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Embrey M, Parveen S, Hafner T, Islam H, Zahid A, Joshi MP. Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study. Antimicrob Resist Infect Control 2024; 13:100. [PMID: 39256798 PMCID: PMC11389115 DOI: 10.1186/s13756-024-01455-9] [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: 09/27/2023] [Accepted: 08/22/2024] [Indexed: 09/12/2024] Open
Abstract
Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh's 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.
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Affiliation(s)
- Martha Embrey
- Global Health Systems Innovation, Management Sciences for Health, Arlington, VA, USA.
| | | | - Tamara Hafner
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA, USA
| | - Hafijul Islam
- Formerly Quality Improvement Secretariat, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Abu Zahid
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dhaka, Bangladesh
| | - Mohan P Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA, USA
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Utari A, Cayami FK, Rahardjo TA, Sabatini SE, Ulvyana V, Winarni TI. Critical issue in the identification of Down syndrome and its problems in Central Java, Indonesia: The fact of needing health care and better management. Intractable Rare Dis Res 2024; 13:121-125. [PMID: 38836178 PMCID: PMC11145408 DOI: 10.5582/irdr.2023.01103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 03/16/2024] [Indexed: 06/06/2024] Open
Abstract
We conducted a cross-sectional study to describe the health care problems of children with Down syndrome in Central Java, Indonesia. A total of 162 children (81 boys, 81 girls) with Down syndrome were included. Congenital heart defects and hypothyroidism were found in about 50%, followed by vision and hearing problems in 27.7% and 17.3%, respectively. Almost half of cases were diagnosed after the first month of age. Advanced maternal age was identified in more than 50%, and less than 10% was based on karyotype analysis. This study describes the essential issues such as critical co-morbidities, delayed diagnosis, advanced maternal age, and lack of (accessibility to) genetic testing facilities; thus, better health care and management is needed.
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Affiliation(s)
- Agustini Utari
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Paediatrics, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Ferdy Kurniawan Cayami
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | | | | | - Vynda Ulvyana
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Tri Indah Winarni
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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Demissie DB, Molla G, Tiruneh Tiyare F, Badacho AS, Tadele A. Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis. SAGE Open Med 2024; 12:20503121241248275. [PMID: 38737837 PMCID: PMC11085007 DOI: 10.1177/20503121241248275] [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: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Background Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. Objective This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. Method We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. Results The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). Conclusions The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.
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Affiliation(s)
- Dereje Bayissa Demissie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Firew Tiruneh Tiyare
- Faculty of Public Health, Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Ashenif Tadele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Paul R, Rashmi R, Srivastava S. Neonatal and Postneonatal Death Clustering Among Siblings in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2017-2018. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1606-1627. [PMID: 34962838 DOI: 10.1177/00302228211066695] [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] [Indexed: 11/16/2022]
Abstract
Despite knowledge of neonatal and postneonatal mortality determinants in Bangladesh, some families continue to lose a larger share of children, a phenomenon known as early-life mortality clustering. This study uses the random intercept Weibull survival regression model to explore the correlation of mortality risk among siblings at the family (or, mother) and community levels. Utilizing the Bangladesh Demographic and Health Survey 2017-2018, we found evidence of death scarring, where children whose previous sibling was not alive at the time of conception had significantly higher odds of neonatal mortality. Moreover, the neonatal (and postneonatal) mortality hazard was highest for children with a birth interval of fewer than 19 months, corresponding to the preceding sibling. The intraclass correlation coefficient's statistically significant values show that neonatal and postneonatal mortality risk is correlated among children of the same family and community. The findings suggest focusing on high-risk families and communities to reduce the mortality level effectively.
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Affiliation(s)
- Ronak Paul
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra
| | - Rashmi Rashmi
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra
| | - Shobhit Srivastava
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra
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Vyas H, Mariam OJ, Bhardwaj P. Quality of maternal and newborn health services and their impact on maternal-neonatal outcome at a primary health center. J Family Med Prim Care 2024; 13:505-511. [PMID: 38605802 PMCID: PMC11006057 DOI: 10.4103/jfmpc.jfmpc_843_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction The utilization of the maternal and newborn health services has increased, but mere increase in utilization of services does not ensure that quality services are being provided. The aim of the study was to assess the quality of maternal and newborn services and their impact on maternal and neonatal outcome at a primary health center of Western Rajasthan in India. Materials and Methods An exploratory study was undertaken at a conveniently selected primary health center providing 24-hour delivery services. Information regarding the availability of services was collected from the available medical officer in charge using an Indian Public Health Standards (IPHS) Proforma. Assessment of quality of services was performed by using WHO standards of care based on assessment of quality of maternal and newborn services tool by the perspectives of the provider as well as the mothers utilizing the services. 36 mothers who delivered at the selected PHC were interviewed. Results All basic obstetric care services were available at the selected primary health centers including the 24 × 7 delivery services. The assessment of quality by provider's perspective revealed that the system of referral could be improved. Quality of maternal and newborn services assessment revealed that the practice of skin to skin contact between the mother and newborn just after the delivery was not being followed and few (30%) mothers informed that they could not start breastfeeding within 1 hours of birth. 47% mothers reported that they were not given the freedom to ask questions during delivery. Maternal and newborn outcome revealed that all mothers (100%) had a normal vaginal delivery, and 22% mothers had an episiotomy. All (100%) newborns cried immediately after birth, and average birthweight was 2.89 kg. Conclusion PHCs are the first point of contact of mothers and healthcare delivery system. Assessment of quality of services is an important tool for quality assurance. Inclusion of evidence-based practices like skin-to-skin contact and early initiation of breastfeeding is important to improve the maternal and newborn well-being.
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Affiliation(s)
- Himanshu Vyas
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Pankaj Bhardwaj
- Department of CMFM, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tamiso A, Jisso M, Abera N, Alemayehu A, Gadisa A, Umer A, Kebede M, Mohammed H, Yazie B, Gizaw HS, Mizana BA, Yesuf EA, Tilahun B, Endehabtu BF, Gonete TZ, Gashu KD, Angaw DA, Gurmu KK, Fikre R. Barriers Towards Obstetric Care Service Utilization in Ethiopia: An Explorative Qualitative Study. Ethiop J Health Sci 2023; 33:105-116. [PMID: 38352664 PMCID: PMC10859740 DOI: 10.4314/ejhs.v33i2.4s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background Obstetric care has been at the center of both global and national agendas. More than 50% of pregnant mothers are still preferring to give birth at home with some even after having full antenatal care. However, a few literatures looked at contributing factors for this problem but they are not conclusive and do not consider different sociocultural context of Ethiopia and different health service related barriers. Hence, the aim of this study was to explore barriers to obstetric care service utilization in Ethiopia using the socio-ecological model. Methods Explorative qualitative study was employed involving key-informant interviews, in-depth interviews, and focus group discussions between October and December 2021; Individual, community, health system, and contextual barriers were explored. Atlas ti. Version 9 was used for analysis. Result Lack of awareness, unfavorable perception, lack of partner involvement, cultural barrier, shortage of supplies, poor infrastructure, provider-related factors, poor monitoring, and evaluation system, challenging topography, and conflict were the major barriers that hinder mothers from receiving obstetrics service in Ethiopia. Conclusion Lack of awareness, unfavorable perception, conflict, problems with health system structure and process, and cultural and geographical conditions were major barriers in Ethiopia. Therefore, packages of intervention is important to avail essential equipment, strengthening follow up system, create awareness, and increase access to health facilities is very important for service improvement by the government and non-governmental organizations. Additionally, implementing conflict resolution mechanism is important for addressing better obstetric service.
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Affiliation(s)
- Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Netsanet Abera
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | | | - Anteneh Gadisa
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | | | | | | | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | | | - Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Kassahun Dessie Gashu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Dessie Abebew Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Addis Ababa, Ethiopi
| | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
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Tasneem S, Ozdal MA. Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11070996. [PMID: 37046923 PMCID: PMC10094328 DOI: 10.3390/healthcare11070996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Despite government efforts, many rural Pakistani women forgo regular antenatal visits, are unprepared for birth, and deliver at home or in private facilities, because they are dissatisfied with public health services. This study examined pregnant women’s perceptions of public health hospital prenatal care to suggest areas for improvement. Using simple random sampling, 200 pregnant women visiting a secondary care public health facility in Sargodha District, Pakistan, were enrolled in a cross-sectional study. The quality of prenatal care was assessed using a structured and validated questionnaire. Descriptive analysis and multivariate linear regression stepwise models were used. Of participants, 52% consider the services to be of poor quality. Education, income, number of living children, and long waiting time influenced the perceived prenatal care quality in the study population. Stakeholders rated existing services as suboptimal, especially in terms of staff availability and time spent, which reduces service use. Facility managers and policymakers should work to improve the quality of services to satisfy patients, encourage them to use antenatal care, and improve the health of both mother and child, especially in rural areas.
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Affiliation(s)
- Saima Tasneem
- Department of Health Management, Institute of Graduate Studies and Research, European University of Lefke, TRNC-10 Mersin, Lefke 99770, Northern Cyprus, Turkey
| | - Macide Artac Ozdal
- Department of Health Management, Faculty of Health Sciences, European University of Lefke, TRNC-10 Mersin, Lefke 99770, Northern Cyprus, Turkey
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Galle A, Moran AC, Bonet M, Graham K, Muzigaba M, Portela A, Day LT, Tuabu GK, Silva BDSÉ, Moller AB. Measures to assess quality of postnatal care: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001384. [PMID: 36963034 PMCID: PMC10021656 DOI: 10.1371/journal.pgph.0001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Allisyn C Moran
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
| | - Katriona Graham
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Moise Muzigaba
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal Newborn Health Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Godwin Kwaku Tuabu
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Bianca De Sá É Silva
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Ann-Beth Moller
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
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Aninanya GA, Williams JE, Williams A, Otupiri E, Howard N. Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives. BMC Health Serv Res 2022; 22:1581. [PMID: 36567357 PMCID: PMC9791727 DOI: 10.1186/s12913-022-08940-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana's Upper East Region. METHODS We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software. RESULTS Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software. CONCLUSION Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.
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Affiliation(s)
- Gifty Apiung Aninanya
- grid.442305.40000 0004 0441 5393Department of Health Services Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Box TL 1350, Tamale, Ghana
| | - John E Williams
- grid.462788.7Dodowa Health Research Centre, PO Box DD1, Dodowa, Ghana
| | - Afua Williams
- grid.434994.70000 0001 0582 2706Ga North Municipal Hospital, Ghana Health Service, Accra, Ghana
| | - Easmon Otupiri
- grid.9829.a0000000109466120Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Natasha Howard
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore , 117549 Singapore ,grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Siseho GM, Mathole T, Jackson D. Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia. Front Pediatr 2022; 10:972815. [PMID: 36699289 PMCID: PMC9869061 DOI: 10.3389/fped.2022.972815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Quality of care around childbirth can reduce above half of the stillbirths and newborn deaths. Northeast Namibia's neonatal mortality is higher than the national level. Yet, no review exists on the quality of care provided around childbirth. This paper reports on baseline assessment for implementing WHO/UNICEF/UNFPA quality measures around childbirth. METHODS A mixed-methods research design was used to assess quality of care around childbirth. To obtain good saturation and adequate women opinions, we purposively sampled the only high-volume hospital in northeast Namibia; observed 53 women at admission, of which 19 progressed to deliver on the same day/hours of data collection; and interviewed 20 staff and 100 women who were discharged after delivery. The sampled hospital accounted for half of all deliveries in that region and had a high (27/1,000) neonatal mortality rate above the national (20/1,000) level. We systematically sampled every 22nd delivery until the 259 mother-baby pair was reached. Data were collected using the Every Mother Every Newborn assessment tool, entered, and analyzed using SPSS V.27. Descriptive statistics was used, and results were summarized into tables and graphs. RESULTS We reviewed 259 mother-baby pair records. Blood pressure, pulse, and temperature measurements were done in 98% of observed women and 90% of interviewed women at discharge. Above 80% of human and essential physical resources were adequately available. Gaps were identified within the WHO/UNICEF/UNFPA quality standard 1, a quality statement on routine postpartum and postnatal newborn care (1.1c), and also within standards 4, 5, and 6 on provider-client interactions (4.1), information sharing (5.3), and companionship (6.1). Only 45% of staff received in-service training/refresher on postnatal care and breastfeeding. Most mothers were not informed about breastfeeding (52%), postpartum care and hygiene (59%), and family planning (72%). On average, 49% of newborn postnatal care interventions (1.1c) were practiced. Few mothers (0-12%) could mention any newborn danger signs. CONCLUSION This is the first study in Namibia to assess WHO/UNICEF/UNFPA quality-of-care measures around childbirth. Measurement of provider-client interactions and information sharing revealed significant deficiencies in this aspect of care that negatively affected the client's experience of care. To achieve reductions in neonatal death, improved training in communication skills to educate clients is likely to have a major positive and relatively low-cost impact.
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Affiliation(s)
- Gloria Mutimbwa Siseho
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal Newborn and Child Health, United Nations Children s Fund (UNICEF), Windhoek, Namibia
| | - Thubelihle Mathole
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Debra Jackson
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Okondo C, Ndwiga C, Sripad P, Abuya T, Warren CE. " You can't even ask a question about your child": Examining experiences of parents or caregivers during hospitalization of their sick young children in Kenya: A qualitative study. FRONTIERS IN HEALTH SERVICES 2022; 2:947334. [PMID: 36925844 PMCID: PMC10012665 DOI: 10.3389/frhs.2022.947334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Background Globally, about 5.2 million children under the age of five died in 2019, and more than half of those deaths occurred in Sub-Saharan Africa. In almost every death of a sick child, there is a parent/caregiver seeking health services for their child. This study sought to understand the experiences of care for parents/caregivers (caregivers) as they navigate the hospital system with the aim of identifying opportunities to improve service delivery and child health outcomes. Methods Qualitative data were collected from five hospitals in Kenya: three in Nairobi County and two in Bungoma County. Twenty-five in-depth interviews with caregivers (couples and single women) of young children 0-24 months old, 17 focus group discussions with women and men, and 64 institutional ethnographic observations were completed. Data were analyzed by initial annotation of transcripts and field materials, followed by open coding and thematic analysis using Nvivo 12 software. Summary themes were used to compare experiences between female and male caregivers, their child's age group, and study sites. Results Caregivers faced complex processes of care while seeking health services for their sick young children. Three overarching themes emerged with some variability across female and male caregiver perspectives: (1) Navigating structural issues: long wait times, confusing payment mechanisms, overcrowding, unhygienic conditions, and strict visitation policies; (2) Interactions with providers: positive experiences, including providers showing empathy and concern, and negative experiences of harsh language, neglect, lack of privacy, discounting caregiver perspectives, and not involving men; Limited communication between caregivers and providers on child's diagnosis, treatment, and progress and lack of communication specifically between male caregivers and providers; and (3) Limited emotional support for both caregivers during difficult diagnosis or bereavement. Conclusions To improve experiences, interventions, programs, and policies need to focus on good provider-caregiver partnerships; enhancing opportunities for male engagement, such as supportive visiting hours; effective communication between caregivers and providers; access to adequate emotional support; and an enabling hospital environment.
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Affiliation(s)
| | | | - Pooja Sripad
- Population Council, Washington, DC, United States
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Peven K, Day LT, Bick D, Purssell E, Taylor C, Akuze J, Mallick L. Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:737-751. [PMID: 34933972 PMCID: PMC8691891 DOI: 10.9745/ghsp-d-21-00209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
Reliable measurement of postnatal content of care is currently lacking despite the critical importance of care in this vulnerable period. We found that there is a large quality-coverage gap with missed opportunities for quality care as well as internal inconsistencies in responses to newborn questions. Background: Reliable measurement of newborn postnatal care is essential to understand gaps in coverage and quality and thereby improve outcomes. This study examined gaps in coverage and measurement of newborn postnatal care in the first 2 days of life. Methods: We analyzed Demographic and Health Survey data from 15 countries for 71,366 births to measure the gap between postnatal contact coverage and content coverage within 2 days of birth. Coverage was a contact with the health system in the first 2 days (postnatal check or newborn care intervention), and quality was defined as reported receipt of 5 health worker-provided interventions. We examined internal consistency between interrelated questions regarding examination of the umbilical cord. Results: Reported coverage of postnatal check ranged from 13% in Ethiopia to 78% in Senegal. Report of specific newborn care interventions varied widely by intervention within and between countries. Quality-coverage gaps were high, ranging from 26% in Malawi to 89% in Burundi. We found some internally inconsistent reporting of newborn care. The percentage of women who reported that a health care provider checked their newborn's umbilical cord but responded “no” to the postnatal check question was as high as 16% in Malawi. Conclusion: Reliable measurement of coverage and content of early postnatal newborn care is essential to track progress in improving quality of care. Postnatal contact coverage is challenging to measure because it may be difficult for women to distinguish postnatal care from intrapartum care and it is a less recognizable concept than antenatal care. Co-coverage measures may provide a useful summary of contact and content, reflecting both coverage and an aspect of quality.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. .,Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Tina Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Joseph Akuze
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology and Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Health Policy, Planning and Management and Centre of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
| | - Lindsay Mallick
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA.,Avenir Health, Glastonbury, CT, USA
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Yusuf SS, Acharya K, Ahmed R, Ahmed A. Understanding general health service readiness and its correlates in the health facilities of Bangladesh: evidence from the Bangladesh Health Facility Survey 2017. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Okedo-Alex IN, Akamike IC, Nwafor JI, Onwasigwe CN. Determinants, reasons for choice and willingness to recommend birthing facility among mothers in public and private health facilities in Ebonyi, Nigeria. Pan Afr Med J 2021; 38:289. [PMID: 34122716 PMCID: PMC8180001 DOI: 10.11604/pamj.2021.38.289.24437] [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: 06/20/2020] [Accepted: 03/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria. Methods this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection. Results the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others. Conclusion regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Johnbosco Ifunanya Nwafor
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Chika Nwakanma Onwasigwe
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
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Nguyen PH, Khương LQ, Pramanik P, Billah SM, Menon P, Piwoz E, Leslie HH. Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys. BMJ Open 2021; 11:e040109. [PMID: 33472778 PMCID: PMC7818835 DOI: 10.1136/bmjopen-2020-040109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh. METHODS We used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles. RESULTS Contact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14-17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp). CONCLUSION Nutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | | | - Priyanjana Pramanik
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Sk Masum Billah
- Maternal and Child Health Division, ICDDRB, Dhaka, Dhaka District, Bangladesh
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Ellen Piwoz
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Hannah H Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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