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Tilahun BT, Tariku Z, Alemu MK, Dejene T, Natae LA, Mohammed H, Assegid DT, Tekle MH. Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia. Int J Public Health 2024; 69:1606626. [PMID: 38841538 PMCID: PMC11150649 DOI: 10.3389/ijph.2024.1606626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives: This study aimed to describe the impact of COVID-19 on maternal and child health service utilization in the Eastern part of Ethiopia. Methods: Comparative analysis was used to examine 2 years of maternal and child health service utilization. Data were extracted from client registers. A traditional Expert Modeler and one-way Analysis of Variance were used to compare service utilization before and during the COVID-19 pandemic. Results: A total of 34,576 client records were reviewed, of which 17,100 (49.5%) and 17,476 (50.5%) had visited the MCH service before and during the COVID-19 pandemic, respectively. The total client visit has shown a 2% percentage point increase. However, postnatal care and child immunization services showed a decrease. Moreover, there was a significant difference between service visits before and during COVID-19 (f = 4.6, p < 0.04). Conclusion: Mothers and children have missed or unattended facility appointments due to protective impositions or fear of getting infected with COVID-19, which might suggest a higher proportion of MCH issues were not addressed during the pandemic. The health system should therefore improve its resilience and strengthen its access at the lowest health care inlets.
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Affiliation(s)
- Bereket Tefera Tilahun
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mesfin Kebede Alemu
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tafese Dejene
- School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Legesse Abera Natae
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Hussen Mohammed
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Daniel Tadesse Assegid
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mickiale Hailu Tekle
- Department of Midwifery, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Lima Figueiredo ER, do Socorro Carvalho Miranda C, Viana Campos AC, de Campos Gomes F, Câmara Rodrigues CN, de Melo-Neto JS. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Womens Health 2024; 24:84. [PMID: 38302949 PMCID: PMC10835861 DOI: 10.1186/s12905-024-02925-3] [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: 11/28/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.
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Affiliation(s)
- Eric Renato Lima Figueiredo
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | | | - Ana Cristina Viana Campos
- Laboratory and Observatory in Surveillance and Social Epidemiology, Federal University of the South and Southeast of Pará (Unifesspa), Marabá, PA, 68500-000, Brazil
| | | | - Cibele Nazaré Câmara Rodrigues
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil
| | - João Simão de Melo-Neto
- Urogenital System Clinical and Experimental Research Unit, Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, 66075-110, Brazil.
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Aryastami NK, Mubasyiroh R. Optimal utilization of maternal health service in Indonesia: a cross-sectional study of Riskesdas 2018. BMJ Open 2023; 13:e067959. [PMID: 37666563 PMCID: PMC10481828 DOI: 10.1136/bmjopen-2022-067959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE This paper analyses the optimal utilization of maternal health services in Indonesia from 2015 to 2018. DESIGN National cross-sectional study. SETTING This study takes place in 34 provinces in Indonesia. PARTICIPANTS The population in this study were mothers in all household members in Basic Health Research of Riskesdas 2018. The sample was all mothers who had a live birth within 5 years before data collection (1 January 2013 to July 2018) and had complete data. The number of samples analysed was 70 878. PRIMARY OUTCOME We developed a scoring for the optimal utilization of maternal health services as the outcome variable. RESULTS This analysis involved 70 787 mothers. The utilization of maternal care was not optimal. Mothers who delivered in health facilities achieved 83.3% of services. Better care is experienced more by mothers who live in urban areas. Mothers who delivered at health facilities significantly used threefold optimal care (ORa=3.15; 95% CI 3.00 to 3.30; p<0001). A statistically significant difference of optimal maternal care was found in mothers with better education (ORa=1.22; 95% CI 1.18 to 1.27; p=0.001); holding health insurance (ORa=1.25; 95% CI 1.21 to 1.30; p<0001), having more access to health facilities (ORa=1.13; 95% CI 1.09 to 1.17); p<0.001), less parity (ORa=1.16; 95% CI 1.11 to 1.20; p<0.001). CONCLUSION The optimal utilization of MHS is independent of the free services delivery, but having health insurance and less parity brought about a better optimal score for MHS. Mothers in rural areas were more protective of optimal utilization. Finally, the eastern region used more optimal health services.
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Affiliation(s)
- Ni Ketut Aryastami
- Research Center for Public Health and Nutrition, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
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Jafree SR, Shah G, Zakar R, Muzamill A, Ahsan H, Burhan SK, Javed A, Durrani RR. Characterizing Social Determinants of Maternal and Child Health: A Qualitative Community Health Needs Assessment in Underserved Areas. Healthcare (Basel) 2023; 11:2224. [PMID: 37570465 PMCID: PMC10418942 DOI: 10.3390/healthcare11152224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to identify social determinants of maternal and child health (SDoH) in Pakistan. Using a qualitative study design, data were collected from community members in seven underserved areas of Lahore City, Pakistan. A total of 22 qualitative in-depth interviews and 10 focus group discussions (FGDs) were conducted. The participants included basic health unit healthcare staff, women of reproductive ages, male family members, mothers-in-law, and religious leaders. We found that maternal and child health is adversely affected by the following socioeconomic and environmental barriers: (i) poor housing quality and sanitation; (ii) inadequate food supply and safety; (iii) unsatisfactory public sector school services; (iv) a lack of safety and security; (v) scarce poverty alleviation efforts and loan schemes; (vi) unsatisfactory transport and internet services; and (vii) inadequate health services. The targets for maternal and child health in Pakistan cannot be met without close coordination between the primary health sector, local governance, and macro state structures, which collectively must monitor and improve housing adequacy, food security, public sector services (primary healthcare services, public schooling, public transport, and public internet access), overall safety, and poverty emergence.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Zahoor Elahi Road, Lahore 54600, Pakistan;
| | - Gulzar Shah
- Department of Health Policy and Community Health Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore 54590, Pakistan;
| | - Anam Muzamill
- Department of Mass Communications, Forman Christian College University, Lahore 54600, Pakistan;
| | - Humna Ahsan
- Department of Economics, Forman Christian College University, Lahore 54600, Pakistan;
| | - Syeda Khadija Burhan
- Department of Education, Forman Christian College University, Lahore 54600, Pakistan;
| | - Ambreen Javed
- Department of English, Forman Christian College University, Lahore 54600, Pakistan;
| | - Rana Rubab Durrani
- Center for Language Development, Forman Christian College University, Lahore 54600, Pakistan;
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Mroz EJ, Willis T, Thomas C, Janes C, Singini D, Njungu M, Smith M. Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia. Int J Health Geogr 2023; 22:17. [PMID: 37525198 PMCID: PMC10391775 DOI: 10.1186/s12942-023-00338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Seasonal floods pose a commonly-recognised barrier to women's access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women's walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access.
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Affiliation(s)
- Elizabeth Jade Mroz
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK.
| | - Thomas Willis
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Thomas
- Lincoln Centre for Water & Planetary Health, University of Lincoln, Lincoln, LN6 7DW, UK
| | - Craig Janes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwimanenwa Njungu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mark Smith
- School of Geography and water@Leeds, University of Leeds, Leeds, LS2 9JT, UK
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Cáceres ÁL, Ramesh RM, Newmai P, Kikon R, Deckert A. Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India-a community-based mixed methods study. Front Public Health 2023; 11:1139334. [PMID: 37483938 PMCID: PMC10358725 DOI: 10.3389/fpubh.2023.1139334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often underestimated due to facility-dependent reporting systems often difficult to access. We studied the utilization of health services for maternal and newborn care and explored how cultural beliefs, perceptions, and practices influence the health-seeking behavior (HSB) of an indigenous tribal community in Northeast India. Methods Within a concurrent triangulation design, the combined results from 7 focus group discussions and 19 in-depth interviews, and the 109 interviews of mothers from a community-based survey were interpreted in a complementary manner. The qualitative data were analyzed using a conceptual framework adapted from the socio-ecological and three-delays model, using a priori thematic coding. Multivariable logistic regression was carried out to identify factors associated with home delivery. Results Only 3.7% of the interviewed mothers received the four recommended antenatal check-ups in health centers, and 40.1% delivered at home. Mothers residing in the villages without a health center or one that was not operational were more likely to deliver at home. HSB was influenced significantly by available finances, the mother's education, low self-esteem, and a strong belief in traditional medicine favored by its availability and religious affiliation. The community sought health services in facilities only in emergency situations, determined primarily by the tribe's poor perception of the quality of health services provided in the irregularly open centers, locally available traditional medicine practitioners, and challenges in geographical access. National schemes intended to incentivize access to facilities failed to impact this community due to flawed program implementation that did not consider this region's cultural, social, and geographical differences. Conclusion The health-seeking behavior of the tribe is a complex, interrelated, and interdependent process framed in a medical pluralistic context. The utilization of health centers and HSBs of indigenous communities may improve when policymakers adopt a "bottom-up approach," addressing structural barriers, tailoring programs to be culturally appropriate, and guaranteeing that the perceived needs of indigenous communities are met before national objectives.
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Affiliation(s)
- Ángela León Cáceres
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Tropical Herping, Quito, Ecuador
| | | | | | | | - Andreas Deckert
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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A cross-sectional study of the role of men and the knowledge of danger signs during pregnancy in southern Mozambique. BMC Pregnancy Childbirth 2020; 20:572. [PMID: 32993554 PMCID: PMC7526108 DOI: 10.1186/s12884-020-03265-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background The role of the male partner and wider family in maternal health, especially in case of emergencies, has been receiving increasing attention over the last decade. Qualitative research has highlighted that women depend on others to access high quality maternity care. Currently little is known about these factors in relation to maternal health in Mozambique. Methods A cross sectional household survey was conducted with men and women in southern Mozambique about decision making, financial support and knowledge of danger signs. A multivariable logistic model was used to identify factors associated with knowledge of danger signs and Cohen’s kappa for agreement among couples. Results A total of 775 men and women from Marracuene and Manhica districts were interviewed. Maternal health care decisions were frequently made jointly by the couple (32–49%) and financial support was mainly provided by the man (46–80%). Parental and parent-in-law involvement in decision making and financial support was minimal (0–3%). The average number of danger signs respondents knew was 2.05 and no significant difference (p = 0.294) was found between men and women. Communication with the partner was a significant predictor for higher knowledge of danger signs for both men (p = 0.01) and women (p = 0.03). There was very low agreement within couples regarding decision making (p = 0.04), financial support (p = 0.01) and presence at antenatal care consultations (p = 0.001). Results suggest women and men have a high willingness for more male participation in antenatal care, although their understanding of what constitutes this participation is not clear. Conclusion The study findings highlight the important role men play in decision making and financial support for maternal health care issues. Strengthening male involvement in antenatal care services, by investing in counselling and receiving couples, could help accelerate gains in maternal health in Mozambique. Maternal health care studies should collect more data from men directly as men and women often report different views and behavior regarding maternal health care issues and male involvement.
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Sevene E, Sharma S, Munguambe K, Sacoor C, Vala A, Macuacua S, Boene H, Mark Ansermino J, Augusto O, Bique C, Bone J, Dunsmuir DT, Lee T, Li J, Macete E, Singer J, Wong H, Nathan HL, Payne BA, Sidat M, Shennan AH, Tchavana C, Tu DK, Vidler M, Bhutta ZA, Magee LA, von Dadelszen P. Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:96-105. [PMID: 32464527 PMCID: PMC7471842 DOI: 10.1016/j.preghy.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Pregnancy hypertension is the third leading cause of maternal mortality in Mozambique and contributes significantly to fetal and neonatal mortality. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Mozambique Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 administrative posts (clusters) in Maputo and Gaza Provinces. The CLIP intervention (6 clusters) consisted of community engagement, community health worker-provided mobile health-guided clinical assessment, initial treatment, and referral to facility either urgently (<4hrs) or non-urgently (<24hrs), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of CLIP contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS 15,013 women (15,123 pregnancies) were recruited in intervention (N = 7930; 2·0% loss to follow-up (LTFU)) and control (N = 7190; 2·8% LTFU) clusters. The primary outcome did not differ between intervention and control clusters (adjusted odds ratio (aOR) 1·31, 95% confidence interval (CI) [0·70, 2·48]; p = 0·40). Compared with intervention arm women without CLIP contacts, those with ≥8 contacts experienced fewer primary outcomes (aOR 0·79 (95% CI 0·63, 0·99); p = 0·041), primarily due to improved maternal outcomes (aOR 0·72 (95% CI 0·53, 0·97); p = 0·033). INTERPRETATION As generally implemented, the CLIP intervention did not improve pregnancy outcomes; community implementation of the WHO eight contact model may be beneficial. FUNDING The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337).
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Affiliation(s)
- Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique.
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Salésio Macuacua
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Direcção Provincial de Saúde, Ministério da Saúde, Av. Eduardo Mondlane n(o) 1008, CP 264 Maputo, Mozambique
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - J Mark Ansermino
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Cassimo Bique
- Departamento de Ginecologia e Obstetrícia, Hospital Central de Maputo, Av. Agostinho Neto n(o) 167, CP 1164 Maputo, Mozambique
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Dustin T Dunsmuir
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Distrito de Marracuene, Estrada Nacional N(o) 1, Maputo, Mozambique
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Corssino Tchavana
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
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Llop-Gironés A, Julià M, Chicumbe S, Dulá J, Odallah AAP, Alvarez F, Zahinos I, Mazive E, Benach J. Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey. Int J Qual Health Care 2020; 31:577-582. [PMID: 30388229 DOI: 10.1093/intqhc/mzy218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/16/2018] [Accepted: 10/15/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the inequalities in the access to and quality of care and its related direct payments. DESIGN Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS). SETTING Nationally-representative sample of households in Mozambique. PARTICIPANTS 11 480 households (58 118 individuals) interviewed during HBS 2014/15. INTERVENTION None. MAIN OUTCOME MEASURES Equity, utilization of healthcare, access to quality care and direct payments. RESULTS About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the individuals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit. CONCLUSIONS This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Mireia Julià
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Sergio Chicumbe
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Janeth Dulá
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Anita Aunda Pedro Odallah
- Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique, Salvador Allende Avenue 702, 257
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique, Avenue 24 de Julho 1989, 493
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid
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11
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Gashaw BT, Schei B, Solbraekke KN, Magnus JH. Ethiopian Health Care Workers' Insights into and Responses to Intimate Partner Violence in Pregnancy-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103745. [PMID: 32466276 PMCID: PMC7277814 DOI: 10.3390/ijerph17103745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy.
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Affiliation(s)
- Bosena Tebeje Gashaw
- College of Health Sciences, Jimma University, 1355 Jimma, Ethiopia
- Faculty of Medicine, University of Oslo, 0316 Oslo, Norway;
- Correspondence:
| | - Berit Schei
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, University of Science and Technology, N-7489 Trondheim, Norway;
- Department of Obstetrics and Gynaecology, St. Olav’s Hospital, 7030 Trondheim University Hospital, N-7489 Trondheim, Norway
| | | | - Jeanette H. Magnus
- Faculty of Medicine, University of Oslo, 0316 Oslo, Norway;
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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12
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Daniele MAS, Martinez-Alvarez M, Etyang AK, Vidler M, Salisbury T, Makanga PT, Musitia P, Flint-O'Kane M, Brown TW, Diallo BA, Boene H, Stones W, von Dadelszen P, Magee LA, Sandall J. The contribution of qualitative research within the PRECISE study in sub-Saharan Africa. Reprod Health 2020; 17:58. [PMID: 32354359 PMCID: PMC7191675 DOI: 10.1186/s12978-020-0875-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as "placental disorders") in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE's objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally.We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health.
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Affiliation(s)
- Marina A S Daniele
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Angela Koech Etyang
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Marianne Vidler
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tatiana Salisbury
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Prestige Tatenda Makanga
- Department of Surveying and Geomatics, Faculty of Science and Technology, Midlands State University, Gweru, Zimbabwe
| | - Peris Musitia
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Meriel Flint-O'Kane
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Wells Brown
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Brahima Amara Diallo
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo Province, Mozambique
| | - William Stones
- Department of Public Health and Department of Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
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13
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Tura HT, Story WT, Licoze A. Community-based savings groups, women's agency, and maternal health service utilisation: Evidence from Mozambique. Glob Public Health 2020; 15:1119-1129. [PMID: 32274971 DOI: 10.1080/17441692.2020.1751232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study, using data collected as part of an ongoing programme evaluation, investigates whether participation in Saving Groups (SGs)-a community-owned microfinance intervention focused on poor households - is associated with maternal health service utilisation, and whether this association is mediated by women's agency - as measured by self-efficacy and decision-making autonomy. We compared maternal health service utilisation among SG members (n=105) and non-members (n=100) in rural Mozambique. We estimated prevalence ratios for SG membership and women's agency using Poisson regression while controlling for confounding factors. We also estimated mediation effects for women's agency. The results showed that SG membership is associated with four or more antenatal care (ANC) visits, skilled birth attendant (SBA) use, and postnatal care within 48 h of delivery. Self-efficacy mediated the relationship between SG membership and ANC vists and SBAuse, but not postnatal care; whereas women's decision-making autonomy mediated the relationship with SBA use and postnatal care, but not ANC visits. This study suggests that the impact of SG membership on use of maternal health services goes beyond improvements in household income and may operate through women's agency by giving women the ability to realize their preference for quality health care.
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Affiliation(s)
- Halkeno T Tura
- Department of Community and Behavioural Health, College of Public Health, University of Iowa, Iowa City, USA
| | - William T Story
- Department of Community and Behavioural Health, College of Public Health, University of Iowa, Iowa City, USA
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14
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Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study. BMC Pregnancy Childbirth 2019; 19:384. [PMID: 31660898 PMCID: PMC6819364 DOI: 10.1186/s12884-019-2530-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 09/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique. METHODS Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. RESULTS Results show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. CONCLUSION A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.
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Agampodi T, Agampodi S, Glozier N, Wms C, Ypjn W, Siribaddana S. How context matters: Demonstrating microgeographical differences in social capital and its implications for mental wellbeing in pregnancy with a novel bubble diagram technique. Health Place 2019; 60:102231. [PMID: 31629193 DOI: 10.1016/j.healthplace.2019.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022]
Abstract
There has been limited exploration of social capital at the contextual level in relation to maternal health, and in particular with the "obstetric transition" and associated mental health problems. In the North Central Province of Sri Lanka, with socio-culturally diverse communities, and a recent history of major conflict, the leading cause of maternal death is suicide. The objective of this study was to identify contextual patterns of social capital constructs that lead to poor maternal mental wellbeing, using a novel bubble visualisation technique, to demonstrate the use of data derived from qualitative approaches. We conducted a qualitative study of pregnant women based on diary entries (n = 41) and interviews (n = 38) in eight different communities of the Anuradhapura district of Sri Lanka. Bubble diagrams were constructed to visualize each context using the frequency and weight of responses given in diaries. Marital, family and neighbourhood cohesion were not homogenous in the district and the bubble diagrams displayed clear microgeographical patterns in which women living in specific communities had poorer mental wellbeing. Such techniques can be used to convey complex social capital implications in digestible way for policy makers and planners to enact locally specific strategies addressing health inequalities.
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Affiliation(s)
- Thilini Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka.
| | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Nicholas Glozier
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sri Lanka
| | - Chithrani Wms
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Warnasekara Ypjn
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Sri Lanka
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16
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Ruiz-Cantero MT, Guijarro-Garvi M, Bean DR, Martínez-Riera JR, Fernández-Sáez J. Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries. Health Place 2019; 57:313-320. [PMID: 31146194 PMCID: PMC6873917 DOI: 10.1016/j.healthplace.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/16/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance-a political determinant scarcely explored in the literature-in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality-which persists despite economic development-all governance dimensions are essential and represent interdependent cornerstones.
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Affiliation(s)
| | - Marta Guijarro-Garvi
- Public Health Research Group, University of Alicante, Spain; Department of Economics, University of Cantabria, Spain.
| | - Donna Rose Bean
- School of Nursing & Health Studies, University of Miami, USA.
| | | | - José Fernández-Sáez
- Public Health Research Group, University of Alicante, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i, Gurina (IDIAPJGol), Spain.
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17
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Adedokun ST, Uthman OA. Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live? BMC Pregnancy Childbirth 2019; 19:93. [PMID: 30866841 PMCID: PMC6416870 DOI: 10.1186/s12884-019-2242-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Health facility delivery has been described as one of the major contributors to improved maternal and child health outcomes. In sub-Saharan Africa where 66% of the global maternal mortality occurred, only 56% of all births take place in health facility. This study examined the individual and contextual predictors of non-use of health service for delivery in Nigeria where less than 40% births occur in health facility. METHODS Data from 2013 Nigeria Demographic and Health Survey (DHS) involving 20,192 women who had delivery within 5 years of the survey were used in the study. Multilevel multivariable logistics regression models which had the structure of non-use of health service for delivery defined at individual, community and state levels were applied in the analysis. Spatial analysis was also used to capture the locations where the phenomenon is prevalent in the country. RESULTS About 62% of the women did not utilize health service during delivery. More than three-quarter of those with no education and 92% of those who did not attend antenatal clinic during pregnancy never utilized health service for delivery. The odds of non-use of health service during delivery increased for women who had no education, from poor households, aged 25-34 years, unmarried, never attended antenatal clinic, experienced difficulty getting to health facility and lived in the most socioeconomically disadvantaged communities and states. CONCLUSIONS This study has demonstrated that non-utilization of health service for delivery is influenced by individual, community and state level factors, with substantial proportions of women not utilizing such service residing in the northern region of Nigeria. Each level should be adequately considered in the design of the appropriate interventions.
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Affiliation(s)
- Sulaimon T. Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan A. Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Makanga PT, Sacoor C, Schuurman N, Lee T, Vilanculo FC, Munguambe K, Boene H, Ukah UV, Vidler M, Magee LA, Sevene E, von Dadelszen P, Firoz T. Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study. BMJ Open 2019; 9:e024042. [PMID: 30782892 PMCID: PMC6367983 DOI: 10.1136/bmjopen-2018-024042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique. DESIGN Retrospective cohort study. Choice of variables informed by literature and Delphi consensus. SETTING Study conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers. PARTICIPANTS A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12-49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies. PRIMARY AND SECONDARY OUTCOME MEASURES A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies. RESULTS A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71. CONCLUSIONS The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration. TRIAL REGISTRATION NUMBER NCT01911494.
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Affiliation(s)
- Prestige Tatenda Makanga
- Surveying and Geomatics Department, Midlands State University Faculty of Science and Technology, Gweru, Midlands, Zimbabwe
| | | | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tang Lee
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Khatia Munguambe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Helena Boene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Esperanca Sevene
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Kings College London, London, London, UK
| | - Tabassum Firoz
- Department of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
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Hobday K, Hulme J, Homer C, Zualo Wate P, Belton S, Prata N. "My job is to get pregnant women to the hospital": a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique. Reprod Health 2018; 15:174. [PMID: 30326927 PMCID: PMC6192310 DOI: 10.1186/s12978-018-0622-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage. Methods This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30–70 and women of reproductive age participated in the study. Data was collected between June–October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11). Results The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births. Conclusions This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication.
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Affiliation(s)
- Karen Hobday
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Jennifer Hulme
- Department of Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Honorary Fellow, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Maternal and Child Health Program, Burnet Institute, Melbourne, Australia
| | - Páscoa Zualo Wate
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Suzanne Belton
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, USA
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Percival V, Dusabe-Richards E, Wurie H, Namakula J, Ssali S, Theobald S. Are health systems interventions gender blind? examining health system reconstruction in conflict affected states. Global Health 2018; 14:90. [PMID: 30157887 PMCID: PMC6116483 DOI: 10.1186/s12992-018-0401-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women's health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. METHODS This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. FINDINGS Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. CONCLUSION The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies.
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Affiliation(s)
- Valerie Percival
- International Affairs, Norman Paterson School of International Affairs, Carleton University, 5319 Richcraft Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | | | - Haja Wurie
- ReBUILD Research Consortium, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Justine Namakula
- ReBUILD Consortium, School of Public Health, Makerere University, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender Studies, ReBUILD consortium, Makerere University, Kampala, Uganda
| | - Sally Theobald
- Social Science and International Health, ReBUILD and RinGs Consortium, Liverpool School of Tropical Medicine, Liverpool, UK
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Ukah UV, Mbofana F, Rocha BM, Loquiha O, Mudenyanga C, Usta M, Urso M, Drebit S, Magee LA, von Dadelszen P. Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique. Hypertension 2017; 69:469-474. [PMID: 28137987 DOI: 10.1161/hypertensionaha.116.08547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/17/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
In well-resourced settings, reduced circulating maternal-free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when preeclampsia is suspected. This blinded, prospective cohort study of maternal plasma PlGF in women with suspected preeclampsia was conducted in antenatal clinics in Maputo, Mozambique. The primary outcome was the clinic-to-delivery interval. Other outcomes included: confirmed diagnosis of preeclampsia, transfer to higher care, mode of delivery, intrauterine fetal death, preterm birth, and low birth weight. Of 696 women, 95 (13.6%) and 601 (86.4%) women had either low (<100 pg/mL) or normal (≥100 pg/mL) plasma PlGF, respectively. The clinic-to-delivery interval was shorter in low PlGF, compared with normal PlGF, women (median 24 days [interquartile range, 10-49] versus 44 [24-81], P=0.0042). Also, low PlGF was associated with a confirmed diagnosis of preeclampsia, higher blood pressure, transfer for higher care, earlier gestational age delivery, delivery within 7 and 14 days, preterm birth, cesarean delivery, lower birth weight, and perinatal loss. In urban Mozambican women with symptoms or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, whether the diagnosis of preeclampsia is confirmed. Therefore, PlGF should improve the provision of precision medicine to individual women and improve pregnancy outcomes for those with preeclampsia or related placenta-mediated complications.
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Affiliation(s)
- U Vivian Ukah
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Francisco Mbofana
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Beatriz Manriquez Rocha
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Osvaldo Loquiha
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Chishamiso Mudenyanga
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Momade Usta
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Marilena Urso
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Sharla Drebit
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Laura A Magee
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.)
| | - Peter von Dadelszen
- From the Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada (U.V.U., S.D.); National Department of Public Health, Ministry of Health, Maputo, Mozambique (F.M.); Maternal, Newborn, + Child Health, Clinton Health Access Initiative, Maputo, Mozambique (B.M.R., C.M.); Faculty of Sciences, Mathematics and Informatics Department, Eduardo Mondlane University, Maputo, Mozambique (O.L.); Department of Obstetrics and Gynaecology, Hospital Geral José Macamo, Maputo, Mozambique (M.U.); PMTCT Technical Program, Centre for Collaboration in Health (CCS), Maputo, Mozambique (M.U.); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, United Kingdom (L.A.M., P.v.D.); and Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (L.A.M., P.v.D.).
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von Dadelszen P, Magee LA. Strategies to reduce the global burden of direct maternal deaths. Obstet Med 2017; 10:5-9. [PMID: 28491124 DOI: 10.1177/1753495x16686287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality; by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader's attention on health advocacy and its central role in altering the risks that many of the world's women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today's girls who will be the women delivering their babies in 2030.
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Affiliation(s)
- Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Laura A Magee
- Molecular and Clinical Sciences Research Institute, St George's, University of London, UK.,Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
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Kinney MV, Smith JM, Doherty T, Hermida J, Daniels K, Belizán JM. Feasibility of community level interventions for pre-eclampsia: perspectives, knowledge and task-sharing from Nigeria, Mozambique, Pakistan and India. Reprod Health 2016; 13:125. [PMID: 27716335 PMCID: PMC5045640 DOI: 10.1186/s12978-016-0245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 01/14/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia and eclampsia, remain one of the leading causes of maternal mortality and are contributory in many foetal/newborn deaths. This editorial discusses a supplement of seven papers which provide the results of the first round of the CLIP (Community Level Interventions for Pre-eclampsia) Feasibility Studies. These studies report a number of enablers and barriers in each setting, which have informed the implementation of a cluster-randomized trial (cRCT) aimed at reducing pre-eclampsia-related, and all-cause, maternal and perinatal mortality and major morbidity using community-based identification and treatment of pre-eclampsia in selected geographies of Nigeria, Mozambique, Pakistan and India. This supplement unpacks the diverse community perspectives on determinants of maternal health, variant health worker knowledge and routine management of HDP, and viability of task sharing for preeclampsia identification and management in select settings. These studies demonstrate the need for strategies to improve health worker knowledge and routine management of HDP and consideration of expanding the role of community health workers to reach the most remote women and families with health education and access to health services.
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Affiliation(s)
| | | | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jorge Hermida
- Center for Human Services, University Research Company, Bethesda, USA
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - José M. Belizán
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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