Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design

Changes in the number and outcome of takeaway food outlet planning applications in response to adoption of management zones around schools in England: A time series analysis

Physical exposure to takeaway food outlets ("takeaways") is associated with poor diet and excess weight, which are leading causes of excess morbidity and mortality. At the end of 2017, 35 local authorities (LAs) in England had adopted takeaway management zones (or "exclusion zones"), which is an urban planning intervention designed to reduce physical exposure to takeaways around schools. In this nationwide, natural experimental study, we used interrupted time series analyses to estimate the impact of this intervention on changes in the total number of takeaway planning applications received by LAs and the percentage rejected, at both first decision and after any appeal, within management zones, per quarter of calendar year. Changes in these proximal process measures would precede downstream retail and health impacts. We observed an overall decrease in the number of applications received by intervention LAs at 12 months post-intervention (6.3 fewer, 95% CI -0.1, -12.5), and an increase in the percentage of applications that were rejected at first (additional 18.8%, 95% CI 3.7, 33.9) and final (additional 19.6%, 95% CI 4.7, 34.6) decision, the latter taking into account any appeal outcomes. This effect size for the number of planning applications was maintained at 24 months, although it was not statistically significant. We also identified three distinct sub-types of management zone regulations (full, town centre exempt, and time management zones). The changes observed in rejections were most prominent for full management zones (where the regulations are applied irrespective of overlap with town centres), where the percentage of applications rejected was increased by an additional 46.1% at 24 months. Our findings suggest that takeaway management zone policies may have the potential to curb the proliferation of new takeaways near schools and subsequently impact on population health.

Influence of Cultural Beliefs on the Utilization of Integrated Maternal, Newborn, and Child Health Services in Benue State, Nigeria

Background The maternal mortality ratio in Nigeria is high at 576 per 100,000 live births. The health policy is in favor of health advocacy programs that promote the utilization of integrated maternal newborn and child health (IMNCH) services in local primary health centers by childbearing mothers. Cultural factors, however, have been shown to limit the widespread adoption of these services. The purpose of this study was to investigate the influence of cultural beliefs on the utilization of IMNCH services by child-bearing mothers (CBMs) in Benue state. Methods A community-based correlational survey research was conducted on a random sample of 1,200 CBMs. A multistage sampling technique was used to select the study participants and a pretested, structured questionnaire was used to collect data through face-to-face interviews. Only 896 copies of the distributed Integrated Maternal Newborn and Child Health Services Utilization Questionnaire (IMNCHSUQ) had complete information and were used for analysis. The collected data were managed and analyzed using SPSS version 25 (IBM Corp., Armonk, NY). Mean, standard deviation, and point-biserial correlation were used to answer the research questions while linear regression was used to test the null hypotheses at a 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (X ®=3.30, SD=0.94); there was a positive moderate relationship between IMNCH utilization and cultural factors (rbp=.43, ρ= 0.000). Results also suggest that cultural factors were significant predictors of IMNCH services utilization in Benue State, Nigeria. Conclusion Any health education program for maternal and child health in Benue State should take cognizance of the cultural values, beliefs, and norms of the people to sustain positive ones while discouraging values and norms detrimental to the health and well-being of CBMs and their children.

Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey

INTRODUCTION

Maternal mortality studies conducted at national level do not provide information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district level variations in Sidama National Regional State, southern Ethiopia.

METHODS

A cross sectional population-based survey was carried in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality.

RESULTS

We registered 10602 live births (LB) and 48 maternal deaths yielding the overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at health facility. Mothers who did not have formal education had higher risk of maternal death (AOR: 4.4; 95% CI: 1.7-11.0). The risk of maternal death was higher in districts with low midwife to population ratio (AOR: 2.9; 95% CI: 1.0-8.9).

CONCLUSION

The high maternal mortality with district level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the life of mothers.