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Zhou Q, Yu Q, Wang X, Shi P, Shen Q, Zhang Z, Chen Z, Pu C, Xu L, Hu Z, Ma A, Gong Z, Xu T, Wang P, Wang H, Hao C, Li L, Gao X, Li C, Hao M. Are Essential Women's Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4261. [PMID: 33920527 PMCID: PMC8072775 DOI: 10.3390/ijerph18084261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to analyze the changes in the 10 major categories of women's healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women's health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women's healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women's healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women's health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.
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Affiliation(s)
- Qingyu Zhou
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qinwen Yu
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Peiwu Shi
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Zhejiang Academy of Medical Sciences, Hangzhou 310012, China
| | - Qunhong Shen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Policy and Management, Tsinghua University, Beijing 100084, China
| | - Zhaoyang Zhang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Project Supervision Center of National Health Commission of the People’s Republic of China, Beijing 100044, China
| | - Zheng Chen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Grassroots Public Health Management Group, Public Health Management Branch of Chinese Preventive Medicine Association, Shanghai 201800, China
| | - Chuan Pu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Lingzhong Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health, Shandong University, Jinan 250012, China
| | - Zhi Hu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Health Service Management, Anhui Medical University, Hefei 230032, China
| | - Anning Ma
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Management, Weifang Medical University, Weifang 261053, China
| | - Zhaohui Gong
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Committee on Medicine and Health of Central Committee of China Zhi Gong Party, Beijing 100011, China
| | - Tianqiang Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Institute of Inspection and Supervision, Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Panshi Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Hua Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Jiangsu Preventive Medicine Association, Nanjing 210009, China
| | - Chao Hao
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Changzhou Center for Disease Control and Prevention, Changzhou 213003, China
| | - Li Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xiang Gao
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Chengyue Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Mo Hao
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
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Ali B, Chauhan S. Inequalities in the utilisation of maternal health Care in Rural India: Evidences from National Family Health Survey III & IV. BMC Public Health 2020; 20:369. [PMID: 32197599 PMCID: PMC7082939 DOI: 10.1186/s12889-020-08480-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services. However, India did not succeed to achieve the target of millennium development goal to reduced maternal mortality ratio by 2015. Also, there is substantial inequality exist at the regional, geographic, economic, and social level, and various socioeconomic factors contribute to the significantly large share in inequality in utilisation of maternal health care in India. METHODS Using data from the National Family Health Survey (2005 and 2015), this study examined the degree of inequality exist in maternal health care namely full antenatal care (full ANC), skilled attendants at birth (SBA), and postnatal care (PNC) in rural India. Descriptive statistics, concentration index (CI), and Wagstaff decomposition method have been performed to understand the pattern of maternal health care utilisation, and to explain the extent of inequality in maternal health care utilisation. RESULTS The study revealed that a substantial gap across socioeconomic groups exist in utilisation of maternal health care has significantly reduced in rural India during 2005-16. The results found a noticeable improvement in maternal health care utilisation, especially in utilisation of skilled attendants at birth (SBA). During this decade, the concentration index for SBA showed a significant decline from 0.28 in 2005-06 to 0.09 in 2015-16, while that of full ANC declined from 0.47 to 0.32 over the same period, and reduction of inequality in full ANC was least. Further, the results of decomposition analysis suggested that secondary and higher education, mass media exposure, and scheduled tribe contributed a significant share to the inequality. CONCLUSION The exposure to mass media is the most significant contributor to inequality, and hence, there is a need for broad dissemination of awareness regarding maternal health care schemes in rural parts of country. Based on findings of study, it is suggested that health scheme related to maternal and child health care under NRHM be continued and focused for lower socioeconomic groups and marginalized mothers to reduce maternal health services inequality, particularly in the component of full ANC.
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Affiliation(s)
- Balhasan Ali
- International Institute for Population Sciences, Govandi station Road, Deonar, Mumbai 400088 India
| | - Shekhar Chauhan
- International Institute for Population Sciences, Govandi station Road, Deonar, Mumbai 400088 India
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Najafizada SAM, Bourgeault IL, Labonté R. Social Determinants of Maternal Health in Afghanistan: A Review. Cent Asian J Glob Health 2017; 6:240. [PMID: 29138735 PMCID: PMC5675389 DOI: 10.5195/cajgh.2017.240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature. METHODS This narrative review was conducted using Arksey and O'Malley's framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. RESULTS A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. CONCLUSION Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations' long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally.
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Affiliation(s)
| | | | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada
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Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health--A landscape analysis. BMC Pregnancy Childbirth 2015; 15:337. [PMID: 26679709 PMCID: PMC4683742 DOI: 10.1186/s12884-015-0784-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022] Open
Abstract
Background Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study’s aim was to analyze the landscape of innovative MNH approaches and related published evidence. Methods Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Results Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Conclusions Future implementation and evaluation efforts need to assess innovations’ effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0784-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karsten Lunze
- Department of Medicine Boston, Boston University, Boston, MA, USA. .,Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Ariel Higgins-Steele
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Aline Simen-Kapeu
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Linda Vesel
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Julia Kim
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,GNH Centre Bhutan, Jaffa's Commercial Building, Room 302, Thimphu, Bhutan.
| | - Kim Dickson
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
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The impact of integrated obstetric and neonatal services on utilization of postpartum maternal health care services. North Clin Istanb 2015; 2:128-135. [PMID: 28058353 PMCID: PMC5175090 DOI: 10.14744/nci.2015.23865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/25/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Postnatal care is an important issue in maintaining and promoting maternal and neonatal health. However, utilization of postpartum maternal health care services is at a low rate in many countries. This study was aimed to investigate the impact of integrated obstetric and neonatal services on utilization rates of postnatal health care service among mothers. METHODS This study was performed among a total of 4193 mothers who gave birth at Maternity Unit of Golcuk Necati Celik State Hospital of Kocaeli Province between 2010 and 2013. All mothers were called back to postnatal care clinic (PNC) for newborn hearing test (NHT) screenings, neonatal and maternal care within two weeks after delivery. The deliveries after, (n=3093) and before (n=1100) utilization of integrated services were compared as for postnatal service utilization rates. RESULTS Utilization rates of neonatal health care, NHT and postpartum maternal health care services significantly increased after implementation of integrated services (p<0.0001). Especially maternal service utilization rates increased from 34% to 99 percent. CONCLUSION Integration of newborn and maternal health care services as a unit increases the utilization of PNC services.
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Sharma B, Ramani KV, Mavalankar D, Kanguru L, Hussein J. Using 'appreciative inquiry' in India to improve infection control practices in maternity care: a qualitative study. Glob Health Action 2015; 8:26693. [PMID: 26119249 PMCID: PMC4483369 DOI: 10.3402/gha.v8.26693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/06/2015] [Accepted: 05/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. OBJECTIVE To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. DESIGN An organisational change process called 'appreciative inquiry' (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. RESULTS Challenges which emerged included management processes (e.g. decision-making and problem-solving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. CONCLUSION Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.
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Affiliation(s)
- Bharati Sharma
- Department of women's and children's health, Karolinska Institute, Stockholm, Sweden.,Indian Institute of Management, Ahmedabad, India.,Indian Institute of Public Health, Gandhinagar, India;
| | - K V Ramani
- Indian Institute of Management, Ahmedabad, India
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Saleem S, McClure EM, Goudar SS, Patel A, Esamai F, Garces A, Chomba E, Althabe F, Moore J, Kodkany B, Pasha O, Belizan J, Mayansyan A, Derman RJ, Hibberd PL, Liechty EA, Krebs NF, Hambidge KM, Buekens P, Carlo WA, Wright LL, Koso-Thomas M, Jobe AH, Goldenberg RL. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries. Bull World Health Organ 2014; 92:605-12. [PMID: 25177075 DOI: 10.2471/blt.13.127464] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 02/13/2014] [Accepted: 03/10/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. METHODS A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. FINDINGS Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77). CONCLUSION Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
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Affiliation(s)
- Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Elizabeth M McClure
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | | | - Fabian Esamai
- Department of Pediatrics, Moi University, Eldoret, Kenya
| | - Ana Garces
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | | | - Janet Moore
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jose Belizan
- Institute of Clinical Effectiveness, Buenos Aires, Argentina
| | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Christiana Health Care, Newark, USA
| | - Patricia L Hibberd
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - K Michael Hambidge
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | | | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, USA
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Robinson N, Kapungu C, Carnahan L, Geller S. Recommendations for scale-up of community-based misoprostol distribution programs. Int J Gynaecol Obstet 2014; 125:285-8. [PMID: 24680582 DOI: 10.1016/j.ijgo.2013.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/18/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
Community-based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource-poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community-based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community-based misoprostol program introduction, expansion, or scale-up.
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Affiliation(s)
- Nuriya Robinson
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA.
| | - Chisina Kapungu
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA; Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, USA
| | - Leslie Carnahan
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, USA
| | - Stacie Geller
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA; Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, USA
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The effect of surveillance and appreciative inquiry on puerperal infections: a longitudinal cohort study in India. PLoS One 2014; 9:e87378. [PMID: 24498089 PMCID: PMC3907541 DOI: 10.1371/journal.pone.0087378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 12/05/2013] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India. Methods This longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups. Findings Of the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91–0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection. Conclusion Interruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced. Trial Registration Controlled-Trials.com ISRCTN03513186
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Dawson AJ, Buchan J, Duffield C, Homer CSE, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan 2013; 29:396-408. [DOI: 10.1093/heapol/czt026] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kizler R, Hollins Martin CJ. Could introducing vacuum delivery into the education curriculum of community midwives in Yemen improve maternal and neonatal mortality and morbidity outcomes? Nurse Educ Pract 2013; 13:73-7. [DOI: 10.1016/j.nepr.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/03/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
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12
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Singh PK, Rai RK, Singh L. Examining the effect of household wealth and migration status on safe delivery care in urban India, 1992-2006. PLoS One 2012; 7:e44901. [PMID: 22970324 PMCID: PMC3436793 DOI: 10.1371/journal.pone.0044901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although the urban health issue has been of long-standing interest to public health researchers, majority of the studies have looked upon the urban poor and migrants as distinct subgroups. Another concern is, whether being poor and at the same time migrant leads to a double disadvantage in the utilization of maternal health services? This study aims to examine the trends and factors that affect safe delivery care utilization among the migrants and the poor in urban India. METHODOLOGY/PRINCIPAL FINDINGS Using data from the National Family Health Survey, 1992-93 and 2005-06, this study grouped the household wealth and migration status into four distinct categories poor-migrant, poor-non migrant, non poor-migrant, non poor-non migrant. Both chi-square test and binary logistic regression were performed to examine the influence of household wealth and migration status on safe delivery care utilization among women who had experienced a birth in the four years preceding the survey. Results suggest a decline in safe delivery care among poor-migrant women during 1992-2006. The present study identifies two distinct groups in terms of safe delivery care utilization in urban India--one for poor-migrant and one for non poor-non migrants. While poor-migrant women were most vulnerable, non poor-non migrant women were the highest users of safe delivery care. CONCLUSION This study reiterates the inequality that underlies the utilization of maternal healthcare services not only by the urban poor but also by poor-migrant women, who deserve special attention. The ongoing programmatic efforts under the National Urban Health Mission should start focusing on the poorest of the poor groups such as poor-migrant women. Importantly, there should be continuous evaluation to examine the progress among target groups within urban areas.
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Singh PK, Rai RK, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in rural India. PLoS One 2012; 7:e31666. [PMID: 22355386 PMCID: PMC3280328 DOI: 10.1371/journal.pone.0031666] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. METHODOLOGY/PRINCIPAL FINDINGS Using the data from third wave of National Family Health Survey (2005-06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15-19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. CONCLUSIONS The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.
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ASSESSING THE UTILIZATION OF MATERNAL AND CHILD HEALTH CARE AMONG MARRIED ADOLESCENT WOMEN: EVIDENCE FROM INDIA. J Biosoc Sci 2011; 44:1-26. [DOI: 10.1017/s0021932011000472] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryThis study explores the prevalence and factors associated with the utilization of maternal and child health care services among married adolescent women in India using the third round of the National Family Health Survey (2005–06). The findings suggest that the utilization of maternal and child health care services among adolescent women is far from satisfactory in India. A little over 10% of adolescent women utilized antenatal care, about 50% utilized safe delivery services and about 41% of the children of adolescent women received full immunization. Large differences by urban–rural residence, educational attainment, religion, economic status and region were evident. Both gross effect and fixed effect binary logit models yielded statistically significant socioeconomic and demographic factors. Women's education, wealth quintile and region are the most important determinants for the utilization of maternal and child health care services. Health care programmes should focus more on educating adolescents, providing financial support, creating awareness and counselling households with married adolescent women. Moreover, there should be substantial financial assistance for the provision of delivery and child care for married women below the age of 19 years.
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Moodley J, Pattinson RC, Baxter C, Sibeko S, Abdool Karim Q. Strengthening HIV services for pregnant women: an opportunity to reduce maternal mortality rates in Southern Africa/sub-Saharan Africa. BJOG 2010; 118:219-25. [DOI: 10.1111/j.1471-0528.2010.02726.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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