Quality Cost Research Articles

Quality–Cost–Environment Assessment of Sustainable Manufacturing of Photovoltaic Panels

This paper aims to develop an integrated Quality–Cost–Environmental (QCE) indicator for the selection of photovoltaic panels (PVps) offered to customers, considering the following criteria: (i) quality satisfaction; (ii) cost-effectiveness; and (iii) environmental impact throughout the life cycle. The proposed QCE indicator was developed within a framework that incorporated an FAHP (Fuzzy Analytic Hierarchy Process), cost-effectiveness analysis (CEA), and life cycle assessment (LCA). The model test confirmed its effectiveness in choosing a PVp which combines environmental friendliness throughout its entire life cycle with satisfactory quality and a reasonable purchase price for customers. The proposed model can be utilized by individuals, businesses, and public entities for the selection of high-quality, cost-efficient, and environmentally friendly PVps—thereby promoting sustainable development.

Research on the improvement mechanism of value-based healthcare objectives in pharmaceutical group procurement

Focusing on the research scenario that integrates value-based healthcare objectives with the pharmaceutical group purchasing model, this study delineates value-based healthcare objectives in pharmaceutical group purchasing from three perspectives: drug sales price, drug quality, and service level. We construct a three-level pharmaceutical group purchasing supply chain consisting of drug manufacturers, medical institutions, and non-profit drug group purchasing organisations. Under centralised and decentralised decision-making, we introduce cost-sharing contracts and “cost-sharing-quantity-discount” contracts to analyse the impact of factors such as drug sales price, quality, and sensitivity of the service level. The study found that: (1) Compared with centralised decision-making, the optimal drug quality and service level in decentralised decision-making and the optimal profits of drug manufacturers and medical institutions will decrease. However, the optimal drug sales price in decentralised decision-making always deviates from that in centralised decision-making, leading to higher or lower drug sales prices. (2) The incorporation of value-based healthcare objectives in the pharmaceutical group purchasing through cost-sharing contracts depends on changes in the proportion of drug quality costs borne by medical institutions. If the proportion is too high, medical institutions will suffer greater losses because they bear too much of the cost. (3) Under certain conditions, cost-sharing contracts can improve supply chain efficiency but cannot achieve supply chain coordination, while the combination of “cost-sharing-quantity-discount” contracts can achieve supply chain coordination in pharmaceutical group purchasing.

Machine-learning-based global optimization of microwave passives with variable-fidelity EM models and response features

Maximizing microwave passive component performance demands precise parameter tuning, particularly as modern circuits grow increasingly intricate. Yet, achieving this often requires a comprehensive approach due to their complex geometries and miniaturized structures. However, the computational burden of optimizing these components via full-wave electromagnetic (EM) simulations is substantial. EM analysis remains crucial for circuit reliability, but the expense of conducting rudimentary EM-driven global optimization by means of popular bio-inspired algorithms is impractical. Similarly, nonlinear system characteristics pose challenges for surrogate-assisted methods. This paper introduces an innovative technique leveraging variable-fidelity EM simulations and response feature technology within a kriging-based machine-learning framework for cost-effective global parameter tuning of microwave passives. The efficiency of this approach stems from performing most operations at the low-fidelity simulation level and regularizing the objective function landscape through the response feature method. The primary prediction tool is a co-kriging surrogate, while a particle swarm optimizer, guided by predicted objective function improvements, handles the search process. Rigorous validation demonstrates the proposed framework's competitive efficacy in design quality and computational cost, typically requiring only sixty high-fidelity EM analyses, juxtaposed with various state-of-the-art benchmark methods. These benchmarks encompass nature-inspired algorithms, gradient search, and machine learning techniques directly interacting with the circuit's frequency characteristics.

A Moiré Removal Method Based on Peak Filtering and Image Enhancement

Screen photos often suffer from moiré patterns, which significantly affect their visual quality. Although many deep learning-based methods for removing moiré patterns have been proposed, they fail to recover images with complex textures and heavy moiré patterns. Here, we focus on text images with heavy moiré patterns and propose a new demoiré approach, incorporating frequency-domain peak filtering and spatial-domain visual quality enhancement. We find that the content of the text image mainly lies in the central region, whereas the moiré pattern lies in the peak region, in the frequency domain. Based on this observation, a peak-filtering algorithm and a central region recovery strategy are proposed to accurately locate and remove moiré patterns while preserving the text parts. In addition, to further remove the noisy background and paint the missing text parts, an image enhancement algorithm utilising the Otsu method is developed. Extensive experimental results show that the proposed method significantly removes severe moiré patterns from images with better visual quality and lower time cost compared to the state-of-the-art methods.

Propofol sedation does not improve measures of colonoscopy quality but increase cost – findings from a large population-based cohort study

Propofol is often used for sedation during colonoscopy. We assessed the impact of propofol sedation on colonoscopy related quality metrics and cost in a population-based cohort study. All colonoscopies performed at 21 hospitals in the province of Ontario, Canada, during an 18-month period, from April 1, 2017 to October 31, 2018, using either propofol or conscious sedation were evaluated. The primary outcome was adenoma detection rate (ADR) and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. Binary outcomes were assessed using a modified Poisson regression model adjusted for clustering and potential confounders based on patient, procedure, and physician characteristics. A total of 46,634 colonoscopies were performed, of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation. Compared to conscious sedation, the use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p<0.0001) but not ssPDR (5.0% vs. 4.7%, p=0.26), PDR (40.5% vs 40.4%, p=0.79), CIR (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%, p=0.45). On multi-variable analysis, propofol sedation was not associated with any differences in ADR (RR=0.90, 95% CI 0.74-1.10, p=0.30), ssPDR (RR=1.20, 95% CI 0.90-1.60, p=0.22), PDR (RR=1.00, 95% CI 0.90-1.11, p=0.99), or CIR (RR=1.00, 95% CI 0.80-1.26, p=0.99). The additional cost associated with propofol sedation was $12,730,496 for every 100,000 cases. The use of propofol sedation was not associated with improved colonoscopy related quality metrics but increased costs. The routine use of propofol for colonoscopy should be reevaluated. None.

EGQCY: A smart contract-based scientific big data system approach for incentive sharing and transaction on the cost of data quality

Currently, scientific big data management is generally faced with the problems of scattered data resources, inconsistent data standards, and the inability to share and circulate data safely. Research personnel attaches great importance to whether sharing the first-hand property is secure under clear ownership and whether it can contribute to the large society. The isolation of the data management system is the obvious obstacle to collecting and managing across-disciplinary data. To a large extent, sharing and trading scientific big data is the primary purpose to realize the clarity of property rights, secure data sharing, and the value of the data assets step by step. We propose to construct a public platform for scientific big data management. The system is managed to unify and authorize the on-chain data, on which data sharing and trading is tracked throughout the process. Smart contracts are executed with vital functions and guarantee price matching in data transactions. We design the incentive mechanism which measures the incentive yield of data cost quality based on Evolutionary Game Theory and Data Quality Control Theory (EGQCY), considering how the cost of data quality performs in controlling and impacting the rational release of the incentive yields in the sharing and trading process. The experiments found that the design of incentive yield and incentive coefficients only significantly affected the transition from low-quality data to medium-quality data. Both parameters converged to fixed values as the cost of data quality increased.

Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984-2022.

This study reviews scholarly publications on data envelopment analysis (DEA) studies on acute care hospital (ACH) efficiency published between 1984 and 2022 in scholarly peer-reviewed journals.We employ systematic literature review (SLR) method to identify and analyze pertinent past research using predetermined steps. The SLR offers a comprehensive resource that meticulously analyzes DEA methodology for practitioners and researchers focusing on ACH efficiency measurement. The articles reviewed in the SLR are analyzed and synthesized based on the nature of the DEA modelling process and the key findings from the DEA models. The key findings from the DEA models are presented under the following sections: effects of different ownership structures; impacts of specific healthcare reforms or other policy interventions; international and multi-state comparisons; effects of changes in competitive environment; impacts of new technology implementations; effects of hospital location; impacts of quality management interventions; impact of COVID-19 on hospital performance; impact of teaching status, and impact of merger. Furthermore, the nature of DEA modelling process focuses on use of sensitivity analysis; choice of inputs and outputs; comparison with Stochastic Frontier Analysis; use of congestion analysis; use of bootstrapping; imposition of weight restrictions; use of DEA window analysis; and exogenous factors. The findings demonstrate that, despite several innovative DEA extensions and hospital applications, over half of the research used the conventional DEA models. The findings also show that the most often used inputs in the DEA models were labor-oriented inputs and hospital beds, whereas the most frequently used outputs were outpatient visits, followed by surgeries, admissions, and inpatient days. Further research on the impact of healthcare reforms and health information technology (HIT) on hospital performance is required, given the number of reforms being implemented in many countries and the role HIT plays in enhancing care quality and lowering costs. We conclude by offering several new research directions for future studies.

Predictive analytics in credit risk management for banks: A comprehensive review

This comprehensive review explores the dynamic landscape of predictive analytics in credit risk management within the banking sector. Anchored in a qualitative research design, the study synthesizes existing literature and real-world case studies to provide a multifaceted understanding of predictive analytics' role in modern banking. The review identifies key trends, highlighting the integration of predictive analytics across diverse banking operations, the transition to advanced machine learning algorithms, the democratization of predictive analytics tools, and the growing emphasis on ethical and regulatory compliance. It underscores the effectiveness of predictive analytics, showcasing its ability to enhance risk assessment precision, decision-making agility, and overall banking performance. Comparative analyses reveal the varying performance of predictive models across contexts, emphasizing the importance of tailored model selection. However, challenges such as data quality, model interpretability, talent scarcity, ethical considerations, and implementation costs pose significant hurdles. Looking forward, predictive analytics promises to be an indispensable tool for mitigating credit risk in the banking sector, offering refined risk assessments, smarter decisions, and enhanced resilience. The insights from this review provide valuable guidance for banking professionals, regulators, and researchers navigating the evolving landscape of predictive analytics in banking.

Development of Eco-friendly Handmade Paper and Paper Board from Soft Bamboo, Whole Banana &amp; Pine Apple Leaves Fibre- Available in N.e. Region of India

The studies were carried out to established suitability of lingo-cellulosic raw materials namely Soft Bamboo (Dendrocalamus arundinacea), Banana (Musa Sapientum) &amp; Pineapple (Ananas Comosus) for making pulps for handmade paper industry which are abundantly available in north eastern part of India. This should help in providing a cost effective, good quality cellulosic raw material as an alternate to cost prohibitive traditionally used cotton hosiery waste traditionally used for manufacturing good quality handmade paper &amp; it’s products. This will help in improving the cost economics &amp; competitiveness of the Indian paper industry in the global market besides addressing the problems of environment &amp; global warming. The Studies thus carried out provide useful information about the nature of these raw materials, suitable pulping process to produce an eco-friendly handmade paper and board &amp; converted products. The research work provides a good quality cost effective lingo-cellulosic raw material for handmade paper industries with a possibility of replacement of the expensive and traditionally used cotton hosiery waste. The paper thus produced using environmental friendly pulping and bleaching process is characterized for its strength properties like tensile, tear, bursting, folding endurance and other parameters. Further the study will be useful in providing opportunities for employment generation and income enhancement among the rural masses as well as addressing the bio-mass dumping.

Enhancement of tomato hedonic quality through fertiliser supplementation with a biostimulant complex comprising molasses, Aloe vera extract and fish-hydrolysate

ABSTRACT Tomato (Solanum lycopersicum) is a popular fruit, grown worldwide for its culinary usages in fresh, processed and cooked foods. Additionally, consumption of tomato fruit is associated with health benefits due to their functional food properties. The signature hedonic measures of tomato fruits are their flavour, aroma and colour, which function as drivers of consumer perception of quality and are therefore associated with purchasing habits. Accordingly, there is interest in strategies to enhance these hedonic measures through supplementation of fertiliser regimens with biostimulants, which have demonstrated improvements to hedonic measures of other food crops. Herein, tomatoes were grown hydroponically with and without supplementation of a biostimulant complex (BC) comprising molasses, Aloe vera extract and fish-hydrolysate. Results identified significant increases in flower and fruit count (1.68-fold, p = 0.033), improvements to the hedonic measures of overall mouthfeel (p = 0.022) and overall visual assessment (p = 0.005), however decreased flavonoid content (0.61-fold, p = 0.022). Accordingly, supplementation of tomato growth with BC was associated with enhancements to the quantity and hedonic quality of tomato at the cost of functional food quality. These findings support the utilisation of biostimulants to enhance food goods’ cultivation and quality perception.

Understanding the relevance and impact of the cost of quality in the construction industry: a systematic literature review using PRISMA

Purpose Construction industry faces challenges in making objective decisions due to monetary value attached to quality. Among various quality management techniques available, cost of quality (COQ) is one such method used to address the concern. However, the absence of measurable COQ factors to monitor quality costs hampers the implementation of COQ framework in the construction industry. Therefore, this study aims to identify COQ factors focused on visible factors (VF) and hidden factors (HF) and the current requirements to achieve it. Design/methodology/approach This study is based on Preferred Reporting Items for Systematic Review and Meta-Analyses protocol guidelines. The present study identified 57 articles published between 1992 and 2023 in peer-reviewed journals. Findings The findings reveal 22 factors, which are grouped into four categories based on COQ. Through systematic review, the authors observed limited methodological and theoretical diversity. In fact, there are no quantitative frameworks to calculate COQ. The study, therefore, developed a framework comprising four major routes/paths of COQ factors within the framework. Practical implications The COQ routes developed through this study will enable the practitioners to meticulously categorise VF and HF, facilitating quantifying of quality throughout the lifecycle of project, which is currently absent from the existing quality assurance/quality control (QA/QC) approach. In addition, these COQ routes stand as essential construction strategies, significantly enhancing outcomes related to time, cost, quality, sustainability and fostering closer relationships within project frameworks. Originality/value The current study contributes significantly to the existing body of knowledge by developing various COQ routes and proposing future research directions to address gaps in the literature.

The Relationship between Food Safety Culture Maturity and Cost of Quality: An Empirical Pilot Study in the Food Industry.

In the food industry, a mature food safety culture (FSC) is linked to better food safety performance. However, the relationship between FSC maturity and key economical performance indicators, such as cost allocation, remains unexplored. This research is the first pilot study to empirically explore the association between FSC maturity and cost of quality (CoQ). A CoQ survey was developed and pretested. CoQ data were collected through collaboration with company management. FSC maturity was assessed through a validated mixed-method assessment (diagnostic instrument, questionnaires, and interviews). A convenience sample of five food processing companies was assembled and subjected to FSC and CoQ assessment. Results revealed that monitoring CoQ is not yet standard practice in the food industry: three out of five companies were unable to specify all failure costs. For prevention and appraisal costs, results showed descriptively and statistically that when these costs are higher, FSC is more mature. Considering the theoretical context of the research (CoQ models and available literature), these results present the first empirical evidence to substantiate that FSC could replace product/service quality in CoQ models. Findings justify the push for a shift in perception, from considering FSC as a task on the list of resource demanding activities toward a narrative in which FSC contributes to financial health.

Quality costs and Industry 4.0: inspection strategy modelling and reviewing

AbstractInspection strategy (IS) is a key component impacting quality costs. Although often considered an inflexible output of initial quality plans, it may require revisions given the dynamic quality situation of the manufacturing system. It is from this background that the present study aims to model and compare different IS based on the cost of quality (CoQ) approach for a case study in the automotive manufacturing industry. While many computational inspection strategy models (ISMs) are available in the literature, most of them face application challenges and struggle to incorporate real-world data. The present study addresses this gap by developing a model that not only represents a real testing station in a manufacturing line but also uses historical production data. Additionally, in relation to model inputs, this study explores the challenges and opportunities of acquiring reliable quality cost estimates in the Industry 4.0 context. Among the main contributions of this work, the developed CoQ-based ISM can be used as a decision-making aiding tool for inspection revision and improvement, while conclusions about quality cost data collection in the industrial digitalization context can help advance the CoQ approach in practice.

A comprehensive quality control and cost comparison study of branded and generic angiotensin receptor blockers

This study was designed to assess both the quality and cost aspects of various branded and generic formulations of angiotensin receptor blockers, specifically Irbesartan, Losartan Potassium, Olmesartan Medoxomil, Telmisartan, and Valsartan. The collected samples underwent distinct quality evaluations using the methods outlined in different global Pharmacopoeias (British Pharmacopoeia/European Pharmacopoeia, Indian Pharmacopoeia and United States Pharmacopoeia). These drugs were characterized using Fourier-Transform Infrared Spectroscopy and Nuclear Magnetic Resonance techniques, while their quality and concentration were analysed using High Performance Liquid Chromatography. The release profile of the drugs was examined through dissolution testing. Additionally, a cost comparison analysis was carried out by determining the prevailing market prices of the drugs. The evaluated branded and generic angiotensin receptor blockers were found to meet the established standards for impurities, active drug content, and dissolution as set by these Pharmacopoeias, indicating their optimal quality. Notably, the generic drugs exhibited significantly lower costs compared to their branded counterparts. This study confirms that the quality of generic angiotensin receptor blockers is equivalent to that of their branded counterparts. Consequently, these findings support the practicality of utilizing generic drugs as a more economically sustainable and cost-effective approach to managing diseases, especially those of chronic nature.

Prediction of Mechanical Properties of Cold-Rolled Steel Based on Improved Graph Attention Network

The prediction of mechanical properties of cold-rolled steel is very important for the quality control, process optimization, and cost control of cold-rolled steel, but it is still a challenging task to predict accurately. For the existing graph structure of graph attention networks, it is difficult to effectively establish the complex coupling relationship and nonlinear causal relationship between variables. At the same time, it is considered that the process of cold-rolled steel has typical full-flow process characteristics and the graph attention network makes it difficult to extract the path information between the central node and its higher-order neighborhood. The neural Granger causality algorithm is used to extract the latent relationship between variables, and the basic graph structure of mechanical property prediction data is constructed. Secondly, the node embedding layer is added before the graph attention network, which leverages the symmetry nature of Node2vec method by incorporating both breadth-first and depth-first exploration strategies. This ensures a balanced exploration of diverse paths in the graph, capturing not only local structures but also higher-order relationships. The combined graph attention networks are then able to effectively capture the symmetry path information between nodes and dependencies between variables. The accuracy and superiority of this method are verified by experiments in real cold-rolled steel production cases.

Pemanfaatan BIM dalam Integrasi Arsitektur dan MEP Pada Proyek Konstruksi Gedung Lab PUT PNJ

Recent building construction projects increasingly prioritize the integration of architectural (design) and MEP (mechanical, electrical, and plumbing) aspects as key elements to achieve effective and sustainable projects. This study aims to explore the close relationship between architecture and MEP in building construction projects and how integrating the two can provide optimal results. This article discusses the important role of Building Information Modeling (BIM) technology in supporting the integration of architecture and MEP. BIM enables architecture and MEP professionals to work collaboratively in an integrated virtual environment, facilitating monitoring, coordination, and early identification of design conflicts. The results showed that effective use of BIM can create more efficient projects in terms of planning, execution, and maintenance. In addition, the study explores planning strategies that support the integration of architecture and MEP, including the selection of environmentally friendly materials, optimal spatial design, and energy efficiency. Comprehensive, sustainable planning can reduce environmental impact, reduce energy consumption, and reduce long-term operating costs. Project control in the context of architectural integration and MEP is also the focus of this study, with emphasis on construction quality monitoring, cost control and risk management. The success of a project often depends on careful control of these aspects. Therefore, this research provides insight into the integration of architecture and MEP in building construction projects and shows how this comprehensive approach can improve efficiency, sustainability, and sustainability as well as overall project outcomes.

Group Warranty Contracts to Coordinate Assembly Supply Chains With Nontestable Components

We consider a supply chain where multiple suppliers and a manufacturer contribute to the assembly of a product (through providing components or labor). The product fails if any of its components (or elements of work) fails, but finding the faulty component can be prohibitively difficult. We study group warranty contracts for the manufacturer to induce suppliers to improve their quality levels. When information is symmetric and the manufacturer can contract on his own quality level, we show that a group warranty contract can achieve the first-best outcome. When the manufacturer’s quality level is not contractible, we show that the manufacturer and all the suppliers under-invest in qualities. We then extend our model to the asymmetric information case where suppliers have private quality cost information. Further, we consider whether the manufacturer benefits from sourcing multiple components from a single supplier, that is, supply consolidation. We find that supply consolidation benefits the manufacturer when his quality level is not contractible, but hurts him in the presence of asymmetric quality cost information of the suppliers.

Assessing the Impact of Antimicrobial Stewardship on Antibiotic Rationality in a Tertiary Hospital Setting

Introduction: Irrational use of antibiotics can lead to antibiotics resistance, necessitating efforts for prevention. The implementation of an Antimicrobial Stewardship Program aims to mitigate inapproriate antimicrobial prescribing. This study aims to compare antibiotic rationality based on quantity, quality, and total cost of antimicrobial utilization following the Antimicrobial Stewardship Program in a tertiary hospital setting.Methods: This was a cross-sectional study. Data were obtained from the medical record of 120 patients hospitalized in the pediatrics ward and classified into two groups: post-program and control. The quantity of antibiotic utilization was measured using Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). Antibiotic rationality was assessed using Gyssens modified category. Normality was evaluated using the Kolmogorov-Smirnov test and analyzed with an independent t-test.Results: There was 10% increase of prudent antibiotic use and a 30.61% reduction in total cost in the post-program study group. However, there was no significant difference in the quantity of antimicrobial utilization in both groups (p=0.06).Conclusion: The program improves the rationality of prudent antibiotic prescription and reduces the total cost of antimicrobial utilization.

Analisis Biaya Kualitas Lingkungan PT PIP Karawang

The purpose of this study is to provide an overview and new insights into the application of environmental quality costs in manufacturing companies, especially PT PIP Karawang. This type of research is qualitative with a case study approach and uses qualitative descriptive analysis techniques. This research reveals that PT PIP has not classified environmental costs as formulated by Hansen and Mowen. PT PIP Karawang has incurred costs related to environmental quality but the classification is still mixed with other costs related to production activities. Regarding the analysis of environmental quality costs according to PSAK, PT PIP has issued costs related to its environmental activities. However, these costs have not been specifically identified by the company, because the identification carried out by PT PIP in carrying out the stages of environmental cost treatment is treated as factory overhead costs. In addition, there is no recognition and measurement of environmental costs incurred according to PSAK, so PT PIP applies the recognition and measurement of environmental costs in accordance with Company policy. PT PIP Karawang has not reported and disclosed the environmental costs incurred because the disclosure of environmental costs is disclosed as overhead costs, so there is no need for special presentation in the financial statements. In addition, PT PIP Karawang has disclosed the GRI 306 standard regarding disclosure of wastewater (influent) and waste management which consists of reporting the volume of waste, type of waste, transportation of waste in collaboration with a transportation company or a utilization company that already has a license from the Ministry of Environment (KLH). Keywords: Environmental Quality Cost, Hansen &amp; Mowen, PSAK, GRI 306

Influence of socio-demographic factors on the use of maternal health care among Muslim women in urban slums of Mumbai, India

Background: Low and middle-income countries such as India face significant challenges in improving maternal health and reducing maternal mortality rate. To combat this problem, it is essential to utilize maternal health-care services. Objective: This study aims to assess the utilization of maternal health-care services (Antenatal care [ANC] and skilled attendance at birth) and the determining factors of maternal health-care utilization. Materials and Methods: This study is cross-sectional. The study is carried out in an urban slum in Mumbai, India. The respondents were selected using a multistage sampling procedure, and 300 Muslim women who delivered in the past 2 years in the reproductive age group (15–49 years) were selected. The data were collected using a structured interview schedule. Data were analyzed using logistic regression analysis. Results: The study shows that maternal health-care utilization among respondents was unsatisfactory. Only 43.8% of the respondents utilized full ANC service and 27.3% still delivered at home with unskilled birth attendance (traditional Dai). A medical emergency, high cost, and lack of quality of services were the most common reasons to deliver at home. Respondents’ age at marriage, education (respondents and partners), monthly income, number of children, and type of family are the most important determining factors for the utilization of maternal health-care services. Conclusion: Better utilization of maternal health-care services can be achieved by improving the overall socioeconomic status of Muslim women. To improve maternal healthcare, special attention is required to be paid to the education of women and spouses. Furthermore, policies may address the women’s subordinate position in socioeconomic parameters. Similarly, close monitoring is required by the government through different agencies on the utilization of maternal health-care services.