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Quispe-Vicuña C, Fernandez-Guzman D, Caira-Chuquineyra B, Failoc-Rojas VE, Bendezu-Quispe G, Urrunaga-Pastor D. Association between receiving information on obstetric complications and institutional delivery: An analysis of the demographic and health survey of Peru, 2019. Heliyon 2023; 9:e21146. [PMID: 38027831 PMCID: PMC10665671 DOI: 10.1016/j.heliyon.2023.e21146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To evaluate the association between receiving information on obstetric complications and institutional delivery in Peruvian women in 2019. Methods We conducted a secondary analysis of the 2019 Peruvian Demographic and Family Health Survey (ENDES) database. The dependent variable was the type of delivery (institutional or non-institutional). The exposure variable was self-reporting of having received information on obstetric complications during prenatal care. The association of interest was evaluated using binary logistic regression models, obtaining crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95 % confidence intervals (95%CI). Values of p < 0.05 were considered statistically significant. Results We included a total of 14,835 women in the analysis. Of the total, 14,088 (94.1 %) reported having received information on pregnancy complications. Also, 13,883 (92.5 %) had an institutional delivery in their last pregnancy. The adjusted model showed that women who reported knowing the complications that can occur in pregnancy had a higher probability of presenting an institutional delivery (aOR = 1.47; 95%CI: 1.04-2.08). Conclusions Receiving information about pregnancy complications was found to be associated with a higher probability of institutional delivery. Ensuring the provision of information to the pregnant woman about pregnancy complications can be a useful strategy to increase institutional delivery.
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Affiliation(s)
- Carlos Quispe-Vicuña
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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Dada S, Aivalli P, De Brún A, Barreix M, Chelwa N, Mutunga Z, Vwalika B, Gilmore B. Understanding communication in community engagement for maternal and newborn health programmes in low- and middle-income countries: a realist review. Health Policy Plan 2023; 38:1079-1098. [PMID: 37650702 PMCID: PMC10566325 DOI: 10.1093/heapol/czad078] [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: 03/27/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context-mechanism-outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Irani L, Verma S, Mathur R, Verma RK, Mohan D, Dhar D, Seth A, Chaudhuri I, Chaudhury MR, Purthy A, Nanda A, Singh S, Gupta A, LeFevre AE. Key learnings from an outcome and embedded process evaluation of a direct to beneficiary mobile health intervention among marginalised women in rural Bihar, India. BMJ Open 2022; 12:e052336. [PMID: 36207036 PMCID: PMC9558784 DOI: 10.1136/bmjopen-2021-052336] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/03/2022] Open
Abstract
INTRODUCTION Mobile Vaani was implemented as a pilot programme across six blocks of Nalanda district in Bihar state, India to increase knowledge of rural women who were members of self-help groups on proper nutrition for pregnant or lactating mothers and infants, family planning and diarrhoea management. Conveners of self-help group meetings, community mobilisers, introduced women to the intervention by giving them access to interactive voice response informational and motivational content. A mixed methods outcome and embedded process evaluation was commissioned to assess the reach and impact of Mobile Vaani. METHODS The outcome evaluation, conducted from January 2017 to November 2018, used a quasi-experimental pre-post design with a sample of 4800 married women aged 15-49 from self-help group households, who had a live birth in the past 24 months. Surveys with community mobilisers followed by meeting observations (n=116), in-depth interviews (n=180) with self-help group members and secondary analyses of system generated data were conducted to assess exposure and perceptions of the intervention. RESULTS From the outcome evaluation, 23% of women interviewed had heard about Mobile Vaani. Women in the intervention arm had significantly higher knowledge than women in the comparison arm for two of seven focus outcomes: knowledge of how to make child's food nutrient and energy dense (treatment-on-treated: 18.8% (95% CI 0.4% to 37.2%, p<0.045)) and awareness of at least two modern spacing family planning methods (treatment-on-treated: 17.6% (95% CI 4.7% to 30.5%, p<0.008)). Women with any awareness of Mobile Vaani were happy with the programme and appreciated the ability to call in and listen to the content. CONCLUSION Low population awareness and programme exposure are underpinned by broader population level barriers to mobile phone access and use among women and missed opportunities by the programme to improve targeting and programme promotion. Further research is needed to assess programmatic linkages with changes in health practices.
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Affiliation(s)
| | | | | | | | - Diwakar Mohan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diva Dhar
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | - Mahua Roy Chaudhury
- Department of Rural Development, Government of Bihar, JEEViKA, Bihar Rural Livelihoods Promotion Society, Patna, India
| | - Apolo Purthy
- Department of Rural Development, Government of Bihar, JEEViKA, Bihar Rural Livelihoods Promotion Society, Patna, India
| | | | | | | | - Amnesty Elizabeth LeFevre
- University of Cape Town, School of Public Health and Family Medicine, Cape Town, Western Cape, South Africa
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Alyahya MS, Khader YS, Al-Sheyab NA, Shattnawi KK, Altal OF, Batieha A. Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits. Am J Perinatol 2021; 40:731-740. [PMID: 34058760 DOI: 10.1055/s-0041-1730434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. STUDY DESIGN A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. RESULTS During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. CONCLUSION The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. KEY POINTS · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Medical Education and Biostatistics, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K Shattnawi
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Altal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Majeed M, Bhatti KH, Amjad MS, Abbasi AM, Bussmann RW, Nawaz F, Rashid A, Mehmood A, Mahmood M, Khan WM, Ahmad KS. Ethno-veterinary uses of Poaceae in Punjab, Pakistan. PLoS One 2020; 15:e0241705. [PMID: 33142315 PMCID: PMC7608896 DOI: 10.1371/journal.pone.0241705] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022] Open
Abstract
Plant species of the Poaceae family are not only used as fodder and forage but also contribute substantially to the treatment of various health disorders, particularly in livestock. Consequently, the present study was aimed to document the therapeutic uses of Poaceae practiced by the inhabitants of the Punjab Province for the treatment of various veterinary health disorders. Semi structured interviews, group discussion and field walks were conducted to collect the data. Quantitative indices including cultural significance index (CSI), relative frequency of citations (RFC), fidelity level (FL), relative popularity level (RPL), and Jaccard Index (JI) were used for the data analysis. Traditional uses of 149 species belonging to 60 genera and 16 tribes of 5 sub families of Poaceae were recorded. Whole plants and leaves were the most consistently used parts with 40.94 and 29.53%. The plants were mainly given orally as fodder (59 reports) without processing followed by decoction (35 reports). Most of the species were employed to treat infectious diseases (25.93%), and digestive disorders (14.10%). Triticum aestivum had the highest CSI, RFC and RPL levels at 8.00, 0.96, 1.00, respectively, followed by Oryza sativa and Poa annua. Likewise, T. aestivum and Saccharum spontaneum had 100% FL and ROP. Jaccard index ranged from 12.25 to 0.37. Twelve plant species namely Chrysopogon zizanioides (anti-inflammatory), Pennisetum lanatum (improve bull fertility), Cymbopogon citratus (glandular secretion), Sorghum saccharatum and Themeda triandra (malaria), Aristida funiculate (anticancer), Koeleria argentia (skin allergies), Tetrapogon villosus (antibacterial), Cynodon radiatus (eyes infection), Sporobolus nervosa (Jaundice), Enneapogon persicus (antifungal), and Panicum repens (dysfunctional cattle organs) were reported for the first time, with novel ethnoveterinary uses. The inhabitants of the study area had a strong association with their surrounding plant diversity and possessed significant knowledge on therapeutic uses of Poaceae to treat various health disorders in animals. Plant species with maximum cultural and medicinal values could be a potential source of novel drugs to cure health disorders in animals and human as well.
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Affiliation(s)
- Muhammad Majeed
- Department of Botany, University of Gujrat, Hafiz Hayat Campus, Gujrat, Punjab, Pakistan
| | - Khizar Hayat Bhatti
- Department of Botany, University of Gujrat, Hafiz Hayat Campus, Gujrat, Punjab, Pakistan
| | - Muhammad Shoaib Amjad
- Department of Botany, Women University of Azad Jammu and Kashmir, Bagh, AJK, Pakistan
| | - Arshad Mehmood Abbasi
- Department of Environmental Sciences, COMSATS University Islamabad, Abbottabad Campus, Pakistan
| | - Rainer W. Bussmann
- Department of Ethnobotany, Institute of Botany, Ilia State University, La Paz, Bolivia
| | - Fahim Nawaz
- Department of Agronomy, MNS, University of Agriculture, Multan, Pakistan
| | - Audil Rashid
- Department of Botany, University of Gujrat, Hafiz Hayat Campus, Gujrat, Punjab, Pakistan
| | - Ansar Mehmood
- Department of Botany, University of Poonch Rawalakot (UPR), Azad Jammu and Kashmir, Pakistan
| | - Majid Mahmood
- Department of Zoology, University of Poonch Rawalakot (UPR), Azad Jammu and Kashmir, Pakistan
| | | | - Khawaja Shafique Ahmad
- Department of Botany, University of Poonch Rawalakot (UPR), Azad Jammu and Kashmir, Pakistan
- * E-mail: ,
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Taremwa IM, Ashaba S, Ayebazibwe C, Kemeza I, Adrama HO, Omoding D, Yatuha J, Hilliard R. Mind the gap: scaling up the utilization of insecticide treated mosquito nets using a knowledge translation model in Isingiro district, rural south western Uganda. Health Psychol Behav Med 2020; 8:383-397. [PMID: 34040878 PMCID: PMC8130719 DOI: 10.1080/21642850.2020.1814782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The phenomenon of Knowledge Translation (KT) is a key intervention towards bridging the ‘know–do’ gap. We conducted a KT initiative in Isingiro district to positively change attitude and improve on the uptake of Insecticide Treated Mosquito Nets (ITNs) as a malaria prevention strategy. Methods: This was a community based interactive initiative that was carried out within the seventeen administrative units of Isingiro district using varied dissemination activities, namely: health talks; drama activities, and the sharing of ITNs success stories. Results: We reached out to 34 dissemination groups, comprising communal gathering, religious crusades, open markets, secondary schools, and district administration. In addition, we spot-visited 46 households to ascertain the physical presence of ITNs, and their appropriate use. The major intervention was improved knowledge base of malaria causation and prevention strategies. The indicators for improved knowledge were hinged on the five-interventions, namely: (a) communal sensitization on malaria to provide, (b) monitoring and support of selected households, (c) emphasis of ITN use as a malaria prevention strategy, (d) promotion of care for ITNs, and (e) promotion of ITN use. In all, the major output was improved knowledge base of malaria causation and prevention strategies by providing accurate information to redress the myths and misconceptions related to malaria and ITNs use. Conclusion: This undertaking describes a consolidated community intervention to promote ITN utilization. It is plausible that this intervention positively enhances and promotes uptake and utilization of ITNs.
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Affiliation(s)
- Ivan Mugisha Taremwa
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carlrona Ayebazibwe
- Department of Information Technology, Uganda Christian University, Mukono, Uganda
| | - Imelda Kemeza
- Department of Educational Foundations and Psychology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Daniel Omoding
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Jane Yatuha
- Department of Biology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robert Hilliard
- Hospital for Sick Children, University of Toronto, Toronto, Canada
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Ameyaw EK, Ahinkorah BO, Seidu AA. Does knowledge of pregnancy complications influence health facility delivery? Analysis of 2014 Bangladesh Demographic and Health Survey. PLoS One 2020; 15:e0237963. [PMID: 32853211 PMCID: PMC7451572 DOI: 10.1371/journal.pone.0237963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Only thirty-seven percent (37%) of deliveries occur in health facilities in Bangladesh despite the enormous benefits of health facility delivery. We investigated women’s recall of receiving counseling on pregnancy complications and how it affects health facility delivery in Bangladesh. Materials and methods Data from the 2014 Bangladesh Demographic and Health Survey was used for the study. After calculating the proportion of women who were informed about pregnancy complications during their last Antenatal Care (ANC) and the number of them who delivered in health facilities, Binary Logistic Regression was utilized in investigating chances of giving birth in health facilities among women who recalled they were told about pregnancy complications and those who were not told. The models were considered significant at 95%. Results A little above half of the women who were told about pregnancy complications during ANC delivered in health facilities (53.3%) and 43.6% of those who were not told delivered in health facilities. The findings revealed that women who were told about pregnancy complications during ANC were more likely to deliver at the health facility compared to those who were not told [COR = 1.56, CI = 1.31–1.87], and this persisted after controlling for the effect of covariates [AOR = 1.44, CI = 1.21–1.71]. Conclusion This study has stressed the importance of telling women about pregnancy complications during ANC by revealing that telling women about pregnancy complications during ANC is likely to result in health facility delivery. Health workers should intensify health education on pregnancy complications during ANC and motivate women to deliver in health facilities.
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Affiliation(s)
- Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- * E-mail:
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Eze II, Mbachu CO, Ossai EN, Nweze CA, Uneke CJ. Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria. BMC Pregnancy Childbirth 2020; 20:369. [PMID: 32571247 PMCID: PMC7310128 DOI: 10.1186/s12884-020-03061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria. METHODS A pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders' engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05. RESULTS The result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012). CONCLUSION With the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.
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Affiliation(s)
- Irene Ifeyinwa Eze
- Department of Community Medicine, College of Medicine, Ebonyi State University, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chinyere Ojiugo Mbachu
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Celestina Adaeze Nweze
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Orubu ESF, Zaman MH, Rahman MT, Wirtz VJ. Veterinary antimicrobial resistance containment in Bangladesh: Evaluating the national action plan and scoping the evidence on implementation. J Glob Antimicrob Resist 2019; 21:105-115. [PMID: 31600599 DOI: 10.1016/j.jgar.2019.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES In 2015, the World Health Organization (WHO) released its global action plan (GAP) on antimicrobial resistance (AMR) as a blueprint for the design of national action plans for AMR containment. Bangladesh, with 80% rural household ownership of at least one livestock, introduced its national action plan in May 2017. The objective of this study was two-fold: (i) to perform a policy content evaluation of the Bangladesh National Action Plan (BNAP) against the GAP with a focus on veterinary AMR containment strategies; and (ii) to assess the evidence on the implementation of veterinary AMR containment strategies of the BNAP. METHODS The BNAP was evaluated against the GAP to identify commonalities and policy gaps. A scoping review of peer-reviewed and grey literature was performed to identity evidence of policy implementation and practice gaps. RESULTS The BNAP is strongly aligned with the GAP. However, the study identified policy gaps, including an explicit financing modality, specifications for antimicrobial stewardship (AMS) in the veterinary sector, and rigorous operational and monitoring & evaluation frameworks. More evidence on implementation is needed in terms of incorporation of AMR in the curriculum of veterinarians, AMS plans throughout the veterinary sector, and infection prevention and control protocols and implementation. CONCLUSION Closing the identified gaps is essential for successful veterinary AMR containment in Bangladesh but will require sustained and significant investment in institutional and human resource development in the coming years.
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Affiliation(s)
- Ebiowei Samuel F Orubu
- Boston University, Institute for Health System Innovation & Policy, 180 Riverway, Boston, MA 02215, USA; Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, MA 02215, USA.
| | - Muhammad H Zaman
- Boston University, Department of Biomedical Engineering, 44 Cummington Mall, Boston, MA 02215, USA
| | - Md Tanvir Rahman
- Bangladesh Agricultural University, Faculty of Veterinary Science, Department of Microbiology and Hygiene, Mymensingh 2202, Bangladesh
| | - Veronika J Wirtz
- Boston University, Department of Global Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA 02118, USA
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Nguyen PH, Frongillo EA, Sanghvi T, Kim SS, Alayon S, Tran LM, Mahmud Z, Aktar B, Menon P. Importance of coverage and quality for impact of nutrition interventions delivered through an existing health programme in Bangladesh. MATERNAL AND CHILD NUTRITION 2018; 14:e12613. [PMID: 29656488 PMCID: PMC6175250 DOI: 10.1111/mcn.12613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 12/01/2022]
Abstract
Understanding implementation of interventions is critical to illuminate if, how, and why the interventions achieve impact. Alive & Thrive integrated a nutrition intervention into an existing maternal, neonatal, and child health (MNCH) programme in Bangladesh, documenting improvements in women's micronutrient supplement intake and dietary diversity. Here, we examined how well the nutrition intervention was implemented and which elements of implementation explained intervention impact. Survey data were collected in 2015 and 2016 from frontline health workers (FLW) and households in areas randomized to nutrition‐focused MNCH (intensified interpersonal counselling, community mobilization, distribution of free micronutrient supplements, and weight‐gain monitoring) or standard MNCH (antenatal care with standard nutrition counselling). Seven intervention elements were measured: time commitment, training quality, knowledge, coverage, counselling quality, supervision, and incentives. Multiple regression was used to derive difference‐in‐differences (DID) estimates. Using village‐level endline data, path analysis was used to determine which elements most explained intervention impacts. FLWs in both areas were highly committed and well supervised. Coverage was high (>90%) for counselling, supplement provision, and weight‐gain monitoring. Improvements were significantly greater for nutrition‐focused MNCH, versus standard MNCH, for training quality (DID: 2.42 points of 10), knowledge (DID: 1.20 points), delivery coverage (DID: 4.16 points), and counselling quality (DID: 1.60 points). Impact was substantially explained by coverage and delivery quality. In conclusion, integration nutrition intervention into the MNCH programme was feasible and well‐implemented. Although differences in coverage and counselling quality most explained impacts, all intervention elements—particularly FLW training and performance—were likely important to achieving impact.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | | | - Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | | | | | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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11
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Einloft ABDN, Cotta RMM, Araújo RMA. [Promoting a healthy diet in childhood: weaknesses in the context of Primary Health Care]. CIENCIA & SAUDE COLETIVA 2017; 23:61-72. [PMID: 29267812 DOI: 10.1590/1413-81232018231.23522017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/15/2017] [Indexed: 11/22/2022] Open
Abstract
This paper reports the experience of the incorporation of perceptions of social actors in the investigation of the weaknesses of the process of implementation of programs that aim to promote a healthy diet in childhood. It involves qualitative research carried out in a medium-sized Brazilian municipality in which the participants were nurses and community health agents. The data were collected through semi-structured questionnaires as well as focus groups. The findings indicated that the quality and continuity of actions to promote a healthy diet were limited due to the precarious working conditions, hence the strong demand for adequate orientation due to the unfavorable context where child health is concerned. Although the reality of peripheral countries points to an incipience in program evaluation, the incorporation of qualitative investigation broadened by the perspective of the participants may constitute an important tool of participation and social responsibility. This minimizes political effects and verticalized and discontinuous actions, helping the generation of opportune and adequate information for the understanding of the different local contexts and social experiences.
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Affiliation(s)
- Ariadne Barbosa do Nascimento Einloft
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Campus Universitário s/n. 36570-000 Viçosa MG Brasil.
| | - Rosângela Minardi Mitre Cotta
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Campus Universitário s/n. 36570-000 Viçosa MG Brasil.
| | - Raquel Maria Amaral Araújo
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Campus Universitário s/n. 36570-000 Viçosa MG Brasil.
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12
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Nguyen PH, Kim SS, Sanghvi T, Mahmud Z, Tran LM, Shabnam S, Aktar B, Haque R, Afsana K, Frongillo EA, Ruel MT, Menon P. Integrating Nutrition Interventions into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation. J Nutr 2017; 147:2326-2337. [PMID: 29021370 PMCID: PMC5697969 DOI: 10.3945/jn.117.257303] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/15/2017] [Accepted: 09/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh.Objectives: We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices.Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n ∼ 300 and 1000 pregnant or recently delivered women, respectively, per survey round). We derived difference-in-difference effect estimates, adjusted for geographic clustering and infant age and sex.Results: Coverage of interpersonal counseling was high; >90% of women in the nutrition-focused MNCH group were visited at home by health workers for maternal nutrition and breastfeeding counseling. The coverage of community mobilization activities was ∼50%. Improvements were significantly greater in the nutrition-focused MNCH group than in the standard MNCH group for consumption of iron and folic acid [effect: 9.8 percentage points (pp); 46 tablets] and calcium supplements (effect: 12.8 pp; 50 tablets). Significant impacts were observed for the number of food groups consumed (effect: 1.6 food groups), percentage of women who consumed ≥5 food groups/d (effect: 30.0 pp), and daily intakes of several micronutrients. A significant impact was also observed for exclusive breastfeeding (EBF; effect: 31 pp) but not for early initiation of breastfeeding.Conclusions: Addressing nutrition during pregnancy by delivering interpersonal counseling and community mobilization, providing free supplements, and ensuring weight-gain monitoring through an existing MNCH program improved maternal dietary diversity, micronutrient supplement consumption, and EBF practices. This trial was registered at clinicaltrials.gov as NCT02745249.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC;
| | - Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | | | | | | | | | | | | | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
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13
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Nguyen PH, Sanghvi T, Tran LM, Afsana K, Mahmud Z, Aktar B, Haque R, Menon P. The nutrition and health risks faced by pregnant adolescents: Insights from a cross-sectional study in Bangladesh. PLoS One 2017; 12:e0178878. [PMID: 28594949 PMCID: PMC5464569 DOI: 10.1371/journal.pone.0178878] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/20/2017] [Indexed: 11/29/2022] Open
Abstract
Little is known about nutrition and well-being indicators of pregnant adolescents and the availability and use of nutrition interventions delivered through maternal, newborn, and child health (MNCH) programs. This study compared the differences between pregnant adolescents and adult pregnant women in services received, and in maternal and child nutrition and health conditions. A survey of 2,000 recently delivered women with infants <6 months of age was carried out in 20 sub-districts in Bangladesh where MNCH program is being implemented. Differences in service use and outcomes between pregnant adolescents and adult women were tested using multivariate regression models. The coverage of antenatal care and nutrition services was similar for adolescent and adult mothers. Compared to adult mothers, adolescent mothers had significantly fewer ownership of assets and lower decision making power. Adolescent mothers weighed significantly less than adult women (45.8 vs 47.1 kg, p = 0.001), and their body mass index was significantly lower (19.7 vs 21.3, p = 0.001). Adolescents recovered later and with greater difficulty after childbirth. Infants of adolescent mothers had significant lower height-for-age z-score (-0.89 vs -0.74, p = 0.04), lower weight-for age z-score (-1.21 vs -1.08, p = 0.02) and higher underweight prevalence (22.4% vs 17.9%, p = 0.04) compared to infants of adult women. In conclusion, this study confirms that adolescent pregnancy poses substantial risks for maternal and infant outcomes, and emphasizes that these risks are significant even where services during pregnancy are available and accessed. A focus on preventing adolescent pregnancy is imperative, while also strengthening health and nutrition services for all pregnant women, whether adult or adolescent.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Tina Sanghvi
- FHI 360, Washington, DC, United States of America
| | - Lan Mai Tran
- FHI 360, Washington, DC, United States of America
| | | | - Zeba Mahmud
- FHI 360, Washington, DC, United States of America
| | | | | | - Purnima Menon
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
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