIC sector ,CHILD mortality ,MATERNAL mortality ,DESCRIPTIVE statistics ,SOFTWARE analytics ,PRIVATE sector ,ORGANIZATIONAL effectiveness ,SYSTEMATIC reviews ,MEDLINE ,TELEMEDICINE ,CHILDBIRTH at home ,BLOCKCHAINS ,ELECTRONIC data interchange ,MEDICAL records ,ABILITY ,QUALITY assurance ,ONLINE information services ,DATA analysis software ,STAKEHOLDER analysis ,COVID-19 pandemic ,GOVERNMENT regulation ,PATIENT participation ,TRAINING - Abstract
Sub-Saharan Africa (SSA) has the highest maternal and under-five mortality rates in the world. The advent of the coronavirus disease 2019 exacerbated the region's problems by overwhelming the health systems and affecting access to healthcare through travel restrictions and rechanelling of resources towards the containment of the pandemic. The region failed to achieve the Millenium Development Goals on maternal and child mortalities, and is poised to fail to achieve the same goals in the Sustainable Development Goals. To improve on the maternal and child health outcomes, many SSA countries introduced digital technologies for educating pregnant and nursing women, making doctors' appointments and sending reminders to mothers and expectant mothers, as well as capturing information about patients and their illnesses. However, the collected epidemiological data are not being utilised to inform patient care and improve on the quality, efficiency and access to maternal, neonatal and child health (MNCH) care. To the researchers' best knowledge, no review paper has been published that focuses on digital health for MNCH care in SSA and proposes data-driven approaches to the same. Therefore, this study sought to: (1) identify digital systems for MNCH in SSA; (2) identify the applicability and weaknesses of the digital MNCH systems in SSA; and (3) propose a data-driven model for diverging emerging technologies into MNCH services in SSA to make better use of data to improve MNCH care coverage, efficiency and quality. The PRISMA methodology was used in this study. The study revealed that there are no data-driven models for monitoring pregnant women and under-five children in Sub-Saharan Africa, with the available digital health technologies mainly based on SMS and websites. Thus, the current digital health systems in SSA do not support real-time, ubiquitous, pervasive and data-driven healthcare. Their main applicability is in non-real-time pregnancy monitoring, education and information dissemination. Unless new and more effective approaches are implemented, SSA might remain with the highest and unacceptable maternal and under-five mortality rates globally. The study proposes feasible emerging technologies that can be used to provide data-driven healthcare for MNCH in SSA, and the recommendations on how to make the transition successful as well as the lessons learn from other regions. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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15. Power of partnerships: What makes a difference in reducing maternal mortality and how can Canadians contribute?
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Shroff, Farah, Minhas, Jasmit S., and Laugen, Christian
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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]
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- 2019
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16. Obstetric complications and delays in seeking emergency care in poor settings of northern India.
- Author
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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
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17. MEDICAID APPROACHES TO ADDRESSING MATERNAL MORTALITY IN THE DISTRICT OF COLUMBIA.
- Author
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WILSON, TARA
- Subjects
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MEDICAID , *MATERNAL mortality , *MATERNAL health services - Abstract
Maternal mortality in Washington, DC, has reached crisis levels. In a country that boasts the highest maternal mortality rate (MMR) in the developed world, DC's MMR is double the national MMR. The closure of obstetrics units in areas of concentrated poverty has made the problem particularly acute in low-income DC communities, and most low-income residents in DC are black. This paper aims to present changes in Medicaid policy that DC City Council may take to prevent further reductions to access to obstetric care and to promote healthy pregnancies. In Part II, this paper will address contributing factors to DC s maternal health crisis, and in Part III, the paper will argue for: (1) increased base payment reimbursement for obstetric services, (2) expanded public transportation to improve access to those hospitals with obstetrics units, and (3) the extension of Medicaid coverage to doula services to improve financial feasibility for hospitals and ensure healthy pregnancies for patients. Finally, Part IV addresses the advocacy required to implement these changes. [ABSTRACT FROM AUTHOR]
- Published
- 2018
18. A COMPARATIVE ASSESSMENT OF MATERNAL HEALTH AND MATERNAL HEALTH POLICIES IN INDIA AND THE U.S.: NEED TO TRANSITION FROM A BIOMEDICAL MODEL TO A BIOPSYCHOSOCIAL MODEL FOR MATERNAL HEALTH POLICIES.
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MALI, NIDHI VIJ
- Subjects
- *
MATERNAL health , *MATERNAL health services , *HEALTH policy , *MATERNAL mortality , *WOMEN'S health services , *GOVERNMENT policy - Abstract
More than 300,000 women died due to pregnancy related causes in 2015, a global maternal mortality ratio (MMR) of 216 per 100,000 live births (Alkema et al., 2016). Millennium Development Goals have led to a 44% decline in global MMR, but significant variations still remain across geographical regions (United Nations [UN], 2015). India accounts for the second highest maternal deaths in the world (World Health Organization [WHO], 2015). In contrast, the U.S. is the only developed country with an increasing MMR in recent years ("Maternal Mortality," 2015). However, little attention has been given to maternal health in public policy research and practice in both countries. This paper compares and contrasts maternal health status and analyzes maternal health policies in India and the U.S. two health models. Based on comparative case analysis, the overall recommendation is to expand the scope of maternal health from a biomedical health model towards a biopsychosocial model and restructure the policy frameworks. This paper contributes to the maternal health discourse and hopes to garner attention of global and regional health policy scholars and policy makers. [ABSTRACT FROM AUTHOR]
- Published
- 2017
19. Changing times? Gender roles and relationships in maternal, newborn and child health in Malawi.
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Manda-Taylor, Lucinda, Mwale, Daniel, Phiri, Tamara, Walsh, Aisling, Matthews, Anne, Brugha, Ruairi, Mwapasa, Victor, and Byrne, Elaine
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- *
GENDER role , *MATERNAL health , *INFANT health , *CHILDREN'S health , *MATERNAL mortality , *MATERNAL health services - Abstract
Background: For years, Malawi remained at the bottom of league tables on maternal, neonatal and child health. Although maternal mortality ratios have reduced and significant progress has been made in reducing neonatal morality, many challenges in achieving universal access to maternal, newborn and child health care still exist in Malawi. In Malawi, there is still minimal, though increasing, male involvement in ANC/PMTCT/MNCH services, but little understanding of why this is the case. The aim of this paper is to explore the role and involvement of men in MNCH services, as part of the broader understanding of those community system factors.Methods: This paper draws on the qualitative data collected in two districts in Malawi to explore the role and involvement of men across the MNCH continuum of care, with a focus on understanding the community systems barriers and enablers to male involvement. A total of 85 IDIs and 20 FGDs were conducted from August 2014 to January 2015. Semi-structure interview guides were used to guide the discussion and a thematic analysis approach was used for data analysis.Results: Policy changes and community and health care provider initiatives stimulated men to get involved in the health of their female partners and children. The informal bylaws, the health care provider strategies and NGO initiatives created an enabling environment to support ANC and delivery service utilisation in Malawi. However, traditional gender roles in the home and the male 'unfriendly' health facility environments still present challenges to male involvement.Conclusion: Traditional notions of men as decision makers and socio-cultural views on maternal health present challenges to male involvement in MNCH programs. Health care provider initiatives need to be sensitive and mindful of gender roles and relations by, for example, creating gender inclusive programs and spaces that aim at reducing perceptions of barriers to male involvement in MNCH services so that programs and spaces that are aimed at involving men are designed to welcome men as full partners in the overall goals for improving maternal, neonatal and child health outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2017
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20. Early indirect impact of COVID-19 pandemic on utilisation and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya: A cross-sectional study.
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Shikuku, Duncan N., Nyaoke, Irene K., Nyaga, Lucy N., and Ameh, Charles A.
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MATERNAL health services ,FAMILY planning ,EVALUATION of medical care ,MEDICAL care for teenagers ,DPT vaccines ,HAEMOPHILUS disease vaccines ,CROSS-sectional method ,AGE distribution ,COMPARATIVE studies ,PREGNANCY outcomes ,PERINATAL death ,CHILD health services ,DESCRIPTIVE statistics ,INFANT health services ,PRENATAL care ,HEPATITIS B vaccines ,CESAREAN section ,MATERNAL mortality ,COVID-19 pandemic ,THERAPEUTICS - Abstract
Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
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21. A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health.
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Glazer, Kimberly B. and Howell, Elizabeth A.
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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
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22. Factors influencing maternal healthcare seeking in a highland region of Madagascar: a mixed methods analysis.
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Andrianantoandro, Voahirana Tantely, Pourette, Dolorès, Rakotomalala, Olivier, Ramaroson, Henintsoa Joyce Valentina, Ratovoson, Rila, and Rakotoarimanana, Feno M. Jacob
- Subjects
- *
MATERNAL health services , *MATERNAL mortality , *PRENATAL care , *CHILDBIRTH , *MIDWIVES , *MIXED methods research - Abstract
Background: In Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery.Method: We used quantitative and qualitative approaches in the study. Two communes of the Vakinankaratra region, which are located in the highlands, were the settings. Data collection occurred from October 2016 to July 2017. A total of 245 pregnant women were included and followed up in the quantitative survey, and among them, 35 participated in in-depth interviews(IDIs). Logistic regressions were applied to explore the influencing factors of antenatal and delivery healthcare seeking practices through thematic qualitative analysis.Results: Among the 245 women surveyed, 13.9% did not attend any ANC visits. School level, occupation and gravidity positively influenced the likelihood of attending one or more ANC visits. The additional use of traditional caregivers remained predominant and was perceived as potentially complementary to medical care. Nine in ten (91%) women expressed a preference for delivery at healthcare facilities (HFs), but 61% of births were assisted by a skilled birth attendant (SBA).The school level; the frequency of ANCs; the origin region; and the preference between modern or traditional care influenced the use of SBAs at delivery. A lack of preparation (financial and logistics problems) and women's low involvement in decision making at delivery were the main barriers to giving birth at HFs.Conclusion: The use of maternal healthcare services is starting to gain ground, although many women and their relatives still use traditional caregivers at the same time. Relatives play a crucial role in maternal healthcare seeking. It would be necessary to target women's relatives for awareness-raising messages about ANC and childbirth in healthcare facilities and to support and formalize collaborations between traditional healers and biomedical caregivers. [ABSTRACT FROM AUTHOR]- Published
- 2021
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23. Morbidities, practices, and seasonality: A study of women in low income households in Delhi.
- Author
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Singh, Shradhanvita, Farooquee, Nehal Ahmed, Jha, Sanjay Kumar, and Anand, Shweta
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RESEARCH ,MATERNAL health services ,SCIENTIFIC observation ,ECONOMIC impact ,HEALTH services accessibility ,COUNSELING ,RESEARCH methodology ,ANTHROPOMETRY ,DISEASES ,INGESTION ,PREGNANT women ,QUANTITATIVE research ,MEDICAL cooperation ,INTERVIEWING ,MEDICAL technology ,SEASONS ,CHILDBIRTH at home ,QUALITATIVE research ,SURVEYS ,PRE-tests & post-tests ,MALPRACTICE ,DISEASE prevalence ,CASE studies ,DESCRIPTIVE statistics ,PRENATAL care ,POVERTY ,PATIENT-professional relations ,MATERNAL mortality ,INFANT mortality ,JUDGMENT sampling ,STATISTICAL sampling ,BODY mass index ,POLICY sciences ,WOMEN'S health ,NUTRITIONAL status - Abstract
Antenatal morbidities and associated malpractices are quite prevalent in slums of Delhi. This paper aims to highlight the relationship between calories intake, seasonality and gravida. It also draws attention towards inter-related aspects of antenatal practices and morbidity among women. Survey of 400 women conducted in the slums of Delhi indicated high occurrence of antenatal and post-natal malpractices. The findings indicated that discrepancies in the advice given by the medical practitioners and traditional birth attendants (TBAs). This was seen to adversely impact a majority of expectant mothers. The finding support a strong direct relationship between calories intake, seasonality morbidity and mortality patterns among women as well as their children. Although ample research has been done on homebirths and their challenges, the perspectives of TBAs (who assist in the majority of homebirths) remain unexamined. The present study sought to add to this knowledge base by uncovering various practices prevalent in low income households of a cosmopolitan city like Delhi. [ABSTRACT FROM AUTHOR]
- Published
- 2021
24. Uterotonics for prevention of postpartum haemorrhage: EN-BIRTH multi-country validation study.
- Author
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Ruysen, Harriet, Shabani, Josephine, Hanson, Claudia, Day, Louise T., Pembe, Andrea B., Peven, Kimberly, Rahman, Qazi Sadeq-ur, Thakur, Nishant, Shirima, Kizito, Tahsina, Tazeen, Gurung, Rejina, Tarimo, Menna Narcis, Moran, Allisyn C., Lawn, Joy E., EN-BIRTH Study Group, Rahman, Ahmed Ehsanur, Zaman, Sojib Bin, Ameen, Shafiqul, Hossain, Tanvir, and Siddique, Abu Bakkar
- Subjects
- *
HEMORRHAGE prevention , *PREGNANCY complications , *POSTNATAL care , *MATERNAL health services , *MATERNAL mortality - Abstract
Background: Postpartum haemorrhage (PPH) is a leading cause of preventable maternal mortality worldwide. The World Health Organization (WHO) recommends uterotonic administration for every woman after birth to prevent PPH. There are no standardised data collected in large-scale measurement platforms. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) is an observational study to assess the validity of measurement of maternal and newborn indicators, and this paper reports findings regarding measurement of coverage and quality for uterotonics.Methods: The EN-BIRTH study took place in five hospitals in Bangladesh, Nepal and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data. We compared observation data for uterotonics to routine hospital register-records and women's report at exit-interview survey. We analysed the coverage and quality gap for timing and dose of administration. The register design was evaluated against gap analyses and qualitative interview data assessing the barriers and enablers to data recording and use.Results: Observed uterotonic coverage was high in all five hospitals (> 99%, 95% CI 98.7-99.8%). Survey-report underestimated coverage (79.5 to 91.7%). "Don't know" replies varied (2.1 to 14.4%) and were higher after caesarean (3.7 to 59.3%). Overall, there was low accuracy in survey data for details of uterotonic administration (type and timing). Register-recorded coverage varied in four hospitals capturing uterotonics in a specific column (21.6, 64.5, 97.6, 99.4%). The average coverage measurement gap was 18.1% for register-recorded and 6.0% for survey-reported coverage. Uterotonics were given to 15.9% of women within the "right time" (1 min) and 69.8% within 3 min. Women's report of knowing the purpose of uterotonics after birth ranged from 0.4 to 64.9% between hospitals. Enabling register design and adequate staffing were reported to improve routine recording.Conclusions: Routine registers have potential to track uterotonic coverage - register data were highly accurate in two EN-BIRTH hospitals, compared to consistently underestimated coverage by survey-report. Although uterotonic coverage was high, there were gaps in observed quality for timing and dose. Standardisation of register design and implementation could improve data quality and data flow from registers into health management information reporting systems, and requires further assessment. [ABSTRACT FROM AUTHOR]- Published
- 2021
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25. Maternal health care service utilization among young married women in India, 1992-2016: trends and determinants.
- Author
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Singh, Pooja, Singh, Kaushalendra Kumar, and Singh, Pragya
- Subjects
- *
MATERNAL health services , *MATERNAL mortality , *YOUNG women , *PRENATAL care , *CHILDBIRTH - Abstract
Background: Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India.Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992-93, 1998-99, 2005-06 and 2015-16. Young married women aged 15-24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05.Results: The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88 and 83% during 2015-16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time.Conclusions: In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states. [ABSTRACT FROM AUTHOR]- Published
- 2021
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26. Indirect cost of maternal mortality in the WHO African Region, 2013.
- Author
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Kirigia, Joses M., Mwabu, Germano M., Orem, Juliet N., and Muthuri, Rosenabi Karimi
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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
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27. Maternal health research outputs and gaps in Latin America: reflections from the mapping study.
- Author
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Vargas-Riaño, Emily, Becerril-Montekio, Víctor, Becerra-Posada, Francisco, and Tristán, Mario
- Subjects
- *
MATERNAL health , *MATERNAL health services , *MATERNAL mortality , *DECISION making , *PUBLIC health , *MENTAL health surveys , *QUESTIONNAIRES , *RESEARCH ,DEVELOPING countries - 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
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28. Maternal Health Phone Line: Saving Women in Papua New Guinea.
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Sabumei, Gaius, Watson, Amanda H. A., Mola, Glen, and Iedema, Rick
- Subjects
- *
EMERGENCY medical services communication systems , *TELEPHONE in medicine , *MATERNAL health services , *MATERNAL mortality - Abstract
This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the "ICTs for healthcare development" model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The "three stages of delay" typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The "three stages of delay" typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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29. The contribution of district prioritization on maternal and newborn health interventions coverage in rural India.
- Author
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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
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30. Socio-economic Determinants in the Utilization of Maternal Health Care in India: Exploring National Level Data.
- Author
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Vivekanandhan, R., Ravishankar, A. K., and Rasool, Nawaz
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MATERNAL health services ,MEDICAL care ,CHILD mortality ,INFANT mortality ,MATERNAL mortality ,WOMEN'S health services - Abstract
Introduction: The maternal health generally refers to the health of women during pregnancy, childbirth and postpartum period. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. The Maternal Mortality Ratio (MMR) estimate for the country indicates an overall decline from 212 in 2007-09 to 178 per one lack live births in 2012, resulting in saving lives of about 9,000 mothers per year 2. The aim of maternal health care services to reduce infant mortality, maternal morbidity and mortality was recognized at the Cairo Conference on Population. Materials and Method: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January -June, 2014. It is a cross sectional dataset available in public domain. The dataset provides information on Social Consumption and Health scenario of the population. To carryout the research, descriptive statistics, bivariate and logistic regression analysis has been used. Findings: The study shows that place of residence, marital status, educational status and wealth index plays an important role in determining the utilization of ante-natal care and post-natal care services. Utilization of services from private sector increases with the increase in the level of socio-economic characteristics. Southern and Western regions of India have 97 percent utilization of ante-natal care and more than 90 percent utilization of post-natal care services in India. Multivariate analysis also depicts close relationship with different predictors as urban place of residence, currently married women, higher educational status and richest wealth category. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the utilization of maternal health care. Western and Southern regions have better utilization of maternal health care services. [ABSTRACT FROM AUTHOR]
- Published
- 2020
31. 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
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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
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32. Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality?
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Bruns, Debra Pettit, Pawloski, Lisa, and Robinson, Cecil
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- *
INFANT mortality , *MATERNAL mortality , *MATERNAL health services , *HEALTH policy , *GROSS domestic product - Abstract
In the rural United States the infant mortality rate (IMR) is 6.5 per 1,000, and in rural states like Alabama this rate jumps to 9.1. Rural obstetric services are disappearing such that over half of U.S. rural counties do not have enough obstetric services. In contrast, Cuba's IMR is 4.3 while spending half as much as a percent of their gross domestic product than the United States. This raises the question: how has Cuba achieved this health outcome and what lessons can be learned and applied in the United States given decreased availability of obstetric services? This paper presents a field case study of one of Cuba's national public health policies. Specifically, we explore Cuba's Hogares Maternos, or maternity homes. We argue that the Cuban model, which focuses on social determinants of health, ought to be explored. We discuss how Hogares Maternos may be adopted and adapted within the rural United States by leveraging existing infrastructure. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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- View/download PDF
33. Evidence Acquisition and Evaluation for Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives.
- Author
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Higgs, Elizabeth S., Stammer, Emily, Roth, Rebecca, and Balster, Robert L.
- Subjects
- *
MATERNAL health services , *OBSTETRICS , *MATERNAL mortality , *PREGNANCY complications , *MOTIVATION (Psychology) - Abstract
Recognizing the need for evidence to inform US Government and governments of the low- and middleincome countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described. [ABSTRACT FROM AUTHOR]
- Published
- 2013
34. Childbirth experience of migrants in China: A systematic review.
- Author
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Cheung, Ngai Fen and Pan, Anshi
- Subjects
- *
CHILDBIRTH , *NEONATAL diseases , *INFANT mortality , *MATERNAL health services , *MEDLINE , *MIDWIVES , *MATERNAL mortality , *NOMADS , *RESEARCH funding , *DESCRIPTIVE statistics - Abstract
As preliminary research into the childbirth experience of migrants in China, this paper presents a systematic review of Chinese and English literature published between 1999 and 2011 on childbirth in migrants in China. Electronic databases were accessed and papers were found by keyword search. A total of 132 Chinese and 9 English papers were catalogued for review. These papers address migrant maternity issues concerning antenatal, intrapartum, postnatal care, institutional issues, family planning or birth control. Since China's economic reforms, the healthcare infrastructure has been inadequate for childbirth in migrants. They experience more adverse birth outcomes than local residents. This suggests that the effects of change upon childbirth and the existing urban and rural care systems cannot meet the needs of the migrants. There is a lack of research in the childbirth experience of women. Knowledge of their childbirth experience will contribute to the understanding of these needs, informing systems' reform. The medical approach results in many unnecessary interventions and higher costs. It is argued here that a midwifery model of care is most appropriate for the childbirth experience of migrant women. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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35. Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities
- Author
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Spangler, Sydney A
- Subjects
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MATERNAL mortality , *CLINICAL medicine , *INTERVIEWING , *MATERNAL health services , *RESEARCH funding , *RURAL conditions , *MIDWIFERY , *KEY performance indicators (Management) , *PREVENTION - Abstract
Current efforts to reduce maternal mortality and morbidity in low-resource settings often depend on global standards and indicators to assess obstetric care, particularly skilled birth attendants and emergency obstetric care. This paper describes challenges in using these standards to assess obstetric services in the Kilombero Valley of Tanzania. A health facility survey and extensive participant observation showed existing services to be complicated and fluid, involving a wide array of skills, resources, and improvisations. Attempts to measure these services against established standards and indicators were not successful. Some aspects of care were over-valued while others were under-valued, with significant neglect of context and quality. This paper discusses the implications of these findings for ongoing maternal health care efforts in unique and complex settings, questioning the current reliance on generic (and often obscure) archetypes of obstetric care in policy and programming. It suggests that current indicators may be insufficient to assess services in low-resource settings, but not that these settings should settle for lower standards of care. In addition to global benchmarks, assessment approaches that emphasize quality of care and recognize available resources might better account for local realities, leading to more effective, more sustainable service delivery. Les activités réalisées actuellement pour réduire la mortalité et la morbidité maternelles dans les contextes à faibles ressources dépendent souvent des normes et indicateurs mondiaux pour évaluer les soins obstétricaux, en particulier le personnel qualifié présent lors de l'accouchement et les soins obstétricaux d'urgence. Cet article décrit les difficultés rencontrées pour utiliser ces normes dans la vallée de Kilombero en Tanzanie. Une enquête sur les centres de santé et une observation approfondie des participants ont montré que les services existants étaient compliqués et fluides, exigeant une large palette de compétences, de ressources et d'improvisation. Les tentatives de mesure de ces services par rapport aux normes et indicateurs établis ont échoué. Certains aspects des soins étaient surévalués, d'autres sous-évalués, alors que le contexte et la qualité étaient négligés. L'article examine les conséquences pour les activités de santé maternelle réalisées dans des environnements singuliers et complexes, et demande s'il est opportun de s'en remettre à des archétypes génériques (et souvent obscurs) de soins obstétricaux dans les politiques et les programmes. Il estime que les indicateurs actuels sont peut-être insuffisants pour évaluer les services dans les contextes à faibles ressources, mais ne suggère pas à ces contextes de se contenter de normes inférieures de soins. Outre les repères mondiaux, des méthodes d'évaluation qui soulignent la qualité des soins et tiennent compte des ressources disponibles sont plus adaptées aux réalités locales, permettant des services plus efficaces et durables. Los esfuerzos en curso por disminuir las tasas de mortalidad y morbilidad maternas en ámbitos de bajos recursos a menudo dependen de normas e indicadores internacionales para evaluar los cuidados obstétricos, particularmente la atención calificada durante el parto y los cuidados obstétricos de emergencia. En este artículo se describen los retos en utilizar estas normas para evaluar los servicios obstétricos en el Valle Kilombero de Tanzania. Mediante una encuesta realizada en una unidad de salud y extensa observación participante se mostró que los servicios son complicados e inciertos, ya que requieren una gran variedad de habilidades, recursos e improvisación. Los intentos por comparar estos servicios con las normas y los indicadores establecidos fracasaron. Algunos aspectos de la atención fueron valorados en exceso mientras que otros no fueron valorados lo suficiente, y se hizo caso omiso del contexto y la calidad. En este artículo se analizan las implicaciones de estos hallazgos para los esfuerzos continuos en salud maternal en ámbitos únicos y complejos, y se cuestiona la dependencia actual de arquetipos genéricos (y a menudo pocos conocidos) de los cuidados obstétricos en políticas y programación. Indica que los indicadores actuales quizás sean insuficientes para evaluar los servicios en ámbitos de bajos recursos, pero no que estos ámbitos deben conformarse con niveles más bajos de atención. Además de indicadores internacionales, diagnósticos que hagan hincapié en la calidad de la atención y reconozcan los recursos disponibles podrían explicar mejor las realidades locales, lo cual facilitaría una prestación de servicios más eficaz y más sostenible. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
36. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census.
- Author
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Cameron, Lisa, Contreras Suarez, Diana, and Cornwell, Katy
- Subjects
- *
MATERNAL mortality , *CENSUS , *MATERNAL health services , *MEDICAL care , *CHILDBIRTH , *SOCIAL status - Abstract
Background: For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households’ socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces. Methods: The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics. Findings: Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies. Conclusion: Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
37. Using a Birth Center Model of Care to Improve Reproductive Outcomes in Informal Settlements-a Case Study.
- Author
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Wallace, Jacqueline
- Subjects
- *
BIRTHING centers , *NEONATAL mortality , *PRENATAL care , *MIDWIVES , *MATERNAL health services , *MATERNAL mortality , *CASE studies - Abstract
The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
38. Social Identity as Determinants to Access Maternal Health Services in Uttar Pradesh, India.
- Author
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Singh, Lakhan
- Subjects
MATERNAL health services ,CASTE discrimination ,GROUP identity ,HEALTH services accessibility ,MEDICAL personnel ,LOGISTIC regression analysis - Abstract
Reduction in maternal mortality is one of UNDP's important Sustainable Development Goals. India alone has a share of almost one-fifth of the world's maternal deaths. Within India, Uttar Pradesh continues to be highest in maternal deaths. Despite unavailability of data on maternal deaths in India, it is evident from proxy indicators on mother's wellbeing that women belonging to lower caste are more vulnerable to maternal deaths than are women of higher caste. Several studies are available on the causes of poor accessibility to maternal health services, but there is a paucity of studies focusing on caste (social identity) as a hindrance to access to maternal health services. Keeping in view the backdrop, the present paper attempts to study the accessibility of maternal health services by different social groups controlling their education and wealth position. The study uses data from the National Family Health Survey-3. The unit of analysis is the women who had home-based child delivery. The dependent variable is the visits made by any health personnel to women who had home-based child delivery. Binary Logistic Regression analysis revealed that after controlling wealth and education, women from scheduled caste category were more than two times less likely to be visited by health workers compared to that for higher caste women. Similarly, educated women of scheduled caste had lower accessibility to health services than did the educated women of the higher caste. Findings suggest that the social identity of a woman is playing a crucial role in or rising over economic and education variables as determinants in accessing maternal health services. This may have a serious implication on the implementation of several maternal health policies in India. [ABSTRACT FROM AUTHOR]
- Published
- 2019
39. Predicting resource-dependent maternal health outcomes at a referral hospital in Zanzibar using patient trajectories and mathematical modeling.
- Author
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Nadkarni, Devika, Minocha, Avijit, Harpaldas, Harshit, Kim, Grace, Gopaluni, Anuraag, Gravelyn, Sara, Rashid, Sarem, Helfrich, Anna, Clifford, Katie, Herklots, Tanneke, Meguid, Tarek, Jacod, Benoit, Desai, Darash, and Zaman, Muhammad H.
- Subjects
- *
MATERNAL health services , *HEALTH outcome assessment , *RESOURCE allocation , *MATERNAL mortality , *LABOR complications (Obstetrics) - Abstract
Poor intra-facility maternity care is a major contributor to maternal mortality in low- and middle-income countries. Close to 830 women die each day due to preventable maternal complications, partly due to the increasing number of women giving birth in health facilities that are not adequately resourced to manage growing patient populations. Barriers to adequate care during the ‘last mile’ of healthcare delivery are attributable to deficiencies at multiple levels: education, staff, medication, facilities, and delays in receiving care. Moreover, the scope and multi-scale interdependence of these factors make individual contributions of each challenging to analyze, particularly in settings where basic data registration is often lacking. To address this need, we have designed and implemented a novel systems-level and dynamic mathematical model that simulates the impact of hospital resource allocations on maternal mortality rates at Mnazi Mmoja Hospital (MMH), a referral hospital in Zanzibar, Tanzania. The purpose of this model is to provide a rigorous and flexible tool that enables hospital administrators and public health officials to quantitatively analyze the impact of resource constraints on patient outcomes within the maternity ward, and prioritize key areas for further human or capital investment. Currently, no such tool exists to assist administrators and policy makers with effective resource allocation and planning. This paper describes the structure and construct of the model, provides validation of the assumptions made with anonymized patient data and discusses the predictive capacity of our model. Application of the model to specific resource allocations, maternal treatment plans, and hospital loads at MMH indicates through quantitative results that medicine stocking schedules and staff allocations are key areas that can be addressed to reduce mortality by up to 5-fold. With data-driven evidence provided by the model, hospital staff, administration, and the local ministries of health can enact policy changes and implement targeted interventions to improve maternal health outcomes at MMH. While our model is able to determine specific gaps in resources and health care delivery specifically at MMH, the model should be viewed as an additional tool that may be used by other facilities seeking to analyze and improve maternal health outcomes in resource constrained environments. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
40. Determinants and causes of maternal mortality in Iran based on ICD-MM: a systematic review.
- Author
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Zalvand, Rostam, Tajvar, Maryam, Pourreza, Abolghasem, and Asheghi, Hadi
- Subjects
- *
CAUSES of death , *DELIVERY (Obstetrics) , *DISEASES , *HEMORRHAGE , *HYPERTENSION , *MATERNAL health services , *MATERNAL mortality , *NOSOLOGY , *POPULATION geography , *PUERPERIUM , *SYSTEMATIC reviews , *SOCIOECONOMIC factors , *REPRODUCTIVE history ,CARDIOVASCULAR disease related mortality - Abstract
Background: No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization. Methods: A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables. Results: Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran. Conclusions: This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
41. The perceptions, health-seeking behaviours and access of Scheduled Caste women to maternal health services in Bihar, India.
- Author
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Patel, Parisa, Das, Mahua, and Das, Utpal
- Subjects
- *
MATERNAL health services , *COMMUNITY health workers , *CONCEPTUAL structures , *HEALTH behavior , *HEALTH facilities , *HEALTH services accessibility , *HEALTH status indicators , *INTERVIEWING , *RESEARCH methodology , *MEDICAL care costs , *MEDICAL personnel , *POSTNATAL care , *SOCIAL classes , *TRANSPORTATION , *PSYCHOLOGY of women , *ACCESS to information - Abstract
The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India. Eighteen in-depth, semi-structured interviews were conducted with SC women in Bihar. Data were analysed using Framework Analysis and presented using the AAAQ Toolbox. Main facilitating factors included the introduction of accredited social health activists (ASHAs), free maternal health services, the Janani Shishu Suraksha Karyakram (JSSK), and changes in the cultural acceptability of institutional delivery. Main barriers included inadequate ASHA coverage, poor information access, transport costs and unauthorised charges to SC women from healthcare staff. SC women in Bihar may be inequitably served by maternal health services, and in some cases may face specific discrimination. Recommendations to improve SC service utilisation include research into the improvement of postnatal care, reducing unauthorised payments to healthcare staff and improvements to the ASHA programme. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
42. Ensuring effective Essential Obstetric Care in resource poor settings.
- Author
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Kongnyuy, E. J., Hofman, J. J., and Van den Broek, N.
- Subjects
- *
OBSTETRICAL emergencies , *MEDICAL care , *OBSTETRICS , *MATERNAL health services , *MATERNAL mortality , *HEALTH planning , *PREVENTION - Abstract
Although Emergency Obstetric Care (EOC) is globally accepted as a key strategy to improve maternal health and reduce maternal mortality, there is still a lot of debate surrounding its use – What is EOC? Is it evidence-based? How can we measure it? How can we improve access to EOC? This paper attempts to answer these questions. Although there are no randomized controlled trials, there is strong evidence from quasi-experimental, observational and ecological studies that EOC should be a critical component of any programme to reduce maternal mortality. This paper also identifies the barriers to accessing EOC and proposes strategies to overcome them which could contribute to achieving Millennium Development Goal 5. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
43. Human resources for maternal health: multi-purpose or specialists?
- Author
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Fauveau, Vincent, Sherratt, Della R., and de Bernis, Luc
- Subjects
- *
MATERNAL health services , *COMMUNITY health workers , *PERSONNEL management , *MIDWIVES , *MATERNAL mortality - Abstract
A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made. In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. Whilst the focus of this paper is on maternal health, it is acknowledged that the interventions to reduce maternal mortality will also contribute to significantly reducing newborn mortality. Addressing each of the seven key areas of work -- recommended by the first International Forum on 'Midwifery in the Community', Tunis, December 2006 -- is essential for the success of any MDG5 programme. We hypothesize that a great deal of the stagnation of maternal health programmes has been the result of confusion and careless choices in scaling up between a limited number of truly skilled birth attendants and large quantities of multi-purpose workers with short training, fewer skills, limited authority and no career pathways. We conclude from the lessons learnt that no significant progress in maternal mortality reduction can be achieved without a strong political decision to empower midwives and others with midwifery skills, and a substantial strengthening of health systems with a focus on quality of care rather than on numbers, to give them the means to respond to the challenge. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
44. Universal reporting of maternal mortality: An achievable goal?
- Author
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Graham, W.J. and Hussein, J.
- Subjects
- *
MATERNAL & infant welfare , *TRENDS , *MATERNAL mortality , *MATERNAL health services , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *PUBLIC health surveillance , *RESEARCH , *WORLD health , *EVALUATION research , *ACQUISITION of data - Abstract
Abstract: This paper aims to highlight the importance of aspiring to achieve universal reporting of maternal deaths as a part of taking responsibility for these avoidable tragedies. The paper first discusses the reasons for reporting maternal deaths, distinguishing between individual case notification and aggregate statistics. This is followed by a summary of the status of reporting at national and international levels, as well as major barriers and facilitators to this process. A new framework is then proposed — the REPORT framework, designed to highlight six factors essential to universal reporting. Malaysia is used to illustrate the relevance of these factors. Finally, the paper makes a Call to Action by FIGO to promote REPORT and to encourage health professionals to play their part in improving the quality of reporting on all maternal deaths — not just those directly in their care. [Copyright &y& Elsevier]
- Published
- 2006
- Full Text
- View/download PDF
45. Improving Tanzanian childbirth service quality.
- Author
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Jaribu, Jennie, Penfold, Suzanne, Green, Cathy, Manzi, Fatuma, and Schellenberg, Joanna
- Subjects
DECISION making ,DELIVERY (Obstetrics) ,INFANT mortality ,MATERNAL health services ,EVALUATION of medical care ,MATERNAL mortality ,PATIENT education ,PREGNANCY ,PREGNANCY complications ,QUALITY assurance ,RURAL population ,HUMAN services programs ,EVALUATION of human services programs ,DIAGNOSIS - Abstract
Purpose The 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/approach A 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. Findings Median 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/implications The 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/value Healthcare 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. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
46. Factors influencing the capacity of women to voice their concerns about maternal health services in the Muanda and Bolenge Health Zones, Democratic Republic of the Congo: a multi-method study.
- Author
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Mafuta, Eric M., De Cock Buning, Tjard, Lolobi, Didier L., Mayala, Papy M., Mambu, Thérèse N. M., Kayembe, Patrick K., and Dieleman, Marjolein A.
- Subjects
- *
MATERNAL health services , *MEDICAL personnel , *DATA analysis , *SOCIOCULTURAL factors , *ELECTRONIC data processing - Abstract
Background: This paper aims to identify factors that influence the capacity of women to voice their concerns regarding maternal health services at the local level.Methods: A secondary analysis was conducted of the data from three studies carried out between 2013 and 2015 in the Democratic Republic of the Congo (DRC) in the context of a WOTRO initiative to improve maternal health services through social accountability mechanisms in the DRC. The data processing and analysis focused on data related to factors that influence the capacity of women to voice their concerns and on the characteristics of women that influence their ability to identify, and address specific problems. Data from 21 interviews and 12 focus group discussions (n = 92) were analysed using an inductive content analysis, and those from one household survey (n = 517) were summarized.Results: The women living in the rural setting were mostly farmers/fisher-women (39.7%) or worked at odd jobs (20.3%). They had not completed secondary school (94.6%). Around one-fifth was younger than 20 years old (21.9%). The majority of women could describe the health service they received but were not able to describe what they should receive as care. They had insufficient knowledge of the health services before their first visit. They were not able to explain the mandate of the health providers. The information they received concerned the types of healthcare they could receive but not the real content of those services, nor their rights and entitlements. They were unaware of their entitlements and rights. They believed that they were laypersons and therefore unable to judge health providers, but when provided with some tools such as a checklist, they reported some abusive and disrespectful treatments. However, community members asserted that the reported actions were not reprehensible acts but actions to encourage a woman and to make her understand the risk of delivery.Conclusions: Factors influencing the capacity of women to voice their concerns in DRC rural settings are mainly associated with insufficient knowledge and socio-cultural context. These findings suggest that initiatives to implement social accountability have to address community capacity-building, health providers' responsiveness and the socio-cultural norms issues. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
47. Gender dynamics affecting maternal health and health care access and use in Uganda.
- Author
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Morgan, Rosemary, Tetui, Moses, Kananura, Rornald Muhumuza, Ekirapa-Kiracho, Elizabeth, George, A. S., and Muhumuza Kananura, Rornald
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MATERNAL health services ,GENDERISM ,GENDER stereotypes ,REPRODUCTIVE health services ,WOMEN'S health services ,DELIVERY (Obstetrics) ,HEALTH services accessibility ,MATERNAL mortality ,QUESTIONNAIRES ,SEXISM ,WOMEN'S health - Abstract
Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term. [ABSTRACT FROM AUTHOR]
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- 2017
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48. Socioeconomic Disparities in Health Outcomes and Access to Health Care across Three Islands in Comoros.
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Kassim, Said Abasse, Alolga, Raphael Nammahime, Kassim, Said Mohamed, Assanhou, Assogba Gabin, Li Hongchao, and Ma Aixia
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EVALUATION of medical care ,MATERNAL health services ,HEALTH services accessibility ,RURAL conditions ,PRACTICAL politics ,HISTORY ,POPULATION geography ,HEALTH status indicators ,SOCIOECONOMIC factors ,SURVEYS ,CHILD health services ,HEALTH equity ,METROPOLITAN areas ,INFANT mortality ,MATERNAL mortality ,CHILD mortality ,HEALTH care rationing - Abstract
The purpose of this paper is two-fold. First, to give an overview of the size and measure trends in health inequalities in the Comoros islands (Comoros) since 1996. Second, to assess the wide differences in health and health care across rural/urban areas and islands in Comoros, by using available and comparable leading indicators, in order to promote regular monitoring of policy goals. This assessment is aimed at reducing health inequalities and providing adequate or equal access to health care between islands. Data from the Demographic and Health Survey, Multiple Indicators Cluster Surveys from 1996, 2000 and 2012, the World Health Organization, the World Bank, the African Development Bank data sources, were analyzed for a population health-oriented approach characterized by measuring health differences from the population average, taking account of the population size of the social groups on both relative and absolute scales. The results showed that there exist geographic disparities in health in Comoros, mainly in maternal and child health. [ABSTRACT FROM AUTHOR]
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- 2017
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49. Utilisation of skilled birth attendants over time in Nigeria and Malawi.
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Atuoye, Kilian N., Amoyaw, Jonathan A., Kuuire, Vincent Z., Kangmennaang, Joseph, Boamah, Sheila A., Vercillo, Siera, Antabe, Roger, McMorris, Meghan, and Luginaah, Isaac
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INFANT mortality , *MATERNAL mortality , *ALLIED health personnel , *GOAL (Psychology) , *MATERNAL health services , *STATISTICS , *SURVEYS , *LOGISTIC regression analysis , *RESIDENTIAL patterns , *SOCIOECONOMIC factors , *WELL-being , *DESCRIPTIVE statistics , *PREVENTION ,DEVELOPING countries - Abstract
Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery – one of the indictors of MDG 5 – has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context. [ABSTRACT FROM AUTHOR]
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- 2017
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50. Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort.
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Kelly, Brian, Mason, Dan, Wright, John, Petherick, Emily S., Mohammed, Mohammed A., and Bates, Chris
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CONFIDENCE intervals ,ETHNIC groups ,FAMILY medicine ,HEALTH services accessibility ,HEALTH status indicators ,MATERNAL health services ,MEDICAL referrals ,MATERNAL mortality ,MULTIVARIATE analysis ,POISSON distribution ,PRIMARY health care ,REGRESSION analysis ,RESEARCH funding ,STATISTICS ,SOCIOECONOMIC factors ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Background The 'Five Year Forward View' (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to general practice (GP) provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers. Method Data from the Born in Bradford cohort (around 12 000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision. Results Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is 'explained' by the nature of GP provision. Women in practices with a low GP to patient ratio had around 09 fewer consultations over the six year period compared to women in practices with the highest ratio. Conclusions Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need. [ABSTRACT FROM AUTHOR]
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- 2017
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