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Taksande AA, Tote S, Taksande A, Javvaji CK. Knowledge, Attitudes, and Perceptions of Medical and Paramedical Students Toward Human Milk Banks and Breast Milk Donation. Cureus 2024; 16:e55145. [PMID: 38558671 PMCID: PMC10979709 DOI: 10.7759/cureus.55145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objectives Human milk benefits for both mothers and babies are widely acknowledged. Human milk banks (HMBs) are essential in providing newborns who would not otherwise have access to pasteurized and stored human milk. The objective of this research was to investigate the understanding, opinions, and outlooks of medical and paramedical students regarding breast milk donation and the concept of an HMB. Material and methods A total of 398 professional female students specializing in physiotherapy, nursing, and medicine were given an online self-administered questionnaire as part of a descriptive cross-sectional study. Data on the characteristics, HMB knowledge, awareness levels, and attitudes toward HMB and breast milk donation were to be gathered through the questionnaire. Every student's answer to the survey was kept private and confidential. Result According to the survey, 188 students (47.24%) belong to the medical college, 126 students (31.66%) belong to the physiotherapy college, and the remaining 84 students (21.11%) are from the nursing college. A total of 294 students (74.12%) had heard about human milk banking before and received information from health professionals (195 students, 48.99%), the news (67 students, 16.83%), and family and friends (61 students, 15.33%). However, only 224 students (56.28%) are willing to feed their babies with HMB milk in the future. On the other hand, 216 students (54.27%) are ready to donate breast milk to HMB. The majority of students have a favorable opinion of breast milk donation. A staggering 394 students (98.99%) think that donating human milk can save babies. Furthermore, 379 students (95.23%) think that all the nutrients needed for a baby's healthy development are found in human milk. Merely 350 students (87.93%) think that breastfeeding does not result in malnourishment for either the mother or the baby. When there is an excess of milk, the majority of students (378 or 94.97%) think that there is nothing wrong with donating it. Moreover, 312 (80.41%) students are happy to donate milk in the future. A total of 373 students (93.71%) are overjoyed that a sick baby will survive because of their donated milk. Only 100 students (25.12%) will give milk, though, and only to the infants of their friends and relatives, never to complete strangers. Conclusion A dearth of knowledge pertaining to human milk banking is rampant among medical and paramedical female students, yet the gravity of the circumstances remains concealed. Consequently, it is imperative to extensively educate all Indian communities about the concept of human milk banking to gain widespread acceptance. This research sheds light on the issue and promotes scientific knowledge of HMB, as many students are unaware of it.
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Affiliation(s)
- Anugya A Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Tote
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Rao AR, Parakh H, Rao PMM, Kumar KY, Qadeer E. Neonatal Deep Palmar Space Infection: An Unusual Presentation. Cureus 2023; 15:e38626. [PMID: 37284368 PMCID: PMC10240973 DOI: 10.7759/cureus.38626] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
Deep palmar space infection is a rare but potentially serious condition in neonates that requires prompt diagnosis and management. We present the case of a neonate who developed a deep palmar space infection on day two of life. The neonate presented with swelling, erythema, tenderness, and limited movement of the affected hand. The diagnosis was confirmed with imaging using ultrasound, which revealed evidence of fluid collection suggestive of an abscess. Surgical drainage of the abscess and appropriate antibiotic therapy resulted in a successful outcome with complete resolution of symptoms and recovery of hand function. This case highlights the importance of early recognition, appropriate diagnostic workup, and prompt surgical intervention for deep palmar space infection in neonates to prevent complications and achieve favourable outcomes. Additionally, infection prevention measures such as maintaining strict aseptic techniques during invasive procedures in neonates should be emphasised to prevent similar infections in the future.
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Affiliation(s)
- A Rupesh Rao
- Pediatrics and Child Health, Hope Children's Hospital, Hyderabad, IND
| | - Hemant Parakh
- Neonatology, Hope Children's Hospital, Hyderabad, IND
| | - P Madan Mohan Rao
- Pediatrics and Child Health, Hope Children's Hospital, Hyderabad, IND
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3
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Muacevic A, Adler JR, Zia BF, Farahi F, Asher Syed M. Occam's Razor Versus Hickam's Dictum: A Case Report of Junctional Epidermolysis Bullosa and Lower Urinary Tract Infection. Cureus 2023; 15:e34117. [PMID: 36843762 PMCID: PMC9946905 DOI: 10.7759/cureus.34117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Epidermolysis bullosa (EB) is a rare heterogeneous group of diseases which typically presents with extensive blistering and mucocutaneous erosions. EB is mechanobullous in nature and thus commonly involves sites of trauma and friction. It is a painful and disfiguring disorder. The involvement of different internal organs and systems, such as respiratory, genitourinary, and gastrointestinal systems, has been reported in the literature depending on the type of EB. We report a case of junctional epidermolysis bullosa (JEB) with urogenital involvement in a female child in Pakistan. JEB is a rare subtype of EB which is transmitted in an autosomal recessive pattern of inheritance. It classically affects neonates. Diagnosis is established after clinical examination, and investigations are directed at the exploration of skin lesions such as histopathological and direct immunofluorescence studies. Management of patients is primarily supportive.
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Muacevic A, Adler JR, Seul L, Adler M, Higgins Joyce A. Utilizing a Video-Based Learning Platform for Teaching Breastfeeding Medicine. Cureus 2022; 14:e31327. [PMID: 36514579 PMCID: PMC9733812 DOI: 10.7759/cureus.31327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/12/2022] Open
Abstract
The American Academy of Pediatrics (AAP) supports exclusive breastfeeding of infants. However, conversations surrounding breastfeeding can be sensitive in nature and cause discomfort for both learners and parents. Additionally, bedside teaching of breastfeeding medicine is a relatively large time commitment which can be difficult for learners rotating through busy delivery centers. These factors along with others have led to known knowledge gaps in medical students, residents, fellows, and even attending knowledge of skill-based breastfeeding competencies supported by the AAP. We aimed to address these gaps by creating a video-based breastfeeding education module working in collaboration with certified lactation consultants at the largest birthing center in Illinois, United States. This technical report describes the utilization of Panopto audio-visual software (Panopto Inc., Seattle, Washington, United States) to successfully create a video-based curriculum for teaching breastfeeding medicine.
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5
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Atim MG, Kajogoo VD, Amare D, Said B, Geleta M, Muchie Y, Tesfahunei HA, Assefa DG, Manyazewal T. COVID-19 and Health Sector Development Plans in Africa: The Impact on Maternal and Child Health Outcomes in Uganda. Risk Manag Healthc Policy 2021; 14:4353-4360. [PMID: 34703344 PMCID: PMC8541793 DOI: 10.2147/rmhp.s328004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/05/2021] [Accepted: 10/08/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Health Sector Development Plans (HSDPs) aim to accelerate movement towards achieving sustainable development goals for health, reducing inequalities, and ending poverty. Reproductive, maternal, newborn and child health (RMNCH) services are vulnerable to economic imbalances, including health insecurity, unmet need for healthcare, and low health expenditure. The same vulnerability influences the potential of a country to combat global outbreaks such as the COVID-19. We aimed to provide some important insights into the impacts of COVID-19 on RMNCH indicators and outcomes of the HSDP in Uganda. Methods We conducted a descriptive study of secondary data obtained from the Ugandan government-led portals, supplemented by analyses of relevant articles published up to 06 May 2021 and deposited in PubMed. Results Through synthesizing actionable and relevant evidence, we realized that RMNCH in Uganda is highly affected by the COVID-19 pandemic and the lockdown measures. The impact was across immunization, antenatal, sexual and reproductive health, emergency and obstetric, and postnatal care services. There was a decline sharply by 9.6% for under-five vitamin A coverage, 9% for DPT3HibHeb3 coverage, 6.8% for measles vaccination coverage, 6% for isoniazid preventive therapy coverage, and 3% for facility-based deliveries. Maternal and under-five deaths increased by 7.6% and 4%, respectively. Outreaches were rarely conducted in the lockdown period. Conclusion The COVID-19 pandemic has created a multitude of questions regarding the optimal policies to mitigate the disease while minimizing the unintended detrimental consequences of RMNCH. The lockdown restrictions threatened to reverse the progress made on the national HSDP for RMNCH. In Uganda, where young women are vulnerable to early marriage, unintended pregnancies, and unsafe abortion, access to RMNCH services should continue regardless of the COVID-19 status in the country. We urge that Uganda and other African countries should build resilient and sustainable health systems that can withstand emerging diseases like the COVID-19.
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Affiliation(s)
- Mary Gorret Atim
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Violet Dismas Kajogoo
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Mafie District Hospital, Mafia Island, Pwani Region, Tanzania
| | - Demeke Amare
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Ethiopian Food and Drug Administration Authority (EFDA), Addis Ababa, Ethiopia
| | - Bibie Said
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Kibong'oto National Tuberculosis Hospital, Kilimanjaro, Tanzania
| | - Melka Geleta
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yilkal Muchie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,All Africa Leprosy and Rehabilitation Training (ALERT) Centre, Addis Ababa, Ethiopia
| | - Hanna Amanuel Tesfahunei
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Hager Biomedical Research Institute, Asmara, Eritrea
| | - Dawit Getachew Assefa
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Nursing, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hategeka C, Lynd LD, Kenyon C, Tuyisenge L, Law MR. Impact of a Multifaceted Intervention to Improve Emergency Care on Newborn and Child Health Outcomes in Rwanda. Health Policy Plan 2021; 37:12-21. [PMID: 34459893 DOI: 10.1093/heapol/czab109] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/17/2021] [Accepted: 08/28/2021] [Indexed: 11/13/2022] Open
Abstract
Implementing context-appropriate neonatal and pediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and pediatric hospital mortality rate. Each hospital contributed data for 12 and 36 months before and after ETAT+ implementation, respectively. Using controlled interrupted time series analysis and segmented regression model, we estimated longitudinal changes in neonatal and pediatric hospital mortality rate in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+ targeted conditions. Our study cohort consisted of seven intervention hospitals and fourteen matched control hospitals contributing 142,424 neonatal and pediatric hospital admissions. After controlling for secular trends and autocorrelation, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and pediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+ targeted neonatal conditions decreased immediately following implementation by 5% (95% CI: -9.25, -0.77) and over time by 0.8% monthly (95% CI: -1.36, -0.25), in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+ targeted pediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+ targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.,Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Cynthia Kenyon
- Division of Neonatal-Perinatal Medicine, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Lisine Tuyisenge
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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7
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Bexson C, Millett C, Santos LMP, de Sousa Soares R, de Oliveira FP, Hone T. Brazil's more doctors programme and infant health outcomes: a longitudinal analysis. Hum Resour Health 2021; 19:97. [PMID: 34391440 PMCID: PMC8363855 DOI: 10.1186/s12960-021-00639-3] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Providing sufficient numbers of human resources for health is essential for effective and accessible health services. Between 2013 and 2018, the Brazilian Ministry of Health implemented the Programa Mais Médicos (PMM) (More Doctors Programme) to increase the supply of primary care doctors in underserved areas of the country. This study investigated the association between PMM and infant health outcomes and assessed if heterogeneity in the impact of PMM varied by municipal socio-economic factors and health indicators. METHODS An ecological longitudinal (panel) study design was employed to analyse data from 5565 Brazilian municipalities over a 12-year period between 2007 and 2018. A differences-in-differences approach was implemented using longitudinal fixed effect regression models to compare infant health outcomes in municipalities receiving a PMM doctor with those that did not receive a PMM doctor. The impact of PMM was assessed on aggregate and in municipality subgroups. RESULTS On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in infant mortality rate (IMR) (of - 0.21; 95% CI: - 0.38, - 0.03) in municipalities with highest IMR prior to the programme's implementation (where (IMR) > 25.2 infant deaths per 1000 live births). The PMM was also associated with an increase in the proportion of expectant mothers receiving seven or more prenatal care visits but only in municipalities with a lower IMR at baseline and high density of non-PMM doctors and community health workers before the PMM. CONCLUSIONS The PMM was associated with reduced infant mortality in municipalities with the highest infant mortality rate prior to the programme. This suggests effectiveness of the PMM was limited only to the areas of greatest need. New programmes to improve the equitable provision of human resources for health should employ comprehensive targeting approaches balancing health needs and socio-economic factors to maximize effectiveness.
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Affiliation(s)
| | | | | | | | | | - Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
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8
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Unumeri GO, Okereke E, Ahonsi BA. Levels and dimensions of client satisfaction with the treatment of recent maternal, newborn and child health related illnesses by frontline health workers in rural Nigeria. Afr J Reprod Health 2021; 24:41-50. [PMID: 34077069 DOI: 10.29063/ajrh2020/v24i4.5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Little is documented about levels of client satisfaction with maternal, newborn and child health services at primary health care (PHC) facilities in Nigeria, besides unsubstantiated anecdotes. This study examined different aspects of client satisfaction at primary healthcare level in Nigeria. Quantitative data were collected using personal digital assistants to capture responses from 1548 households in Bauchi and Cross River States. Descriptive statistics were used to summarize study results as frequency tables and percentages. Majority of the study respondents utilized government health facilities for treatment, however some clients used private sector health facilities. Women, newborns and under-fives were treated for a variety of illnesses and disease conditions. Treatment outcomes and levels of satisfaction did not appear to differ by cadre of healthcare provider. Respondents' level of satisfaction with healthcare services at primary healthcare level in Nigeria appear to reflect their modest quality of care expectations, especially in poor PHC rural settings.
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Affiliation(s)
- Godwin O Unumeri
- Population Council Nigeria, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Ekechi Okereke
- Population Council Nigeria, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
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Bergen N, Ruckert A, Abebe L, Asfaw S, Kiros G, Mamo A, Morankar S, Kulkarni MA, Labonté R. Characterizing 'health equity' as a national health sector priority for maternal, newborn, and child health in Ethiopia. Glob Health Action 2021; 14:1853386. [PMID: 33380284 PMCID: PMC7782227 DOI: 10.1080/16549716.2020.1853386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/21/2022] Open
Abstract
Background: The pursuit of health equity is a priority in Ethiopia, especially with regards to maternal, newborn, and child health (MNCH). To date, there has been little characterization of the ‘problem’ of health inequity, and the normative assumptions implicit in the representation of the problem. Yet, such insights have implications for shaping the framing, incentivization, and implementation of health policies and their wider impact. Objective: In this article, we characterize how health (in)equity is represented as a policy issue, how this representation came about, and the underlying assumptions. Methods: We draw from Bacchi’s ‘what is the problem represented to be’ approach to explore how national-level actors in the health sector constitute the problem. The data for our analysis encompass 23 key informant interviews with national health sector actors working in leadership positions on MNCH in Ethiopia, and six policy documents. Findings were derived from thematic and content analysis. Results: Health inequity is a normalized and inevitable concern that is regarded as actionable (can be altered) but not fully resolvable (can never be fully achieved). Operationally, health equity is viewed as a technocratic matter, reflected in the widespread use of metrics to motivate and measure progress. These representations are shaped by Ethiopia’s rapid expansion of health services into rural areas during the 2000s leading to the positive international attention and funding the country received for improved MNCH indicators. Expanding the coverage and efficiency of health service provision, especially in rural areas, is associated with economic productivity. Conclusion: The metrication of health equity may detract from the fairness, justice, and morality underpinnings of the concept. The findings of this study point to the implications of global pressures in terms of maximizing health investments, and call into question how social, political, and economic determinants of health are addressed through broader development agendas.
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Affiliation(s)
- Nicole Bergen
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa , Ottawa, Canada
| | - Arne Ruckert
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Lakew Abebe
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Shifera Asfaw
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Getachew Kiros
- Faculty of Health Sciences, School of Nursing, University of Ottawa , Ottawa, Canada
| | - Abebe Mamo
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Sudhakar Morankar
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Manisha A Kulkarni
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Ronald Labonté
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
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10
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Miller NP, Bagheri Ardestani F, Wong H, Stokes S, Mengistu B, Paulos M, Agonafir N, Sylla M, Ameha A, Birhanu BG, Khan S, Lemango ET. Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review. Health Policy Plan 2021; 36:1187-1196. [PMID: 33885143 PMCID: PMC8496769 DOI: 10.1093/heapol/czab047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 10/02/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
The Ethiopian Federal Ministry of Health and partners have scaled up integrated
community case management (iCCM) and community-based newborn care (CBNC),
allowing health extension workers (HEWs) to manage the major causes of child and
newborn death at the community level. However, low service uptake remains a key
challenge. We conducted a scoping review of peer-reviewed and grey literature to
assess barriers to the utilization of HEW services and to explore potential
solutions. The review, which was conducted to inform the Optimizing the Health
Extension Program project, which aimed to increase the utilization of iCCM and
CBNC services, included 24 peer-reviewed articles and 18 grey literature
documents. Demand-side barriers to utilization included lack of knowledge about
the signs and symptoms of childhood illnesses and danger signs; low awareness of
curative services offered by HEWs; preference for home-based care, traditional
care, or religious intervention; distance, lack of transportation and cost of
care seeking; the need to obtain husband’s permission to seek care and
opposition of traditional or religious leaders. Supply-side barriers included
health post closures, drug stockouts, disrespectful care and limited skill and
confidence of HEWs, particularly with regard to the management of newborn
illnesses. Potential solutions included community education and demand
generation activities, finding ways to facilitate and subsidize transportation
to health facilities, engaging family members and traditional and religious
leaders, ensuring consistent availability of services at health posts and
strengthening supervision and supply chain management. Both demand generation
and improvement of service delivery are necessary to achieve the expected impact
of iCCM and CBNC. Key steps for improving utilization would be carrying out
multifaceted demand generation activities, ensuring availability of HEWs in
health posts and ensuring consistent supplies of essential commodities. The
Women’s Development Army has the potential to improving linkages between
HEWs and communities, but this strategy needs to be strengthened to be
effective.
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Affiliation(s)
- Nathan P Miller
- Health Section, UNICEF, 3 UN Plaza, New York, NY 10017, USA.,Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | | | - Hayes Wong
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | - Sonya Stokes
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY 10032, USA
| | - Birkety Mengistu
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Meron Paulos
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Nesibu Agonafir
- PATH Ethiopia, Bole Medhaniyalem Street #03, Bole, Addis Ababa, Ethiopia
| | - Mariame Sylla
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Agazi Ameha
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Bizuhan Gelaw Birhanu
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
| | - Sadaf Khan
- Maternal Newborn Child Health and Nutrition, PATH, 2201 Westlake Ave. Ste 200, Seattle, WA 98121, USA
| | - Ephrem Tekle Lemango
- Programs Section, Maternal, Child Health and Nutrition Directorate, Ministry of Health, Sudan Street, Addis Ababa, Ethiopia
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Yao J, Perzynski AT, Tarabichi Y, Swarup N, Roy A. Socioeconomic Distress as a Predictor of Missed First Outpatient Newborn Visits. Cureus 2021; 13:e14132. [PMID: 33912364 PMCID: PMC8071602 DOI: 10.7759/cureus.14132] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To determine if the Area Deprivation Index (ADI) can serve as a predictor for patients from geographic regions of high socioeconomic distress as high risk for having no-shows to first-year newborn visits. Methods We assessed the no-show rate per patient from a large public safety-net hospital in Cleveland, Ohio, and the ADI of the census-designated tract for each patient's home geographic identifier (GEOID), aggregated into quintiles, and calculated differences in no-show-rates across census-designated tracts of different ADIs. Results A total of 2944 newborns from an approximate 18-month follow-up period between 2015-2017 were included. Large differences in no-shows per individual patient record (chi-square = 225, p = <0.001, df = 4) were found across quintiles of ADI. Heat-mapping indicated that census tracts with the highest ADIs and highest rates of no-show appointments encompass Cleveland's inner-city region. Conclusion The ADI is demonstrated to identify communities at high risk of no-show newborn appointments. Mapping these communities and their socioeconomic distress levels represented by ADI and missed appointment rate for each community can provide future direction for interventions targeted towards these communities to reduce no-show rates and improve overall community infant health.
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Affiliation(s)
- Jimmy Yao
- Pediatrics, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Adam T Perzynski
- Epidemiology and Public Health, MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Yasir Tarabichi
- Internal Medicine and Research Informatics, MetroHealth Medical Center, Cleveland, USA
| | - Namita Swarup
- Pediatrics, MetroHealth Medical Center, Cleveland, USA
| | - Aparna Roy
- Pediatrics, MetroHealth Medical Center, Cleveland, USA
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Mukinda FK, Van Belle S, George A, Schneider H. The crowded space of local accountability for maternal, newborn and child health: a case study of the South African health system. Health Policy Plan 2020; 35:279-290. [PMID: 31865365 PMCID: PMC7152728 DOI: 10.1093/heapol/czz162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 11/15/2019] [Indexed: 11/13/2022] Open
Abstract
Global and national accountability for maternal, newborn and child health (MNCH) is increasingly invoked as central to addressing preventable mortality and morbidity. Strategies of accountability for MNCH include policy and budget tracking, maternal and perinatal death surveillance, performance targets and various forms of social accountability. However, little is known about how the growing number of accountability strategies for MNCH is received by frontline actors, and how they are integrated into the overall functioning of local health systems. We conducted a case study of mechanisms of local accountability for MNCH in South Africa, involving a document review of national policies, programme reports, and other literature directly or indirectly related to MNCH, and in-depth research in one district. The latter included observations of accountability practices (e.g. through routine meetings) and in-depth interviews with 37 purposely selected health managers and frontline health workers involved in MNCH. Data collection and analysis were guided by a framework that defined accountability as answerability and action (both individual and collective), addressing performance, financial and public accountability, and involving both formal and informal processes. Nineteen individual accountability mechanisms were identified, 10 directly and 9 indirectly related to MNCH, most of which addressed performance accountability. Frontline managers and providers at local level are targeted by a web of multiple, formal accountability mechanisms, which are sometimes synergistic but often duplicative, together giving rise to local contexts of 'accountability overloads'. These result in a tendency towards bureaucratic compliance, demotivation, reduced efficiency and effectiveness, and limited space for innovation. The functioning of formal accountability mechanisms is shaped by local cultures and relationships, creating an accountability ecosystem involving multiple actors and roles. There is a need to streamline formal accountability mechanisms and consider the kinds of actions that build positive cultures of local accountability.
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Affiliation(s)
- Fidele Kanyimbu Mukinda
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Private Bag X17 Bellville, Cape Town 7535, South Africa
| | | | - Asha George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Private Bag X17 Bellville, Cape Town 7535, South Africa
| | - Helen Schneider
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Private Bag X17 Bellville, Cape Town 7535, South Africa.,UWC/SAMRC Health Services and Systems Unit, Cape Town, South Africa
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Kaneko K, Niyonkuru J, Juma N, Mbonabuca T, Osaki K, Aoyama A. Effectiveness of the Maternal and Child Health handbook in Burundi for increasing notification of birth at health facilities and postnatal care uptake. Glob Health Action 2018; 10:1297604. [PMID: 28462634 PMCID: PMC5496056 DOI: 10.1080/16549716.2017.1297604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 11/29/2022] Open
Abstract
Background: In Burundi, birth certificate ownership (56.4%) and postnatal care (PNC) coverage (30%) remain low. Birth certificates prove birth registration and allow clients to receive free medical care including PNC. To obtain birth certificates, notification of birth by witnesses is indispensable. However, use of existing parallel home-based records for mother and child has prevented clients from successfully receiving notification of birth and related information. Objective: To assess the effectiveness of the Maternal and Child Health (MCH) handbook for increasing notification of birth at health facilities and PNC uptake. Methods: Pre- and post-introduction measurement were applied including: (i) structured interviews with two different sets of randomly selected mothers having infants aged less than six weeks at the pre- or post-studies; and (ii) secondary data from the national health management information system. Results: 95.1% of mothers had an MCH handbook post-study. Significant improvement was observed in the proportion of mothers receiving notification of birth at health facilities, from 4.6% to 61.0% (95% confidence interval [CI]: 55.9%–66.2%), and the proportion of mothers receiving guidance on PNC, from 35.9% to 64.2% (95% CI: 59.2%–69.3%). The annual PNC coverage (43.9% to 54.2%; p < 0.05) in the Gitega District significantly increased from 2013 to 2014. Among MCH handbook owners, mothers giving birth at hospitals/clinics had 2.62 higher odds (95% CI: 1.63–4.22) of obtaining notification of birth than mothers giving birth at health centers. Conversely, mothers delivering at hospitals/clinics had 0.51 lower odds (95% CI: 1.63–4.22) of receiving PNC guidance than mothers delivering at health centers. Conclusions: As previous studies showed, the MCH handbook appeared to help health personnel provide guidance on PNC, thereby it may have increased PNC. Furthermore, this study suggests the handbook contributed to every birth being counted. However, to increase the effectiveness of the handbook, health personnel should be encouraged toward its proper use.
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Affiliation(s)
- Kayo Kaneko
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Jacques Niyonkuru
- b Direction of Healthcare Supply and Demand , Ministry of Health and Fight against HIV/AIDS , Bujumbura , Burundi
| | - Ndereye Juma
- c National Reproductive Health Program , Ministry of Health and Fight against HIV/AIDS , Bujumbura , Burundi
| | - Térence Mbonabuca
- d Direction of the Internal Administration , Ministry of Home Affairs , Bujumbura , Burundi
| | - Keiko Osaki
- e Human Development Department , Japan International Cooperation Agency , Tokyo , Japan
| | - Atsuko Aoyama
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Nagoya , Japan
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Isabirye P, Abesiga M. How Kabarole Hospital in western Uganda saved mothers' lives through team-based problem-solving. BMJ Open Qual 2018; 6:e000191. [PMID: 29450302 PMCID: PMC5699133 DOI: 10.1136/bmjoq-2017-000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 11/15/2022] Open
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Maitra C, Hodge A, Jimenez Soto E. A scoping review of cost benefit analysis in reproductive, maternal, newborn and child health: What we know and what are the gaps? Health Policy Plan 2016; 31:1530-1547. [PMID: 27371550 DOI: 10.1093/heapol/czw078] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/14/2022] Open
Abstract
Growing evidence suggests that early life investments in health are associated with improved human capital and economic outcomes. Various recent global studies have simulated the expected economic returns from alternative packages of interventions in reproductive, maternal, newborn and child health (RMNCH). However, very little is known about the comparability of estimates of the economic returns of RMNCH interventions across studies in low and middle income countries. Our study aims to fill this gap. We performed a comprehensive scoping review of the recent literature (2000-2013) on the economic returns (i.e. benefit-cost ratios) of RMNCH-related interventions, conducted in low and middle income countries. A total of 36 studies were identified. They were read in full and information was abstracted on both the estimates of benefit-cost ratios, the methodological approach and assumptions used. The estimated economic returns fluctuated considerably across settings as the associated costs of disease patterns, social behaviours and health systems varied. Yet, greater sources of variation stemmed from differences in methodology. The observed methodological inconsistencies limit the accuracy and comparability of the estimated returns across various contexts. The reviewed studies suggest that the benefit-cost ratios are favourable in the majority of cases, providing further support to a growing body of economic literature that suggests investments early in life, such as those interventions related to RMNCH, are good investments. Beyond advocacy purposes, for the reviewed literature to be used by policymakers to inform their decisions on investments, a consistent methodological approach should be adopted.
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Affiliation(s)
| | | | - Eliana Jimenez Soto
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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Hargreaves JRM, Goodman C, Davey C, Willey BA, Avan BI, Schellenberg JRA. Measuring implementation strength: lessons from the evaluation of public health strategies in low- and middle-income settings. Health Policy Plan 2016; 31:860-7. [PMID: 26965038 PMCID: PMC4977426 DOI: 10.1093/heapol/czw001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Accepted: 12/29/2015] [Indexed: 11/28/2022] Open
Abstract
Evaluation of strategies to ensure evidence-based, low-cost interventions reach those in need is critical. One approach is to measure the strength, or intensity, with which packages of interventions are delivered, in order to explore the association between implementation strength and public health gains. A recent systematic review suggested methodological guidance was needed. We described the approaches used in three examples of measures of implementation strength in evaluation. These addressed important public health topics with a substantial disease burden in low-and middle-income countries; they involved large-scale implementation; and featured evaluation designs without comparison areas. Strengths and weaknesses of the approaches were discussed. In the evaluation of Ethiopia’s Health Extension Programme, implementation strength scoring for each kebele (ward) was based on aggregated data from interviews with mothers of children aged 12–23 months, reflecting their reports of contact with four elements of the programme. An evaluation of the Avahan HIV prevention programme in India used the cumulative amount of Avahan funding per HIV-infected person spent each year in each district. In these cases, a single measure was developed and the association with hypothesised programme outcomes presented. In the evaluation of the Affordable Medicines Facility—malaria, several implementation strength measures were developed based on the duration of activity of the programme and the level of implementation of supporting interventions. Measuring the strength of programme implementation and assessing its association with outcomes is a promising approach to strengthen pragmatic impact evaluation. Five key aspects of developing an implementation strength measure are to: (a) develop a logic model; (b) identify aspects of implementation to be assessed; (c) design and implement data collection from a range of data sources; (d) decide whether and how to combine data into a single measure; and, (e) plan whether and how to use the measure(s) in outcome analysis.
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Affiliation(s)
| | | | | | | | - Bilal Iqbal Avan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abegunde D, Orobaton N, Shoretire K, Ibrahim M, Mohammed Z, Abdulazeez J, Gwamzhi R, Ganiyu A. Monitoring maternal, newborn, and child health interventions using lot quality assurance sampling in Sokoto State of northern Nigeria. Glob Health Action 2015; 8:27526. [PMID: 26455491 PMCID: PMC4600711 DOI: 10.3402/gha.v8.27526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 02/08/2015] [Revised: 07/25/2015] [Accepted: 08/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal mortality ratio and infant mortality rate are as high as 1,576 per 100,000 live births and 78 per 1,000 live births, respectively, in Nigeria's northwestern region, where Sokoto State is located. Using applicable monitoring indicators for tracking progress in the UN/WHO framework on continuum of maternal, newborn, and child health care, this study evaluated the progress of Sokoto toward achieving the Millennium Development Goals (MDGs) 4 and 5 by December 2015. The changes in outcomes in 2012-2013 associated with maternal and child health interventions were assessed. DESIGN We used baseline and follow-up lot quality assurance sampling (LQAS) data obtained in 2012 and 2013, respectively. In each of the surveys, data were obtained from 437 households sampled from 19 LQAS locations in each of the 23 local government areas (LGAs). The composite state-level coverage estimates of the respective indicators were aggregated from estimated LGA coverage estimates. RESULTS None of the nine indicators associated with the continuum of maternal, neonatal, and child care satisfied the recommended 90% coverage target for achieving MDGs 4 and 5. Similarly, the average state coverage estimates were lower than national coverage estimates. Marginal improvements in coverage were obtained in the demand for family planning satisfied, antenatal care visits, postnatal care for mothers, and exclusive breast-feeding. Antibiotic treatment for acute pneumonia increased significantly by 12.8 percentage points. The majority of the LGAs were classifiable as low-performing, high-priority areas for intensified program intervention. CONCLUSIONS Despite the limited time left in the countdown to December 2015, Sokoto State, Nigeria, is not on track to achieving the MDG 90% coverage of indicators tied to the continuum of maternal and child care, to reduce maternal and childhood mortality by a third by 2015. Targeted health system investments at the primary care level remain a priority, for intensive program scale-up to accelerate impact.
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Affiliation(s)
- Dele Abegunde
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria;
| | - Nosa Orobaton
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
| | - Kamil Shoretire
- Jhpeigo - Targeted States High Impact Project Nigeria, Bauchi, Nigeria
| | - Mohammed Ibrahim
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
| | - Zainab Mohammed
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
| | - Jumare Abdulazeez
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
| | - Ringpon Gwamzhi
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
| | - Akeem Ganiyu
- United States Agency for International Development - John Snow Inc. Research and Training, Inc. - Targeted States High Impact Project Nigeria
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Roberton T, Applegate J, Lefevre AE, Mosha I, Cooper CM, Silverman M, Feldhaus I, Chebet JJ, Mpembeni R, Semu H, Killewo J, Winch P, Baqui AH, George AS. Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania. Hum Resour Health 2015; 13:19. [PMID: 25880459 PMCID: PMC4403773 DOI: 10.1186/s12960-015-0010-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/08/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. METHODS Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. RESULTS CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. CONCLUSIONS Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development. Facility health workers, while important for technical oversight, may not be the best mentors for certain tasks such as community relationship-building. We suggest further exploring CHW supervision innovations, such as an enhanced role for community actors, who may be more suitable to support CHWs engaged primarily in health promotion than scarce and over-worked facility health workers.
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Affiliation(s)
- Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jennifer Applegate
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Amnesty E Lefevre
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Idda Mosha
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | | | - Marissa Silverman
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Isabelle Feldhaus
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Joy J Chebet
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | - Helen Semu
- Ministry of Health and Social Welfare, 6 Samora Machel Avenue, 11478, Dar es Salaam, Tanzania.
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | - Peter Winch
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Asha S George
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
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Mukonka VM, Malumo S, Kalesha P, Nambao M, Mwale R, Mwinga K, Katepa-Bwalya M, Babaniyi O, Mason E, Phiri C, Wamulume PK. Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) - the Zambian experience. BMC Public Health 2014; 14:60. [PMID: 24447509 PMCID: PMC3909314 DOI: 10.1186/1471-2458-14-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 01/18/2014] [Indexed: 12/05/2022] Open
Abstract
Initiatives such as the Country Countdown to 2015 Conference on Millennium Development Goals (MDGs) have provided countries with high maternal and child deaths like Zambia a platform to assess progress, discuss challenges and share lessons learnt as a conduit for national commitment to reaching and attaining the MDGs four and five. This paper discusses and highlights the process of holding a successful country countdown conference and shares Zambia's experience with other countries planning to organise country countdown to 2015 Conferences on MDGs.
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Affiliation(s)
- Victor M Mukonka
- Copperbelt University, School of Medicine, Ndola Central Hospital, 6th Floor, West wing, P. O. Box 71191, Ndola, Zambia
| | - Sarai Malumo
- United Nations Population Fund, Country Office, Lusaka, Zambia
| | - Penelope Kalesha
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Mary Nambao
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Rodgers Mwale
- United Nations Children’s Fund, Country Office, Lusaka, Zambia
| | - Kasonde Mwinga
- World Health Organisation, Regional Office, Brazzaville, Republic of Congo
| | | | | | - Elizabeth Mason
- World Health Organisation, Headquarters, Geneva, Switzerland
| | - Caroline Phiri
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Pauline K Wamulume
- Ministry of Health, National Malaria Control Centre, P. O. Box 32509, Lusaka, Zambia
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Findley SE, Uwemedimo OT, Doctor HV, Green C, Adamu F, Afenyadu GY. Comparison of high- versus low-intensity community health worker intervention to promote newborn and child health in Northern Nigeria. Int J Womens Health 2013; 5:717-28. [PMID: 24194649 PMCID: PMC3814931 DOI: 10.2147/ijwh.s49785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Northern Nigeria, infant mortality rates are two to three times higher than in the southern states, and, in 2008, a partnership program to improve maternal, newborn, and child health was established to reduce infant and child mortality in three Northern Nigeria states. The program intervention zones received government-supported health services plus integrated interventions at primary health care posts and development of community-based service delivery (CBSD) with a network of community volunteers and community health workers (CHWs), who focus on educating women about danger signs for themselves and their infants and promoting appropriate responses to the observation of those danger signs, consistent with the approach of the World Health Organization Integrated Management of Neonatal and Childhood Illness strategy. Before going to scale in the rest of the state, it is important to identify the relative effectiveness of the low-intensity volunteer approach versus the more intensive CBSD approach with CHWs. METHODS We conducted stratified cluster sample household surveys at baseline (2009) and follow-up (2011) to assess changes in newborn and sick child care practices among women with births in the five prior years (baseline: n = 6,906; follow-up: n = 2,310). The follow-up respondents were grouped by level of intensity of the CHW interventions in their community, with "low" including group activities led only by a trained community volunteer and "high" including the community volunteer activities plus CBSD from a CHW providing one-on-one advice and assistance. t-tests were used to test for significant differences from baseline to follow-up, and F-statistics, which adjust for the stratified cluster design, were used to test for significant differences between the control, low-intensity, and high-intensity intervention groups at follow-up. These analyses focused on changes in newborn and sick child care practices. RESULTS Anti-tetanus vaccination coverage during pregnancy increased from 69.2% at baseline to 85.7% at follow-up in the intervention areas. Breastfeeding within 24 hours increased from 42.9% to 59.0% in the intervention areas, and more newborns were checked by health workers within 48 hours (from 16.8% at baseline to 26.8% at follow-up in the intervention areas). Newborns were more likely to be checked by trained health personnel, and they received more comprehensive newborn care. Compared to the control communities, more than twice as many women in intervention communities knew to watch for specific newborn danger signs. Compared to the control and low-intensity intervention communities, more mothers in the high-intensity communities learned about the care of sick children from CHWs, with a corresponding decline those seeking advice from family or friends or traditional birth attendants. Significantly fewer mothers did nothing when their child was sick. High-intensity intervention communities experienced the most decline. Those who did nothing for children with fever or cough declined from 35% to 30%, and with diarrhea from 40% to 31%. Use of medications, both traditional and modern, increased from baseline to follow-up, with no differentiation in use by intervention area. CONCLUSION The community-based approach to promoting improved newborn and sick child care through community volunteers and CHWs resulted in improved newborn and sick child care. The low-intensity approach with community volunteers appears to have been as effective as the higher-intensity CBSD approach with CHWs for several of the key newborn and sick child care indicators, particularly in the provision of appropriate home care for children with fever or cough.
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Affiliation(s)
- Sally E Findley
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Singh PK, Rai RK, Kumar C. Equity in maternal, newborn, and child health care coverage in India. Glob Health Action 2013; 6:22217. [PMID: 24119659 PMCID: PMC3772319 DOI: 10.3402/gha.v6i0.22217] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets. OBJECTIVE This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH) care services across household wealth quintiles in India and its states. DESIGN Utilizing the District Level Household and Facility Survey conducted during 2007-08, this paper has constructed a Composite Coverage Index (CCI) in MNCH care. RESULTS The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a ≤50% coverage in MNCH care services, which demands special attention. CONCLUSION India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.
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Affiliation(s)
- Prashant Kumar Singh
- Department of Population Studies, International Institute for Population Sciences, Deonar, Mumbai, India;
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Osaki K, Hattori T, Kosen S. The role of home-based records in the establishment of a continuum of care for mothers, newborns, and children in Indonesia. Glob Health Action 2013; 6:1-12. [PMID: 23651873 PMCID: PMC3647040 DOI: 10.3402/gha.v6i0.20429] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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] [Received: 01/16/2013] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The provision of appropriate care along the continuum of maternal, newborn, and child health (MNCH) service delivery is a challenge in developing countries. To improve this, in the 1990s, Indonesia introduced the maternal and child health (MCH) handbook, as an integrated form of parallel home-based records. OBJECTIVE This study aimed to identify the roles of home-based records both before and after childbirth, especially in provinces where the MCH handbook (MCHHB) was extensively promoted, by examining their association with MNCH service uptake. DESIGN This was a cross-sectional study using nationally representative data sets, the Indonesia Demographic and Health Surveys (IDHSs) from 1997, 2002-2003, and 2007. The IDHS identifies respondents' ownership of home-based records before and after childbirth. Multivariate logistic regression was used to examine associations between record ownership and service utilisation in national data and data from two provinces, West Sumatra and North Sulawesi, where ownership of pre- and post-natal records served as a proxy for MCHHB ownership. RESULTS Pre- and post-natal record ownership increased from 1997 to 2007. Provincial data from 2007 showed that handbook ownership was associated with having delivery assisted by trained personnel [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.05-4.25], receiving maternal care (aOR: 3.92, 95% CI: 2.35-6.52), completing 12 doses of child immunisation for seven diseases (aOR: 4.86, 95% CI: 2.37-9.95), and having immunisation before and after childbirth (aOR: 5.40, 95% CI: 2.28-12.76), whereas national data showed that service utilisation was associated with ownership of both records compared with owning a single record or none. CONCLUSION Our results suggest that pre- and post-natal home-based record use may be effective for ensuring service utilisation. In addition, since the handbook is an efficient home-based record for use throughout children's life courses, it could be an effective tool for promoting the continuum of MNCH care in Indonesia.
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Affiliation(s)
- Keiko Osaki
- Human Development Department, Japan International Cooperation Agency, Tokyo, Japan.
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