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Hassen SS, Lelisho ME, Tareke SA. Multilevel Count Regression Analysis of Factors Associated with the Desired Number of Antenatal Care Service Visits in Ethiopia. J Racial Ethn Health Disparities 2024; 11:1973-1983. [PMID: 37314688 DOI: 10.1007/s40615-023-01666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Visiting the desired number of antenatal care services improve the success of maternal health programs in terms of mother and child health. The study aimed to identify the factors associated with differences in the number of antenatal care service visits across and within regions of Ethiopia by using the 2019 Ethiopian Mini Demographic Health Survey (EMDHS). METHODS A total of 3979 women who were pregnant or gave birth within 5 years preceding the survey from the 2019 Ethiopian Mini Demographic Health Survey were included in the analysis. A multi-level Hurdle negative binomial regression model was selected to consider the hierarchical nature of the data in determining the factors associated with the barriers to the desired number of antenatal care service visits. RESULTS About one-fourth (26.2%) of mothers did not visit any antenatal care, and only 137 (3.4%) women visited the service eight times and above. The random intercept with the fixed coefficient of multilevel Hurdle negative binomial model results has shown that women in the age group between 25 and 34 (AOR = 1.057), in the age group between 35 and 49 (AOR = 1.108), protestant religion follower women (AOR = 0.918), Muslim women (AOR = 0.945), other religion follower women (AOR = 0.768), mothers in primary educational level (AOR = 1.123), secondary and higher education level (AOR = 1.228), rich mothers (AOR = 1.134), and mothers living in rural (AOR = 0.789) were statistically associated with regional variation regarding the frequency of ANC service visits. CONCLUSIONS The majority of pregnant women did not visit antenatal care services according to the findings of this study. This study's results revealed that the predictor variables such as mother's age, education level, religion, place of residence, marital status, and wealth index were significant, and the findings revealed that there were regional differences in ANC visits in Ethiopia. Women's economic and educational interventions should be a top priority.
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Affiliation(s)
- Sali Suleman Hassen
- Department of Statistics, MSc. in Biostatistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
| | - Mesfin Esayas Lelisho
- Department of Statistics, MSc. in Biostatistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Seid Ali Tareke
- Department of Statistics, MSc. in Biostatistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
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Sutarsa IN, Campbell L, Ariawan IMD, Kasim R, Marten R, Rajan D, Hall Dykgraaf S. Multisectoral interventions and health system performance: a systematic review. Bull World Health Organ 2024; 102:521-532F. [PMID: 38933474 PMCID: PMC11197648 DOI: 10.2471/blt.23.291246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To conduct a systematic review on the effects of multisectoral interventions for health on health system performance. Methods We conducted a systematic review according to the preferred reporting items for systematic review and meta-analysis protocols. We searched for peer-reviewed journal articles in PubMed®, Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment. Findings We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these. Conclusion Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care.
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Affiliation(s)
- I Nyoman Sutarsa
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton 2601, Australia
| | - Lachlan Campbell
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton 2601, Australia
| | - I Made Dwi Ariawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Indonesia
| | - Rosny Kasim
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton 2601, Australia
| | - Robert Marten
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Dheepa Rajan
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Sally Hall Dykgraaf
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton 2601, Australia
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Oles W, Alexander M, Negron R, Nelson J, Iriarte E, Airoldi EM, Christakis NA, Forastiere L. Maternal and child health intervention to promote behaviour change: a population-level cluster-randomised controlled trial in Honduras. BMJ Open 2024; 14:e060784. [PMID: 38858139 PMCID: PMC11168147 DOI: 10.1136/bmjopen-2022-060784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 12/05/2023] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES To assess the efficacy of a sustained educational intervention to affect diverse outcomes across the pregnancy and infancy timeline. SETTING A multi-arm cluster-randomised controlled trial in 99 villages in Honduras' Copán region, involving 16 301 people in 5633 households from October 2015 to December 2019. PARTICIPANTS Residents aged 12 and older were eligible. A photographic census involved 93% of the population, with 13 881 and 10 263 individuals completing baseline and endline surveys, respectively. INTERVENTION 22-month household-based counselling intervention aiming to improve practices, knowledge and attitudes related to maternal, neonatal and child health. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were prenatal/postnatal care behaviours, facility births, exclusive breast feeding, parental involvement, treatment of diarrhoea and respiratory illness, reproductive health, and gender/reproductive norms. Secondary outcomes were knowledge and attitudes related to the primary outcomes. RESULTS Parents targeted for the intervention were 16.4% (95% CI 3.1%-29.8%, p=0.016) more likely to have their newborn's health checked in a health facility within 3 days of birth; 19.6% (95% CI 4.2%-35.1%, p=0.013) more likely to not wrap a fajero around the umbilical cord in the first week after birth; and 8.9% (95% CI 0.3%-17.5%, p=0.043) more likely to report that the mother breast fed immediately after birth. Changes in knowledge and attitudes related to these primary outcomes were also observed. We found no significant effect on various other practices. CONCLUSION A sustained counselling intervention delivered in the home setting by community health workers can meaningfully change practices, knowledge and attitudes related to proper newborn care following birth, including professional care-seeking, umbilical cord care and breast feeding. TRIAL REGISTRATION NUMBER NCT02694679.
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Affiliation(s)
- William Oles
- Yale Institute for Network Science, Yale University, New Haven, Connecticut, USA
| | - Marcus Alexander
- Yale Institute for Network Science, Yale University, New Haven, Connecticut, USA
| | - Rennie Negron
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Nelson
- Inter-American Development Bank, Washington, District of Columbia, USA
| | - Emma Iriarte
- Inter-American Development Bank, Washington, District of Columbia, USA
| | - Edoardo M Airoldi
- Department of Statistics, Operations, and Data Science, Fox School of Business, Temple University, Philadelphia, Pennsylvania, USA
- Data Science Institute, Temple University, Philadelphia, Pennsylvania, USA
| | - Nicholas A Christakis
- Yale Institute for Network Science, Yale University, New Haven, Connecticut, USA
- Departments of Sociology and Medicine, Yale University, New Haven, Connecticut, USA
| | - Laura Forastiere
- Yale Institute for Network Science, Yale University, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
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Lateef MA, Kuupiel D, Mchunu GG, Pillay JD. Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:440. [PMID: 38673351 PMCID: PMC11050659 DOI: 10.3390/ijerph21040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.
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Affiliation(s)
- Monsurat A. Lateef
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Desmond Kuupiel
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Gugu G. Mchunu
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Julian D. Pillay
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
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Suh H, Kalai S, Trivedi N, Underwood C, Hendrickson ZM. Effects of women's economic empowerment interventions on antenatal care outcomes: a systematic review. BMJ Open 2023; 13:e061693. [PMID: 36914184 PMCID: PMC10016312 DOI: 10.1136/bmjopen-2022-061693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES Early and adequate antenatal care (ANC) has been shown to reduce maternal morbidity and mortality globally. Increasing evidence suggests that women's economic empowerment (WEE) is a critical factor that may influence uptake of ANC during pregnancy. However, existing literature lacks a comprehensive synthesis of studies on WEE interventions and their effects on ANC outcomes. This systematic review analyses WEE interventions at the household, community and national levels and their effects on ANC outcomes in low-income and middle-income countries, where the majority of maternal deaths occur. METHODS Six electronic databases were systematically searched as well as 19 websites of relevant organisations. Studies published in English and after 2010 were included. RESULTS Following abstract and full-text review, 37 studies were included in this review. Seven studies used an experimental study design, 26 studies used a quasi-experimental study design, 1 study used an observational design and 1 study was a systematic review with meta-analysis. Thirty-one included studies evaluated a household-level intervention, and six studies evaluated a community-level intervention. No included studies examined a national-level intervention. CONCLUSION Most included studies on household-level and community-level interventions found a positive association between the intervention and the number of ANC visits women received. This review emphasises the need for more WEE interventions that empower women at the national level, for the expansion of the definition of WEE to be more inclusive of the multidimensionality of WEE interventions and the social determinants of health, and the standardisation of ANC outcome measurement globally.
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Affiliation(s)
- Heezy Suh
- Department of Public Health Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shiri Kalai
- Department of Public Health Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Niki Trivedi
- Department of Public Health Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carol Underwood
- Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zoé Mistrale Hendrickson
- Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Wafula ST, Nalugya A, Kananura RM, Mugambe RK, Kyangwa M, Isunju JB, Kyobe B, Ssekamatte T, Namutamba S, Namazzi G, Ekirapa EK, Musoke D, Walter F, Waiswa P. Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda. Glob Health Action 2022; 15:2141312. [DOI: 10.1080/16549716.2022.2141312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Solomon T Wafula
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rornald M Kananura
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Kyangwa
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John B Isunju
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Betty Kyobe
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Namutamba
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gertrude Namazzi
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth K Ekirapa
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Florian Walter
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health 2022; 21:49. [PMID: 35410258 PMCID: PMC8996551 DOI: 10.1186/s12939-021-01615-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve? Methods We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis. Results One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. Conclusion In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity. Trial registration PROSPERO registration number CRD42020177333. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01615-y.
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Aji B, Anandari D, Soetikno H, Sumawan H. Sustaining maternal and child health programs when donor funding ends: A case study of stakeholder involvement in Indonesia. Int J Health Plann Manage 2022; 37:2049-2062. [DOI: 10.1002/hpm.3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 12/07/2021] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Budi Aji
- School of Public Health Faculty of Health Sciences Jenderal Soedirman University Purwokerto Indonesia
| | - Dian Anandari
- School of Public Health Faculty of Health Sciences Jenderal Soedirman University Purwokerto Indonesia
| | | | - Herman Sumawan
- Faculty of Medicine Jenderal Soedirman University Purwokerto Indonesia
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Moos B, Williams D, Bolon I, Mupfasoni D, Abela-Ridder B, Ruiz de Castaneda R. A scoping review of current practices on community engagement in rural East Africa: Recommendations for snakebite envenoming. Toxicon X 2021; 11:100073. [PMID: 34381992 PMCID: PMC8334718 DOI: 10.1016/j.toxcx.2021.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/01/2022] Open
Abstract
Community empowerment and engagement is one of the four strategic aims highlighted in the WHO strategy to prevent and control snakebite envenoming. Inappropriate health-seeking behaviours contribute to adverse outcomes, and community engagement is key in driving behavioural change. WHO has highlighted East Africa as a geographical area of concern for snakebite envenoming. The overall aim of the project is to develop a community engagement toolkit for snakebite envenoming and other NTDs. The objective of this scoping review was to identify current practices in recent community engagement in rural East Africa; the applicability of these results to snakebite envenoming are discussed. PubMed, Web of Science, PsycINFO and Google Scholar were searched from 1 January 2017 to 3 September 2020. Search terms were used to identify publications which related to rural communities and health or disease, for both humans and animals. After reviewing the full papers for all geographical areas, 112 publications were included, 30 of which were conducted in East Africa. Papers included nine different countries and covered a broad range of health topics; notably, water, sanitation and hygiene, nutrition, and maternal and child health. Only one publication considered animal health. The most common form of engagement was in the context of a group meeting, lecture, presentation, discussion or question and answer session (63.3%). A variety of locations within the community were used to engage with people, the most common being an individual's household (23.3%). Communication factors was the key influencer for engagement, both positively and negatively. Key barriers to engagement include local languages and health beliefs, literacy levels, mobile phone ownership and the level of mobile Internet coverage, burden of agricultural work and weather conditions. This study provides an extensive overview of recent public health community engagement in East Africa, which will serve as a useful resource for any group seeking to plan an intervention in remote and rural areas in East Africa. Furthermore, it serves as a guide to help tailor community engagement to snakebite envenoming.
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Affiliation(s)
- Bethany Moos
- Hedena Health, 207 London Road, Headington, Oxford, UK
| | - David Williams
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, CH-1202, Geneva, Switzerland
| | - Denise Mupfasoni
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
| | - Rafael Ruiz de Castaneda
- Division of Tropical and Humanitarian Medicine & Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Lee H, Maffioli EM, Veliz PT, Munro-Kramer ML, Phiri TK, Sakala I, Kaunda J, Chiboola NM, Lori JR. Role of Savings and Internal Lending Communities (SILCs) in improving household wealth and financial preparedness for birth in rural Zambia. Health Policy Plan 2021; 36:1269-1278. [PMID: 33909075 PMCID: PMC8428586 DOI: 10.1093/heapol/czab049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Savings and Internal Lending Communities (SILCs) are a type of informal microfinance mechanism adapted in many low- and middle-income countries (LMICs) to improve financial resources for poor and rural communities. Although SILCs are often paired with other health and non-health-related interventions, few studies have examined SILCs in the context of maternal health. This study examined the association between SILC participation, household wealth and financial preparedness for birth. The study also examined the association between sex and financial preparedness for birth. A secondary analysis was conducted on individual survey data collected from SILC participants in two rural districts of Zambia between October 2017 and February 2018. A convenience sample of 600 participants (Lundazi: n = 297; Mansa: n = 303) was analysed. Descriptive analyses were run to examine SILC participation and household wealth. Multiple binary logistic regression models were fit to assess the unadjusted and adjusted relationship between (1) SILC participation and household wealth, (2) SILC participation and financial preparedness for birth and (3) sex and financial preparedness for birth. The results show that SILC participation led to an average increase of 7.32 items of the 13 household wealth items. SILC participants who had their most recent childbirth after joining SILCs were more likely to be financially prepared for birth [adjusted odds ratio (AOR): 2.99; 95% confidence interval (95% CI): 1.70-5.26; P < 0.001] than participants who had their most recent childbirth before joining SILCs. Females were more likely to be financially prepared for birth than males if they had their most recent birth before joining an SILC (AOR: 1.79; 95% CI: 1.16-2.66; P < 0.01). SILC participation is shown to increase household wealth and financial preparedness for birth for both men and women. SILCs are a promising intervention that can help poor and rural populations by increasing financial resources and financially preparing parents for birth.
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Affiliation(s)
- HaEun Lee
- Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Elisa M Maffioli
- Health Management and Policy, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Philip T Veliz
- Applied Biostatistics Laboratory, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Michelle L Munro-Kramer
- Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Tenford K Phiri
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Isaac Sakala
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Jameson Kaunda
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Nchimunya M Chiboola
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Jody R Lori
- Associate Dean of Global Affairs, Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
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11
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Louart S, Bonnet E, Ridde V. Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries. Health Policy Plan 2021; 36:101-116. [PMID: 33212491 PMCID: PMC7938515 DOI: 10.1093/heapol/czaa093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.
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Affiliation(s)
- Sarah Louart
- Univ. Lille, CNRS, UMR 8019 - CLERSE - Centre Lillois d’Études et de Recherches sociologiques et Économiques, F-59000 Lille, France
| | - Emmanuel Bonnet
- Institute for Research on Sustainable Development, UMI Résiliences 236, Bondy, France
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, Paris 75006, France
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12
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Esteves Mills J, Flynn E, Cumming O, Dreibelbis R. Determinants of clean birthing practices in low- and middle-income countries: a scoping review. BMC Public Health 2020; 20:602. [PMID: 32357872 PMCID: PMC7195776 DOI: 10.1186/s12889-020-8431-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. Methods We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants – capability, opportunity and motivation. Results Seventy-eight studies were included in the review: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours – commonly referred to as “the six cleans” – featured in 31 studies. Determinants of hand hygiene (n = 13) and clean cord care (n = 11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. Conclusions Efforts to combine clean birthing practices into a single suite of behaviours – such as the “six cleans”– may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.
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Affiliation(s)
- Joanna Esteves Mills
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Erin Flynn
- Infection & Immunity, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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13
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Masoi TJ, Kibusi SM. Improving pregnant women's knowledge on danger signs and birth preparedness practices using an interactive mobile messaging alert system in Dodoma region, Tanzania: a controlled quasi experimental study. Reprod Health 2019; 16:177. [PMID: 31831076 PMCID: PMC6909441 DOI: 10.1186/s12978-019-0838-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Unacceptably high maternal and perinatal mortality remain a major challenge in many low income countries. Early detection and management of danger signs through improved access to maternal services is highly needed for better maternal and infant outcomes. The aim of this study was to test the effectiveness of an interactive mobile messaging alert system on improving knowledge on danger signs, birth preparedness and complication readiness practices among pregnant women in Dodoma region, Tanzania. Methods A controlled quasi experimental study of 450 randomly selected pregnant women attending antenatal care was carried in Dodoma municipal. Participants were recruited at less than 20 weeks of gestation during the first visit where 150 were assigned to the intervention and 300 to the control group. The intervention groups was enrolled in an interactive mobile messaging system and received health education messages and were also able to send and receive individualized responses on a need basis. The control group continued receiving usual antenatal care services offered at the ANC centers. Pregnant women were followed from their initial visit to the point of delivery. Level of knowledge on danger signs and birth preparedness were assessed at baseline and a post test was again given after delivery for both groups. Analyses of covariance, linear regression were employed to test the effectiveness of the intervention. Results The mean age of participants was 25.6 years ranging from 16 to 48 years. There was significant mean scores differences for both knowleadge and birth preparedness between the intervention and the control group after the intervention (p < .001). The mean knowleadge score was (M = 9.531,SD = 2.666 in the intervention compared to M = 6.518,SD = 4.304 in the control, equivalent to an effect size of 85% of the intervention. Meanwhile, the mean score for IBPACR was M = 4.165,SD = 1.365 for the intervention compared to M = 2.631,SD = 1.775 in the control group with an effect size of 90% A multivariate linear regression showed a positive association between the intervention (p < 0.001) and level of knowledge (B = 2.910,95%CI = 2.199–3.621) and birth preparediness (B = 1.463,95%CI = 1.185–1.740). Conclusion The Interactive mobile messaging alert system demonstrated to be effective in increasing women’s knowledge on danger signs and improving their birth preparedness practices.
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Affiliation(s)
- Theresia J Masoi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania. .,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania.
| | - Stephen M Kibusi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania.,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania
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Ouedraogo CT, Wessells KR, Young RR, Bamba IF, Faye MT, Banda N, Hess SY. The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger. BMJ Glob Health 2019; 4:e001200. [PMID: 31908852 PMCID: PMC6936581 DOI: 10.1136/bmjgh-2018-001200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Anaemia is prevalent among pregnant women in rural Niger and antenatal care (ANC) attendance is suboptimal. We designed a programmatic intervention including community-based behaviour change communication, provision of essential drugs (including iron folic acid (IFA) supplements) and quality improvement activities at selected integrated health centres (IHCs). Objective To assess the impact of the programmatic intervention on: (1) utilisation of ANC, (2) adherence to daily IFA supplementation and (3) prevalence of adequate gestational weight gain (GWG) and anaemia among pregnant women in Zinder, Niger. Methods Using a quasi-experimental study design comparing a cohort of women at baseline to another cohort of women at endline, 18 IHCs and surrounding villages were randomly assigned to time of enrolment over 1 year. A baseline survey was implemented among randomly selected pregnant women in 68 village clusters. Subsequently, the intervention was rolled out and an endline survey was implemented 6 months later in the same villages. Results Mean age in the baseline (n=1385) and endline (n=922) surveys was 25.8±6.4 years. The percentage of pregnant women who reported attending any number of ANC and an adequate number of ANC for their gestational age, respectively, was not significantly different between the endline and the baseline surveys. Pregnant women in the endline survey were more likely to have received IFA (60.0% vs 45.8%, OR: 2.7 (1.2, 6.1)); and the proportion of pregnant women who reportedly consumed IFA daily in the previous 7 days was significantly higher in the endline than in the baseline survey (46.4% vs 32.8%, OR: 2.8 (1.2, 6.5)). There was no impact on the prevalence of adequate GWG or anaemia. Conclusions The programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving and consuming IFA supplements as recommended, but did not affect ANC attendance and nutritional status.
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Affiliation(s)
- Cesaire T Ouedraogo
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
- Helen Keller International, Niamey, Niger
| | - K Ryan Wessells
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Rebecca R Young
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | | | | | | | - Sonja Y Hess
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
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15
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O’Donovan J, Hamala R, Namanda AS, Musoke D, Ssemugabo C, Winters N. ‘We are the people whose opinions don’t matter’. A photovoice study exploring challenges faced by community health workers in Uganda. Glob Public Health 2019; 15:384-401. [DOI: 10.1080/17441692.2019.1663233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- James O’Donovan
- Learning and New Technologies Research Group, Department of Education, The University of Oxford, Oxford, UK
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Rebecca Hamala
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | | | - David Musoke
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Niall Winters
- Learning and New Technologies Research Group, Department of Education, The University of Oxford, Oxford, UK
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16
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Paina L, Namazzi G, Tetui M, Mayora C, Kananura RM, Kiwanuka SN, Waiswa P, Mutebi A, Ekirapa-Kiracho E. Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda. Global Health 2019; 15:38. [PMID: 31196193 PMCID: PMC6567581 DOI: 10.1186/s12992-019-0483-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedded in implementation research, to reduce barriers to access to care. In this paper, we describe two of projects that were initially conceived to tackle the financial barriers to access to care – through a voucher program in the community - on the demand side - and a series of health systems strengthening activities at the district and facility level - on the supply side. Over time, the projects diverged in the content of the intervention and the modality in which they were implemented, providing an opportunity for reflection on innovation and scaling up. In this short report, we used an adaptation of Greenhalgh’s Model of Diffusion to reflect on these projects’ approaches to implementing innovative interventions, with the ultimate goal of reducing maternal and neonatal mortality in rural Uganda. We found that the adapted model of diffusion of innovations facilitated the emergence of insights on barriers and facilitators to the implementation of health systems interventions. Health systems research projects would benefit from analyses beyond the implementation period, in order to better understand how adoption and diffusion happen, or not, over time, after the external catalyst departs.
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Affiliation(s)
- Ligia Paina
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gertrude Namazzi
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Chrispus Mayora
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Rornald Muhumuza Kananura
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
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17
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Mallick L, Dontamsetti T, Pullum T, Fleuret J. Using the Uganda Demographic and Health Surveys from 2011 and 2016 to assess changes in Saving Mothers, Giving Life intervention districts. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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18
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Ekirapa-Kiracho E, Tetui M, Bua J, Muhumuza Kananura R, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L, Namusoke Kiwanuka S. Maternal and neonatal implementation for equitable systems. A study design paper. Glob Health Action 2018; 10:1346925. [PMID: 28849723 PMCID: PMC5645657 DOI: 10.1080/16549716.2017.1346925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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Affiliation(s)
| | - Moses Tetui
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,b Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - John Bua
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Peter Waiswa
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,c Global Health Division , Karolinska Institutet , Stockholm , Sweden.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Fred Makumbi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Lynn Atuyambe
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Judith Ajeani
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Asha George
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,f School of Public Health , University of the Western Cape , Robert Sobukwe Road , Bellville 7535 , Republic of South Africa
| | - Aloysuis Mutebi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ayub Kakaire
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Gertrude Namazzi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ligia Paina
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Namazzi G, Okuga M, Tetui M, Muhumuza Kananura R, Kakaire A, Namutamba S, Mutebi A, Namusoke Kiwanuka S, Ekirapa-Kiracho E, Waiswa P. Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda. Glob Health Action 2018; 10:1345495. [PMID: 28849718 PMCID: PMC5786312 DOI: 10.1080/16549716.2017.1345495] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy. Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences. Results: CHWs’ knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (≥ 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles. Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local solutions regarding CHW motivation are necessary for sustainability.
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Affiliation(s)
- Gertrude Namazzi
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda.,b Centre of Excellence for Maternal and Newborn Health Research , Makerere University , Kampala , Uganda
| | - Monica Okuga
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda.,b Centre of Excellence for Maternal and Newborn Health Research , Makerere University , Kampala , Uganda
| | - Moses Tetui
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda.,c Umeå International School of Public Health (UISPH) , Umeå University , Umeå , Sweden
| | | | - Ayub Kakaire
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda.,b Centre of Excellence for Maternal and Newborn Health Research , Makerere University , Kampala , Uganda
| | - Sarah Namutamba
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda
| | - Aloysius Mutebi
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda
| | | | | | - Peter Waiswa
- a Makerere University , School of Public Health (MakSPH) , Kampala , Uganda.,b Centre of Excellence for Maternal and Newborn Health Research , Makerere University , Kampala , Uganda.,d Global Health Division , Karolinska Institutet , Stockholm , Sweden
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20
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Ekirapa-Kiracho E, Paina L, Muhumuza Kananura R, Mutebi A, Jane P, Tumuhairwe J, Tetui M, Kiwanuka SN. 'Nurture the sprouting bud; do not uproot it'. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda. Glob Health Action 2018; 10:1347311. [PMID: 28820046 PMCID: PMC5645701 DOI: 10.1080/16549716.2017.1347311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Ligia Paina
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Aloysius Mutebi
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Pacuto Jane
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | | | - Moses Tetui
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda.,d Department of Public Health and Clinical Medicine Sweden , Umeå University, Epidemiology and Global Health Unit , Umeå , Sweden
| | - Suzanne N Kiwanuka
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
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Beck DC, Munro-Kramer ML, Lori JR. A scoping review on community mobilisation for maternal and child health in sub-Saharan Africa: Impact on empowerment. Glob Public Health 2018; 14:375-395. [PMID: 30182808 DOI: 10.1080/17441692.2018.1516228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This review integrates evidence on community mobilisation (CM) for maternal and child health in sub-Saharan Africa (SSA) to identify the impact on empowerment. For the purposes of this review we use the following definition of CM: 'a capacity-building process through which community members, groups or organizations plan, carry out and evaluate activities on a participatory and sustained basis to improve their health and other conditions, either on their own initiative or stimulated by others', [Howard-Grabman, L., Storti, C., Hummer, P., Pooler, B., & Geneva: USAID (2007). Demystifying community mobilization: An effective strategy to improve maternal and newborn health. Retrieved from http://pdf.usaid.gov/pdf_docs/pnadi338.pdf, p. 5]. A scoping review was chosen to conduct a search and analysis of the literature due to the broad, complex nature of the topic. The search yielded 136 articles, and 19 met the inclusion criteria. This review illustrates CM as an important research process for engaging the community, ensuring that interventions are meeting the needs of the community, take context into account and are sustainable. Community mobilisation was associated with positive behaviour change and/or health outcomes. However, community mobilisation was not defined or operationalised consistently among the identified studies. Empowerment was also not defined, measured, or reported on in the articles. This review provides recommendations for the reporting of CM and its influence on empowerment in communities in sub-Saharan Africa.
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Affiliation(s)
- Dana C Beck
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Michelle L Munro-Kramer
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Jody R Lori
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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George A, Tetui M, Pariyo GW, Peterson SS. Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda. Glob Health Action 2017; 10:1359924. [PMID: 28876193 PMCID: PMC5786315 DOI: 10.1080/16549716.2017.1359924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan S Peterson
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Health Section, Programme Division, UNICEF NY, New York, NY, USA
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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