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Biswas B, Kumar N, Rahaman MM, Das S, Hoque MA. Socioeconomic inequality and urban-rural disparity of antenatal care visits in Bangladesh: A trend and decomposition analysis. PLoS One 2024; 19:e0301106. [PMID: 38527067 PMCID: PMC10962795 DOI: 10.1371/journal.pone.0301106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Socioeconomic inequality in antenatal care visits is a great concern in developing countries including Bangladesh; however, there is a scarcity of investigation to assess the factors of inequality and these changes over time. In this study, we investigated the trend of socioeconomic inequalities (2004-2017) in 1+ANC and 4+ANC visits, and extracted determinants contributions to the observed inequalities and urban-rural disparities in Bangladesh over the period from 2011 to 2017. METHODS The data from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 2004, 2007, 2011 and 2017 were analyzed in this study. The analysis began with exploratory and bivariate analysis, followed by the application of logistic regression models. To measure the inequalities, the Erreygers concentration index was used, and regression-based decomposition analyses were utilized to unravel the determinant's contribution to the observed inequalities. The Blinder-Oaxaca type decomposition is also used to decompose the urban-rural disparity into the factors. RESULTS Our analysis results showed that the prevalence of 1+ANC and 4+ANC visits has increased across all the determinants, although the rate of 4+ANC visits remains notably low. The magnitudes of socioeconomic inequality in 4+ANC visits represented an irregular pattern at both the national and urban levels, whereas it increased gradually in rural Bangladesh. However, inequalities in 1+ANC visits declined substantially after 2011 across the national, rural and urban areas of Bangladesh. Decomposition analyses have suggested that wealth status, women's education, place of residence (only for 4+ANC visits), caesarean delivery, husband education, and watching television (TV) are the main determinants to attribute and changes in the level of inequality and urban-rural disparity between the years 2011 and 2017. CONCLUSIONS According to the findings of our study, it is imperative for authorities to ensure antenatal care visits are more accessible for rural and underprivileged women. Additionally, should focus on delivering high-quality education, ensuring the completion of education, reducing income disparity as well as launching a program to enhance awareness about health facilities, and the impact of caesarean delivery.
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Affiliation(s)
- Biplab Biswas
- Faculty of Science, Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
- Faculty of Science, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Nishith Kumar
- Faculty of Science, Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Md. Matiur Rahaman
- Faculty of Science, Department of Statistics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Sukanta Das
- Faculty of Science, Department of Statistics, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Aminul Hoque
- Faculty of Science, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Khatri RB, Assefa Y, Durham J. Multidomain and multilevel strategies to improve equity in maternal and newborn health services in Nepal: perspectives of health managers and policymakers. Int J Equity Health 2023; 22:105. [PMID: 37237251 DOI: 10.1186/s12939-023-01905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Nepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal. METHODS Twenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke's thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework. RESULTS Participants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems. CONCLUSIONS Multidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country's federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Jo Durham
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Basargekar P. Achieving MDG of reducing maternal mortality ratio: A comparative study of selected South Asian countries. Health Care Women Int 2023; 44:111-125. [PMID: 35830495 DOI: 10.1080/07399332.2021.1916822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reducing the maternal mortality ratio (MMR) by three quarters by 2015 was one of the major Millennium Development Goals (MDGs). I performed a comparative study of policy tools and outcomes for reducing the MMR in five major South Asian Countries-Bangladesh, India, Nepal, Pakistan, and Sri Lanka. I observed that countries with a greater focus on achieving gender parity and equal health access and having specific healthcare policies to promote maternal care were more successful in achieving the MDG of reducing the MMR. Thus, any healthcare policy targeting women should also consider gender parity and women empowerment policies of a country.
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Affiliation(s)
- Prema Basargekar
- Department of Economics, K J Somaiya Institute of Management, Mumbai, India
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Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M. Maternal and perinatal death surveillance and response: a systematic review of qualitative studies. Bull World Health Organ 2023; 101:62-75G. [PMID: 36593778 PMCID: PMC9795385 DOI: 10.2471/blt.22.288703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To understand the experiences and perceptions of people implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries, and the mechanisms by which this process can achieve its intended outcomes. Methods In June 2022, we systematically searched seven databases for qualitative studies of stakeholders implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries. Two reviewers independently screened articles and assessed their quality. We used thematic synthesis to derive descriptive themes and a realist approach to understand the context-mechanism-outcome configurations. Findings Fifty-nine studies met the inclusion criteria. Good outcomes (improved quality of care or reduced mortality) were underpinned by a functional action cycle. Mechanisms for effective death surveillance and response included learning, vigilance and implementation of recommendations which motivated further engagement. The key context to enable effective death surveillance and response was a blame-free learning environment with good leadership. Inadequate outcomes (lack of improvement in care and mortality and discontinuation of death surveillance and response) resulted from a vicious cycle of under-reporting, inaccurate data, and inadequate review and recommendations, which led to demotivation and disengagement. Some harmful outcomes were reported, such as inappropriate referrals and worsened staff shortages, which resulted from a fear of negative consequences, including blame, disciplinary action or litigation. Conclusion Conditions needed for effective maternal and/or perinatal death surveillance and response include: separation of the process from litigation and disciplinary procedures; comprehensive guidelines and training; adequate resources to implement recommendations; and supportive supervision to enable safe learning.
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Affiliation(s)
- Merlin L Willcox
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Immaculate A Okello
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Alice Maidwell-Smith
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close, SouthamptonSO16 5SE, England
| | - Abera K Tura
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, England
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Nabyonga-Orem J, Asamani JA. Evolution of health sector strategic planning in Tanzania: What have we learnt and how can we improve? Int J Health Plann Manage 2022; 38:662-678. [PMID: 36536481 DOI: 10.1002/hpm.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/26/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Progressive realization of Universal Health Coverage is inevitable given resource constraints. The incremental approach must be reflected in health sector strategic plans which serve as roadmaps. Using a matrix based on the health systems building blocks to extract data, we reviewed three successive sector strategies to assess priority issues addressed. We undertook a thematic synthesis to draw lessons and conclusion reported in this paper. Our review shows good practice as well as areas desiring attention if health sector strategic plans are to serve the intended purpose. Although all strategies were aligned to global and national development aspirations, were developed in a participatory manner they did not reflect the required incremental approach. The challenges to be addressed and the priorities remained largely the same over a 15-year period. The strategies and key results areas to be implemented in the different strategies were numerous with funding gaps. Improving the utility of strategic plans requires improving both the process and content. Implied in this approach is the need for prioritised and affordable strategic plans that reflect incremental efforts to attaining long term targets coupled with strong trend analysis and monitoring. Additionally, we advocate for strategic plan with a longer timeframe perhaps 10 years with adjustments at regular intervals.
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Affiliation(s)
- Juliet Nabyonga-Orem
- World Health Organization, Inter-Country Support Team for Eastern & Southern Africa, UHC Life Course cluster, Harare, Zimbabwe.,Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - James Avoka Asamani
- World Health Organization, Inter-Country Support Team for Eastern & Southern Africa, UHC Life Course cluster, Harare, Zimbabwe.,Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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A stakeholder group assessment of interactions between child health and the sustainable development goals in Cambodia. COMMUNICATIONS MEDICINE 2022; 2:68. [PMID: 35721832 PMCID: PMC9203784 DOI: 10.1038/s43856-022-00135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Background With the implementation of the Sustainable Development Goals, a systematic assessment of how the goals influence child health and vice versa has been lacking. We aimed to contribute to such an assessment by investigating the interactions between child health and the Sustainable Development Goals in Cambodia. Methods Based on the SDG Synergies approach, 272 interactions between 16 Cambodian Sustainable Development Goals and child health were evaluated by an interdisciplinary Cambodian stakeholder group. From this a cross-impact matrix was derived and network analysis applied to determine first and second-order effects of the interactions with a focus on child health. Results We show that with the exception of Cambodian Sustainable Development Goal 15 (life on land) the interactions are perceived to be synergistic between the child health and the Cambodian Sustainable Development Goals, and progress on Cambodian Sustainable Development Goal 16 (peace, justice and strong institutions) could have the largest potential to contribute to the achievement of the Cambodian Sustainable Development Goals, both when it comes to first and second-order interactions. Conclusions In this stakeholder assessment, our findings provide novel insights on how complex relationships play out at the country level and highlight important synergies and trade-offs, vital for accelerating the work toward the betterment of child health and achieving the Sustainable Development Goals. The Sustainable Development Goals (SDGs) are a set of 17 global goals set by the United Nations to guide the world toward development that meets the needs of the present without compromising the ability of future generations to meet their own needs. The efforts to achieve the different SDGs are interconnected. To better understand in what way, a group with different expertize and perspectives was assembled in Cambodia to score the linkages between the SDGs and child health. This identified that most goals promote better child health and that advancements in child health also help achieve the SDGs in Cambodia. Our study provides useful knowledge and a practical approach for policy makers trying to accelerate the work toward better child health in Cambodia. Helldén et al. apply the Sustainable Development Goals (SDGs) Synergies approach to investigate interactions between SDGs and child health in Cambodia in an interdisciplinary Cambodian stakeholder group. They identify SDGs that positively influence child health and show that progress on child health also promotes the achievement of most other goals.
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Impact of Drinking Water Source and Sanitation Facility on Malnutrition Prevalence in Children under Three: A Gender-Disaggregated Analysis Using PDHS 2017-18. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111674. [PMID: 36360402 PMCID: PMC9688703 DOI: 10.3390/children9111674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The proposed research studied the determinants of male and female child malnutrition in Pakistan. More specifically, it observed the role of the sanitation facility and drinking water source as important determinants of malnutrition in a gender analysis. METHODS Novel data of 1010 children under three years of age from PDHS 2017-18 were used. A CIAF (Cumulative Index for Anthropometric Failure) was established to assess malnourishment in the children. Discrete-choice logistic methodology was applied in this empirical research to study the likelihood of malnourishment in children. RESULTS The logistic regression results depicted that factors such as a child belonging to a deprived area, the status of home wealth, and the education of the mother were common determinants of malnutrition in children. Factors such as a child having diarrhea (OR = 1.55, CI = 0.96-2.50) and the drinking water source (OR = 0.62, CI = 0.37-1.03) were separate prominent predictors of malnutrition in male children whereas the sanitation facility was the main determinant of malnutrition in female children (OR = 0.64, CI = 0.43-0.95). CONCLUSION This study concludes that important links exist between the drinking water source and male child malnutrition and between sanitation facilities and female child malnutrition.
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Socioeconomic inequalities in the continuum of care across women’s reproductive life cycle in Bangladesh. Sci Rep 2022; 12:15618. [PMID: 36114413 PMCID: PMC9481551 DOI: 10.1038/s41598-022-19888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
We examined the association between socioeconomic status (SES) and continuum of care (CoC) completion rate in maternal, neonatal, and child health among mothers in Bangladesh. We used data from the Bangladesh Demographic Health Survey (BDHS) from 2017 to 2018. Our findings were based on the responses of 1527 married women who had at least one child aged 12 to 23 months at the time of the survey. As a measure of SES, we focused on the standard of living (hereinafter referred to as wealth). The CoC for maternal and child health (MNCH) services is the study's outcome variable. The CoC was calculated using seven MNCH interventions: four or more antenatal care (ANC) visits with a skilled practitioner, delivery by a skilled birth attendant, post-natal care for mothers (PNCM) within two days of giving birth, post-natal care for newborns (PNCM) within two days of birth, immunization, age-appropriate breastfeeding, and maternal current use of modern family planning (FP) methods. Only 18.1% of Bangladeshi women completed all seven MNCH care interventions during the reproductive life span. Participants in the high SES group were 2.30 times (95% confidence interval [CI] 1.61–3.28) more likely than those in the low SES group to have higher composite care index (CCI) scores. Women with secondary or higher secondary education, as well as women who were exposed to mass media at least once a week, women who lived in an urban setting, women who had an intended pregnancy, and women with one parity, are associated with high CCI scores when other sociodemographic variables are considered. The complete CoC for MNCH reveals an extremely low completion rate, which may suggest that Bangladeshi mothers, newborns, and children are not receiving the most out of their present health care. Participants in the high SES group displayed higher CCI values than those in the low SES group, indicating that SES is one of the primary drivers of completion of CoC for MNCH services.
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Bangura MS, Zhao Y, Gonzalez Mendez MJ, Wang Y, Didier Sama S, Xu K, Ren R, Ma L, Qiao YL. Case study of cervical cancer prevention in two sub-Saharan African countries: Rwanda and Sierra Leone. Front Med (Lausanne) 2022; 9:928685. [PMID: 36186799 PMCID: PMC9521665 DOI: 10.3389/fmed.2022.928685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCervical cancer is a public health issue of global concern. It is a preventable disease but continues to threaten the lives of women, especially in developing countries in sub-Saharan Africa.MethodsWe selected two African countries in sub-Saharan Africa (the Republic of Rwanda and the Republic of Sierra Leone) to show a good example of cervical cancer prevention and constrains hindering countries from effectively implementing cervical cancer programs. Secondary data were collected from the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), the Global Burden of Cancer (GLOBOCAN), the United Nations Development Programme (UNDP), and the World Bank and from official websites of the selected countries. A descriptive analysis method was used to source data and compare variables such as the associated factors, disease burden, prevention programs, health workforce, success factors, and challenges.ResultsRwanda achieved 93.3% human papillomavirus (HPV) vaccination of the three doses vaccinating girls in class 6, as a result of effective school-based platform delivery system and community partnership to identify girls who are out of school. Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries. The country also introduced a nationwide cervical cancer screening and treatment program. An impressive decreased cervical cancer incidence rate in Rwanda in recent years was observed. Sierra Leone lags behind in terms of almost all cervical cancer prevention programs. Therefore, Sierra Leone needs more efforts to implement cervical cancer intervention programs at the national level, including HPV vaccination, and train and increase the number of health professionals, treatment, and palliative care services to accelerate cervical cancer activities.ConclusionThe disease burden of cervical cancer for Rwanda and Sierra Leone is heavy. There remains huge room for improvement in preventing and controlling cervical cancer in these countries. The goal of cervical cancer elimination would not be feasible in countries without the awareness and will of the policymakers and the public, the compliance to fund cervical cancer programs, the prioritization of cervical cancer activities, the availability of resources, the adequate health workforce and infrastructure, the cross-sectional collaboration and planning, inter-sectorial, national, regional, and international partnerships.
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Affiliation(s)
| | - Yuqian Zhao
- Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Yixuan Wang
- School of Public Health, Dalian Medical University, Dalian, China
| | - Salah Didier Sama
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kunpeng Xu
- Department of Quality Management, Dalian 3rd People's Hospital, Dalian, China
| | - Ran Ren
- School of Public Health, Dalian Medical University, Dalian, China
| | - Li Ma
- School of Public Health, Dalian Medical University, Dalian, China
- *Correspondence: Li Ma
| | - You-Lin Qiao
- School of Public Health, Dalian Medical University, Dalian, China
- School of Population Medicine and Public Health, Peking Union Medical College, Beijing, China
- You-Lin Qiao
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Vaivada T, Lassi ZS, Irfan O, Salam RA, Das JK, Oh C, Carducci B, Jain RP, Als D, Sharma N, Keats EC, Patton GC, Kruk ME, Black RE, Bhutta ZA. What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years. Lancet 2022; 399:1810-1829. [PMID: 35489360 DOI: 10.1016/s0140-6736(21)02725-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. We review the current evidence base on the effectiveness of a variety of essential and emerging interventions that can be delivered from before conception until age 20 years to help children and adolescents not only survive into adulthood, but also to grow and develop optimally, support their wellbeing, and help them reach their full developmental potential. Although scaling up evidence-based interventions in children younger than 5 years might have the greatest effect on reducing child mortality rates, we highlight interventions and evidence gaps for school-age children (5-9 years) and the transition from childhood to adolescence (10-19 years), including interventions to support mental health and positive development, and address unintentional injuries, neglected tropical diseases, and non-communicable diseases.
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Affiliation(s)
- Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zohra S Lassi
- Robinson Research Institute and Adelaide Medical School, the University of Adelaide, SA, Australia; Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Omar Irfan
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Christina Oh
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bianca Carducci
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Reena P Jain
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daina Als
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Naeha Sharma
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily C Keats
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Johns Hopkins University, MD, USA
| | - Zulfiqar A Bhutta
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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The association between institutional delivery and neonatal mortality based on the quality of maternal and newborn health system in India. Sci Rep 2022; 12:6220. [PMID: 35418654 PMCID: PMC9007995 DOI: 10.1038/s41598-022-10214-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/28/2022] [Indexed: 01/31/2023] Open
Abstract
Over 600,000 newborns in India died in their first month of life in 2017 despite large increases in access to maternal health services. We assess whether maternal and newborn health system quality in India is adequate for institutional delivery to reduce neonatal mortality. We identified recent births from the cross-sectional 2015–2016 National Family Health Survey and used reported content of antenatal care and immediate postpartum care averaged at the district level to characterize health system quality for maternity and newborn services. We used random effect logistic models to assess the relationship between institutional delivery and neonatal (death within the first 28 days of life) and early neonatal (death within 7 days of live births) mortality by quintile of district maternal and newborn health system quality. Three quarters of 191,963 births were in health facilities; 2% of newborns died within 28 days. District-level quality scores ranged from 40 to 90% of expected interventions. Institutional delivery was not protective against newborn mortality in the districts with poorest health system quality, but was associated with decreased mortality in districts with higher quality. Predicted neonatal mortality in the highest quintile of quality would be 0.018 (95% CI 0.010, 0.026) for home delivery and 0.010 (0.007, 0.013) for institutional delivery. Measurement of quality is limited by lack of data on quality of acute and referral care. Institutional delivery is associated with meaningful survival gains where quality of maternity services is higher. Addressing health system quality is an essential element of achieving the promise of increased access to maternal health services.
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Li H, Nawsherwan, Fan C, Yin S, Haq IU, Mubarik S, Nabi G, Khan S, Hua L. Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China's universal two-child policy. Sci Rep 2022; 12:5048. [PMID: 35322808 PMCID: PMC8943149 DOI: 10.1038/s41598-022-08396-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
The universal two-child policy (TCP; 2016) in China has affected many aspects of maternal-neonatal health. A tertiary hospital-based retrospective study (2011–2019) was used to find the association of these policy changes with maternal age and pregnancy outcomes in women with AMA (≥ 35 years) in the Hubei Province, China. The proportion of neonatal births to women with AMA increased by 68.8% from 12.5% in the one-child policy (OCP) period to 21.1% in the universal TCP period [aOR 1.76 (95% CI: 1.60, 1.93)]. In the univariate analysis, the proportion of preterm births (29.4% to 24.1%), low birth weight (LBW) (20.9% to 15.9%), and hypertensive disorders of pregnancy (HDP) (11.5% to 9.2%) significantly (p < 0.05) decreased in women with AMA from the OCP period to universal TCP period. However, the proportion of intrauterine growth restriction (IUGR) (0.2% to 0.7%) and gestational diabetes mellitus (GDM) (1.7% to 15.6%) was significantly (p < 0.05) increased over the policy changes. After adjusting for confounding factors, only the risk of GDM increased [aOR 10.91 (95% CI: 6.05, 19.67)] in women with AMA from the OCP period to the universal TCP period. In conclusion, the risk of GDM increased in women with AMA from the OCP period to the universal TCP period.
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Affiliation(s)
- Hui Li
- Department of Medicine, Taixing People Hospital, Taizhou, Jiangsu, China
| | - Nawsherwan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Shanshan Yin
- Henan Academy of Medical Sciences, Zhengzhou, Henan, China
| | - Ijaz Ul Haq
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland
| | - Suliman Khan
- Advanced Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Linlin Hua
- Advanced Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Sarker AR, Ali SMZ, Ahmed M, Chowdhury SMZI, Ali N. Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS One 2022; 17:e0262900. [PMID: 35073368 PMCID: PMC8786169 DOI: 10.1371/journal.pone.0262900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. Results We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. Conclusions Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.
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Affiliation(s)
| | - S. M. Zulfiqar Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | - Maruf Ahmed
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
| | | | - Nausad Ali
- Bangladesh Institute of Development Studies, Agargaon, Dhaka, Bangladesh
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Sonza A, da Cunha de Sá-Caputo D, Sartorio A, Tamini S, Seixas A, Sanudo B, Süßenbach J, Provenza MM, Xavier VL, Taiar R, Bernardo-Filho M. COVID-19 Lockdown and the Behavior Change on Physical Exercise, Pain and Psychological Well-Being: An International Multicentric Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073810. [PMID: 33917363 PMCID: PMC8038730 DOI: 10.3390/ijerph18073810] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022]
Abstract
Objective: To evaluate the impact of the COVID-19 pandemic and the following lockdown on physical exercise (PEx) practice, pain, and psychological well-being. Methods: A cross-sectional multicentric study was performed using a nonrandom convenience sampling from the general population (≥18 years-old) of 6 countries (Brazil, Italy, France, Portugal, Germany, and Spain) adopting social isolation (SI). The validated self-administered online survey (PEF-COVID19) was used. The tests T-test and Chi-square with Bonferroni correction were used for statistical analysis and a multivariate logistic regression model (p ˂ 0.05). Results: We included 3194 replies and ~80% of the respondents were in SI. Brazilian sample was highly influenced by the pandemic considering PEx practice and habits, pain, anxiety, and stress (p ˂ 0.05). Among the European countries, Italy presented the major changes. The model to predict the non-practice of PEx during SI showed that the variables countries, smoking, SI, and PEx level were significant predictors (p ˂ 0.001). Conclusion: The pandemic changed the PEx practice and habits, and the psychological well-being of populations in different manners. Countries, smoking, SI, and PEx level were predictors for the non-practice of PEx. Public health strategies are suggested to avoid sedentary lifestyles and quality of life decrease.
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Affiliation(s)
- Anelise Sonza
- Programa de Pós-Graduação em Fisioterapia e Programa de Pós-Graduação em Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina, 88085-350 Florianópolis, Brazil;
| | - Danúbia da Cunha de Sá-Caputo
- Laboratório de Vibrações Mecânicas, Policlínica Piquet Carneiro, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, 20550-900 Rio de Janeiro, Brazil; (D.d.C.d.S.-C.); (M.B.-F.)
- Faculdade Bezerra de Araújo, 23052-090 Rio de Janeiro, Brazil
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research & Division of Auxology and Metabolic Diseases, 28824 Piancavallo (VB), Italy; (A.S.); (S.T.)
| | - Sofia Tamini
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research & Division of Auxology and Metabolic Diseases, 28824 Piancavallo (VB), Italy; (A.S.); (S.T.)
| | - Adérito Seixas
- Escola Superior de Saúde, Universidade Fernando Pessoa, 4200-253 Porto, Portugal;
| | - Borja Sanudo
- Departamento de Educación Física y Deporte, Universidad de Sevilla, 41013 Seville, Spain;
| | - Jessica Süßenbach
- Institut für Bewegung, Sport und Gesundheit, Leuphana Universität Lüneburg, 78120 Lüneburg, Germany;
| | - Marcello Montillo Provenza
- Instituto de Matematica e Estatistica, Universidade do Estado do Rio de Janeiro, 20550-900 Rio de Janeiro, Brazil; (M.M.P.); (V.L.X.)
| | - Vinicius Layter Xavier
- Instituto de Matematica e Estatistica, Universidade do Estado do Rio de Janeiro, 20550-900 Rio de Janeiro, Brazil; (M.M.P.); (V.L.X.)
| | - Redha Taiar
- MATIM, Université de Reims Champagne Ardenne, 51100 Reims, France
- Correspondence:
| | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas, Policlínica Piquet Carneiro, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, 20550-900 Rio de Janeiro, Brazil; (D.d.C.d.S.-C.); (M.B.-F.)
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Chang KT, Hossain P, Sarker M, Montagu D, Chakraborty NM, Sprockett A. Translating international guidelines for use in routine maternal and neonatal healthcare quality measurement. Glob Health Action 2021; 13:1783956. [PMID: 32657252 PMCID: PMC7480423 DOI: 10.1080/16549716.2020.1783956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Improving facility-based quality for maternal and neonatal care is the key to reducing morbidity and mortality rates in low- and middle-income countries. Recent guidance from WHO and others has produced a large number of indicators to choose from to track quality. OBJECTIVE To explore how to translate complex global maternal and neonatal health standards into actionable application at the facility level. METHODS We applied a two-step process as an example of how the 352 indicators in WHO's 2016 Standards for Improving Quality of Maternal and Newborn Care in Health Facilities might be reduced to only those with the strongest evidence base, associated with outcomes, and actionable by facility managers. We applied Hill criteria and assessed whether indicators were within the control of facility managers. We next conducted a rapid review of supporting literature and applied GRADE analysis, retaining those with scores of 'moderate' or 'high'. To understand the utility and barriers to measuring this limited set of indicators in practice, we undertook a case study of hypothetical measurement application in two districts in Bangladesh, interviewing 25 clinicians, managers, and other stakeholders. RESULTS From the initial 352 indicators, 56 were retained. The 56 indicators were used as a base for interviews. Respondents emphasized the practical challenges to the use of complex guides and the need for parsimonious and actionable sets of quality indicators. CONCLUSIONS This work offers one way to move towards a reduced quality indicator set, beginning from current WHO guidance. Despite study limitations, this work provides evidence of the need for reduced and evidence-based sets of quality indicators if guides are to be used to improve quality in practice. We hope that future research will build on and refine our efforts. Measuring quality effectively so that evidence guides and improves practice is the first step to assuring safe maternal and neonatal care.
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Affiliation(s)
| | - Puspita Hossain
- James P. Grant School of Public Health, BRAC University , Dhaka, Bangladesh
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University , Dhaka, Bangladesh.,Heidelberg Institute of Global Health, University of Heidelberg , Germany
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Gora GA, Umer MF, Ojulu PO, Betaw ST, Cham AO, Gora OA, Qi X. Non-Institutional Childbirths and the Associated Socio-Demographic Factors in Gambella Regional State, Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2859. [PMID: 33799658 PMCID: PMC8001352 DOI: 10.3390/ijerph18062859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Abstract
The decades-long global efforts to reduce maternal morbidity and mortality have shown overall progress, but most developing countries are still lagging significantly. This study aimed to assess the prevalence of non-institutional childbirths in the Gambella State and to identify socio-demographic factors responsible for non-institutional utilization of available birth services by reproductive-aged mothers. A community-based cross-sectional study design was adopted using a multi-stage random sampling technique. Binary logistic regression was used to identify factors associated with the selected place of birth. EpiData version 3.1 and SPSS version 13.0 were applied for data entry and analyses. All the 657 eligible mothers recruited for this study responded to the interview. 71% of the total respondents had non-institutional childbirths (NICB), and the rest had their most recent childbirth in an institution with skilled healthcare providers' assistance. Socio-demographic factors were significantly associated with NICB. Nuer (AOR = 2.12, 95% CI: 1.23-3.63) and Majang ethnic (AOR = 1.98, 95% CI: 1.02-3.83) groups had higher rates of NICB than the rest of the study population. The prevalence of non-institutional childbirths in Gambella remained two times higher than the institutional childbirths.
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Affiliation(s)
- Gnkambo Agwa Gora
- Gambela People National Regional State Bureau of Health, Gambela People National Regional State, Gambella 5440, Ethiopia;
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Muhammad Farooq Umer
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China;
- School of Public Health, Alshifa Trust, Rawalpindi 46600, Punjab, Pakistan
| | - Peter Obang Ojulu
- Department of Education, Gambella Teacher Education and Health Science College, Gambella 5440, Ethiopia;
| | | | - Akwoma Okugn Cham
- Public Health Emergency, Gambella People National Regional State, Bureau of Health, Gambella 5440, Ethiopia;
| | - Ojulu Agwa Gora
- Disease Prevention and Control, Gambella People National Regional State, Bureau of Health, Gambella 5440, Ethiopia;
| | - Xin Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China;
- Global Health Institute, Xi’an Jiaotong University, Xi’an 710061, China
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Socio-economic status and the double burden of malnutrition in Cambodia between 2000 and 2014: overweight mothers and stunted children. Public Health Nutr 2021; 24:1806-1817. [PMID: 33632364 PMCID: PMC8094435 DOI: 10.1017/s1368980021000689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time. DESIGN We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon. PARTICIPANTS We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers. SETTING Nationally representative household survey across all regions. RESULTS SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. CONCLUSIONS Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.
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Exploring knowledge translation practices in a global health program: case study on the establishment of the Pakistan National Maternal, Neonatal, and Child Health Program. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rawal LB, Kharel C, Yadav UN, Kanda K, Biswas T, Vandelanotte C, Baral S, Abdullah AS. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study. BMJ Open 2020; 10:e040350. [PMID: 33318116 PMCID: PMC7737104 DOI: 10.1136/bmjopen-2020-040350] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal. DESIGN We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders' consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically. SETTING Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level. PARTICIPANTS We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6). RESULTS The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation. CONCLUSION Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW's capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, NSW, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
- Translational Health Research Institute (THRI) and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Australia, Sydney, New South Wales, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | | | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu 215347, China, Kunsan, China
- School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
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Brault MA, Mwinga K, Kipp AM, Kennedy SB, Maimbolwa M, Moyo P, Ngure K, Haley CA, Vermund SH. Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals? Glob Health Action 2020; 13:1732668. [PMID: 32114967 PMCID: PMC7067162 DOI: 10.1080/16549716.2020.1732668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries – Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kasonde Mwinga
- Rwanda Country Office, World Health Organization, Kigali, Rwanda (Formerly, WHO African Regional Office, Brazzaville, Congo)
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | - Margaret Maimbolwa
- Department of Nursing Sciences, University of Zambia School of Medicine, Lusaka, Zambia
| | - Precious Moyo
- Collaborative Research Program, University of Zimbabwe-University of California, San Francisco, Harare, Zimbabwe
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Connie A Haley
- Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, CT, USA
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Gbagbo FY, Nkrumah J. Implications of self-medication in pregnancy for Safe Motherhood and Sustainable Development Goal-3 in selected Ghanaian communities. PUBLIC HEALTH IN PRACTICE 2020; 1:100017. [PMID: 36101688 PMCID: PMC9461335 DOI: 10.1016/j.puhip.2020.100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives This study explored self-medication in pregnancy and its implications for achieving Safe Motherhood and Sustainable Development Goal-3 initiatives in some Ghanaian communities. Study design A facility-based cross-sectional descriptive design using mixed method approach of data collection. Methods Multi-staged simple random and purposive sampling techniques were used to select 136 pregnant women from public Antenatal Clinics in Efutu and Agona West municipalities in the Central Region of Ghana from June to August 2018. Quantitative data were collected using structured questionnaires and analyzed with Statistical Package for Social Sciences version 23.0 whilst interview guides were used to collect qualitative data via Focus Group Discussions and content analysis done. Results Self-medication in the study area is a common practice among most (88%) pregnant women of all socioeconomic backgrounds, those in the first trimester of pregnancy (68.7%) and routine Antenatal clinic attendants (69%). Religion (p = 0.003) and educational (p = 0.004) backgrounds of respondents were significantly associated with self-medication in pregnancy and motivated by reproductive intentions, availability of medicines, time factor, media advertisements and societal influences relating to beliefs, fears, expectations and perceptions. Majority (90%) of respondents had no side effects. Conclusions A nation-wide evaluation of public health education on the dangers of self-medication in pregnancy and implementation of drug regulatory policies are highly recommended in Ghana. Implications of self-medication in pregnancy for achieving Sustainable Development Goal-3 initiatives in Ghana. Facility-based, cross-sectional, descriptive and mixed method design involving 136 pregnant women attending Antenatal Clinics in Ghana from June to August, 2018. Self-medication is common among (88%) pregnant women during their first trimester (68.7%) and also among routine Antenatal clinic attendants (69%) with about 90% having no side effects. Religion (X2= 0.003) and education (X2 = 0.004) is significant.
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Carmone AE, Kalaris K, Leydon N, Sirivansanti N, Smith JM, Storey A, Malata A. Developing a Common Understanding of Networks of Care through a Scoping Study. Health Syst Reform 2020; 6:e1810921. [PMID: 33021881 DOI: 10.1080/23288604.2020.1810921] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multi-method scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low- and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.
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Affiliation(s)
- Andy E Carmone
- Clinical Sciences, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Katherine Kalaris
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Nicholas Leydon
- Global Delivery Programs, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Nicole Sirivansanti
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Jeffrey M Smith
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Address Malata
- Office of the Chancellor, Vice Chancellor, Malawi University of Science and Technology , Limbe, Malawi
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Walker ME, Tchir D, Szafron M, Anonson J. The influence of welfare spending on national immunization outcomes: A scoping review. Scand J Public Health 2020; 49:628-638. [PMID: 32880208 DOI: 10.1177/1403494820953344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: National policies influence the environments in which people live, but the ways in which these national policies influence people's health are not well understood. Welfare spending is one national policy that may influence population health. While some research indicates higher levels of welfare investment may positively influence health, mixed findings contradict this conclusion. These mixed results examining the link between welfare policies and health may be better understood by investigating the relationship between welfare spending and preventative health interventions, such as immunization. Objective: This article's purpose is to summarize the literature studying the relationship between national welfare spending and immunization outcomes. Design: This scoping review used the Joanna Briggs scoping review method. Data sources: The scoping review utilized scholarly databases and a focused gray literature search to find research articles that explored relationships between welfare spending and immunization outcomes. Review methods: Data was extracted from articles, including themes, aims, populations, years of study, methods, and findings. The articles' themes were further analyzed with a word cloud and principal component analysis to determine which themes were more likely to coincide in the literature. Results: Seven articles were included in the review. Most of these articles did not address the relationship between welfare spending or policy and immunizations directly or with rigorous methods. Conclusions: Ultimately, the results of the scoping review suggest a lack of literature regarding the relationship between welfare spending and immunization outcomes. Further research is needed to understand the impacts of national welfare spending on immunization outcomes.
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Affiliation(s)
- Mary Ellen Walker
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Devan Tchir
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - June Anonson
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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Chen P, Li M, Zhu J, Wang Y, Mu Y, Li Q, Dai L, Liu Z, Liang J, Liu H. Provincial-level outcomes of China's 'Reducing maternal mortality and eliminating neonatal tetanus' program. Sci Rep 2020; 10:13328. [PMID: 32770045 PMCID: PMC7414118 DOI: 10.1038/s41598-020-70257-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/08/2020] [Indexed: 12/04/2022] Open
Abstract
To determine whether the nationwide program ‘Reducing maternal mortality and eliminating neonatal tetanus’ contributed to the rapid decline in China’s maternal mortality ratio (MMR) and neonatal tetanus elimination by enhancing hospital delivery, we compared MMR and neonatal tetanus incidence rate (NTR) reductions by province from 2000 to 2013. The difference-in-difference method was used to analyze the program effect. Long-term effects were analyzed relative to MMR and NTR in 2000 and 2002, respectively, while short-term effects in a given year were analyzed relative to MMR and NTR in the preceding year. The national program was associated with a faster decline in MMR in the long term. The rate of decline showed an inverse ‘U’ shape from 2000 to 2013, peaking in 2009. The program had a short-term effect in MMR reduction in 2005, 2007, and 2009. The program was also associated with faster decline in NTR in the short term at some time points, but this association was not consistent and was not found in the long term. In conclusion, the program accelerated decline of MMR from 2000 to 2013 but did not clearly reduce NTR at the province level. Therefore, this targeted program worked efficiently in resource-poor areas.
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Affiliation(s)
- Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Ren Min South Road Section 3 No. 17, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Dai
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liang
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Hanming Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No. 17, Chengdu, Sichuan, China.
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Saulnier DD, Hean H, Thol D, Ir P, Hanson C, Von Schreeb J, Mölsted Alvesson H. Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia. BMJ Glob Health 2020; 5:e002272. [PMID: 32332036 PMCID: PMC7204936 DOI: 10.1136/bmjgh-2019-002272] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/27/2020] [Accepted: 03/30/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Resilient health systems have the capacity to continue providing health services to meet the community's diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system's joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system's capacity to absorb, adapt or transform as viewed through a framework on health systems resilience. METHODS Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework. RESULTS The theme 'Responsible for the status quo' reflected the community's responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding. CONCLUSIONS The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system's resilience by creating room for the community to adapt and transform when experiencing floods.
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Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hom Hean
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Dawin Thol
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Department of Preventive Medicine, Phnom Penh, Cambodia
| | - Por Ir
- Technical Bureau, National Institute of Public Health, Phnom Penh, Cambodia
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Bustreo F, Doebbler C. Universal Health Coverage: Are We Losing Our Way on Women's and Children's Health? Health Hum Rights 2019; 21:229-234. [PMID: 31885452 PMCID: PMC6927374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Flavia Bustreo
- Former Assistant Director-General for Family, Women’s and Children’s Health at the World Health Organization
| | - Curtis Doebbler
- Research Professor of Law at the University of Makeni, Sierra Leone, Visiting Professor at Webster University Geneva, Switzerland, and an attorney at the Refugee and Immigrant Center for Education and Legal Services, USA
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Haley CA, Brault MA, Mwinga K, Desta T, Ngure K, Kennedy SB, Maimbolwa M, Moyo P, Vermund SH, Kipp AM. Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health. Health Policy Plan 2019; 34:24-36. [PMID: 30698696 PMCID: PMC6479825 DOI: 10.1093/heapol/czy105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2018] [Indexed: 11/12/2022] Open
Abstract
Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Our individual case studies suggested that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. To elucidate specific components of national HGL that may have substantially influenced the pace of reductions in child mortality, we conducted a cross-country analysis of national policies and strategies pertaining to maternal, neonatal and child health (MNCH) and qualitative interviews with individuals working in MNCH in each of the four study countries. The three aspects of HGL identified in this study which most consistently contributed to the different progress towards MDG#4 among the four study countries were (1) establishing child survival as a top national priority backed by a comprehensive policy and strategy framework and sufficient human, financial and material resources; (2) bringing together donors, strategic partners, health and non-health stakeholders and beneficiaries to collaborate in strategic planning, decision-making, resource-allocation and coordination of services; and (3) maintaining accountability through a 'monitor-review-act' approach to improve MNCH. Although child mortality in sub-Saharan Africa remains high, this comparative study suggests key health leadership and governance factors that can facilitate reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
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Affiliation(s)
- Connie A Haley
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
| | - Marie A Brault
- Department of Anthropology, University of Connecticut, 354 Mansfield Road, Storrs, CT, USA
| | - Kasonde Mwinga
- World Health Organization, Regional Office for Africa, Cite du Djoue, Brazzaville, Congo
| | - Teshome Desta
- World Health Organization, Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | | | - Precious Moyo
- Collaborative Research Program, University of Zimbabwe/University of California, San Francisco, Harare, Zimbabwe
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
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Todd CS, Chowdhury Z, Mahmud Z, Islam N, Shabnam S, Parvin M, Bernholc A, Martinez A, Aktar B, Afsana K, Sanghvi T. Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: A nested cross-sectional study. PLoS Med 2019; 16:e1002927. [PMID: 31584939 PMCID: PMC6777761 DOI: 10.1371/journal.pmed.1002927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/30/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. METHODS AND FINDINGS We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42-60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32-0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19-0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15-0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11-0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers' catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use. CONCLUSIONS Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women's ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes.
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Affiliation(s)
- Catherine S. Todd
- Global Health, Population, and Nutrition, FHI 360, Durham, North Carolina, United States of America
- * E-mail:
| | | | - Zeba Mahmud
- Alive & Thrive Program Office, Dhaka, Bangladesh
| | | | | | | | - Alissa Bernholc
- Global Health, Population, and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Andres Martinez
- Global Health, Population, and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Bachera Aktar
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kaosar Afsana
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tina Sanghvi
- Alive & Thrive Headquarters Office, Washington, District of Columbia, United States of America
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Akgungor S, Alaei K, Chao WF, Harrington A, Alaei A. Correlation between human rights promotion and health protection: a cross country analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2019. [DOI: 10.1108/ijhrh-07-2018-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the correlation among health outcomes, and civil and political rights (CPR) and also economic, social and cultural rights.
Design/methodology/approach
The study uses cross-sectional data from 161 countries. The authors use health outcomes and human rights variables in the model. In order to combine dimensions of human rights, this paper uses factor analysis and obtains proxy variables that measure economic, social and cultural rights and CPR. The two proxy variables are used as independent variables to explain variations in health in a regression model. The paper then classifies countries by cluster analysis and explores the patterns of different components of human rights and health outcomes across country clusters.
Findings
The regression model demonstrates that the economic, social and cultural rights variables explain variations in all health outcomes. The relationship between CPR and health is weaker than that of the economic, social and cultural rights. Cluster analysis further reveals that despite the country’s commitment to CPR, those that highly respect economic, social and cultural rights lead to superior health outcomes. The more respect a country has for economic, social and cultural rights, the better the health outcomes for the citizens of that country.
Practical implications
National policies should consider equal emphasis on all dimensions of human rights for further improvements in health.
Originality/value
The sole promotion of CPR such as democracy and empowerment, absence of adequate support of economic, social and cultural rights such as rights to housing, education, food and work can only contribute partially to health.
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Ahmed SM, Rawal LB, Naher N, Hossain T. 'Connecting the dots' for generating a momentum for Universal Health Coverage in Bangladesh: findings from a cross-sectional descriptive study. BMJ Open 2019; 9:e024509. [PMID: 31320340 PMCID: PMC6661671 DOI: 10.1136/bmjopen-2018-024509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to 'connect the dots' for 'generating a momentum for Universal Health Coverage (UHC)' in the country. DESIGN Cross-sectional descriptive study, using document review and qualitative methods. SETTING Bangladesh, 17 UHC-related projects funded by the RF Transforming Health Systems (THS) initiative during 2010-2013. DATA Available reports of the completed and on-going UHC projects, policy documents of the government relevant to UHC, key-informant interviews and feedback from grant recipients and relevant stakeholders in the policy and practice. OUTCOME MEASURES Key policy initiatives undertaken for implementing UHC activities by the government post grants disbursement. RESULTS The RF THS grants simultaneously targeted and connected the academia, the public and non-profit development sectors and news media for awareness-building and advocacy on UHC, develop relevant policies and capacity for implementation including evidence generation. This strategy helped relevant stakeholders to come together to discuss and debate the core concepts, scopes and modalities of UHC in an attempt to reach a consensus. Additionally, experiences gained from implementation of the pilot projects helped in identifying possible entry points for initiating UHC activities in a low resource setting like Bangladesh. CONCLUSIONS During early years of UHC-related activities in Bangladesh, strategic investments of the RF THS initiative played a catalytic role in sensitising and mobilising different constituencies for concerted activities and undertaking necessary first steps. Learnings from this strategy may be of help to countries under similar conditions of 'low resource, apparent commitment, but poor governance,' on their journey towards UHC.
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Affiliation(s)
- Syed Masud Ahmed
- Centre of Excellence for Health Systems and UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Lal B Rawal
- School of Social Science and Psychology, Western Sydney University, Penrith, New South Wales, Australia
- Health Systems and Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | - Nahitun Naher
- Centre of Excellence for Health Systems and UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tarek Hossain
- Centre of Excellence for Health Systems and UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Mahumud RA, Alam K, Renzaho AMN, Sarker AR, Sultana M, Sheikh N, Rawal LB, Gow J. Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis. PLoS One 2019; 14:e0218515. [PMID: 31216352 PMCID: PMC6583970 DOI: 10.1371/journal.pone.0218515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever. MATERIALS AND METHODS A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity. RESULTS The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage. CONCLUSIONS High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Andre M. N. Renzaho
- School of Social Science and Psychology, Western Sydney University, Sydney Australia
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde Business School, Glasgow, United Kingdom
| | - Marufa Sultana
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- School of Health & Social Development, Deakin University, Melbourne, Australia
| | - Nurnabi Sheikh
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Lal B. Rawal
- School of Social Science and Psychology, Western Sydney University, Sydney Australia
| | - Jeff Gow
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Ogbuabor DC, Onwujekwe OE. Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria. Glob Health Action 2019; 11:1535031. [PMID: 30353792 PMCID: PMC6201800 DOI: 10.1080/16549716.2018.1535031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited. OBJECTIVE This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria. METHODS We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach. RESULTS The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers' adherence to claims' submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity. CONCLUSIONS Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.
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Affiliation(s)
- Daniel C Ogbuabor
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,b Department of Health Systems and Policy , Sustainable Impact Resource Agency , Enugu , Nigeria
| | - Obinna E Onwujekwe
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,c Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine , University of Nigeria Enugu Campus , Enugu , Nigeria
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Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China. J Patient Saf 2019; 16:e284-e291. [PMID: 30633065 PMCID: PMC7678668 DOI: 10.1097/pts.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Supplemental digital content is available in the text. The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.
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Kaba MW, Baesel K, Poch B, Bun S, Cerceau S, Bury L, Schwarz B, Keo O, Tung R, Cheang K, Rasanathan K. IDPoor: a poverty identification programme that enables collaboration across sectors for maternal and child health in Cambodia. BMJ 2018; 363:k4698. [PMID: 30530736 PMCID: PMC6282729 DOI: 10.1136/bmj.k4698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Mary White Kaba and colleagues describe how Cambodia’s national poverty identification system, IDPoor, has provided a nexus for different sectors’ contributions to maternal and child health among the poor
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Affiliation(s)
| | - Klaus Baesel
- Improving Maternal and Newborn Care Project, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Phnom Penh, Cambodia
| | | | - Samnang Bun
- Bureau of Health Economics and Financing, Department of Planning and Health Information, Ministry of Health, Phnom Penh, Cambodia
| | - Sabine Cerceau
- Support to the Identification of Poor Households Programme in Cambodia Project, GIZ, Phnom Penh, Cambodia
| | | | - Bastian Schwarz
- Sector Initiative Population Dynamics and Sexual and Reproductive Health and Rights, GIZ, Bonn, Germany
| | - Ouly Keo
- Department of IDPoor, Ministry of Planning, Phnom Penh, Cambodia
| | - Rathavy Tung
- National Maternal and Child Health Centre, Ministry of Health, Phnom Penh, Cambodia
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Allen E, Schellenberg J, Berhanu D, Cousens S, Marchant T. Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia. PLoS One 2018; 13:e0199937. [PMID: 30071026 PMCID: PMC6071969 DOI: 10.1371/journal.pone.0199937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts. Methods and findings Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period. Conclusions Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.
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Affiliation(s)
- Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bjegovic-Mikanovic V, Santric-Milicevic M, Cichowska A, von Krauss MK, Perfilieva G, Rebac B, Zuleta-Marin I, Dieleman M, Zwanikken P. Sustaining success: aligning the public health workforce in South-Eastern Europe with strategic public health priorities. Int J Public Health 2018; 63:651-662. [PMID: 29732515 DOI: 10.1007/s00038-018-1105-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES To map out the Public Health Workforce (PHW) involved in successful public health interventions. METHODS We did a pilot assessment of human resources involved in successful interventions addressing public health challenges in the countries of South-Eastern Europe (SEE). High-level representatives of eight countries reported about success stories through the coaching by experts. During synthesizing qualitative data, experts applied triangulation by contacting additional sources of evidence and used the framework method in data analysis. RESULTS SEE countries tailored public health priorities towards social determinants, health equalities, and prevention of non-communicable diseases. A variety of organizations participated in achieving public health success. The same applies to the wide array of professions involved in the delivery of Essential Public Health Operations (EPHOs). Key enablers of the successful work of PHW were staff capacities, competences, interdisciplinary networking, productivity, and funding. CONCLUSIONS Despite diversity across countries, successful public health interventions have similar ingredients. Although PHW is aligned with the specific public health success, a productive interface between health and other sectors is crucial for rolling-out successful interventions.
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Affiliation(s)
- Vesna Bjegovic-Mikanovic
- Faculty of Medicine, Centre School of Public Health and Management, University of Belgrade, Dr Subotica 15, 11000, Belgrade, Serbia.
| | - Milena Santric-Milicevic
- Faculty of Medicine, Centre School of Public Health and Management, University of Belgrade, Dr Subotica 15, 11000, Belgrade, Serbia
| | - Anna Cichowska
- Division of Health Systems and Public Health, Public Health Services, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Martin Krayer von Krauss
- Division of Health Systems and Public Health, Public Health Services, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Galina Perfilieva
- Division of Health Systems and Public Health, Human Resources for Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Boris Rebac
- WHO Country Office, Sarajevo, Bosnia and Herzegovina
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Self-medication practice and associated factors among pregnant women in Addis Ababa, Ethiopia. Trop Med Health 2018; 46:10. [PMID: 29743807 PMCID: PMC5928590 DOI: 10.1186/s41182-018-0091-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Self-medication which is the act of obtaining and using one or more medicines without medical supervision is a common practice among pregnant women. Unless proper caution is taken, it may result in maternal and fetal adverse outcomes. In Ethiopia, information on self-medication practice during pregnancy is scanty. Hence, this study aimed to assess self-medication practice and associated factors among pregnant women in government health centers in Addis Ababa. Methods An institution-based mixed study design using a sequential explanatory approach was employed among 617 pregnant women and nine key informants in Addis Ababa from May 8, 2017, to June 30, 2017. Multi-stage sampling technique was used to select study participants, and purposive sampling technique was used to select the key informants. The quantitative data were collected using a structured interview questionnaire and analyzed using Statistical Product and Service Solutions (SPSS) version 23.0 whereas semi-structured questionnaire was used for in-depth interviews. Binary logistic regression was used for quantitative data analysis, and thematic analysis method was used for qualitative data. Results The prevalence of self-medication practice was 26.6%. Previous medication use (Adjusted odds ratio (AOR) = 4.20, 95% CI 2.70-6.53), gestational period (AOR = 0.63, 95% CI 0.41-0.98), education on self-medication (AOR = 0.36, 95% CI 0.21-0.62), previous pregnancy and delivery related problems (AOR = 1.71, 95% CI 1.06-2.76), and knowledge about risk of self-medication (AOR = 0.64, 95% CI 0.42-0.97) were significantly associated with self-medication practice. Lack of attention and priority of program designers, absence of strategies and guidelines; weak screening mechanisms, and regulatory enforcement were cited by the key informants as contributing factors for self-medication practices. Conclusions Considerable proportion of pregnant women practiced self-medication, including medicines categorized to have high risks. Gestational period, previous medication use, education on self-medication, previous pregnancy- and delivery-related problems, and knowledge were significantly associated with self-medication practice. In addition, there are correctable gaps in program designing, screening of pregnant women, regulatory enforcement, and strategies and guidelines. Hence, necessary measures at all levels must be taken to reduce risks of self-medication during pregnancy.
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Nsibande D, Loveday M, Daniels K, Sanders D, Doherty T, Zembe W. Approaches and strategies used in the training and supervision of Health Extension Workers (HEWs) delivering integrated community case management (iCCM) of childhood illness in Ethiopia: a qualitative rapid appraisal. Afr Health Sci 2018; 18:188-197. [PMID: 29977273 PMCID: PMC6016977 DOI: 10.4314/ahs.v18i1.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Globally, preventable and treatable childhood conditions such as pneumonia, diarrhoea, malaria, malnutrition and newborn conditions still account for 75% of under-five mortality. To reduce the mortality rate from these conditions, Ethiopia launched an ambitious Health Extension Programme (HEP) in 2003. Trained Community Health Workers (CHWs), named Health Extension Workers (HEWs) were deployed to deliver a package of care which includes integrated Community Case-Management (iCCM) of common childhood diseases. Objectives This qualitative study aimed to explore approaches and strategies used in the HEW training and supervision as part of an evaluation of the Catalytic Initiative to Save a Million Lives. Method A qualitative rapid appraisal study using focus group discussions and in-depth interviews was conducted. Results Training of HEWs followed a cascaded training of trainer approach supported by implementing partners under guidance of the Ministry of Health. A comprehensive planning phase enabled good coverage of districts and consistency in training approaches. Training was complemented by on-going supportive supervision. HEW motivation was enhanced through regular review meetings and opportunities for career progression. Conclusion These findings describe a thorough approach to training and supervision of HEWs delivering iCCM in rural Ethiopia. Ongoing investments by partners will be critical for long-term sustainability.
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Affiliation(s)
- Duduzile Nsibande
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Bellville, South Africa
- School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - 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
- School of Public Health, University of Witwatersrand, South Africa
| | - Wanga Zembe
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Doherty T, Rohde S, Besada D, Kerber K, Manda S, Loveday M, Nsibande D, Daviaud E, Kinney M, Zembe W, Leon N, Rudan I, Degefie T, Sanders D. Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys. J Glob Health 2018; 6:020401. [PMID: 29309064 PMCID: PMC4854592 DOI: 10.7189/jogh.06.020401] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background To examine changes in under–5 mortality, coverage of child survival
interventions and nutritional status of children in Ethiopia between 2000
and 2011. Using the Lives Saved Tool, the impact of changes in coverage of
child survival interventions on under–5 lives saved was estimated. Methods Estimates of child mortality were generated using three Ethiopia Demographic
and Health Surveys undertaken between 2000 and 2011. Coverage indicators for
high impact child health interventions were calculated and the Lives Saved
Tool (LiST) was used to estimate child lives saved in 2011. Results The mortality rate in children younger than 5 years decreased rapidly from
218 child deaths per 1000 live births (95% confidence interval 183 to 252)
in the period 1987–1991 to 88 child deaths per 1000 live births in the
period 2007–2011 (78 to 98). The prevalence of moderate or severe
stunting in children aged 6–35 months also declined significantly.
Improvements in the coverage of interventions relevant to child survival in
rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid,
DPT3 and measles vaccination, oral rehydration solution (ORS) and
care–seeking for suspected pneumonia. The LiST analysis estimates that
there were 60 700 child deaths averted in 2011, primarily
attributable to decreases in wasting rates (18%), stunting rates (13%) and
water, sanitation and hygiene (WASH) interventions (13%). Conclusions Improvements in the nutritional status of children and increases in coverage
of high impact interventions most notably WASH and ORS have contributed to
the decline in under–5 mortality in Ethiopia. These proximal
determinants however do not fully explain the mortality reduction which is
plausibly also due to the synergistic effect of major child health and
nutrition policies and delivery strategies.
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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, Cape Town, South Africa
| | - Sarah Rohde
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Donela Besada
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kate Kerber
- Saving Newborn Lives/Save the Children, Cape Town, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Durban, South Africa
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Nsibande
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mary Kinney
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
| | - Wanga Zembe
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Teviot Place, Edinburgh, Scotland, UK
| | | | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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40
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McArthur JW, Rasmussen K, Yamey G. How many lives are at stake? Assessing 2030 sustainable development goal trajectories for maternal and child health. BMJ 2018; 360:k373. [PMID: 29449222 PMCID: PMC5813301 DOI: 10.1136/bmj.k373] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
John W McArthur, Krista Rasmussen, and Gavin Yamey examine how far countries have to go to meet the targets for maternal and child mortality and what needs to be done to help them
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Affiliation(s)
- John W McArthur
- Global Economy and Development Program, Brookings Institution, Washington, DC 20036, USA
| | - Krista Rasmussen
- Global Economy and Development Program, Brookings Institution, Washington, DC 20036, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham NC, USA
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Goldenberg RL, Saleem S, Ali S, Moore JL, Lokangako A, Tshefu A, Mwenechanya M, Chomba E, Garces A, Figueroa L, Goudar S, Kodkany B, Patel A, Esamai F, Nsyonge P, Harrison MS, Bauserman M, Bose CL, Krebs NF, Hambidge KM, Derman RJ, Hibberd PL, Liechty EA, Wallace DD, Belizan JM, Miodovnik M, Koso-Thomas M, Carlo WA, Jobe AH, McClure EM. Maternal near miss in low-resource areas. Int J Gynaecol Obstet 2017; 138:347-355. [PMID: 28513837 DOI: 10.1002/ijgo.12219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/15/2017] [Accepted: 05/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe the Global Network Near-Miss Maternal Mortality System and its application in seven sites. METHODS In a population-based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near-miss event. The WHO maternal near-miss criteria were modified for low-resource settings. The ratio of near-miss events to maternal deaths was calculated. RESULTS Among 122 707 women screened, 18 307 (15.0%) had a potential near-miss event, of whom 4866 (26.6%; 4.0% of all women) had a near-miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near-miss events to maternal deaths was 26 to 1. The most common factors involved in near-miss cases were the hematologic/coagulation system, infection, and cardiovascular system. CONCLUSION By using the Global Network Near-Miss Maternal Mortality System, large numbers of women were screened for near-miss events, including those delivering at home or a low-level maternity clinic. The 4.0% incidence of near-miss maternal mortality is similar to previously reported data. The ratio of 26 near-miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality.
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Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - Adrien Lokangako
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | - Ana Garces
- Maternal and Child Health, INCAP, Guatemala City, Guatemala
| | | | | | | | | | | | - Paul Nsyonge
- School of Medicine, Moi University, Eldoret, Kenya
| | - Margo S Harrison
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | | | - Richard J Derman
- School of Global Public Health, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Dennis D Wallace
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA
| | - Jose M Belizan
- IECS University of Buenos Aires, Buenos Aires, Argentina
| | - Menachem Miodovnik
- Perinatology and Pregnancy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Marion Koso-Thomas
- Perinatology and Pregnancy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alan H Jobe
- Department of Pediatrics, Cincinnati Hospital for Children, Cincinnati, OH, USA
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA
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Khatri RB, Dangi TP, Gautam R, Shrestha KN, Homer CSE. Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study. PLoS One 2017; 12:e0177602. [PMID: 28493987 PMCID: PMC5426683 DOI: 10.1371/journal.pone.0177602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. Methods We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Results Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. Conclusion The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.
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Affiliation(s)
| | | | - Rupesh Gautam
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Moucheraud C, Owen H, Singh NS, Ng CK, Requejo J, Lawn JE, Berman P. Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? BMC Public Health 2016; 16 Suppl 2:794. [PMID: 27633919 PMCID: PMC5025828 DOI: 10.1186/s12889-016-3401-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Methods Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). Results The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30–40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. Conclusions These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3401-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Corrina Moucheraud
- University of California Fielding School of Public Health, Los Angeles, CA, 90095, USA.
| | - Helen Owen
- Centre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Neha S Singh
- Centre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Jennifer Requejo
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Peter Berman
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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Frost L, Hinton R, Pratt BA, Murray J, Arscott-Mills S, Jack S, de Francisco A, Kuruvilla S. Using multistakeholder dialogues to assess policies, programmes and progress for women's, children's and adolescents' health. Bull World Health Organ 2016; 94:393-5. [PMID: 27147770 PMCID: PMC4850542 DOI: 10.2471/blt.16.171710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Laura Frost
- Global Health Insights, New York, United States of America (USA)
| | - Rachael Hinton
- The Partnership for Maternal, Newborn & Child Health, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Beth Anne Pratt
- Global Health Insights, New York, United States of America (USA)
| | | | | | - Susan Jack
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Andres de Francisco
- The Partnership for Maternal, Newborn & Child Health, avenue Appia 20, 1211 Geneva 27, Switzerland
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45
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Bustreo F, Gorna R, Nabarro D. Knowledge for effective action to improve the health of women, children and adolescents in the sustainable development era. Bull World Health Organ 2016; 94:310-310A. [PMID: 27147754 PMCID: PMC4850545 DOI: 10.2471/blt.16.174243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Flavia Bustreo
- Family, Women's and Children's Health, World Health Organization avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Robin Gorna
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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Kuruvilla S, Bustreo F, Kuo T, Mishra CK, Taylor K, Fogstad H, Gupta GR, Gilmore K, Temmerman M, Thomas J, Rasanathan K, Chaiban T, Mohan A, Gruending A, Schweitzer J, Dini HS, Borrazzo J, Fassil H, Gronseth L, Khosla R, Cheeseman R, Gorna R, McDougall L, Toure K, Rogers K, Dodson K, Sharma A, Seoane M, Costello A. The Global strategy for women's, children's and adolescents' health (2016-2030): a roadmap based on evidence and country experience. Bull World Health Organ 2016; 94:398-400. [PMID: 27147772 PMCID: PMC4850541 DOI: 10.2471/blt.16.170431] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/06/2016] [Accepted: 03/06/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shyama Kuruvilla
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Flavia Bustreo
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Taona Kuo
- Executive Office of the United Nations Secretary-General, Every Woman Every Child Health Team, New York, United States of America (USA)
| | - CK Mishra
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Katie Taylor
- United States Agency for International Development, Government of the United States of America, Washington, USA
| | - Helga Fogstad
- Norwegian Agency for Development Cooperation, Government of Norway, Oslo, Norway
| | | | - Kate Gilmore
- United Nations Office of the High Commissioner for Human Rights, Geneva, Switzerland
| | | | - Joe Thomas
- Partners in Population and Development, Dhaka, Bangladesh
| | | | - Ted Chaiban
- United Nations Children’s Fund, New York, USA
| | - Anshu Mohan
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Anna Gruending
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Hannah Sarah Dini
- Executive Office of the United Nations Secretary-General, Every Woman Every Child Health Team, New York, United States of America (USA)
| | - John Borrazzo
- United States Agency for International Development, Government of the United States of America, Washington, USA
| | - Hareya Fassil
- United States Agency for International Development, Government of the United States of America, Washington, USA
| | - Lars Gronseth
- Norwegian Agency for Development Cooperation, Government of Norway, Oslo, Norway
| | - Rajat Khosla
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Robin Gorna
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Lori McDougall
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Kadidiatou Toure
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Kate Rogers
- United Nations Children’s Fund, New York, USA
| | | | | | - Marta Seoane
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Anthony Costello
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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