The Landscape on Access to Maternal and Child Health Services During the COVID‐19 Pandemic in South Africa

BackgroundMANOSHI, an integrated community-based package of essential Maternal, Neonatal and Child Health (MNCH) services is being implemented by BRAC in the urban slums of Bangladesh since 2007. The objective of the formative research done during the inception phase was to understand the context and existing resources available in the slums, to reduce uncertainty about anticipated effects, and develop and refine the intervention components.MethodsData were collected during Jan-Sept 2007 in one of the earliest sites of programme intervention in the Dhaka metropolitan area. A conceptual framework guided data collection at different stages. Besides exploring slum characteristics, studies were done to map existing MNCH service providing facilities and providers, explore existing MNCH-related practices, and make an inventory of community networks/groups with a stake in MNCH service provision. Also, initial perception and expectations regarding the community delivery centres launched by the programme was explored. Transect walk, observation, pile sorting, informal and focus group discussions, in-depth interviews, case studies, network analysis and small quantitative surveys were done to collect data.ResultsFindings reveal that though there are various MNCH services and providers available in the slums, their capacity to provide rational and quality services is questionable. Community has superficial knowledge of MNCH care and services, but this is inadequate to facilitate the optimal survival of mothers and neonates. Due to economic hardships, the slum community mainly relies on cheap informal sector for health care. Cultural beliefs and practices also reinforce this behaviour including home delivery without skilled assistance. Men and women differed in their perception of pregnancy and delivery: men were more concerned with expenses while women expressed fear of the whole process, including delivering at hospitals. People expected 'one-stop' MNCH services from the community delivery centres by skilled personnel. Social support network for health was poor compared to other networks. Referral linkages to higher facilities were inadequate, fragmentary, and disorganised.ConclusionsFindings from formative research reduced contextual uncertainty about existing MNCH resources and care in the slum. It informed MANOSHI to build up an intervention which is relevant and responsive to the felt needs of the slum population.

Objective: Male involvement (MI) in maternal and child health (MCH) services such as pre-conception care, antenatal care (ANC), prevention of mother-to-child transmission (PMTCT) of HIV, skilled delivery is an integral intervention that improves MCH outcomes. Suba sub County in western Kenya has the highest prevalence of HIV in Kenya. Moreover, data is skewed on men’s knowledge and perceptions regarding their involvement in MCH services. Methods: This mixed method cross-sectional study, collected data using questionnaire among 354 male participants, and conducted 4 focus group discussions (FGDs) and 6 key informant interviews (KIIs). STATA version 11 was used for quantitative data analysis. The thematic content analysis was used to analyze qualitative data. Results: The majority of the participants (52.3%) were aged >30 years, 44.9% had primary level of education and 63.1% engaged in fishing activities. About 54.5% of the participants were not aware of the Ministry of Health’s effort to enhance men’s attendance to MCH clinics, while men’s age, various cultural taboos and provider’s attitude were perceived as influencing MI in MCH services. Overall 16.3% of the participants were involved in MCH services. Health worker provider’s attitude towards men (OR 0.5, 95% Cl 0.3 to 0.8), men’s preferred time of attending MCH clinic (OR 6.7, 95% Cl 1.1-43.5), the frequency of men accompanying spouse to MCH clinic (OR 0.1, 95% Cl 0.04-0.3), duration taken to reach MCH clinic (OR 5.6, 95% Cl 1.3-24.6), use of family planning methods (OR 0.36, 95% Cl 0.18-0.72) and awareness about the methods used to reduce HIV mother to child transmission (MTCT) (OR 35, 95% Cl 0.19-0.65) were independently associated with men’s attendance of the MCH clinics. Conclusion: Significantly there was low male involvement in MCH services (16.3% compared to the > 30% targets by Kenya PMTCT guidelines, 2012) in this high HIV prevalent region. Enhanced dissemination and awareness creation on the importance of MI in MCH services could improve male involvement Key words : Male Involvement, Maternal and Child Health Services, Knowledge, Perceptions and Correlates, Suba sub county western Kenya DOI : 10.7176/JHMN/60-15 Publication date :March 31 st 2019

Involvement and practice of community pharmacists in maternal and child health services: A systematic review.

Background: Accredited Social Health Activist (ASHA) programme has been accepted, and the services utilization has been increased among many Indian communities since its inception in 2005 under National Rural Health Mission (NRHM). ASHA worker's knowledge is important for the success of this program. Objectives: To assess the level of knowledge of ASHA workers about Maternal and Child Health (MCH) services. To determine the association between socio-demographic characteristics and the level of knowledge of ASHA workers about Maternal and Child Health services. Methods and Material: A cross sectional study was conducted among 295 ASHA workers of Mysuru Taluk, Karnataka from January to April 2019. Sample size was calculated based on the estimation of proportions method and all the ASHA workers were selected randomly. The semi-structured self-administered questionnaire formulated based on the ASHA modules and translated into the local language (Kannada) was used for data collection. Descriptive data was analyzed by using frequency, percentage, mean and standard deviation. For the association between variables, Chi-square / Fisher’s exact test was used. Results: Knowledge about Antenatal Care was average among half (51.5%) of the participants. All the listed danger signs during pregnancy were identified only by 49.5% of ASHA workers. About 50% of the respondents were not aware of the exclusive breastfeeding till six months after birth. Conclusions: Knowledge levels about maternal and child health services were found to be average in most of ASHA workers.

We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states.

BackgroundThe resilience of Peru´s health system was weakened by a political crisis that started in 2016 and was further challenged by the coronavirus 2019 (COVID-19) pandemic. We assessed the indirect impact of the pandemic on the utilisation of essential maternal and child health (MCH) services in Peru at national and subnational levels.MethodsWe assessed the trends in MCH services utilisation and the percentage change from 2018 to 2021, using routine health facility data. We used an interrupted time series analysis to quantify the impact of COVID-19 on the utilisation of health services.ResultsThe utilisation of most maternal and child health services dropped dramatically in 2020 after the outbreak. However, we observed a quick recovery in 2021, with service utilisation fairly similar or higher to the pre-pandemic period (2018–2019). The decrease was higher in the utilisation of antenatal care visit one or more (incidence rate ratio (IRR) = 0.79; 95% CI = 0.74–0.83) and antenatal care visits four or more (IRR= 0.76; 95% = 0.74–0.79) in 2020. The IRR showed a drop of 5, 6, 9, and 13% in the utilisation of skilled birth attendances, institutional deliveries, caesarean sections and postnatal care visits within two days of childbirth, respectively in 2020 in comparison to pre-pandemic service utilisation. In 2020 the utilisation decreased in all three natural regions, with the Rainforest being the most affected. In 2021 there was a recovery in all natural regions.ConclusionsThe pandemic decreased the utilisation of essential maternal and child health services in Peru. This highlights the need to preserve the resilience of a health system both at central and local levels, to face more successfully future pandemics.

Maternal and Child Health (MCH) service for female worker from before the pregnancy until the first day of a child’s life needs to be done because of so many risks that the worker will face. Accompaniment is done to determine the health condition of the worker and the health of the fetus (infant). The purpose of this study was to provide an overview about characteristics of the maternal and child health service of female workers with maternal and child health status in Indonesia.The design of this study was observational descriptive. The study was conducted on female workers in industrial area with 500 respondents. This study variables were included marital status, age of first pregnancy, pregnancy examination, personnel who assisted the process of pregnancy check up until maternity process, the place of maternity, pregnancy disorder, miscarriage / abortus, exclusive breastfeeding and immunization. Data collection techniques in the form of filling questionnaires either in direct interview or not. The results showed that 66.6% of female workers married at the age of 17-25 years. 67.2% were pregnant at the age of 20-27 years. 56.6% of female workers performed monthly pregnancy checkups. 67% of pregnancy checks performed by midwives. 43.05% stated that delivery was done at midwife’s home. 31.7% of female workers experienced pregnancy disorders. 47.7% of workers provided exclusive breastfeeding. 99% of workers have provided basic immunization. The Maternal and Child Health service that have been received are good enough but the health promotion and provision of MCH service should be done in the company.

ABSTRACTStunting is a linear growth disorder considered as a serious health problem in Indonesia, where its prevalence is related to maternal and child health (MCH) services. This study aimed to compare the coverage of maternal and child health services between two surveys and analyze how they relate to the prevalence of stunting. The study used aggregate data from the 2013 and 2018 Basic Health Research Reports using a cross-sectional approach. The research sample spanned to 34 provinces in Indonesia. Stunting prevalence was taken as aggregate data from individuals based on height-for-age z-scores (HAZ). The independent variable was the achievement of MCH service indicators. Data analysis used variance measures, correlations, simple linear regression, and paired T-tests. The results found variations in the prevalence of stunting, with 25.4% in 2013 and 25.1% in 2018. There was a 7.4% decrease in severe stunting prevalence between 2013 and 2018, but the decrease was not significant (p = 0.506). The analysis results of the 2013 Basic Health Research showed that MCH service indicators related to stunting prevalence were coverage of antenatal care, iron consumption, delivery by health personnel, delivery in health facilities, postpartum maternal health services, low birth weight (LBW) prevalence, neonatal examination, complete immunization, health card ownership, and growth monitoring. The analysis results of the 2018 Basic Health Research showed that MCH indicators were related to the prevalence of antenatal care coverage, delivery by health personnel, and delivery in health facilities, postpartum maternal health services, LBW prevalence, neonatal examination, and complete immunization. There was a significant increase in the coverage of MCH services from 2013 and 2018 (p < 0.0001), except for the coverage of Fe tablet consumption, the prevalence of stunted birth babies, ownership of health cards, provision of vitamin A, and provision of colostrum. The better the coverage of MCH services, the lower the stunting prevalence. Efforts to improve the MCH service programs are required to reduce the prevalence of stunting for Indonesian children. Keywords: stunting, children under five years old, coverage of maternal and child health services

This is a follow-up to a 1984 study that analyzed the relationship between areal variation in the contraceptive prevalence time series and in the intensity of maternal and child health (MCH) services of the Matlab Family Planning Health Services Project. Results based on 69 months of observation suggested that the addition of MCH components to a program with basic MCH and comprehensive family planning services had no incremental impact on family planning efficacy. However, basic MCH services, involving clinical back-up to family planning and child care since the beginning of the program in Matlab, may have contributed to clients' faith in the clinic staff and the overall efficacy of the Matlab program. In the 18 months that followed the cut-off date for this analysis, contraceptive prevalence increased markedly in the study areas. The present analysis repeats the earlier one for the extended time series to determine if the intensification of health services in Matlab contributed to this secondary increase in prevalence, and to ascertain whether the MCH service regimes have long-run differential impacts. Results for the 87-month time series are similar to those of the previous analysis, suggesting that the introduction of additional MCH inputs in the Matlab service area over the 1982-83 period had no incremental impact on the contraceptive prevalence rate time trend.

ObjectivesThe study aimed to assess the oral health promotion services provided as part of the maternal and child health (MCH) services in the Tshwane Health District, Pretoria, South Africa.MethodsThe research design was a descriptive cross-sectional study using a modified standard questionnaire. The population was drawn from the parents/caregivers (PCGs) and the MCH nurses at seven clinics during June 2012 and June 2013 in Pretoria.ResultsThe nurses’ response rate was 83%; average age of 37 years. The majority of the nurses (65%) were females; 60% were professional nurses. Most (63%) of the nurses reported that they provided oral health education (OHE) services. A shortage of dental education materials (43%), staff time (48%), and staff training (52%) were large constraints to nurses providing OHE. The majority of PCGs (n = 382; mean age 31.5 years) had a low education level (76%). About 55% of PCGs received information on children’s oral health from the television and 35% at the MCH clinics. PCGs beliefs were worrying as about 38% believed primary dentition is not important and need not be saved.ConclusionThere is evidence of minimal integration of OHE at MCH sites. Parents’ beliefs are still worrying as a significant number do not regard the primary dentition as important. The MCH site remains an important easily accessible area for integration of oral health services with general health in complementing efforts in prevention of early childhood caries.

Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12-23months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators - 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals.

Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.

In Bokeo province, Lao People’s Democratic Republic, the high rates of poverty and poor health outcomes are striking. According to data collected from the Lao government, the area has a high mortality rate among mothers and children under five years old. Consequently, there is an urgent need for significant enhancements in maternal and child health (MCH) services. This study aims to investigate the perspectives of healthcare providers on the MCH situation, difficulties, challenges, and potential solutions for the growth and implementation of MCH services. We conducted in-depth interviews with 45 healthcare providers from varying healthcare system levels using qualitative methods. The key findings are as follows: Healthcare providers demonstrate a strong understanding of MCH policies, acknowledgment of national objectives, and dedication to personal growth. However, significant obstacles exist, including access barriers for ethnic minorities, transportation complications, inadequate healthcare personnel, and insufficient equipment and infrastructure. Healthcare providers have also indicated a need for more training and opportunities for professional development to improve MCH outcomes. To enhance MCH outcomes in Bokeo province, addressing these challenges and supporting healthcare providers in their quest for self-improvementis essential. The findings of our study can aid in creating targeted interventions and policies to improve MCH outcomes in Bokeo province and similar regions. By focusing on critical areas such as antenatal care, skilled birth attendance, postnatal care, immunizations, nutrition, family planning, health education, and access to healthcare, we can strive towards improved health outcomes and reduced mortality rates.

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.