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Belay DM, Erku D, Bayih WA, Kassie YT, Minuye Birhane B, Assefa Y. Improving the quality of neonatal health care in Ethiopia: a systematic review. Front Med (Lausanne) 2024; 11:1293473. [PMID: 38841585 PMCID: PMC11150606 DOI: 10.3389/fmed.2024.1293473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. Methods We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Results We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. Conclusions This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.
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Affiliation(s)
- Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Erku
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Wubet Alebachew Bayih
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Umar N, Hill Z, Schellenberg J, Sambo NU, Shuaibu A, Aliyu AM, Kulani KK, Abdullahi MU, Usman A, Mohammed H, Adamu H, Ibrahim M, Mohammed A, Abdulhamid A, Muhammed Z, Alfayo A, Marchant T. Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment. BMJ Glob Health 2023; 8:e013498. [PMID: 38148109 PMCID: PMC10753731 DOI: 10.1136/bmjgh-2023-013498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has accelerated the use of mobile phones to provide primary health care services and maintain continuity of care. This study aims to understand rural women's preferences for telephone call engagement with primary health care providers in Nigeria. METHODS A discrete choice experiment was conducted alongside an action research project that empowered primary health care workers to develop and implement a telephone call intervention to assess and enhance experiences with facility childbirth care. Between January and March 2022, 30 providers from 10 primary health care facilities implemented the choice experiment among rural women who had institutional childbirth to elicit service user preferences for telephone call engagement. The women were asked to express their preferred scenario for telephone call engagement with their primary health care providers. Generalised linear mixed models were used to estimate women's preferences. RESULTS Data for 460 women were available for the discrete choice experiment. The study showed that rural women have preferences for telephone call engagement with primary health care providers. Specifically, women preferred engaging with female to male callers (β=1.665 (95% CI 1.41, 1.93), SE=0.13, p<0.001), preferred call duration under 15 min (β=1.287 (95% CI 0.61, 1.96), SE=0.34, p<0.001) and preferred being notified before the telephone engagement (warm calling) (β=1.828 (95% CI 1.10, 2.56), SE=0.37, p<0.001). Phone credit incentive was also a statistically significant predictor of women's preferences for engagement. However, neither the availability of scheduling options, the period of the day or the day of the week predicts women's preferences. CONCLUSIONS The study highlights the importance of understanding rural women's preferences for telephone call engagement with healthcare providers in low-income and middle-income countries. These findings can inform the development of mobile phone-based interventions and improve acceptability and broader adoption.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Abdulrahman Shuaibu
- Office of the Executive Secretary, State Primary Health Care Development Agency, Gombe, Nigeria
| | | | | | | | - Ahmed Usman
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hafsat Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hajara Adamu
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Maryam Ibrahim
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adamu Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adama Abdulhamid
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Zainab Muhammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Afodiya Alfayo
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Gupta N, Cookson SR. Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data. Healthcare (Basel) 2023; 11:2854. [PMID: 37957999 PMCID: PMC10650143 DOI: 10.3390/healthcare11212854] [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: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada
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Wuneh AD, Bezabih AM, Okwaraji YB, Persson LÅ, Medhanyie AA. Wealth and Education Inequities in Maternal and Child Health Services Utilization in Rural Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5421. [PMID: 35564817 PMCID: PMC9099508 DOI: 10.3390/ijerph19095421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022]
Abstract
As part of the 2030 maternal and child health targets, Ethiopia strives for universal and equitable use of health services. We aimed to examine the association between household wealth, maternal education, and the interplay between these in utilization of maternal and child health services. Data emanating from the evaluation of the Optimizing of Health Extension Program intervention. Women in the reproductive age of 15 to 49 years and children aged 12-23 months were included in the study. We used logistic regression with marginal effects to examine the association between household wealth, women's educational level, four or more antenatal care visits, skilled assistance at delivery, and full immunization of children. Further, we analyzed the interactions between household wealth and education on these outcomes. Household wealth was positively associated with skilled assistance at delivery and full child immunization. Women's education had a positive association only with skilled assistance at delivery. Educated women had skilled attendance at delivery, especially in the better-off households. Our results show the importance of poverty alleviation and girls' education for universal health coverage.
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Affiliation(s)
- Alem Desta Wuneh
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Yemisrach Behailu Okwaraji
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Lars Åke Persson
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
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Willey B, Umar N, Beaumont E, Allen E, Anyanti J, Bello AB, Bhattacharya A, Exley J, Makowiecka K, Okolo M, Sani R, Schellenberg J, Spicer N, Usman UA, Gana AM, Shuaibu A, Marchant T. Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study. BMJ Open 2022; 12:e048877. [PMID: 35105566 PMCID: PMC8808391 DOI: 10.1136/bmjopen-2021-048877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING Gombe state, Northeast Nigeria. PARTICIPANTS Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES Eighteen indicators of maternal and newborn healthcare. RESULTS Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings.
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Affiliation(s)
- Barbara Willey
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nasir Umar
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Beaumont
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Neil Spicer
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ahmed Mohammed Gana
- Office of the Honourable Commissioner for Health (and former Executive Secretary GSPCDA), Gombe State Ministry, Gombe, Nigeria
| | - Abdulrahman Shuaibu
- Office of the Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
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Avan BI, Berhanu D, Mekonnen Y, Beaumont E, Tomlin K, Allen E, Schellenberg J. Embedding Community-Based Newborn Care in the Ethiopian health system: lessons from a 4-year programme evaluation. Health Policy Plan 2021; 36:i22-i32. [PMID: 34849897 PMCID: PMC8633669 DOI: 10.1093/heapol/czab085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
Despite remarkable gains, improving neonatal survival globally remains slow paced. Innovative service-delivery packages have been developed for community health workers (CHWs) to maximize system efficiency and increase the reach of services. However, embedding these in health systems needs structural and procedural alignment. The Community-Based Newborn Care (CBNC) programme was a response to high neonatal mortality in Ethiopia. Key aspects include simplified treatment for neonatal illness, integrated outreach services and task-shifting. Using the CHW functionality model by WHO, this study evaluates the health system response to the programme, including quality of care. A before-and-after study was conducted with three survey time points: baseline (November 2013), midline (December 2015) and follow-up (December 2017-4 years after the programme started). Data were collected at a sample of primary healthcare facilities from 101 districts across four regions. Analysis took two perspectives: (1) health system response, through supplies, infrastructure support and supervision, assessed through interviews and observations at health facilities and (2) quality of care, through CHWs' theoretical capacity to deliver services, as well as their performance, assessed through functional health literacy and direct observation of young infant case management. Results showed gains in services for young infants, with antibiotics and job aids available at over 90% of health centres. However, services at health posts remained inadequate in 2017. In terms of quality of care, only 37% of CHWs correctly diagnosed key conditions in sick young infants at midline. CHWs' functional health literacy declined by over 70% in basic aspects of case management during the study. Although the frequency of quarterly supportive supervision visits was above 80% during 2013-2017, visits lacked support for managing sick young infants. Infrastructure and resources improved over the course of the CBNC programme implementation. However, embedding and scaling up the programme lacked the systems-thinking and attention to health system building-blocks needed to optimize service delivery.
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Affiliation(s)
- Bilal Iqbal Avan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Della Berhanu
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Postal code 1242, Ethiopia
| | | | - Emma Beaumont
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Keith Tomlin
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
| | - Joanna Schellenberg
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1 7HT, UK
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Sociodemographic Inequalities in Health Insurance Ownership among Women in Selected Francophone Countries in Sub-Saharan Africa. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6516202. [PMID: 34458369 PMCID: PMC8387175 DOI: 10.1155/2021/6516202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/24/2021] [Accepted: 08/06/2021] [Indexed: 12/11/2022]
Abstract
In sub-Saharan Africa, improving equitable access to healthcare remains a major challenge for public health systems. Health policymakers encourage the adoption of health insurance schemes to promote universal healthcare. Nonetheless, progress towards this goal remains suboptimal due to inequalities health insurance ownership especially among women. In this study, we aimed to explore the sociodemographic factors contributing to health insurance ownership among women in selected francophone countries in sub-Saharan Africa. Methods. This study is based on cross-sectional data obtained from Demographic and Health Surveys on five countries including Benin (n = 13,407), Madagascar (n = 12,448), Mali (n = 10,326), Niger (n = 12,558), and Togo (n = 6,979). The explanatory factors included participant age, marital status, type of residency, education, household wealth quantile, employment stats, and access to electronic media. Associations between health insurance ownership and the explanatory factors were analyzed using multivariate regression analysis, and effect sizes were reported in terms in average marginal effects (AMEs). Results. The highest percentage of insurance ownership was observed for Togo (3.31%), followed by Madagascar (2.23%) and Mali (2.2%). After stratifying by place of residency, the percentages were found to be significantly lower in the rural areas for all countries, with the most noticeable difference observed for Niger (7.73% in urban vs. 0.54% in rural women). Higher levels of education and wealth quantile were positively associated with insurance ownership in all five countries. In the pooled sample, women in the higher education category had higher likelihood of having an insurance: Benin (AME = 1.18; 95% CI = 1.10, 1.27), Madagascar (AME = 1.10; 95% CI = 1.05, 1.15), Mali (AME = 1.14; 95% CI = 1.04, 1.24), Niger (AME = 1.13; 95% CI = 1.07, 1.21), and Togo (AME = 1.17; 95% CI = 1.09, 1.26). Regarding wealth status, women from the households in the highest wealth quantile had 4% higher likelihood of having insurance in Benin and Mali and 6% higher likelihood in Madagascar and Togo. Conclusions. Percentage of women who reported having health insurance was noticeably low in all five countries. As indicated by the multivariate analyses, the actual situation is likely to be even worse due to significant socioeconomic inequalities in the distribution of women having an insurance plan. Increasing women's access to healthcare is an urgent priority for population health promotion in these countries, and therefore, addressing the entrenched sociodemographic disparities should be given urgent policy attention in an effort to strengthen universal healthcare-related goals.
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Berhanu D, Allen E, Beaumont E, Tomlin K, Taddesse N, Dinsa G, Mekonnen Y, Hailu H, Balliet M, Lensink N, Schellenberg J, Avan BI. Coverage of antenatal, intrapartum, and newborn care in 104 districts of Ethiopia: A before and after study four years after the launch of the national Community-Based Newborn Care programme. PLoS One 2021; 16:e0251706. [PMID: 34351944 PMCID: PMC8341496 DOI: 10.1371/journal.pone.0251706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Access to health services across the continuum of care improves maternal and newborn health outcomes. Ethiopia launched the Community-Based Newborn Care programme in 2013 to increase the coverage of antenatal care, institutional delivery, postnatal care and newborn care. The programme also introduced gentamicin and amoxicillin treatment by health extension workers for young infants with possible serious bacterial infection when referral was not possible. This study aimed to assess the extent to which the coverage of health services for mothers and their young infants increased after the initiation of the programme. METHODS A baseline survey was conducted in October-December 2013 and a follow-up survey four years later in November-December 2017. At baseline, 10,224 households and 1,016 women who had a live birth in the 3-15 months prior to the survey were included. In the follow-up survey, 10,270 households and 1,057 women with a recent live birth were included. Women were asked about their experience of care during pregnancy, delivery and postpartum periods, as well as the treatment provided for their child's illness in the first 59 days of life. RESULTS Between baseline and follow-up surveys the proportion of women reporting at least one antenatal care visit increased by 15 percentage points (95% CI: 10,19), four or more antenatal care visits increased by 17 percentage points (95%CI: 13,22), and institutional delivery increased by 40 percentage points (95% CI: 35,44). In contrast, the proportion of newborns with a postnatal care visit within 48 hours of birth decreased by 6 percentage points (95% CI: -10, -3) for home deliveries and by 14 percentage points (95% CI: -21, -7) for facility deliveries. The proportion of mothers reporting that their young infant with possible serious bacterial infection received amoxicillin for seven days increased by 50 percentage points (95% CI: 37,62) and gentamicin for seven days increased by 15 percentage points (95% CI: 5,25). Concurrent use of both antibiotics increased by 12 percentage points (95% CI: 4,19). CONCLUSION The Community-Based Newborn Care programme was an ambitious initiative to enhance the access to services for pregnant women and newborns. Major improvements were seen for the number of antenatal care visits and institutional delivery, while postnatal care remained alarmingly low. Antibiotic treatment for young infants with possible serious bacterial infection increased, although most treatment did not follow national guidelines. Improving postnatal care coverage and using a simplified antibiotic regimen following recent World Health Organization guidelines could address gaps in the care provided for sick young infants.
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Affiliation(s)
- Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Beaumont
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Keith Tomlin
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
| | | | - Girmaye Dinsa
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
- Department of Public Health and Health Policy, College of Health and Medical Sciences Haramaya University, Ethiopia
| | | | | | - Manuela Balliet
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bilal Iqbal Avan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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9
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Peven K, Mallick L, Taylor C, Bick D, Day LT, Kadzem L, Purssell E. Equity in newborn care, evidence from national surveys in low- and middle-income countries. Int J Equity Health 2021; 20:132. [PMID: 34090427 PMCID: PMC8178885 DOI: 10.1186/s12939-021-01452-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia. METHODS We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health. RESULTS Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births. CONCLUSION This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
- Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK.
| | - Lindsay Mallick
- University of Maryland, College Park, MD, USA
- Avenir Health, Glastonbury, CT, USA
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise T Day
- Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
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10
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Exley J, Hanson C, Umar N, Willey B, Shuaibu A, Marchant T. Provision of essential evidence-based interventions during facility-based childbirth: cross-sectional observations of births in northeast Nigeria. BMJ Open 2020; 10:e037625. [PMID: 33099494 PMCID: PMC7590366 DOI: 10.1136/bmjopen-2020-037625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To measure the provision of evidence-based preventive and promotive interventions to women, and subsequently their newborns, during childbirth in a high-mortality setting. DESIGN AND PARTICIPANTS Cross-sectional observations of care provided to women, and their newborns during the intrapartum and immediate postpartum period using a standardised checklist capturing healthcare worker behaviours regarding lifesaving and respectful care. SETTING Ten primary healthcare facilities in Gombe state, northeast Nigeria. The northeast region of Nigeria has some of the highest maternal and newborn death rates globally. MAIN OUTCOME MEASURES Data on 50 measures of internationally recommended evidence-based interventions and good practice. RESULTS 1875 women were admitted to a health facility during the observation period; of these, 1804 gave birth in the facility and did not experience an adverse event or death. Many clinical interventions around the time of birth were routinely implemented, including provision of uterotonic (96% (95% CI 93% to 98%)), whereas risk-assessment measures, such as history-taking or checking vital signs were rarely completed: just 2% (95% CI 2% to 7%) of women had their temperature taken and 12% (95% CI 9% to 16%) were asked about complications during the pregnancy. CONCLUSIONS The majority of women did not receive the recommended routine processes of childbirth care they and their newborns needed to benefit from their choice to deliver in a health facility. In particular, few benefited from even basic risk assessments, leading to missed opportunities to identify risks. To continue with the recommendation of childbirth care in primary healthcare facilities in high mortality settings like Gombe, it is crucial that birth attendant capacity, capability and prioritisation processes are addressed.
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Affiliation(s)
- Josephine Exley
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Nasir Umar
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Barbara Willey
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdulrahman Shuaibu
- The Executive Secretary, Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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