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Neill R, Zia N, Ashraf L, Khan Z, Pryor W, Bachani AM. Integration measurement and its applications in low- and middle-income country health systems: a scoping review. BMC Public Health 2023; 23:1876. [PMID: 37770887 PMCID: PMC10537146 DOI: 10.1186/s12889-023-16724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. METHODS Arksey and O'Malley's framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. RESULTS We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. CONCLUSION We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.
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Affiliation(s)
- Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Lamisa Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Zainab Khan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Wesley Pryor
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Tiruneh GT, Hirschhorn LR, Fesseha N, Emaway D, Eifler K, Betemariam W. Care-seeking behaviours of mothers and associated factors for possible serious bacterial infection in young infants during COVID-19 pandemic in Ethiopia: mixed-methods formative research. BMJ Open 2023; 13:e073118. [PMID: 37407046 DOI: 10.1136/bmjopen-2023-073118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Implementation research was employed to examine rates and contextual factors associated with mothers' care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access and implementation during the COVID-19 pandemic. DESIGN We conducted formative research involving household survey and programmatic qualitative study. SETTING This formative study was conducted in Dembecha and Lume woredas of Amhara and Oromia regions. PARTICIPANTS Data were captured from 4262 mothers aged 15-49 years who gave live birth 2-14 months before data collection, and interviews with 18 programme managers and 16 service providers in April to May 2021. ANALYSIS A multilevel regression model was employed to identify predictors of maternal care-seeking for PSBI and thematic qualitative analysis to inform strategy development to strengthen PSBI implementation. RESULTS Overall, 12% (95% CI 11.0% to 12.9%) and 8% (95% CI 7.9% to 9.6%) of mothers reported any newborn illness and severe neonatal infection (PSBI), respectively. More than half of mothers sought formal medical care, 56% (95% CI 50.7% to 60.8%) for PSBI. Women who received postnatal care within 6 weeks (adjusted OR (AOR) 2.08; 95% CI 1.12 to 3.87) and complete antenatal care (ie, weight measured, blood pressure taken, urine and blood tested) (AOR 2.04; 95% CI 1.12 to 3.75) had higher odds of care-seeking for PSBI. Conversely, fear of COVID-19 (AOR 0.27; 95% CI 0.15 to 0.47) and residing more than 2 hours of walking distance from the health centre (AOR 0.39; 95% CI 0.16 to 0.93) were negatively associated with care-seeking for severe newborn infection. Multiple pre-existing health system bottlenecks were identified from interviews as barriers to PSBI service delivery and exacerbated by the COVID-19 pandemic. CONCLUSION We found gaps in and factors associated with care-seeking behaviour of mothers for their sick young infants including fear of COVID-19 and pre-existing health system-level barriers. The findings of the study were used to design and implement strategies to mitigate COVID-19 impacts on management of PSBI.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
- Behavioral Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Lisa R Hirschhorn
- Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, Illinois, USA
| | - Nebreed Fesseha
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
| | - Dessalew Emaway
- Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
| | - Kristin Eifler
- International Division, JSI Research & Training Institute, Boston, Massachusetts, USA
| | - Wuleta Betemariam
- Center for Healthy Women, Children, and Communities, JSI Research & Training Institute, Washington, DC, USA
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Sultana N, Hossain A, Das H, Pallikadavath S, Koeryaman M, Rahman M, Chowdhury AH, Bhuiya A, Mahmood SS, Hanifi SMA. Is the maternal health voucher scheme associated with increasing routine immunization coverage? Experience from Bangladesh. Front Public Health 2023; 11:963162. [PMID: 36817885 PMCID: PMC9937056 DOI: 10.3389/fpubh.2023.963162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Bangladesh initiated the Maternal Health Voucher Scheme (MHVS) in 2007 to improve maternal and child health practices and bring equity to the mainstream of health systems by reducing financial and institutional barriers. In this study, we investigated whether the MHVS has an association with immunization coverage in a rural area of Bangladesh. Between 30 October 2016 and 15 June 2017, we carried out a cross-sectional survey in two low performing areas in terms of immunization coverage- Chattogram (erstwhile Chittagong division) and Sylhet division of Bangladesh. We calculated the coverage of fully immunized children (FIC) for 1151 children aged 12-23 months of age. We compared the coverage of FIC between children whose mothers enrolled in MHVS and children whose mother did not. We analyzed immunization coverage using crude odds ratio (OR) and adjusted OR (aOR) from binary logistic regression models. The overall coverage of FIC was 86%. Ninety-three percent children whose mothers were MHVS members were fully immunized whereas the percentage was 84% for the children of mothers who were not enrolled in MHVS. Multivariate analysis also shows that FIC coverage was higher for children whose mothers enrolled in MHVS compared to those children whose mothers did not; the aOR was 2.03 (95% confidence interval 1.11-3.71). MHVS provides a window for non-targeted benefits of childhood vaccination. Providing health education to pregnant mothers during prenatal care may motivate them to immunize their children. Programmes targeted for mothers during pregnancy, childbirth and post-natal may further increase utilization of priority health services such as childhood immunization.
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Affiliation(s)
- Nazia Sultana
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh,*Correspondence: Nazia Sultana ✉
| | - Aazia Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Hemel Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mira Koeryaman
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mohammad Rahman
- Salford Business School, University of Salford, Salford, United Kingdom
| | | | - Abbas Bhuiya
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - S. M. A. Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Chowdhury SK. Uptake of antepartum care services in a matrilineal-matrilocal society: a study of Garo indigenous women in Bangladesh. BMC Pregnancy Childbirth 2023; 23:75. [PMID: 36709250 PMCID: PMC9883956 DOI: 10.1186/s12884-023-05404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The indigenous Garo is a close-knit matrilineal-matrilocal community. This community's expectant mothers receive less antepartum biomedical care, making them prone to maternal mortality. This study developed a conceptual framework to explore how the external environment, personal predispositions, enabling components and perceived antepartum care needs influence and generate a gap in antepartum biomedical care uptake. METHODS The author used qualitative data from the study area. The data were collected through conducting 24 semi-structured interviews with purposively selected Garo women. After transcribing the data, the author generated the themes, grouped them into two broader domains, and analyzed them using the grounded theory approach. RESULTS The emergent themes suggest adding the external environment (i.e., healthcare facilities' availability and services and culturally relevant healthcare services) to Anderson's behavioral model to understand indigenous women's antepartum care uptake disparity. Antepartum care uptake disparities arise when Andersen's behavioral model's other three drivers-personal predisposition, enabling components, and needs components-interact with the external environment. The interplay between enabling resources and the external environment is the conduit by which their predispositions and perceived needs are shaped and, thus, generate a disparity in antepartum care uptake. The data demonstrate that enabling resources include gendered power dynamics in families, home composition and income, men's spousal role, community practices of maternal health, and mother groups' and husbands' knowledge. Birth order, past treatment, late pregnancy, and healthcare knowledge are predispositions. According to data, social support, home-based care, mental health well-being, cultural norms and rituals, doctors' friendliness, affordable care, and transportation costs are perceived needs. CONCLUSIONS Garo family members (mothers/in-laws and male husbands) should be included in health intervention initiatives to address the problem with effective health education, highlighting the advantages of biomedical antepartum care. Health policymakers should ensure the availability of nearby and culturally appropriate pregnancy care services.
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Affiliation(s)
- Suban Kumar Chowdhury
- grid.412656.20000 0004 0451 7306Department of International Relations, University of Rajshahi, Rajshahi, Bangladesh
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Buli TD, Wakgari N, Ganfure G, Wondimu F, Dube DL, Moti G, Doba YS. Completion of the continuum of maternity care and associated factors among women who gave birth in the last 6 months in Chelia district, West Shoa zone, Ethiopia: A community-based cross-sectional study. Front Public Health 2023; 10:1026236. [PMID: 36684973 PMCID: PMC9845613 DOI: 10.3389/fpubh.2022.1026236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background The continuum of maternity care is a continuity of care that a woman receives during pregnancy, childbirth, and the postpartum period from skilled providers in a comprehensive and integrated manner. Despite existing evidence regarding maternal healthcare services discretely, the continuum of maternity care and its associated factors are not well-known in Ethiopia. Objective This study assessed the completion of the maternity continuum of care and associated factors among women who gave birth 6 months prior to the study in the Chelia district. Methods A community-based cross-sectional study with a stratified random sampling technique was conducted among 428 mothers at 10 randomly selected kebeles. Pretested and structured questionnaires were used to collect data. Bi-variable and multivariable logistic regression analyzes were performed to identify associated factors. Adjusted odds ratio with its 95% confidence interval was used to determine the degree of association, and statistical significance was declared at a p-value of <0.05. Results In this study, 92 (21.5%) mothers completed the continuum of maternity care. Secondary and above education of mothers (AOR = 4.20, 95% CI:1.26-13.97), ≤30 min spent on walking by foot (AOR = 4.00, 95% CI: 1.67-9.58), using an ambulance to reach health facility (AOR = 3.68, 95% CI: 1.23-11.06), para ≥5 mothers (AOR = 0.21, 95% CI: 0.05-0.90), planned pregnancy (AOR = 3.29, 95% CI: 1.02-10.57), attending pregnant women's conference (AOR = 13.96, 95% CI: 6.22-31.30), early antenatal care booking (AOR = 3.30, 95% CI: 1.54-7.05), accompanied by partners (AOR = 3.64, 95% CI: 1.76-7.53), and informed to return for postnatal care (AOR = 3.57, 95% CI: 1.47-8.70) were the factors identified. Conclusion In this study, completion of the maternity continuum of care was low. Therefore, appropriate strategic interventions that retain women in the continuum of maternity care by targeting those factors were recommended to increase the uptake of the continuum of maternity care.
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Affiliation(s)
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gemechu Ganfure
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Fikadu Wondimu
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dereje Lemma Dube
- Department of Obstetrics and Gynecology, Ambo University Referral Hospital, Ambo, Ethiopia
| | - Gonfa Moti
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Yonas Sagni Doba
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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Exploration of spatial clustering in maternal health continuum of care across districts of India: A geospatial analysis of demographic and health survey data. PLoS One 2022; 17:e0279117. [PMID: 36520872 PMCID: PMC9754170 DOI: 10.1371/journal.pone.0279117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India. DATA AND METHODS The study is based on the fourth round of National Family Health Survey data conducted in 2015-16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC. FINDINGS Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran's I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC. CONCLUSION The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.
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Phway P, Kyaw AT, Mon AS, Mya KS. Continuum of care of mothers and immunization status of their children: A secondary analysis of 2015–2016 Myanmar Demographic and Health Survey. PUBLIC HEALTH IN PRACTICE 2022; 4:100335. [DOI: 10.1016/j.puhip.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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Faradita I, Sitaresmi MN, Wahab A. Association between Maternal Health Care and Basic Immunization Completeness in Children Aged 12–23 Months: Analysis of 2017 Indonesian Demographic and Health Survey. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The coverage of complete basic immunization in Indonesia is still lower than the target stated in the 2015-2019 Ministry of Health Strategic Plan. It may be caused by several factors, one of the essential factors is maternal health services.
AIM: The study aims to assess the association between maternal health services and immunization completeness in Indonesian children aged 12–23 months.
METHODS: A cross-sectional design was conducted using the 2017 Indonesian Demographic Health Survey. Two-stage stratified random sampling was used to obtain representative samples from all provinces in Indonesia. The subjects of this study were mothers who had children aged 12–23 months. A total of 3,398 samples were obtained after considering the inclusion and exclusion criteria. The data were analyzed using chi-square and logistic regression.
RESULTS: The prevalence of complete immunization of Indonesian children aged 12–23 months was 61.4%. From multivariate analysis, we found that mothers who attend more than four antenatal care (ANC) (Adjusted odds ratio [AOR] 3.23 95% Confidence interval [CI] [2.31–4.52]), delivery by health-professionals (AOR 3.32 95%CI [2.26–4.88]), and attended postnatal care (PNC) (AOR 1.31 95% CI [1.07–1.59]) were predictors of complete child immunization. In addition, children whose mothers had a higher educational level and who live in Java-Bali were more likely to be completely vaccinated.
CONCLUSION: Maternal health services, which consist of ANC services, delivery by health workers, and PNC services, were associated with the completeness of basic immunization in Indonesian children aged 12–23 months. Strategies to improve immunization coverage must be carried out by increasing the continuity of maternal health services since pregnancy, childbirth, and postpartum.
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Pakrashi D, Maiti SN, Gautam A, Nanda P, Borkotoky K, Datta N. Family planning campaigns on television and contraceptive use in India. Int J Health Plann Manage 2022; 37:1492-1511. [PMID: 35001417 DOI: 10.1002/hpm.3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The paper examines the association between viewing family planning campaigns on television and being aware, improved intention to use, and current usage of modern contraceptives in India. DATA The study uses detailed data of the currently married women from the current round of the National Family Health Survey. METHODS We use the instrumental variable approach, propensity score matching method, besides the ordinary least square regression technique to estimate the association between viewing family planning campaigns on television and knowledge, intention to use, and current usage among the currently married women. CONCLUSION The overall results suggest that currently married women who have seen family planning campaigns on television in the last few months are more likely to know, have a higher intention to use and use modern family planning methods. The effectiveness gets amplified when exposure to such campaigns is complemented with motivation provided by frontline health workers.
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Affiliation(s)
- Debayan Pakrashi
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Surya Nath Maiti
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Abhishek Gautam
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
| | - Priya Nanda
- Bill & Melinda Gates Foundation, New Delhi, India
| | - Kakoli Borkotoky
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
| | - Nitin Datta
- International Centre for Research on Women's (ICRW) Asia Regional Office, New Delhi, India
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Addisu D, Mekie M, Melkie A, Abie H, Dagnew E, Bezie M, Degu A, Biru S, Chanie ES. Continuum of maternal healthcare services utilization and its associated factors in Ethiopia: A systematic review and meta-analysis. WOMEN'S HEALTH 2022; 18:17455057221091732. [PMID: 35412408 PMCID: PMC9008832 DOI: 10.1177/17455057221091732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The continuum of care throughout pregnancy, childbirth, and postnatal period is one of the vital strategies for improving maternal and neonatal health and preventing maternal and neonatal mortalities and morbidities. The level and determinants of the complete continuum of care for maternal health services reported by different studies were extremely varied in Ethiopia. Therefore, this meta-analysis aimed to estimate the overall prevalence of a complete continuum of maternal health care services utilization and its associated factors in Ethiopia. Databases such as PubMed/MEDLINE, Science Direct, DOJA, African journals online, Cochrane library, Google scholar, web of science, and Ethiopian universities’ institutional repository were used to search for relevant studies. A total of seven studies with 4854 study participants were involved in this study. Data were extracted by two reviewers and exported to STATA Version 11 for analysis. The I2 statistics and Egger’s test were used to assess heterogeneity and publication bias, respectively. The random-effects random effects model was used to estimate the level of complete continuum of care for maternal health services. The pooled prevalence of complete continuum of maternal healthcare services utilization was 25.51%. Employed mothers (OR = 3.16, 95%CI = 1.82, 5.47), first antenatal ante natal care visit before 16 weeks (OR = 7.53, 95% CI = 2.94, 19.29), birth preparedness and complication readiness plan (OR = 1.95, 95% CI = 1.12, 3.41), secondary and above educational status (OR = 2.97, 95% CI = 2.00, 4.41), planned pregnancy (OR = 6.86, 95% CI = 3.47, 13.58) and autonomy (OR = 3.73, 95% CI = 2.24–6.23) were significantly associated with continuum of maternal healthcare services utilization. In conclusion, the national level of complete continuum of maternal healthcare service utilization was low in Ethiopia. Being employed mothers, first ante natal care visit before 16 weeks, birth preparedness and complication readiness plan, secondary and above educational status, autonomy, and planned pregnancy were the major determinants of continuum of maternal healthcare services utilization.
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Affiliation(s)
- Dagne Addisu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Maru Mekie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abenezer Melkie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Abie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Minale Bezie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemu Degu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shimeles Biru
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Kothavale A, Meher T. Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study. BMC Pregnancy Childbirth 2021; 21:731. [PMID: 34706680 PMCID: PMC8554854 DOI: 10.1186/s12884-021-04198-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? Methods The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. Results Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. Conclusion The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04198-2.
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Affiliation(s)
- Ajinkya Kothavale
- International Institute for Population Sciences (IIPS), Mumbai, Deonar, 400088, India.
| | - Trupti Meher
- International Institute for Population Sciences (IIPS), Mumbai, Deonar, 400088, India.
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Maharatha TM, Dash U. Inequity in health care utilization for common childhood illnesses in India: measurement and decomposition analysis using the India demographic and health survey 2015-16. BMC Health Serv Res 2021; 21:881. [PMID: 34452619 PMCID: PMC8394173 DOI: 10.1186/s12913-021-06887-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Though child mortality has dropped remarkably, it is considerably high in South Asia. Across the globe, 5.2 million children under 5 years of age died in 2019, and India accounts for a significant portion of these deaths. Common childhood illnesses are the leading cause of these deaths. Seeking care from formal providers can reduce these avoidable deaths. Inequity is a crucial blockage in optimum utilization of medical treatment for children. Hence, the present study analyzes the inequalities and horizontal inequities in utilizing the medical treatment for diarrhea, fever, acute respiratory infection (ARI), and any of these common childhood illnesses in India and across the Indian states. The study also attempts to locate significant contributors to these inequalities. METHODS The study used 0 to 59 months children's data sourced from the Demographic and Health Survey, India (2015-16). Concentration Index (CI) and Erreygers Corrected Concentration Index (EI) were used to measure the inequalities. The Horizontal Inequity Index (HII) was deployed to estimate inequity. The decomposition method introduced by Erreygers was applied to determine the significant contributors of inequalities. RESULTS The EI in medical treatment-seeking for common childhood illnesses was 0.16, while the HII was 0.15. The highest inequality was perceived in the utilization of medical treatment for ARI (0.17). The primary contributing factors of these inequalities were continuum of maternal care (18.7%), media exposure (12%), affordability (9.3%), place of residence (9.1%), mother's education (8.5%), and state groups (8.8%). The North-Eastern states showed the highest level of inequality across the Indian states. CONCLUSION The study reveals that the horizontal inequity in medical treatment utilization for children in India is pro-rich. The findings of the study suggest that attuning the efforts of existing maternal and child health programs into one seamless chain of care can bring the inequalities down and improve the utilization of child health care services. The spread of health education through different media sources, reaching out to rural and remote places with adequate health personnel, and easing out the financial hardship in accessing medical treatment could be the cornerstone in accelerating the utilization level amongst the impoverished children.
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Affiliation(s)
- Tulasi Malini Maharatha
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.
| | - Umakant Dash
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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