Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia

Experiences of healthcare providers and caregivers regarding health system bottlenecks affecting child healthcare service delivery in a rural district: Empirical qualitative study

AIM

To explore the experiences of nurses and caregivers about the health system bottlenecks to the delivery of child healthcare services in a rural district in Ghana.

DESIGN

The study employed a qualitative approach using an exploratory, descriptive design.

METHODS

Collection of data was through semi-structured, face-to-face interviews with 26 participants in the Nkwanta South Municipality, Ghana. Audio recordings of interviews were transcribed verbatim and analysed qualitatively. Inductive codes generated were organised into themes and sub-themes.

RESULTS

The main health system bottlenecks that emerged were the poor state of in-patient facilities, inadequate basic logistics and persistent shortage of essential medicines needed for child healthcare delivery.

CONCLUSIONS

Health system bottlenecks have the tendency to affect the treatment and hospitalisation outcomes of sick children and eventually impact the state of child healthcare negatively. Concerted efforts by government and local authorities to remove these barriers will help to improve child health and child health outcomes.

PUBLIC CONTRIBUTION

A total of 26 participants comprising nurses and caregivers, agreed and participated in this study. Interviews with these participants were conducts either in the health facilities or in the communities where they live. Their responses contributed significantly to the content of this article.

The potent paracrine effect of umbilical cord mesenchymal stem cells mediates mitochondrial quality control to restore chemotherapy-induced damage in ovarian granulosa cells

The basic principle of chemotherapy is to attack cells with fast growth, and cancer cells are targeted by anticancer drugs because they have a faster growth rate than normal cells. High doses of anticancer drugs may cause an irreversible decline in reproductive capacity, and novel approaches for fertility preservation and/or restoration after anticancer treatment are urgently needed. Here, we provide important insights into the recovery of human reproductive cells damaged by chemotherapy. We performed a detailed screening of the cytokines of various human mesenchymal stem cells (hMSCs) to select superior MSCs. Also, we analyzed the Ovarian granulosa cell (OGC)-)-specific functions for restoring function, apoptosis, and mitochondrial functions to confirm the recovery mechanism in damaged OGCs. As a result, we demonstrated that conditioned media (CM) of Umbilical cord mesenchymal stem cells (UC-MSCs) could restore the functions of damaged OGCs primarily through antiapoptotic and antioxidant effects. Furthermore, CM changed the phenotype of damaged OGCs to an energetic status by restoring mitochondrial function and enhanced the mitochondrial metabolic activity decreased by chemotherapy. Finally, we demonstrated that the restoration of mitochondrial function in damaged OGCs was mediated through mitochondrial autophagy (mitophagy). Our findings offer new insights into the potential of stem cell-based therapy for fertility preservation and/or restoration in female cancer patients.

Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study

OBJECTIVES

To assess completeness and accuracy of the family folder in terms of capturing community-level health data.

STUDY DESIGN

A capture-recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia.

PARTICIPANTS

Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts.

PRIMARY AND SECONDARY OUTCOME MEASURES

Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively.

RESULTS

Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15-49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p<0.001), 0.73 (95% CI 0.67 to 0.88) and 0.91 (95% CI 0.85 to 0.96), respectively. However, the live births, child health service indicators and child health events were more erratically reported in the three data sources. The concordance correlation among the three sources, for live births and neonatal deaths was 0.094 (95% CI -0.232 to 0.420) and 0.092 (95% CI -0.230 to 0.423) respectively, and for the other parameters were close to 0.

CONCLUSION

The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.

Inequalities of Infant Mortality in Ethiopia

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality is still high, albeit substantial progress has been made in the last few decades. However, there is significant inequalities in infant mortalities in Ethiopia. Understanding the main sources of inequalities in infant mortalities would help identify disadvantaged groups, and develop equity-directed policies. Thus, the purpose of the study was to provide a diagnosis of inequalities of infant mortalities in Ethiopia from four dimensions of inequalities (sex, residence type, mother's education, and household wealth). (2) Methods: Data disaggregated by infant mortalities and infant mortality inequality dimensions (sex, residence type, mother's education, and household wealth) from the WHO Health Equity Monitor Database were used. Data were based on Ethiopia's Demographic and Health Surveys (EDHS) of 2000 (n = 14,072), 2005 (n = 14,500), 2011 (n = 17,817), and 2016 (n = 16,650) households. We used the WHO Health Equity Assessment Toolkit (HEAT) software to find estimates of infant mortalities along with inequality measures. (3) Results: Inequalities related to sex, residence type, mother's education, and household wealth still exist; however, differences in infant mortalities arising from residence type, mother's education, and household wealth were narrowing with the exception of sex-related inequality where male infants were markedly at a disadvantage. (4) Conclusions: Although inequalities of infant mortalities related to social groups still exist, there is a substantial sex related infant mortality inequality with disproportional deaths of male infants. Efforts directed at reducing infant mortality in Ethiopia should focus on improving the survival of male infants.

"If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility"-A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services in Northern Ethiopia

In earlier studies, we have shown that the utilization of maternal health services in rural Ethiopia was distributed in a pro-rich fashion, while the coverage of child immunization was equitably distributed. Hence, this study aimed to explore mothers' and primary healthcare workers' perceptions of inequities in maternal, newborn, and child health services in rural Ethiopia, along with the factors that could influence such differentials. A qualitative study was conducted from November to December 2019 in two rural districts in Tigray, Ethiopia. Twenty-two in-depth interviews and three focus group discussions were carried out with mothers who had given birth during the last year before the survey. We also interviewed women's development group leaders, health extension workers, and health workers. The final sample was determined based on the principle of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Two major themes emerged during the analysis that characterized the distribution of the service utilization and perceived causes of inequity. These were: (1) perceptions of the inequity in the use of maternal and child health services, and (2) perceived causes of inequity in maternal and child health service utilization. The mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service. The inequity in the maternal and child health services was linked to poverty, lack of education, lack of access, and poor-quality services. The poor, the uneducated, and women who were distant from health facilities had a low utilization rate of services. The weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children by improving access and empowering women through poverty alleviation and education.

Survival time discrepancy among under-five-year children of rural parts of Ethiopia

BACKGROUND

Ethiopia is ranked as the fifth of heavy under-five death burdened countries with the highest burden in its rural areas. This study aimed to identify the determinants of under-five deaths in rural parts of Ethiopia.

STUDY DESIGN

A population-based cross-sectional study.

METHODS

The data for this study was extracted from the 2016 Ethiopian Demographic and Health Survey. Descriptive analysis, non-parametric estimation, and Cox proportional hazards regression model were used to examine the determinants of under-five mortality.

RESULTS

A total of 7301 under-five eligible children from rural areas were involved in this survey, and 6.5% of the cases were passed away before reaching their fifth birthday. Male children's death accounted for 59.7% of the death rate in the participants. An estimated median survival time was 31 months [95% CI: 30-32]. About 83% of children's death occurred among children delivered at home. Cox proportional hazard regression model revealed that gender, delivery-place, family-size, mother's education, number of children, contraceptive use, and source of drinking water had significant effects on survival time of under-five children. Under-five mortality was significantly fewer in female children (HR  =  0.728; 95% CI: 0.606-0.875, P =  0.001), children delivered at health facilities (HR  =  0.738; 95% CI: 0.572-0.951, P =  0.019), and those from secondary and above educated mothers (HR  =  0.464; 95% CI: 0.301-0.714, P =  0.001), compared to the reference category.

CONCLUSION

Significant risk factors were associated with under-five mortality in rural areas. Delivering in health facilities, uses of contraceptives, mother's education, and improvement of infrastructures should be areas of concern to decrease under-five children's deaths.

Barriers to Maternal and Child Health Care Service Uptake in Assosa Zone, Benishangul Gumuz Region, Ethiopia: A Qualitative Study

Background

Ethiopia has reduced maternal mortality from 871 to 412 per 100,000 live births between 2000 and 2016. In 2019, under-5 mortality rates in Ethiopia were 55 deaths per 1,000 live births. Benishangul Gumuz was the second-largest region in the under-5 mortality rate (98/1,000 live births) in the country. Maternal and child health care service uptake is an important indicator of health outcomes. This study is aimed at exploring major barriers to maternal and child health care uptake in Assosa Zone.

Methods

This study was conducted in the Bambasi, Menge, and Sherkole districts of the Assosa Zone from July 17 to August 31/2019. The study explored the life experience of study participants about MCH services. The sampling technique was purposive, and data collection methods were focus group discussions, key informant interviews, and in-depth interviews. Data were analyzed thematically.

Result

The main barriers to child health care services were financial problems, lack of knowledge, preference of traditional medicines for a sick child, women having no time to care for their sick child, poor roads. poor health facility readiness, the poor economy of families, lack of ambulance, cultural and traditional beliefs, providers being male, and unprofessional behaviors which were the major barriers hindering the uptake of maternal health service utilization.

Conclusion

Poor health facility readiness, indirect costs, inaccessibility to health facilities, and cultural and traditional practices were among the major barriers to service uptake identified by this research in the study area.

Using a theory of change to develop an integrated intervention for depression, diabetes and hypertension in Zimbabwe: lessons from the Friendship Bench project

BACKGROUND

Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension care into the existing Friendship Bench in order to come up with an integrated care package for depression, hypertension and diabetes aimed at strengthening NCD care in primary health care systems in Zimbabwe.

METHOD

A theory of change workshop with 18 stakeholders from diverse backgrounds was carried out in February 2020. Participants included grandmothers working on the Friendship Bench project (n = 4), policymakers from the ministry of health (n = 2), people with lived experience for the three NCDs (n = 4), health care workers (n = 2), and traditional healers (n = 2). Findings from earlier work (situational analysis, desk review, FGDs and clinic-based surveys) on the three NCDs were shared before starting the ToC. A facilitator with previous experience running ToCs led the workshop and facilitated the co-production of the ToC map. Through an iterative process, consensus between the 18 stakeholders was reached, and a causal pathway leading to developing a framework for an intervention was formulated.

RESULTS

The ToC singled out the need to use expert clients (people with lived experience) to promote a patient-centred care approach that would leverage the existing Friendship Bench approach. In the face of COVID-19, the stakeholders further endorsed the use of existing digital platforms, notably WhatsApp, as an alternative way to reach out to clients and provide support. Leveraging existing community support groups as an entry point for people in need of NCD care was highlighted as a win-win by all stakeholders. A final framework for an NCD care package supported by Friendship Bench was presented to policymakers and accepted to be piloted in five geographical areas.

CONCLUSIONS

The ToC can be used to build consensus on how best to use using an existing intervention for common mental disorders to integrate care for diabetes and hypertension. There is a need to evaluate this new intervention through an adequately powered study.

Health Care–Seeking Behavior of Children With Acute Respiratory Infections Symptoms: Analysis of the 2012 and 2017 Indonesia Demographic and Health Surveys

Our study examined factors associated with the utilization of health services in children younger than 5 years with acute respiratory infections (ARIs) symptoms in Indonesia. Data were derived from the 2012 and 2017 Indonesia Demographic and Health Survey. Information from 1408 children younger than 5 years showing ARI symptoms in the past 2 weeks before the survey was analyzed using logistic regression analyses. Around 25% of children younger than 5 years with ARI symptoms did not receive medical care. The odds of receiving care increased in mothers from rich households. The odds reduced in children aged 2 or more years; children of mothers not assisted by trained delivery attendants; mothers attending none or <4 antenatal visits; mothers delivering at home, and mothers reporting that permission to visit health services was a problem. Efforts to improve care-seeking behavior are required. Health promotion strategies and interventions to improve access to reach community not regularly exposed to health services are important.

Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study

BACKGROUND

Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density.

OBJECTIVE

Explore barriers and facilitators for the consumption of animal source foods among 6-23 months old children from the rural communities of Northern Ethiopia.

METHODS

A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data.

RESULTS

Consumption of animal source foods among 6-23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children's diet. Lack of nutrition knowledge, high cost of animal source foods, mothers' workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities.

CONCLUSIONS

Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6-23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6-23 months old children in the rural communities of Northern Ethiopia are recommended.