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Sáenz R, Nigenda G, Gómez-Duarte I, Rojas K, Castro A, Serván-Mori E. Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019. Int J Equity Health 2024; 23:96. [PMID: 38730305 PMCID: PMC11088099 DOI: 10.1186/s12939-024-02100-y] [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: 06/01/2023] [Accepted: 01/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.
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Affiliation(s)
- Rocío Sáenz
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ingrid Gómez-Duarte
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Karol Rojas
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Arachu Castro
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, State of Louisiana, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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Solomon SS, McFall AM, Srikrishnan AK, Verma V, Anand S, Khan RT, Kushwaha BS, Vasudevan C, Saravanan S, Paneerselvam N, Kumar MS, Das C, Celentano DD, Mehta SH, Lucas GM. Voucher incentives to improve viral suppression among HIV-positive people who inject drugs and men who have sex with men in India: a cluster randomised trial. Lancet HIV 2024; 11:e309-e320. [PMID: 38583461 PMCID: PMC11177221 DOI: 10.1016/s2352-3018(24)00005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Progress on HIV treatment outcomes for people who inject drugs and men who have sex with men in India has been slow compared with that in other populations. We assessed whether HIV treatment incentives would improve outcomes among these groups. METHODS We did a matched-pair, cluster randomised trial in 16 sites (eight for people who inject drugs and eight for men who have sex with men) across 15 cities in India. We recruited cohorts of HIV-positive people who inject drugs or men who have sex with men who were antiretroviral therapy (ART)-naive or had less than 12 months of ART exposure. We randomised sites to provide incentives or usual care. At intervention sites, we provided incentive vouchers, which could be exchanged for food or household goods, for attending motivational interviewing sessions and timely appointments at government ART clinics. An ART-naive participant meeting all targets could earn the equivalent to 14 days' wages over 12 months. The primary outcome was survival with viral suppression at 12 months. We used an intention-to-treat analytic approach appropriate for matched-pair cluster randomised trials, adjusting for baseline viral suppression. This study was registered with ClinicalTrials.gov, NCT02969915, and is complete. FINDINGS Between Oct 30, 2017, and Oct 12, 2018, we recruited 1200 people who inject drugs and 1114 men who have sex with men living with HIV. Among people who inject drugs, 154 (12·8%) identified as female gender and 1046 (87·2%) as male. The site median percentage of participants earning one or more incentives was 96·1% (IQR 93·7-98·1). At 12 months, HIV viral suppression was 31·9% (n=383) among people who inject drugs and 52·1% (n=580) among men who have sex with men. The incentive intervention was not associated with significantly improved survival with viral suppression compared with usual care (adjusted prevalence difference 9·6 percentage points, 95% CI -4·4 to 23·7). INTERPRETATION Despite high intervention engagement, incentives did not improve survival with viral suppression among people who inject drugs and men who have sex with men living with HIV in India. The poor outcomes overall underscore the need for innovative, multilevel approaches to engage marginalised people living with HIV in low-income and middle-income settings. FUNDING US National Institutes of Health, Elton John AIDS Foundation.
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Affiliation(s)
- Sunil S Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Vinita Verma
- National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Rifa T Khan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Bhawani Singh Kushwaha
- National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India
| | | | | | | | | | - Chinmoyee Das
- National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Mukonka V, Sialubanje C, McAuliffe FM, Babaniyi O, Malumo S, Phiri J, Fitzpatrick P. Effect of a mother-baby delivery pack on institutional deliveries: A community intervention trial to address maternal mortality in rural Zambia. PLoS One 2024; 19:e0296001. [PMID: 38466648 PMCID: PMC10927137 DOI: 10.1371/journal.pone.0296001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the effect of providing additional health education during antenatal care (ANC) and a mother-baby delivery pack on institutional deliveries in Monze, Zambia. SETTING 16 primary health facilities conducting deliveries in the district. PARTICIPANT A total of 5000 pregnant women at any gestation and age attending antenatal care (ANC) services in selected health facilities were eligible for enrolment into the study. Out of these, 4,500 (90%) were enrolled into and completed the study. A total of 3,882 (77.6%) were included in the analysis; 12.4% were not included in the analysis due to incomplete data. INTERVENTION A three-year study (2012 to 2014) analysing baseline delivery data for 2012 and 2013 followed by a community intervention trial was conducted from January to December 2014. Health facilities on the western side were assigned to the intervention arm; those on the eastern side were in the control. In addition to the health education provided during routine ANC visits, participants in the intervention arm received health education and a mother-baby delivery pack when they arrived at the health facility for delivery. Participants in the control arm continued with routine ANC services. OUTCOME MEASURES The primary measure was the number of institutional deliveries in both arms over the one-year period. Secondary measures were utilisation of ANC, post-natal care (PNC) and under-five clinic services. Descriptive statistics (frequencies, proportions, means and standard deviation) were computed to summarise participant characteristics. Chi-square and Independent T-tests were used to make comparisons between the two arms. One way analysis of variance (ANOVA) was used to test the effect of the intervention after one year (p-value<0.05). Analysis was conducted using R-studio statistical software version 4.2.1. The p-value<0.05 was considered significant. RESULTS Analysis showed a 15.9% increase in the number of institutional deliveries and a significant difference in the mean number of deliveries between intervention and control arms after one year (F(1,46) = 18.85, p<0.001). Post hoc analysis showed a significant difference in the mean number of deliveries between the intervention and control arms for 2014 (p<0.001). Compared to the control arm, participants in the intervention arm returned earlier for PNC clinic visit, brought their children back and started the under-five clinic visits earlier. CONCLUSION These findings provide evidence for the effectiveness of the mother-baby delivery pack and additional health education sessions on increasing institutional deliveries, PNC and under-five children's clinic utilisation in rural Zambia. TRIAL REGISTRATION ISRCTN Registry (ISRCTN15439813 DOI 10.1186/ISRCTN15439813); Pan African Clinical Trial Registry (PACTR202212611709509).
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Affiliation(s)
- Victor Mukonka
- School of Medicine, Copperbelt University, Ndola, Zambia
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Cephas Sialubanje
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | | - Sarai Malumo
- World Health Organization, Country Office, Lusaka, Zambia
| | - Joseph Phiri
- National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Habte A, Tamene A, Tesfaye L. Towards a positive postnatal experience in Sub-Saharan African countries: the receipt of adequate services during the immediate postpartum period: a multilevel analysis. Front Public Health 2023; 11:1272888. [PMID: 38155886 PMCID: PMC10753759 DOI: 10.3389/fpubh.2023.1272888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Background Existing studies in the Sub-Saharan African (SSA) region have focused mainly on the frequency of postnatal visits, with little emphasis on the adequacy of care provided during visits. Hence, this study aimed to investigate the magnitude of receiving an adequate number of World Health Organization-recommended contents of care during the immediate postpartum visit, and its predictors in SSA countries. Methods The appended women file of the most recent (2016-2021) standardized Demographic and Health Survey report of eighteen Sub-Saharan African countries with a weighted sample of 56,673 women was used for the study. The influence of each predictor on the uptake of adequate postnatal care has been examined using multilevel mixed-effects logistic regression. Significant predictors were reported using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (95% CI). Results The pooled prevalence of adequate postnatal care service uptake was found to be 42.94% (95% CI: 34.14, 49.13). Living in the southern sub-region (aOR = 3.08 95% CI: 2.50, 3.80), institutional delivery (aOR = 3.15; 95% CI: 2.90, 3.43), early initiation of ANC (aOR = 1.74; 95% CI: 1.45, 2.09), quality of antenatal care (aOR = 1.59; 95% CI: 1.42, 1.78), Caesarean delivery (aOR = 1.59; 95% CI: 1.42, 1.78), autonomy in decision-making (aOR = 1.30; 95% CI: 1.11, 1.39), high acceptance toward wife beating attitude (aOR = 0.83; 95% CI: 0.73, 0.94), and reading newspapers (aOR = 1.37; 95% CI: 1.21, 1.56) were identified as predictors of receiving adequate postnatal services during the immediate postpartum period. Conclusion The findings revealed low coverage of adequate postnatal care service uptake in the region. The Federal Ministry of Health and healthcare managers in each country should coordinate their efforts to develop interventions that promote women's empowerment to enhance their autonomy in decision-making and to reduce attitudes towards wife beating. Healthcare providers ought to strive to provide skilled delivery services and early initiation of antenatal care.
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Affiliation(s)
- Aklilu Habte
- School of Public Health College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Serván-Mori E, Meneses-Navarro S, Garcia-Diaz R, Flamand L, Gómez-Dantés O, Lozano R. Inequitable Financial Protection in Health for Indigenous Populations: the Mexican Case. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01770-8. [PMID: 37697143 DOI: 10.1007/s40615-023-01770-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020. METHODS We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors. RESULTS We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs). CONCLUSION In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - Sergio Meneses-Navarro
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico.
- The National Council of Humanities, Sciences and Technology, Del. Benito Juarez, Mexico.
| | - Rocio Garcia-Diaz
- Tecnologico de Monterrey, School of Social Science and Government, Monterrey, Nuevo Leon, Mexico
| | - Laura Flamand
- Center for International Studies, The College of Mexico, Mexico City, Mexico
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Camara BS, Delamou A, Grovogui FM, de Kok BC, Benova L, El Ayadi AM, Gerrets R, Grietens KP, Delvaux T. Interventions to increase facility births and provision of postpartum care in sub-Saharan Africa: a scoping review. Reprod Health 2021; 18:16. [PMID: 33478542 PMCID: PMC7819232 DOI: 10.1186/s12978-021-01072-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Most maternal deaths occur during the intrapartum and peripartum periods in sub-Saharan Africa, emphasizing the importance of timely access to quality health service for childbirth and postpartum care. Increasing facility births and provision of postpartum care has been the focus of numerous interventions globally, including in sub-Saharan Africa. The objective of this scoping review is to synthetize the characteristics and effectiveness of interventions to increase facility births or provision of postpartum care in sub-Saharan Africa. Methods We searched for systematic reviews, scoping reviews, qualitative studies and quantitative studies using experimental, quasi experimental, or observational designs, which reported on interventions for increasing facility birth or provision of postpartum care in sub-Saharan Africa. These studies were published in English or French. The search comprised six scientific literature databases (Pubmed, CAIRN, la Banque de Données en Santé Publique, the Cochrane Library). We also used Google Scholar and snowball or citation tracking. Results Strategies identified in the literature as increasing facility births in the sub-Saharan African context include community awareness raising, health expenses reduction (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Strategies that were found to increase provision of postpartum care include improvement of care quality, community-level identification and referrals of postpartum problems and transport voucher program. Conclusions To accelerate achievements in facility birth and provision of postpartum care in sub-Saharan Africa, we recommend strategies that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend that more intervention studies are implemented in West and Central Africa, and focused more on postpartum. Plain English summary In in sub-Saharan Africa, many women die when giving or few days after birth. This happens because they do not have access to good health services in a timely manner during labor and after giving birth. Worldwide, many interventions have been implemented to Increase the number of women giving birth in a health facility or receiving care from health professional after giving birth. The objective of this study is to synthetize the characteristics and effectiveness of interventions that have been implemented in sub-Saharan Africa, aiming to increase the number of women giving birth in a health facility or receiving care from health professional after birth. To proceed with this synthesis, we did a review of studies that have reported on such interventions in sub-Saharan Africa. These studies were published in English or French. The interventions identified to increase the number of women giving birth in a health facility include community awareness raising, reduction of health expenses (transportation or user fee), non-monetary incentive programs (baby kits), or a combination of these with improvement of care quality (patient’s privacy, waiting time, training of provider), and or follow-up of pregnant women to use health facility for birth. Interventions implemented to increase the number women receiving care from a health professional after birth include improvement of care quality, transport voucher program and community-level identification and referrals to the health center of mothers’ health problems. In sub-Saharan Africa, to accelerate increase in the number of women giving birth in a health facility and receiving care from a health professional after, we recommend interventions that can be implemented sustainably or produce sustainable change. How to sustainably motivate community actors in health interventions may be particularly important in this respect. Furthermore, we recommend the conduct in West and Central Africa, of more studies targeting interventions to increase the number of women giving birth in a health facility and or receiving care from a health professional after birth.
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Affiliation(s)
- Bienvenu Salim Camara
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. .,Department of Anthropology, Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands. .,Centre National de Formation Et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
| | - Alexandre Delamou
- Centre National de Formation Et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre D'Excellence Africain Pour La Prévention Et Le Contrôle Des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Fassou Mathias Grovogui
- Centre National de Formation Et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Bregje Christina de Kok
- Department of Anthropology, Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Alison Marie El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Rene Gerrets
- Department of Anthropology, Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Koen Peeters Grietens
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Serván‐Mori E, Mendoza MÁ, Chivardi C, Pineda‐Antúnez C, Rodríguez‐Franco R, Nigenda G. A spatio‐temporal cluster analysis of technical efficiency in the production of outpatient maternal health services and its structural correlates in México. Int J Health Plann Manage 2019; 34:e1417-e1436. [DOI: 10.1002/hpm.2785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - Carlos Chivardi
- Center for Health Systems Research National Institute of Public Health Cuernavaca Morelos México
| | - Carlos Pineda‐Antúnez
- Center for Health Systems Research National Institute of Public Health Cuernavaca Morelos México
| | - Roxana Rodríguez‐Franco
- Center for Health Systems Research National Institute of Public Health Cuernavaca Morelos México
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics National Autonomous University of Mexico Mexico City México
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Leight J, Sharma V, Brown W, Costica L, Abdulaziz Sule F, Bjorkman Nyqvist M. Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial. PLoS One 2018; 13:e0208885. [PMID: 30586441 PMCID: PMC6306201 DOI: 10.1371/journal.pone.0208885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes. This paper reports a secondary analysis of data from a cluster randomized trial in rural northern Nigeria in which birth kits were distributed by community health workers to pregnant women in their homes, analyzing non-experimental variation in receipt and use of birth kits. More specifically, associations between pregnant women's baseline characteristics and receipt and use of birth kits, and associations between birth kit use, care utilization and maternal and newborn outcomes were assessed. METHODS AND FINDINGS Baseline, post-birth and endline data related to 3,317 births observed over a period of three years in 72 intervention communities in Jigawa state, Nigeria, were analyzed using hierarchical, logistic regression models. In total, 140 women received birth kits, and 72 women used the kits. There were no associations between baseline demographic characteristics, health history, and knowledge and attitudes and receipt of a kit, suggesting that community health workers did not systematically target the distribution of birth kits. However, women who used the kit reported reduced odds of past pregnancy complications (OR = 0.44, 95% CI: 0.19-1.00) as well as significantly higher odds of feeling generally healthy at baseline (OR = 2.00, 95% CI: 1.06-3.76), of exposure to radio media (OR = 1.97, 95% CI: 1.21-3.22), and of perceiving themselves as having a low-risk pregnancy (OR = 3.05, 95% CI:1.39-6.68). While there were no significant associations between birth kit use and facility based delivery, skilled birth attendance or post-natal care, women who used a kit exhibited significantly lower odds of completing four or more ANC visits (adjusted OR = 0.39, 95% CI: 0.18-0.85) and significantly higher odds of reporting prolonged labor (adjusted OR = 4.75, 95% CI: 1.36-16.59), and post-partum bleeding (adjusted OR = 3.25, 95% CI: 1.11-9.52). CONCLUSIONS This evidence suggests that use of birth kits is low in a rural population characterized by minimal baseline utilization of maternal and neonatal health services, and the use of birth kits was not associated with reductions in maternal or neonatal morbidity. While further research is required to understand how the effectiveness of birth kits may be shaped by the mechanism through which women access and utilize the kits, our findings suggest that the provision of kits to women outside of the formal health system may be associated with increased risk of adverse outcomes.
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Affiliation(s)
- Jessica Leight
- Economics Department, American University, Washington, D.C., United States of America
| | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Cambridge, MA, United States of America
| | - Willa Brown
- Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Laura Costica
- Planned Parenthood Federation of Nigeria, Abuja, Nigeria
| | - Fatima Abdulaziz Sule
- Economics Department, American University, Washington D.C., United States of America
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Serván-Mori E, Chivardi C, Mendoza MÁ, Nigenda G. A longitudinal assessment of technical efficiency in the outpatient production of maternal health services in México. Health Policy Plan 2018; 33:888-897. [PMID: 30137317 DOI: 10.1093/heapol/czy074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 11/14/2022] Open
Abstract
We assess technical efficiency (TE) level for Mexican Ministry of Health (MoH) primary care units. Assessment was focused on the production of adequate maternal health services defined as the coverage level of women who received timely and frequent antenatal care, and institutional and medical care during childbirth. We conducted a longitudinal analysis of administrative and socio-demographic information concerning 233 health jurisdictions for the period 2008-15. Crude TE was calculated using window data envelopment analysis (Windows-DEA). Empirical analysis included the description of several factors affecting the production of maternal health services, including the heterogeneity and trends assessment of TE among health jurisdictions. We estimated a pooled regression model with robust standard errors to identify correlates of TE and estimated adjusted performance scores. Results indicate that while the production of adequate maternal-health services and TE in health jurisdictions proved insufficient, they rose by 22% (from 40.9% to 49.8%) and 14% (from 54.3% to 62%), respectively, over time. Furthermore, variance in efficiency among production units diminished and persistent regularities were observed. Performance was highest in the Northern as opposed to the Southern and Southeastern health jurisdictions, but lowest in the most marginalized zones of the country marked by economic inequality and the presence of indigenous populations. The Mexican Health System has reached a paradoxical situation: the steady escalation of financial resources in the public health subsystem over the past 15 years has yielded sub-optimal results as regards coverage for essential maternal health interventions among the poorest. Mexican government must put in place a set of measures to guarantee efficiency in the system's performance without affecting equity gains. This necessarily involves reconsidering, and where necessary replacing, the criteria behind the allocation and distribution of resources, as well as the mechanisms for controlling how resources are used and accountability is fulfilled.
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Affiliation(s)
| | | | - Miguel Ángel Mendoza
- School of Economics, National Autonomous University of México, México City, México
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of México, México City, México
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Mudhune S, Phiri SC, Prescott MR, McCarthy EA, Banda A, Haimbe P, Mwansa FD, Mwiche A, Bwalya F, Kabamba M, Shakwelele H, Prust ML. Impact of the Safe Childbirth Checklist on health worker childbirth practices in Luapula province of Zambia: a pre-post study. BMC Public Health 2018; 18:892. [PMID: 30021547 PMCID: PMC6052582 DOI: 10.1186/s12889-018-5813-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background A strong evidence base exists regarding routine and emergency services that can effectively prevent or reduce maternal and new-born mortality. However, even when skilled providers care for women in labour, many of the recommended services are not provided, despite being available. Barriers to the provision of appropriate childbirth services may include lack of availability of supplies, limited health worker knowledge and confidence, or inadequate time. The WHO Safe Childbirth Checklist (SCC) includes reminders for evidenced-based practices at specific points in the childbirth process. Zambia is currently considering nation-wide adoption of the SCC, but there is a need for context-specific evidence. Beginning in September 2017, a program is being implemented in Nchelenge District to pilot use of the SCC, along with coaching that focuses on strengthening the systems that allow the essential practices in childbirth to be performed. Methods This study will use a pre-post study design to measure health worker adherence to the essential practices for delivery care outlined in the SCC. Data will be collected through observations of health workers as they care for mothers during childbirth at four facilities. Data collection will take place before the start of the intervention, at 3 months, and at 6 months post-intervention. The primary outcome interest is the change in the average proportion of essential childbirth practices completed. A health worker questionnaire will be administered at the time that the SCC is introduced and 6 months later to gather their perspectives on incorporating the SCC into clinical practice in Zambia. Discussion Findings are expected to inform plans for introducing the SCC in Zambia. This evaluation will aim to understand uptake and impact of the SCC and associated coaching in the context of a basic level of mentorship that the government could feasibly provide at a national scale. Trial registration Clinical Trials.gov (NCT03263182) Registered August 28, 2017.
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Affiliation(s)
- Sandra Mudhune
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia.
| | | | | | | | - Aaron Banda
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
| | - Prudence Haimbe
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
| | | | | | | | | | - Hilda Shakwelele
- Clinton Health Access Initiative, PO Box 51071, Ridgeway, Lusaka, Zambia
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Zeng W, Li G, Ahn H, Nguyen HTH, Shepard DS, Nair D. Cost-effectiveness of health systems strengthening interventions in improving maternal and child health in low- and middle-income countries: a systematic review. Health Policy Plan 2017; 33:283-297. [DOI: 10.1093/heapol/czx172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 01/17/2023] Open
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Sialubanje C, Massar K, Horstkotte L, Hamer DH, Ruiter RAC. Increasing utilisation of skilled facility-based maternal healthcare services in rural Zambia: the role of safe motherhood action groups. Reprod Health 2017; 14:81. [PMID: 28693621 PMCID: PMC5504812 DOI: 10.1186/s12978-017-0342-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/15/2017] [Indexed: 12/03/2022] Open
Abstract
Background Community-centred health interventions, such as Safe Motherhood Action groups (SMAGs), have potential to lead to desired health behavioural change and favourable health outcomes. SMAGs are community-based volunteer groups that aim to reduce critical delays that occur at household level with regard to decision-making about seeking life-saving maternal care at health facilities. The aim of this study was to explore perspectives, roles, achievements and challenges of the SMAG programme in Kalomo, Zambia. Methods In-depth interviews (IDIs) were conducted in 7 health centres in Kalomo district between 1st April and 20th May, 2015 with 46 respondents comprising 22 SMAG members, 5 headmen, 10 mothers, 3 husbands, 5 nurses, and 1 district maternal and child health coordinator. Perspectives on the selection, training, roles, achievements and challenges of the SMAG programme were explored. Results Respondents were aware of the presence, selection, training and roles of the SMAG members and had a positive attitude towards the programme. They believed that the SMAG programme led to an increase in women’s risk perception about pregnancy and childbirth-related complications. Further, participants believed that the programme resulted in increased utilisation of facility-based antenatal, delivery and postnatal care, and improvement in maternal and newborn health outcomes. However, various challenges affected implementation of the SMAG programme. Among these were insufficient material and financial support to the programme, lack of refresher training for SMAG members, poor quality of care in health care facilities due to a lack of maternity waiting homes, low staffing levels in health facilities, the poor state and small size of the labour wards, and lack of equipment to handle obstetric emergencies. Conclusion The SMAG programme has potential to be an important community intervention for increasing utilisation of facility-based skilled care and improving maternal and newborn health outcomes.
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Affiliation(s)
- Cephas Sialubanje
- Ministry of Health, Monze District Medical Office, P.O. Box 660144, Monze, Zambia. .,Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands
| | - Larah Horstkotte
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands
| | - Davidson H Hamer
- Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia.,Centre for Global Health and Development Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA.,Department of Global Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands
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