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Feng Y, Maimaitiming M, Shi J, Wang M, Li N, Jin Y, Zheng ZJ. Inequity of maternal-child health services in ASEAN member states from 1993 to 2021. Int J Equity Health 2023; 22:149. [PMID: 37550702 PMCID: PMC10408145 DOI: 10.1186/s12939-023-01974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Inequity in maternal-child health services is a challenge to global health as it hinders the achievement of Sustainable Development Goals (SDGs) and Universal Health Coverage. Though the Association of Southeast Asian Nations (ASEAN) has made remarkable achievements in maternal-child health, there remain gaps in reaching global goals. This study aimed to compare and investigate the inequity in maternal-child health (MCH) services in ASEAN member states to help guide policy decisions to improve equitable health services in the SDG era and beyond. METHODS Using the WHO Health Inequality Monitor, we identified inequity summary measures for five MCH services in ASEAN member states from 1993 to 2021: antenatal care, births attended by skilled health personnel, diphtheria, tetanus and pertussis (DTP3) immunization, measles immunization, and polio immunization. We divided the analysis dimension of inequity into urban-rural inequity, economic status inequity, and sub-regional inequity. Trends of absolute and relative inequity in every dimension of MCH services in ASEAN member states were examined with the principal component analysis (PCA). RESULTS The mean coverages of MCH services are 98.80% (Thailand), 86.72% (Cambodia), 84.54% (Viet Nam), 78.52 (Indonesia), 76.94% (Timor-Leste), 72.40% (Lao PDR), 68.10% (Philippines) and 48.52% (Myanmar) in 2021. Thailand have the lowest MCH services absolute inequity indexes of -1.945, followed by Vietnam (-1.449). Lao PDR and Myanmar have relatively higher MCH services absolute inequity indexes of 0.852 and 0.054 respectively. The service in Cambodia, Indonesia, and the Philippines is pro-specific regions (with subnational region absolute inequity indexes of -0.02, 0.01, and 1.01 respectively). The service in Myanmar is pro-rich (with economic status absolute inequity index of 0.43). The service in Lao PDR and Timor-Leste is pro-urban areas, pro-rich, and pro-specific regions. CONCLUSION The inequity of MCH services in ASEAN persists but is in a declining trend. Thailand and Vietnam have performed well in ensuring MCH services equity, while Laos and Myanmar are still facing serious inequity dilemmas. The progress of MCH service equity in Myanmar, Cambodia, the Philippines, and Indonesia is uneven. It is acceptable to learn from the successful experiences of Thailand and Vietnam to improve the equities in other ASEAN countries. Policies should be developed according to the specific types of MCH inequity in member states to improve equity levels.
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Affiliation(s)
- Yikai Feng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Minmin Wang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Dovel K, Kalande P, Udedi E, Bruns L, Desmond C, Mbalanga C, Gupta S, Phiri S, Chivwala M, Richter L, Coates TJ. Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi-An Endline Evaluation. AIDS Behav 2023:10.1007/s10461-022-03975-0. [PMID: 36746875 DOI: 10.1007/s10461-022-03975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers' retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.
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Affiliation(s)
- Kathryn Dovel
- Partners in Hope, Implementation Science, Lilongwe, Malawi.
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | | | - Evelyn Udedi
- University of California Global Health Institute, San Francisco, CA, USA
| | - Laurie Bruns
- University of California Global Health Institute, San Francisco, CA, USA
| | | | | | - Sundeep Gupta
- Partners in Hope, Implementation Science, Lilongwe, Malawi
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Sam Phiri
- Partners in Hope, Implementation Science, Lilongwe, Malawi
| | | | - Linda Richter
- University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- University of California Global Health Institute, San Francisco, CA, USA
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Dennis CL, Prioreschi A, Brown HK, Brennenstuhl S, Bell RC, Atkinson S, Misita D, Marini F, Carsley S, Jiwani-Ebrahim N, Birken C. Medical, behavioural and social preconception and interconception risk factors among pregnancy planning and recently pregnant Canadian women. Fam Med Community Health 2022; 10:fmch-2021-001175. [PMID: 36113893 PMCID: PMC9486295 DOI: 10.1136/fmch-2021-001175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women. DESIGN Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors. Prevalence of each risk factor and the total number of risk factors present was calculated. Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors. Exploratory factor analysis determined how risk factors clustered, and Spearman's r determined how demographic characteristics related to risk factors within each cluster. SETTING Canada. PARTICIPANTS Participants were recruited via advertisements on public health websites, social media, parenting webpages and referrals from ongoing studies or existing research datasets. Women were eligible to participate if they could read and understand English, were able to access a telephone or the internet, and were either planning a first pregnancy (preconception) or had ≥1 child in the past 5 years and were thus in the interconception period. RESULTS Most women (n=1080) were 34 or older, and were in the interconception period (98%). Most reported risks in only one of the 12 possible risk factor categories (55%), but women reported on average 4 risks each. Common risks were a history of caesarean section (33.1%), miscarriage (27.2%) and high birth weight (13.5%). Just over 40% had fair or poor eating habits, and nearly half were not getting enough physical activity. Three-quarters had a body mass index indicating overweight or obesity. Those without a postsecondary degree (OR 2.35; 95% CI 1.74 to 3.17) and single women (OR 2.22, 95% CI 1.25 to 3.96) had over twice the odds of having more risk factors. Those with two children or more had 60% lower odds of having more risk factors (OR 0.68, 95% CI 0.52 to 0.86). Low education and being born outside Canada were correlated with the greatest number of risk clusters. CONCLUSIONS Many of the common risk factors were behavioural and thus preventable. Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health & Society, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Dragana Misita
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Flavia Marini
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sarah Carsley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Catherine Birken
- Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Anderson ACT, Richards A, Delucchi K, Khalili M. Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011-2016: results from a national survey. BMC Health Serv Res 2022; 22:516. [PMID: 35436953 PMCID: PMC9016947 DOI: 10.1186/s12913-022-07902-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/04/2022] [Indexed: 01/05/2023] Open
Abstract
Background Hepatitis B virus birth dose (HepB-BD) vaccination is recommended to reduce mother to infant transmission. We evaluated the HepB-BD status of women who gave birth between 2011 and 2016 (N = 3,583) using the 2015–2016 Myanmar Demographic and Health Survey. Methods Frequency distributions of HepB-BD vaccination across maternal and health system factors, concentration indices, and logistic regression models were used to estimate coverage, inequity, and factors associated with vaccination. Results The majority of participants were younger than 30 years of age, lived in rural areas, and were multiparous. Almost all received antenatal care (ANC), but only 43% received recommended ANC services, and 60% gave birth at home. The overall HepB-BD coverage rate was 26%. Vaccination coverage was higher in urban areas and was inequitably concentrated among children of more educated and wealthier women. HepB-BD coverage was also positively associated with receipt of ANC at non-governmental facilities, and delivery at a facility, skilled provider at birth and Cesarean delivery. After adjusting for sociodemographic and health system factors, receipt of the HepB-BD was positively associated with weekly media exposure, receipt of recommended ANC, and Cesarean delivery, and inversely associated with home delivery. Conclusions Both socioeconomic and health systems factors influenced suboptimal and inequitable vaccination coverage. Improved access to quality ANC and delivery services may increase HepB-BD coverage although targeted approaches to reach home births are likely required to achieve national goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07902-w.
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Affiliation(s)
- August C T Anderson
- School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Adam Richards
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Washington, DC, NW, 20052, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Mandana Khalili
- Department of Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Building 5, Suite 3D4, San Francisco, CA, 94110, USA.
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Morioka H, Watanabe H, Iwasa T, Kagami S, Irahara M. Prospects for maternal and child health in Japan. J Med Invest 2022; 69:159-164. [PMID: 36244764 DOI: 10.2152/jmi.69.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In Japan, outcome measures for maternal and child health measures such as maternal, perinatal, and infant mortality have consistently shown a trend toward improvement. On the other hand, the problems of the declining birth rate, child abuse, and domestic violence have become evident since the 1990s. In terms of Japan's maternal and child health, it is necessary to take measures to preserve mental health of mothers and children, and also to respond to family issues such as abuse and violence. The services needed such as comprehensive support centers for families with children and new postpartum care programs have been established. It is necessary to further improve the competence of doctors, public health nurses, and midwives working in the maternal and child health field and to promptly construct a cooperation system in the community. J. Med. Invest. 69 : 159-164, August, 2022.
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Affiliation(s)
- Hisayoshi Morioka
- Department of Public Health, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiroyoshi Watanabe
- Department of Pediatrics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shoji Kagami
- Department of Pediatrics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Nugroho HSW, Notobroto HB, Rosyanti L. Acceptance Model of a Mandatory Health Information System in Indonesia. Healthc Inform Res 2021; 27:127-136. [PMID: 34015878 PMCID: PMC8137876 DOI: 10.4258/hir.2021.27.2.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The purpose of this study was to develop a model of acceptance of the Mother and Child Health Information System in the Ngawi Regency Health Office, Indonesia based on the technology acceptance model, by integrating organizational support and personal characteristics as external variables and enjoyment as an intervening variable. Methods The design of this study was cross-sectional. The subjects of this study were 217 village midwives who had operated the Maternal and Child Health Information System in the Ngawi Regency Health Office, Indonesia. The variables studied were perceived organizational support, personal characteristics, perceived ease of use, perceived usefulness, perceived enjoyment, behavioral intention, and actual system use. Data were collected through questionnaires, and then analyzed using structural equation modeling. Results In terms of the total effect, the most meaningful factor affecting actual system use was perceived organizational support (0.766), followed in descending order by behavioral intention to use (0.344), perceived enjoyment (0.238), personal characteristics (0.118), perceived usefulness (0.054), and perceived ease of use (0.048). Conclusions In the acceptance model of the Mother and Child Health Information System in Ngawi Regency, perceived organizational support was the main determinant of actual system use, while enjoyment was the main intermediate determinant of the indirect effects of perceived organizational support and personal characteristics on actual system use.
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Affiliation(s)
| | | | - Lilin Rosyanti
- Department of Nursing, Poltekkes Kemenkes Kendari, Kendari, Indonesia
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7
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Damayanti NA, Setijanto D, Hargono A, Wulandari RD, Santi MW, Tjahjono B, Ramadhani A. Integrated Information System for Early Detection of Maternal Risk Factors Based on Continuum of Care Approach of Mother and Toddler Cohorts. Healthc Inform Res 2019; 25:153-160. [PMID: 31406607 PMCID: PMC6689509 DOI: 10.4258/hir.2019.25.3.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/16/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study is to demonstrate how an integrated information system of mother and toddler cohorts can be developed as a basis of the continuum of care approach that subsequently can be used as the basis of early detection of risk factors of maternal mortality. Methods This research was carried out qualitatively. The data was collected through three techniques: in-depth interviews, focus group discussion, and document studies at six public health centers located in four sub-districts of Surabaya, Indonesia. This research was conducted from 2016 to 2018. Results The data collected from this research has become a basis input data requirement analysis for an integrated mother and toddler cohort information system. The system accommodates all the variables in each period of pre-marriage, pregnancy, labor, infancy and toddlerhood. The system facilitates healthcare workers to retrieve data and information related to mother and toddler health status. Conclusions The availability of various pieces of information enables the health status of mothers and toddlers to be monitored thoroughly throughout their long-life cycle. This continuum of care approach is beneficial in the early detection and management of risk factors of maternal mortality, such as pregnancy complications as well as childbirth and postpartum complications.
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Affiliation(s)
| | | | - Arief Hargono
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | | | - Maya Weka Santi
- Health Department, State Polytechnic of Jember, Jember, Indonesia
| | - Benny Tjahjono
- Centre for Business in Society, Coventry University, Coventry, UK
| | - Aulia Ramadhani
- Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Agricola E, Gesualdo F, Alimenti L, Pandolfi E, Carloni E, D'Ambrosio A, Russo L, Campagna I, Ferretti B, Tozzi AE. Knowledge attitude and practice toward pertussis vaccination during pregnancy among pregnant and postpartum Italian women. Hum Vaccin Immunother 2017; 12:1982-1988. [PMID: 27712242 DOI: 10.1080/21645515.2016.1188242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In Italy, no specific recommendation toward maternal pertussis immunization during pregnancy has been issued. However, vaccination during pregnancy will be likely integrated in the Italian immunization program in the future. In order to identify barriers to achieving a sufficient vaccination coverage during pregnancy, we investigated knowledge, attitude and practice toward pertussis vaccination during pregnancy through a web-based survey. A total of 343 Italian pregnant women (N = 164) and women in the postpartum period (N = 183) completed the online questionnaire. More than a half of the study population was uncertain regarding the benefits of the vaccination during pregnancy. Only 1.7% of women in the postpartum had received the vaccination during pregnancy, and 21% of pregnant women declared the intention to be vaccinated in pregnancy. Only 34% would accept the vaccination in the current or in a future pregnancy, if recommended by a physician, and a half would remain uncertain. Perceiving the vaccine as harmful for the fetus' development is associated to a decreased willingness to be vaccinated if recommended by a HCP, both in pregnant women (OR 0.25 p = 0.010 95% CI 0.09-0.72) and in women in the postpartum period (OR 0.32 p = 0.006 95% CI 0.15-0.72). Our study suggests that the vaccination recommendation by physicians might not be sufficient to adequately raise vaccination coverage against pertussis among Italian pregnant women. A combination of educational interventions and tailored communi-cation campaigns could be implemented to promote maternal immunization.
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Affiliation(s)
- Eleonora Agricola
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Francesco Gesualdo
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Lia Alimenti
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Elisabetta Pandolfi
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Emanuela Carloni
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Angelo D'Ambrosio
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Luisa Russo
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Ilaria Campagna
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Beatrice Ferretti
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
| | - Alberto E Tozzi
- a Multifactorial Disease and Complex Phenotypes, Bambino Gesù Children Hospital IRCCS , Rome , Italy
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Moravcsik-Kornyicki Á, Kósa Z, Gyulai A, Jávorné Erdei R, Kósa K. [Regional inequalities of health status of pregnant women in Hungary - Long-term series analysis]. Orv Hetil 2017; 158:1131-1142. [PMID: 28714334 DOI: 10.1556/650.2017.30799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monitoring the health status of populations is essential for good health policy decisions. This is particularly true in maternal and child health where targeted and timely interventions may have long-term consequences. AIM Our objective was to describe changes in the health status of pregnant women at the national and county level during the period of 1997-2012. METHOD Data were extracted from the mandatory annual reports of district nurses responsible for primary maternal care. Information on the smoking status of expecting mothers, special care during pregnancy, pregnant women entering into maternity care after 28 weeks of pregnancy, borne woman without district nurse care were analysed using Microsoft Excel and STATA 13.0. RESULTS The mean prevalence of smoking was 13.8% among pregnant women during the investigation period. The ratio of smoking pregnant women was higher (p<0.01) in Borsod-Abaúj-Zemplén, Nógrád, Heves, Szabolcs-Szatmár-Bereg, and Somogy counties. The ratio of pregnants requiring special care was higher (p<0.01) than the national average in Somogy, Szabolcs-Szatmár-Bereg, Borsod-Abaúj-Zemplén and Nógrád counties. More, than 1% of the pregnant women entered into care only after the 28th week of the pregnancy. Women who were registered by district nurses and gave birth less than 1% did not participate in pregnant nursing. CONCLUSION National data hide significant regional disparities within the country which should be amended by targeted interventions, taking into account the large regional inequalities in the country. Orv Hetil. 2017; 158(29): 1131-1142.
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Affiliation(s)
- Ágota Moravcsik-Kornyicki
- Egészségtudományi Intézet, Védőnői Módszertani és Népegészségtani Tanszék, Debreceni Egyetem, Egészségügyi Kar Nyíregyháza, Sóstói út 2-4., 4400
| | - Zsigmond Kósa
- Egészségtudományi Intézet, Védőnői Módszertani és Népegészségtani Tanszék, Debreceni Egyetem, Egészségügyi Kar Nyíregyháza, Sóstói út 2-4., 4400
| | - Anikó Gyulai
- Egészségtudományi Intézet, Védőnői Módszertani és Népegészségtani Tanszék, Debreceni Egyetem, Egészségügyi Kar Nyíregyháza, Sóstói út 2-4., 4400
| | - Renáta Jávorné Erdei
- Egészségtudományi Intézet, Védőnői Módszertani és Népegészségtani Tanszék, Debreceni Egyetem, Egészségügyi Kar Nyíregyháza, Sóstói út 2-4., 4400
| | - Karolina Kósa
- Magatartástudományi Intézet, Debreceni Egyetem, Népegészségügyi Kar Debrecen
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Al-Nuaimi N, Katende G, Arulappan J. Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries. Sultan Qaboos Univ Med J 2017; 17:e155-e161. [PMID: 28690886 DOI: 10.18295/squmj.2016.17.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/06/2017] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
Abstract
Optimal breastfeeding practices entail the early initiation of breastfeeding soon after delivery of the baby, exclusive breastfeeding for the first six months of life and the continuation of breastfeeding complemented by solid food up until two years of age. Breastfeeding has wide-ranging health benefits for both the mother and her child; however, many factors contribute to low rates of exclusive breastfeeding. This article highlights the benefits of optimal breastfeeding as well as trends and determinants associated with breastfeeding both worldwide and in Gulf Cooperation Council (GCC) countries. Strategies to optimise breastfeeding and overcome breastfeeding barriers in the GCC region are recommended, including community health and education programmes and 'baby-friendly' hospital initiatives. Advocates of breastfeeding are needed at the national, community and family levels. In addition, more systematic research should be conducted to examine breastfeeding practices and the best strategies to promote breastfeeding in this region.
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Affiliation(s)
- Nisreen Al-Nuaimi
- Department of Maternal & Child Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Godfrey Katende
- Department of Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Judie Arulappan
- Department of Maternal & Child Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Ntambue AM, Malonga FK, Cowgill KD, Dramaix-Wilmet M, Donnen P. Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011. BMC Pregnancy Childbirth 2017; 17:40. [PMID: 28103822 DOI: 10.1186/s12884-017-1224-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi. Methods This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards. Results The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one. In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities. Conclusion Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1224-9) contains supplementary material, which is available to authorized users.
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Abstract
BACKGROUND Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome). METHODS Data came from the "Birth in Brazil" survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI. RESULTS Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome. CONCLUSIONS The chance of being breastfed in the first hour after birth in Baby-Friendly hospitals was twice as high as at non-accredited hospitals, which shows the importance of this initiative for timely initiation of breastfeeding.
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Affiliation(s)
- Márcia Lazaro de Carvalho
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 806 – Manguinhos, Rio de Janeiro, CEP 21041-210 Brazil
| | - Cristiano Siqueira Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Av. Brasil, 4.365 - Pavilhão Haity Moussatché - Manguinhos, Rio de Janeiro, CEP: 21040-900 Brazil
| | - Maria Inês Couto de Oliveira
- Departament of Epidemiology and Biostatistics. Institute of Public Health, Fluminense Federal University, Rua Marques de Paraná, n° 303, anexo, 3° andar, Centro, Niterói, Rio de Janeiro, CEP: 24033-900 Brazil
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 806 – Manguinhos, Rio de Janeiro, CEP 21041-210 Brazil
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