1
|
Knop MR, Nagashima-Hayashi M, Lin R, Saing CH, Ung M, Oy S, Yam ELY, Zahari M, Yi S. Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review. BMC Med 2024; 22:196. [PMID: 38750486 PMCID: PMC11095039 DOI: 10.1186/s12916-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years. METHODS A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures. RESULTS From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive. CONCLUSIONS This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.
Collapse
Affiliation(s)
- Marianne Ravn Knop
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ruixi Lin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Esabelle Lo Yan Yam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA.
| |
Collapse
|
2
|
Coffey PS, Khan S, Ebeling E, Engmann C. Perceived progress toward scale of 14 maternal, newborn, child health, and nutrition (MNCHN) assets at subnational level in Burkina Faso, Ethiopia, India, Kenya, and Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002309. [PMID: 38489291 PMCID: PMC10942054 DOI: 10.1371/journal.pgph.0002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
Inequitable coverage of evidence-based MNCHN interventions is particularly pronounced in low and middle income countries where access and delivery of these interventions can vary dramatically at the subnational level. We conducted health system assessments in nine subnational geographies in five countries (Burkina Faso, Ethiopia, India, Kenya and Nigeria) to explore progress toward scale of 14 evidence-based MNCHN interventions (iron-folic acid, oxytocin, magnesium sulfate, misoprostol; 7.1% chlorhexidine for umbilical cord care, neonatal resuscitation, kangaroo mother care, community regimen for the treatment of possible severe bacterial infection; amoxicillin dispersible tablets, multiple micronutrient supplements, balanced energy protein supplementation, early and exclusive breastfeeding, feeding of small and sick newborns, and management of severe and moderate acute malnutrition in children less than five years old). Between March and October 2021, we conducted key informant interviews with a purposive sample of 275 healthcare providers and 94 district health management (DHMT) staff to better understand bottlenecks, facilitators and uptake of the interventions across varied subnational settings. Across all interventions and geographies, providers and DHMT staff perceived lack of robust HMIS data as the most significant barrier to scale followed by weak facility infrastructure. DHMT staff viewed limited budget allocation and training as a much larger barrier than healthcare providers, most likely given their purview as subnational managers. Healthcare providers were focused on supply chain and staffing, which affect workflows and service provision. Understanding provider and health facility management views of why interventions do or do not advance towards effective coverage can assist in creating enabling environments for the scale of best practices. These types of data are most helpful when collected at the subnational level, which allows for comparisons both within and between countries to show health disparities. Importantly, this strategic data collection can provide a starting point for improvement efforts to address existing health system gaps.
Collapse
Affiliation(s)
| | - Sadaf Khan
- PATH, Seattle, Washington, United States of America
| | - Elan Ebeling
- PATH, Seattle, Washington, United States of America
| | | |
Collapse
|
3
|
Constantine A, Fantaye AW, Buh A, Obegu P, Fournier K, Kasonde M, Jacobs C, Clementina P, Gobina R, Kibu O, Foretia D, Nkangu M, Yaya S. Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol. PLoS One 2024; 19:e0295437. [PMID: 38446819 PMCID: PMC10917244 DOI: 10.1371/journal.pone.0295437] [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: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.
Collapse
Affiliation(s)
- Asahngwa Constantine
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Pamela Obegu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Fournier
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Ronald Gobina
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Odette Kibu
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Denis Foretia
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Miriam Nkangu
- Bruyere Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| |
Collapse
|
4
|
Klarman MB, Chi X, Cajusma Y, Flaherty KE, Capois AC, Dofiné MDV, Exantus L, Friesen J, Beau de Rochars VM, Becker T, Baril C, Gurka MJ, Nelson EJ. Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting. BMJ Paediatr Open 2024; 8:e002164. [PMID: 38191203 PMCID: PMC10806461 DOI: 10.1136/bmjpo-2023-002164] [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: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS). METHODS A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference). RESULTS A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen's kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported 'fast breathing' were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for 'no' and 'some' dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered. CONCLUSION Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation. TRIAL REGISTRATION NUMBER NCT03943654.
Collapse
Affiliation(s)
- Molly B Klarman
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Youseline Cajusma
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Katelyn E Flaherty
- Departments of Emergency Medicine and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
| | - Anne Carine Capois
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | | | - Lerby Exantus
- Faculté de Médecine et de Pharmacie, Université d'État d'Haiti, Port-au-Prince, Haiti
| | | | | | - Torben Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Chantale Baril
- Faculté de Médecine et de Pharmacie, Université d'État d'Haiti, Port-au-Prince, Haiti
| | - Matthew J Gurka
- Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
5
|
Jarawan E, Boiangiu M, Zeng W. Strengthening provider accountability: A scoping review of accountability/monitoring frameworks for quality of RMNCH care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001968. [PMID: 37943720 PMCID: PMC10635430 DOI: 10.1371/journal.pgph.0001968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
Increasing health providers' accountability is an important element in improving quality of care (QoC) for reproductive, maternal, neonatal, and child health (RMNCH), so as to improve health outcomes of the population in many low- and middle-income countries (LMICs). Implemented RMNCH monitoring initiatives vary in their settings, methods of data collection, and indicators selected for monitoring. The purpose of this study is to evaluate the monitoring/accountability frameworks used by key global monitoring initiatives and provide insights for countries to develop context-customized indicators for RMNCH monitoring and accountability in middle-income countries. The authors conducted a scoping review of key global monitoring initiatives on their monitoring/accountability framework and associated indicators. Data was extracted into a spreadsheet template for analysis. Monitoring/accountability frameworks corresponding to the selected global RMNCH initiatives were described, analyzed, and then categorized the monitoring indicators used by the initiatives according to the type of indicators, quality domains, monitoring levels, and type of services. The results showed that all frameworks regarded developing quality indicators and their monitoring as important elements of accountability and emphasized the role of health systems blocks as inputs for QoC. The researchers demonstrated the importance of measuring quality through both condition-specific and general health system indicators. However, given the different purposes of global monitoring initiatives, the indicators they used varied. We found a lack of indicators measuring QoC of reproductive health. In terms of quality domains, the timeliness and efficiency of RMNCH services were neglected, as few of these indicators were selected for monitoring. Global monitoring initiatives provide valuable frameworks for countries to understand which key indicators need to be tracked to achieve global objectives and develop the foundation for their own accountability/monitoring systems. Gaps in quality indicator design and use emphasize countries need to build on what the global initiatives have achieved to systematically examine quality concerns, develop a tailored and effective accountability/monitoring framework, and improve population health.
Collapse
Affiliation(s)
- Eva Jarawan
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States of America
| | - Mara Boiangiu
- Georgetown University, Washington, DC, United States of America
| | - Wu Zeng
- Department of Global Health, School of Health, Georgetown University, Washington, DC, United States of America
| |
Collapse
|
6
|
Asefa A, Gebremedhin S, Marthias T, Nababan H, Christou A, Semaan A, Banke-Thomas A, Tabana H, Al-beity FMA, Dossou JP, Gutema K, Delvaux T, Birabwa C, Dennis M, Grovogui FM, McPake B, Beňová L. Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries. Int J Equity Health 2023; 22:203. [PMID: 37784140 PMCID: PMC10544383 DOI: 10.1186/s12939-023-02015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. METHODS We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. RESULTS The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. CONCLUSIONS Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.
Collapse
Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tiara Marthias
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Herfina Nababan
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany
| | - Aliki Christou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrcis/Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine Et en Démographie, Cotonou, Bénin
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Fassou Mathias Grovogui
- Centre National de Formation Et de Recherche en Santé Rurale (CNFRSR), Maferinyah, Forécariah Guinea
| | - Barbara McPake
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
7
|
Kawuma R, Lunkuse JF, Ssembajjwe W, Kayesu I, Price MA, Brickley DB, Abaasa A, Mayanja Y. "I fear those things": non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1198672. [PMID: 37649966 PMCID: PMC10465063 DOI: 10.3389/frph.2023.1198672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Background Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost. Methods We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically. Results All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception. Conclusion Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.
Collapse
Affiliation(s)
- Rachel Kawuma
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Wilber Ssembajjwe
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Ivy Kayesu
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Matt A. Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, United States
- IAVI, New York, NY, United States
| | - Debbie B. Brickley
- Institute for Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Andrew Abaasa
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yunia Mayanja
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| |
Collapse
|
8
|
Kaplan L, Richert K, Hülsen V, Diba F, Marthoenis M, Muhsin M, Samadi S, Susanti S, Sofyan H, Ichsan I, Vollmer S. Impact of the WHO Safe Childbirth Checklist on safety culture among health workers: A randomized controlled trial in Aceh, Indonesia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001801. [PMID: 37327202 PMCID: PMC10275423 DOI: 10.1371/journal.pgph.0001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/28/2023] [Indexed: 06/18/2023]
Abstract
The World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control facilities). We introduced the SCC in combination with a medium intensity coaching in health facilities which already offered at minimum basic emergency obstetric and newborn care (BEMonC). We assess the effects of using the SCC on 14 outcome variables measuring self-perceived information access, information transmission, frequency of errors, workload and access to resources at the facility level. We apply Ordinary Least Square regressions to identify an Intention to Treat Effect (ITT) and Instrumental Variable regressions to determine a Complier Average Causal Effect (CACE). The results suggest that the treatment significantly improved self-assessed attitudes regarding the probability of calling attention to problems with patient care (ITT 0.6945 standard deviations) and the frequency of errors in times of excessive workload (ITT -0.6318 standard deviations). Moreover, self-assessed resource access increased (ITT 0.6150 standard deviations). The other eleven outcomes were unaffected. The findings suggest that checklists can contribute to an improvement in some dimensions of safety culture among health workers. However, the complier analysis also highlights that achieving adherence remains a key challenge to make checklists effective.
Collapse
Affiliation(s)
- Lennart Kaplan
- University of Goettingen, Göttingen, Germany
- German Institute of Development and Sustainability, Bonn, Germany
| | | | | | - Farah Diba
- Universitas Syiah Kuala, Banda Aceh, Indonesia
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Ferreira LZ, Utazi CE, Huicho L, Nilsen K, Hartwig FP, Tatem AJ, Barros AJD. Geographic inequalities in health intervention coverage – mapping the composite coverage index in Peru using geospatial modelling. BMC Public Health 2022; 22:2104. [PMID: 36397019 PMCID: PMC9670533 DOI: 10.1186/s12889-022-14371-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The composite coverage index (CCI) provides an integrated perspective towards universal health coverage in the context of reproductive, maternal, newborn and child health. Given the sample design of most household surveys does not provide coverage estimates below the first administrative level, approaches for achieving more granular estimates are needed. We used a model-based geostatistical approach to estimate the CCI at multiple resolutions in Peru. Methods We generated estimates for the eight indicators on which the CCI is based for the departments, provinces, and areas of 5 × 5 km of Peru using data from two national household surveys carried out in 2018 and 2019 plus geospatial covariates. Bayesian geostatistical models were fit using the INLA-SPDE approach. We assessed model fit using cross-validation at the survey cluster level and by comparing modelled and direct survey estimates at the department-level. Results CCI coverage in the provinces along the coast was consistently higher than in the remainder of the country. Jungle areas in the north and east presented the lowest coverage levels and the largest gaps between and within provinces. The greatest inequalities were found, unsurprisingly, in the largest provinces where populations are scattered in jungle territory and are difficult to reach. Conclusions Our study highlighted provinces with high levels of inequality in CCI coverage indicating areas, mostly low-populated jungle areas, where more attention is needed. We also uncovered other areas, such as the border with Bolivia, where coverage is lower than the coastal provinces and should receive increased efforts. More generally, our results make the case for high-resolution estimates to unveil geographic inequities otherwise hidden by the usual levels of survey representativeness. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14371-7.
Collapse
|
10
|
Kawuki J, Gatasi G, Sserwanja Q, Mukunya D, Musaba MW. Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study. BMC Womens Health 2022; 22:369. [PMID: 36068524 PMCID: PMC9447358 DOI: 10.1186/s12905-022-01956-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Modern contraceptive use has been shown to influence population growth, protect women’s health and rights, as well as prevent sexually transmitted infections (STIs) for barrier contraceptive methods such as condoms. The present study aimed at assessing the level of utilization and factors associated with modern contraceptive use among sexually active adolescent girls in Rwanda.
Methods
We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 data of 539 sexually active adolescent girls (aged 15 to 19 years). Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to assess the association between various socio-demographics and modern contraceptive use using SPSS version 25. Modern contraception included the use of products or medical procedures that interfere with reproduction from acts of sexual intercourse.
Results
Of the 539 sexually active girls, only 94 (17.4%, 95% CI: 13.8–20.1) were using modern contraceptives. Implants (69.1%) and male condoms (12.8%) were the most used options. Modern contraceptive use was positively associated with older age (AOR = 10.28, 95% CI: 1.34–78.70), higher educational level (AOR = 6.98, 95% CI: 1.08–45.07), history of having a sexually transmitted infection (AOR = 8.27, 95% CI: 2.54–26.99), working status (AOR = 1.72, 95% CI: 1.03–2.88) and being from a female-headed household (AOR = 1.96, 95% CI: 1.12–3.43). However, not being in a union (AOR = 0.18, 95% CI: 0.10–0.35) and region (AOR = 0.28, 95% CI: 0.10–0.80) had negative associations.
Conclusions
To promote utilisation of modern contraceptives, family planning campaigns need to place more emphasis on the younger, unmarried adolescents, as well as those with lower educational levels. Consideration of household and regional dynamics is also highlighted.
Collapse
|
11
|
McCauley H, Lowe K, Furtado N, Mangiaterra V, van den Broek N. Essential components of postnatal care - a systematic literature review and development of signal functions to guide monitoring and evaluation. BMC Pregnancy Childbirth 2022; 22:448. [PMID: 35643432 PMCID: PMC9148465 DOI: 10.1186/s12884-022-04752-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal Care (PNC) is one of the healthcare-packages in the continuum of care for mothers and children that needs to be in place to reduce global maternal and perinatal mortality and morbidity. We sought to identify the essential components of PNC and develop signal functions to reflect these which can be used for the monitoring and evaluation of availability and quality of PNC. METHODS Systematic review of the literature using MESH headings for databases (Cinahl, Cochrane, Global Health, Medline, PubMed, and Web of Science). Papers and reports on content of PNC published from 2000-2020 were included. Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. RESULTS Forty-Eight papers and reports are included in the systematic review from which 22 essential components of PNC were extracted and used to develop 14 signal functions. Signal functions are used in obstetrics to denote a list of interventions that address major causes of maternal and perinatal morbidity or mortality. For each signal function we identified the equipment, medication and consumables required for implementation. The prevention and management of infectious diseases (malaria, HIV, tuberculosis) are considered essential components of routine PNC depending on population disease burden or whether the population is considered at risk. Screening and management of pre-eclampsia, maternal anaemia and mental health are recommended universally. Promotion of and support of exclusive breastfeeding and uptake of a modern contraceptive method are also considered essential components of PNC. For the new-born baby, cord care, monitoring of growth and development, screening for congenital disease and commencing vaccinations are considered essential signal functions. Screening for gender-based violence (GBV) including intimate partner- violence (IPV) is recommended when counselling can be provided and/or a referral pathway is in place. Debriefing following birth (complicated or un-complicated) was agreed through consensus-building as an important component of PNC. CONCLUSIONS Signal functions were developed which can be used for monitoring and evaluation of content and quality of PNC. Country adaptation and validation is recommended and further work is needed to examine if the proposed signal functions can serve as a useful monitoring and evaluation tool. TRIAL REGISTRATION The systematic review protocol was registered: PROSPERO 2018 CRD42018107054 .
Collapse
Affiliation(s)
- Hannah McCauley
- Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA UK
| | - Kirsty Lowe
- Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA UK
| | - Nicholas Furtado
- The Global Fund for Aids Tuberculosis and Malaria, Switzerland Geneva
| | - Viviana Mangiaterra
- The Global Fund for Aids Tuberculosis and Malaria, Switzerland Geneva
- Bocconi School of Management, Bocconi University, Milan, Italy
| | | |
Collapse
|
12
|
Dawood Z, Majeed N. Assessing neo-natal mortality trends in Pakistan: an insight using equity lens. Arch Public Health 2022; 80:7. [PMID: 34983629 PMCID: PMC8725521 DOI: 10.1186/s13690-021-00767-1] [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: 09/16/2020] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost 2.5 million neonates died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of 5 years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across several dimensions - including wealth, ethnicity, and geography - continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. METHODS The study was done using raw data from the last three Pakistan Demographic & Health Surveys (2017-18, 2012-13 and 2006-07). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. RESULTS The situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist. CONCLUSIONS Presentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.
Collapse
Affiliation(s)
- Zainab Dawood
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Naeem Majeed
- Department of Public Health, University of the Punjab, Lahore, Pakistan.
| |
Collapse
|
13
|
Klarman M, Schon J, Cajusma Y, Maples S, Beau de Rochars VEM, Baril C, Nelson EJ. Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti. BMJ Open 2021; 11:e047367. [PMID: 34810180 PMCID: PMC8609929 DOI: 10.1136/bmjopen-2020-047367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled. OUTCOME MEASURES Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis. RESULTS Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar's χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional. CONCLUSION Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.
Collapse
Affiliation(s)
- Molly Klarman
- Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Justin Schon
- Anthropology, University of Florida, Gainesville, Florida, USA
| | | | - Stace Maples
- Branner Earth Sciences Library, Stanford University, Stanford, California, USA
| | - Valery E M Beau de Rochars
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Chantale Baril
- Pediatrics, State University Hospital of Haiti, Port Au Prince, Haiti
| | - Eric J Nelson
- Pediatrics; Environmental and Global Health, University of Florida Health, Gainesville, Florida, USA
| |
Collapse
|
14
|
Avan BI, Berhanu D, Mekonnen Y, Beaumont E, Tomlin K, Allen E, Schellenberg J. Embedding Community-Based Newborn Care in the Ethiopian health system: lessons from a 4-year programme evaluation. Health Policy Plan 2021; 36:i22-i32. [PMID: 34849897 PMCID: PMC8633669 DOI: 10.1093/heapol/czab085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
Despite remarkable gains, improving neonatal survival globally remains slow paced. Innovative service-delivery packages have been developed for community health workers (CHWs) to maximize system efficiency and increase the reach of services. However, embedding these in health systems needs structural and procedural alignment. The Community-Based Newborn Care (CBNC) programme was a response to high neonatal mortality in Ethiopia. Key aspects include simplified treatment for neonatal illness, integrated outreach services and task-shifting. Using the CHW functionality model by WHO, this study evaluates the health system response to the programme, including quality of care. A before-and-after study was conducted with three survey time points: baseline (November 2013), midline (December 2015) and follow-up (December 2017-4 years after the programme started). Data were collected at a sample of primary healthcare facilities from 101 districts across four regions. Analysis took two perspectives: (1) health system response, through supplies, infrastructure support and supervision, assessed through interviews and observations at health facilities and (2) quality of care, through CHWs' theoretical capacity to deliver services, as well as their performance, assessed through functional health literacy and direct observation of young infant case management. Results showed gains in services for young infants, with antibiotics and job aids available at over 90% of health centres. However, services at health posts remained inadequate in 2017. In terms of quality of care, only 37% of CHWs correctly diagnosed key conditions in sick young infants at midline. CHWs' functional health literacy declined by over 70% in basic aspects of case management during the study. Although the frequency of quarterly supportive supervision visits was above 80% during 2013-2017, visits lacked support for managing sick young infants. Infrastructure and resources improved over the course of the CBNC programme implementation. However, embedding and scaling up the programme lacked the systems-thinking and attention to health system building-blocks needed to optimize service delivery.
Collapse
Affiliation(s)
- Bilal Iqbal Avan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Della Berhanu
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Postal code 1242, Ethiopia
| | | | - Emma Beaumont
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Keith Tomlin
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Joanna Schellenberg
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| |
Collapse
|
15
|
Anindya K, Marthias T, Vellakkal S, Carvalho N, Atun R, Morgan A, Zhao Y, Hulse ESG, McPake B, Lee JT. Socioeconomic inequalities in effective service coverage for reproductive, maternal, newborn, and child health: a comparative analysis of 39 low-income and middle-income countries. EClinicalMedicine 2021; 40:101103. [PMID: 34527893 PMCID: PMC8430373 DOI: 10.1016/j.eclinm.2021.101103] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reducing socioeconomic inequalities in access to good quality health care is key for countries to achieve Universal Health Coverage. This study aims to assess socioeconomic inequalities in effective coverage of reproductive, maternal, newborn and child health (RMNCH) in low- and middle-income countries (LMICs). METHODS Using the most recent national health surveys from 39 LMICs (between 2014 and 2018), we calculated coverage indicators using effective coverage care cascade that consists of service contact, crude coverage, quality-adjusted coverage, and user-adherence-adjusted coverage. We quantified wealth-related and education-related inequality using the relative index of inequality, slope index of inequality, and concentration index. FINDINGS The quality-adjusted coverage of RMNCH services in 39 countries was substantially lower than service contact, in particular for postnatal care (64 percentage points [pp], p-value<0·0001), family planning (48·7 pp, p<0·0001), and antenatal care (43·6 pp, p<0·0001) outcomes. Upper-middle-income countries had higher effective coverage levels compared with low- and lower-middle-income countries in family planning, antenatal care, delivery care, and postnatal care. Socioeconomic inequalities tend to be wider when using effective coverage measurement compared with crude and service contact measurements. Our findings show that upper-middle-income countries had a lower magnitude of inequality compared with low- and lower-middle-income countries. INTERPRETATION Reliance on the average contact coverage tends to underestimate the levels of socioeconomic inequalities for RMNCH service use in LMICs. Hence, the effective coverage measurement using a care cascade approach should be applied. While RMNCH coverages vary considerably across countries, equitable improvement in quality of care is particularly needed for lower-middle-income and low-income countries. FUNDING None.
Collapse
Affiliation(s)
- Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Tiara Marthias
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sukumar Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India
| | - Natalie Carvalho
- Center for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Alison Morgan
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Global Financing Facility, The World Bank Group, Washington, DC, United States
| | - Yang Zhao
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Emily SG Hulse
- Center for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| |
Collapse
|
16
|
Taniguchi H, Rahman MM, Swe KT, Islam MR, Rahman MS, Parsell N, Hussain A, Shibuya K, Hashizume M. Equity and determinants in universal health coverage indicators in Iraq, 2000-2030: a national and subnational study. Int J Equity Health 2021; 20:196. [PMID: 34461904 PMCID: PMC8404248 DOI: 10.1186/s12939-021-01532-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Equity is one of three dimensions of universal health coverage (UHC). However, Iraq has had capital-focused health services and successive conflicts and political turmoil have hampered health services around the country. Iraq has embarked on a new reconstruction process since 2018 and it could be time to aim for equitable healthcare access to realise UHC. We aimed to examine inequality and determinants associated with Iraq’s progress towards UHC targets. Methods We assessed the progress toward UHC in the context of equity using six nationally representative population-based household surveys in Iraq in 2000–2018. We included 14 health service indicators and two financial risk protection indicators in our UHC progress assessment. Bayesian hierarchical regression model was used to estimate the trend, projection, and determinant analyses. Slope and relative index of inequality were used to assess wealth-based inequality. Results In the national-level health service indicators, inequality indices decreased substantially from 2000 to 2030. However, the wide inequalities are projected to remain in DTP3, measles, full immunisations, and antenatal care in 2030. The pro-rich inequality gap in catastrophic health expenditure increased significantly in all governorates except Sulaimaniya from 2007 to 2012. The higher increases in pro-rich inequality were found in Missan, Karbala, Erbil, and Diala. Mothers’ higher education and more antenatal care visits were possible factors for increased coverage of health service indicators. The higher number of children and elderly population in the households were potential risk factors for an increased risk of catastrophic and impoverishing health payment in Iraq. Conclusions To reduce inequality in Iraq, urgent health-system reform is needed, with consideration for vulnerable households having female-heads, less educated mothers, and more children and/or elderly people. Considering varying inequity between and within governorates in Iraq, reconstruction of primary healthcare across the country and cross-sectoral targeted interventions for women should be prioritised. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01532-0.
Collapse
Affiliation(s)
- Hiroko Taniguchi
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Md Mizanur Rahman
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1, Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Khin Thet Swe
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1, Naka, Kunitachi, Tokyo, 186-8601, Japan
| | - Md Rashedul Islam
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.,United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
| | - Nadia Parsell
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ashraf Hussain
- Department of Family and Community Medicine, College of Medicine, University of Babylon, Babil, Iraq
| | - Kenji Shibuya
- Soma COVID Vaccination Medical Center, Soma City Hall, 63-3, Kitamachi, Nakamura, Soma, Fukushima, 976-8601, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
17
|
Tola HH, Gamtesa DF. High Inequality and Slow Services Improvement in Newborn and Child Health Interventions in Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 11:513-523. [PMID: 33408550 PMCID: PMC7781033 DOI: 10.2147/phmt.s286652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/10/2020] [Indexed: 11/03/2022]
Abstract
Background In the previous years, efforts have been made to reduce the inequality gap in newborn and child health interventions in Ethiopia. However, there is still limited evidence on the extent and trends of inequality on newborn and child health interventions. Thus, we aimed to assess newborn and child health interventions, inequality levels, and trends during four demographic and health survey periods based on inequality dimensions: economic status, education level, residency, and child’s sex in Ethiopia. Methods We conducted an inequality analysis on four periods (2000, 2005, 2011, and 2016) of the Ethiopian Demographic and Health Survey (EDHS) data. We estimated inequality related to economic and education status using percentage, relative concentration index, and slope index, while mean percentage difference and ratio were used to assess inequality due to residency and child’s sex. Results The coverage of services was concentrated in the richest quintile, highly educated families, and urban dwellers. Child and newborn health intervention service coverage improvement in the past four survey periods was less than 10.0% for all services, and there is high disparity between sub-national regions. Full immunization-related inequality was highest in Ethiopia compared to four east-central African countries. Conclusion Increasing service coverage and improving equitable access to routine immunizations could fill the existing inequality gap while focusing on the underserved group. In addition, strengthening regular monitoring processes is also vital to know those left behind.
Collapse
Affiliation(s)
- Habteyes Hailu Tola
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dinka Fikadu Gamtesa
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| |
Collapse
|
18
|
Hategeka C, Arsenault C, Kruk ME. Temporal trends in coverage, quality and equity of maternal and child health services in Rwanda, 2000-2015. BMJ Glob Health 2020; 5:e002768. [PMID: 33187962 PMCID: PMC7668303 DOI: 10.1136/bmjgh-2020-002768] [Citation(s) in RCA: 16] [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] [Received: 04/29/2020] [Revised: 09/11/2020] [Accepted: 09/30/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Achieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective coverage and equity of MCH services in Rwanda in the Millennium Development Goal (MDG) era to help guide policy decisions to improve equitable health gains in the SDG era and beyond. METHODS Using four rounds of Rwanda demographic and health surveys conducted from 2000 to 2015, we identified coverage and quality indicators for five MCH services: antenatal care (ANC), delivery care, and care for child diarrhoea, suspected pneumonia and fever. We calculated crude coverage and quality in each survey and used these to estimate effective coverage. The effective coverage should be regarded as an upper bound because there were few available quality measures. We also described equity in effective coverage of these five MCH services over time across the wealth index, area of residence and maternal education using equiplots. RESULTS A total of 48 910 women aged 15-49 years and 33 429 children under 5 years were included across the four survey rounds. In 2015, average effective coverage was 33.2% (range 19.9%-44.2%) across all five MCH services, 30.1% (range 19.9%-40.2%) for maternal health services (average of ANC and delivery) and 35.3% (range 27.3%-44.2%) for sick child care (diarrhoea, pneumonia and fever). This is in contrast to crude coverage which averaged 56.5% (range 43.6%-90.7%) across all five MCH services, 67.3% (range 43.9%-90.7%) for maternal health services and 49.2% (range 43.6%-53.9%) for sick child care. Between 2010 and 2015 effective coverage increased by 154.2% (range 127.3%-170.0%) for maternal health services and by 27.4% (range 4.2%-79.6%) for sick child care. These increases were associated with widening socioeconomic inequalities in effective coverage for maternal health services, and narrowing inequalities in effective coverage for sick child care. CONCLUSION While effective coverage of common MCH services generally improved in the MDG era, it still lagged substantially behind crude coverage for the same services due to low-quality care. Overall, effective coverage of MCH services remained suboptimal and inequitable. Policies should focus on improving effective coverage of these services and reducing inequities.
Collapse
Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|