Coverage Of Maternal Health Services Research Articles

‘That is because we are alone’: A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

ABSTRACT This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Association between media exposure and maternal health service use in Nepal: A further analysis of Nepal Demographic and Health Survey-2022.

Nepal has made incremental progress in improving coverage of maternal health services leading to improved health outcomes. Government and other health sector stakeholders have consistently considered dissemination of educational messages on maternal health through mass media. However, in Nepal's context, the media's influence on the uptake of maternal health services is less known. This study examines the links between media exposure and maternal health service use in Nepal. Our analysis is based on the nationally representative Nepal Demographic and Health Survey (NDHS) 2022 data. We analyzed data from 1933 women aged 15-49 who had given birth in the two years preceding the survey. Weight analysis was performed to account for complex survey design. We presented categorical variables as frequency, percentage, and corresponding 95% Confidence Interval (CI). Univariable and multivariable logistic regression assessed the association between media exposure and maternal health service use, and the results are presented as crude (COR) and adjusted odds ratios (AOR) along with 95% CI. Women exposed to internet use had 1.59 times [AOR = 1.59, 95% CI = 1.16, 2.19], and those exposed to radio and television health programs had 1.73 times [AOR = 1.73, 95% CI = 1.17, 2.56] higher odds of having four or more Antenatal Care (ANC) visits. Similarly, women exposed to mass media had 1.32 times [AOR = 1.32, 95% CI = 1.00, 1.74] and those exposed to health programs had 1.50 times [AOR = 1.50, 95% CI = 1.02, 2.21] higher odds of having an institutional delivery. However, mass media exposure, internet use, and health program exposure were not significantly associated with increased postnatal care of mother and newborn. Exposure to health programs and internet use are positively associated with four or more ANC visits. Exposure to mass media and health programs are positively associated with increased institutional delivery. Our findings imply that well-designed campaigns and awareness programs delivered through mass media platforms play a vital role in enhancing the uptake of maternal health services.

Public health expenditure and household poverty: case study of Egypt

The insufficient and inefficient public expenditure on health services by any health system creates physical and financial barriers to using health care services, especially for poor people and uncovered informal sector workers. This leads to the appearance of household direct out-of-pocket (OOP) payments on health services. OOP will push households into poverty if it exceeds their monetary income, as they cut their spending on other essential needs such as food, clothing, or education fees. The main objective of studying public health expenditure is to provide essential health services to all citizens equally without pushing them into poverty due to health payments OOP. This paper examines the average coverage of Reproductive, Maternal, and Child Health (RMNCH) services according to place of residence and wealth quintile from 2005 to 2015. The rationale for choosing RMNCH only as an indication of health coverage is due to data limitations. This paper depends on World Health Organization (WHO) data. The paper evaluates poverty impact by using poverty head counts and poverty gaps before and after OOP through using nationally representative surveys of Egypt for the years 2005, 2009, 2011, 2013, and 2015. Results show a gap in covering RMNCH services among different groups, but the gap is decreasing over time. Results also show that OOP payments pushed on average 30% of Egyptian households into poverty during the period of the study.

Assessing equity and efficiency of health financing towards universal health coverage between regions in Tanzania

Equity and efficiency in health financing are intermediate universal health coverage (UHC) objectives. While there is growing attention to monitoring these goals at the national level, subnational assessment is also needed to uncover potential divergences across subnational units. We assessed whether health funds were allocated or contributed equitably and spent efficiently across 26 regions in Tanzania in 2017/18 for four sources of funding. Government and donor health basket fund (HBF) expenditure data were obtained from government authorities. Household contributions to health insurance and out-of-pocket payments were obtained from the national household budget survey. We used the Kakwani index (KI) to measure regional funding equity, whereby regional GDP per capita measured regional economic status. Efficiency analysis included four financing inputs and two UHC outputs (maternal health service coverage and financial protection indices). Data envelopment analysis estimated efficiency scores. There was substantial variation in per capita regional funding, especially in insurance contributions (TZS 473–13,520), and service coverage performance (49–86.3%). There was less variation in per capita HBF spending (TZS 1294–2394) and financial protection (93.5–99.4%). Government spending (KI: -0.047, p = 0.348) was proportional to regional economic status; but HBF spending (KI: -0.195, p < 0.001) was significantly progressive (equitably distributed), being targeted to regions with high economic need (poor). The burden of contributing to social health insurance (NHIF) was proportional (KI: 0.058, p = 0.613), while the burden of paying for community-based insurance (CHF, KI: -0.152, p=0.012) and out-of-pocket payments (KI: -0.187, p=0.005) was higher among the poor (regressive). The average efficiency score across regions was 90%, indicating that 90% of financial resources were used optimally, while 10% were wasted or underutilised. Tanzania should continue mobilising domestic resources for health towards UHC, and reduce reliance on inequitable out-of-pocket payments and community-based health insurance. Policymakers must enhance resource allocation formulas, public financial management, and sub-national resource tracking to improve equity and efficiency in resource use.

Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries

BackgroundEnsuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa.MethodsWe analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care.ResultsWe included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care.ConclusionsPersistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.

Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.

Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries

BackgroundPersistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region.MethodsWe conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality.ResultsThe percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor.ConclusionsAddressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.

Tracking progress towards equitable maternal and child health in Yunnan: a systematic assessment for the Health Programme for Poverty Alleviation in China during 2015–2020

ObjectivesTo inform the impacts of health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness in Yunnan, the main battlefield...

Coverage and Quality of Maternal and Infant Health Services in Rural Area of District Kanpur Nagar

Introduction: Most maternal deaths are preventable because there are proven medical procedures to prevent, diagnose, and treat problems. Basic maternal services help reduce and manage pregnancy complications and reduce preventable deaths. Aim and Objective: To assess the quality and extent of maternal and infant health services provided. Material and Methods: The present cross-sectional study was conducted by the Department of Community Medicine, GSVM Medical College Kanpur, using a multistage random sample including women with children less than one year of age and infants (less than one year of age) born to these women in rural blocks of Kanpur Nagar district to assess maternal and infant care services from February 2021 to September 2022. Results: Weight and height were measured in 86.58% of participants, abdominal examination was performed in 81.52% of participants, and blood pressure was checked in 86.84% of participants. Hb test was done in 91.65% participants, urine test for proteinuria was done in 28.35% participants, majority of the study participants received counseling on danger signs (79.49%), dietary counseling (86.58%), newborn care (94.43%), family planning (87.84%). Similar results to NFHS-5 in rural Uttar Pradesh were found in previous published research. Conclusion: The percentage of 4 ANC visits was found to be low in the present study along with low consumption of iron and folic acid.

Assessing universal maternal health service coverage and their determinants in India: A multicentric cross-sectional study.

Universal maternal health coverage (UHC) envisages access to quality healthcare services by pregnant and lactating women without any financial hardship. Our present study attempts to assess the UHC for maternal health services and their determinants, including access to quality antenatal care (ANC), quality postnatal care (PNC), and child immunization among the marginalized populations of India. It was a community-based cross-sectional study across five states of India among pregnant or lactating women. Quality ANC score was calculated using four indicators, including ANC registration month, attendance of four or more ANC visits, receiving at least one tetanus toxoid injection, and consumption of 100 iron-folic acid (IFA) tablets. Similarly, quality PNC care score was calculated using four indicators, including PNC within 48 h, breastfeeding initiation time, institutional delivery, and accessing conditional maternity benefit scheme. Logistic or generalized linear regression was used to depict associations depending on the outcome variables. A total of 12,976 pregnant women's and 18,061 lactating mothers' data were analyzed. Illiterate women, women from below the poverty line, and rural areas had low-quality ANC and PNC scores compared with their counterparts. Marginalized women had lower odds of immunization of children and lower quality PNC scores than nonmarginalized. Sociodemographic factors, such as caste, education of women, area of residence, and economic status, are major determinants of quality ANC and PNC scores and immunization of children. Hence, interventionists ought to design community-based interventions that address the challenges in the uptake of health services.

Utilization and factors associated with health facility delivery among women of reproductive age in rural Ethiopia: Mixed effect logistic regression analysis.

Worldwide over 800 women lose their life each day from complication in pregnancy and child birth. Health facility delivery is one of the key strategies for reducing maternal mortality and for ensuring safe birth. Inequity by urban-rural residence is one of the most pronounced challenges in maternal health service coverage with women living in rural areas at a greater disadvantage than other women. This study aims to assess the magnitude and factors affecting the utilization of health facility delivery for the most recent live birth among women of reproductive age in rural Ethiopia. This is a cross-sectional study based on a data from Ethiopian Mini Demographic and Health Survey 2019 dataset with a total weighted sample of 2900 women of reproductive age group in rural Ethiopia. Data cleaning, coding and labeling were done using STATA version 14 software. Multilevel mixed effect logistic regression model was employed to identify associated factors. Only 44% of reproductive-age women in rural Ethiopia gave their most recent live birth in health institutions. In the multivariable multilevel binary logistic regression analysis; educational status, wealth index, attending 4+ANC, and had ANC from skilled provider were found to be statistically significant factors associated with health facility delivery. In a rural part of Ethiopia, the prevalence of institutional delivery is low. Especial emphasis should be given for mothers with no formal education, and poor household wealth index, Furthermore, implementing public health programs that target to enable women to have more frequent Antenatal Care follow-up from skilled providers may increase the number of health facility deliveries.

Multidomain and multilevel strategies to improve equity in maternal and newborn health services in Nepal: perspectives of health managers and policymakers

BackgroundNepal has committed to achieving universal coverage of quality maternal and newborn health (MNH) services by 2030. Achieving this, however, requires urgently addressing the widening inequity gradient in MNH care utilisation. This qualitative study examined the multidomain systemic and organisational challenges, operating in multi-level health systems, that influence equitable access to MNH services in Nepal.MethodsTwenty-eight in-depth interviews were conducted with health policymakers and program managers to understand supply-side perspectives of drivers of inequity in MNH services. Braun and Clarke’s thematic approach was employed in analysing the data. Themes were generated and explained using a multidomain (structural, intermediary, and health system) and multi-level (micro, meso and macro) analytical framework.ResultsParticipants identified underlying factors that intersect at the micro, meso and macro levels of the health system to create inequity in MNH services. Key challenges identified at the macro (federal) level included corruption and poor accountability, weak digital governance and institutionalisation of policies, politicisation of the health workforce, poor regulation of private MNH services, weak health management, and lack of integration of health in all policies. At the meso (provincial) level, identified factors included weak decentralisation, inadequate evidence-based planning, lack of contextualizing health services for the population, and non-health sector policies. Challenges at the micro (local) level were poor quality health care, inadequate empowerment in household decision making and lack of community participation. Structural drivers operated mostly at macro-level political factors; intermediary challenges were within the non-health sector but influenced supply and demand sides of health systems.ConclusionsMultidomain systemic and organisational challenges, operating in multi-level health systems, influence the provision of equitable health services in Nepal. Policy reforms and institutional arrangements that align with the country’s federalised health system are needed to narrow the gap. Such reform efforts should include policy and strategic reforms at the federal level, contextualisation of macro-policies at the provincial level, and context-specific health service delivery at the local level. Macro-level policies should be guided by political commitment and strong accountability, including a policy framework for regulating private health services. The decentralisation of power, resources, and institutions at the provincial level is essential for technical support to the local health systems. Integrating health in all policies and implementation is critical in addressing contextual social determinants of health.

Examining the relationship between armed conflict and coverage of maternal and child health services in 35 countries in sub-Saharan Africa: a geospatial analysis

Armed conflict is on the rise in sub-Saharan Africa and affects public infrastructures, including health systems, although evidence on population health is sparse. We aimed to establish how these disruptions ultimately affect health service coverage. We geospatially matched Demographic and Health Survey data with the Uppsala Conflict Data Program Georeferenced Events Dataset, covering 35 countries for the period from 1990 to 2020. We relied on linear probability models with fixed effects to capture the effect of nearby armed conflict (within 50 km of the survey cluster) on four service coverage indicators along the continuum of maternal and child health care. We also investigated effect heterogeneity by varying conflict intensity and duration, and sociodemographic status. The estimated coefficients represent the decrease in the probability (in percentage points) of the child or their mother being covered by the respective health service following deadly conflicts within 50 km. Any nearby armed conflict was associated with reduced coverage for all examined health services, with the exception of early antenatal care: early antenatal care (-0·5 percentage points, 95% CI -1·1 to 0·1), facility-based delivery (-2·0, -2·5 to -1·4), timely childhood vaccination (-2·5, -3·1 to -1·9), and treatment of common childhood illnesses (-2·5, -3·5 to -1·4). For all four health services, the negative effects increased for high-intensity conflicts and were significant throughout. When examining conflict duration, we did not find negative effects on the treatment of common childhood illnesses in prolonged conflicts. The analysis on effect heterogeneity revealed that, except for timely childhood vaccination, the negative effects of armed conflict on health service coverage were more pronounced in urban settings. Our findings suggest that health service coverage is significantly affected by contemporaneous conflict, but health systems can adapt to provide routine services, such as child curative services, in situations of prolonged conflict. Our analysis underlines the importance of studying health service coverage during conflict both at the finest possible scales and across different indicators, pointing at the need for differential policy interventions. None. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

Coverage of maternal health services to maternal mortality ratio moderated by public health center accreditation status and causes of maternal death

Maternal mortality is a benchmark in monitoring maternal health globally, the quality of reproductive health services in general, and the country's development towards the Sustainable Development Goals. The purpose of this study was to determine the effect of maternal health service coverage on the Maternal Mortality Ratio (MMR) moderated by the accreditation status of public health centers (PHC) and the causes of maternal mortality. This research is a quantitative analytic method of observational cross-sectional design. The research subjects included all pregnant women, mothers in labor, and postpartum mothers in Indonesia in 2020 with a total sampling technique. The data on the results of health program achievements in Indonesia in 2020, conducted a path analysis using the SmartPLS program. The coverage of maternal health services had a significant negative effect of 54.9% on the MMR (p=0.036) and a significant positive effect of 59.2% on the accreditation status of PHC (p=0.002). The accreditation status of PHC and causes of maternal death did not significantly affect the MMR (p=0.632; p=0.531). The coverage of maternal health services mediated by the accreditation status of PHC did not significantly affect the MMR (p=0.657). The coverage of maternal health services moderated by the accreditation status of PHC and causes of maternal death did not significantly affect the MMR (p=0.643; p=0.318). Increasing the coverage of maternal health services can reduce the MMR and improve the accreditation of PHC. The results of this study can be used as material for evaluation and motivation to increase the coverage of maternal health services in PHC. Abstrak: Kematian ibu merupakan tolak ukur dalam memonitor kesehatan ibu secara global, kualitas pelayanan kesehatan reproduksi secara umum, dan perkembangan negara dalam Sustainable Development Goals (SDGs). Tujuan penelitian ini adalah untuk mengetahui pengaruh cakupan pelayanan kesehatan maternal terhadap rasio kematian ibu dimoderasi oleh status akreditasi Puskesmas dan penyebab kematian ibu. Penelitian ini merupakan kuantitatif metode analitik observasional desain cross sectional. Subjek penelitian meliputi seluruh ibu hamil, ibu bersalin, dan ibu nifas di Indonesia pada tahun 2020 dengan teknik total sampling. Data hasil capaian program kesehatan di Indonesia pada tahun 2020 dilakukan analisis jalur menggunakan program SmartPLS. Cakupan pelayanan kesehatan maternal berpengaruh negatif signifikan 54,9% terhadap rasio kematian ibu (p=0,036) dan berpengaruh positif signifikan 59,2% terhadap status akreditasi Puskesmas (p=0,002). Status akreditasi Puskesmas dan penyebab kematian ibu tidak berpengaruh signifikan terhadap rasio kematian ibu (p=0,632; p=0,531). Cakupan pelayanan kesehatan maternal yang dimediasi oleh status akreditasi Puskesmas tidak berpengaruh signifikan terhadap rasio kematian ibu (p=0,657). Cakupan pelayanan kesehatan maternal yang dimoderasi oleh status akreditasi Puskesmas dan penyebab kematian ibu tidak berpengaruh signifikan terhadap rasio kematian ibu (p=0,643; p=0,318). Peningkatan cakupan pelayanan kesehatan maternal dapat menurunkan rasio kematian ibu dan meningkatkan status akreditasi Puskesmas. Hasil penelitian ini dapat dijadikan sebagai bahan evaluasi dan motivasi untuk meningkatkan cakupan pelayanan kesehatan maternal di Puskesmas.

Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean

IntroductionReducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women’s health and economic empowerment. To support investment decisions, we estimated...

Maternal Health Outcomes in a Somalia Post-war Context: a PhD thesis analyzing trends towards universal health coverage

Abstract Somalia has one of the highest maternal mortality ratios in the world and an inequitable distribution of maternal health outcomes and service utilisation. Like other developing countries, Somalia has adopted the global policy goal of attaining universal health coverage of health services and improved health outcomes across all populations. Although United Nations agencies track the progress towards achieving universal health coverage as part of health targets for achieving the Sustainable Development Goals, empirical case studies are rarely documented, especially in developing countries and even more so in post-war contexts such as Somalia. Literature shows the overall progress towards globally agreed-upon targets for maternal health lagging in war-affected countries, with persistent socioeconomic gradients in health outcomes. However, little is known about the mechanisms through which the social determinants of health impact on the distribution of maternal health outcomes. The aim of this study is to examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes in Somalia. Specifically, the study will analyse the policy context and progress towards achieving universal health coverage of maternal health services in Somalia; analyse trends in maternal health outcomes and inequities in Somalia; and examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes. A mixed-methods case study design will be adopted, employing both qualitative and quantitative approaches to data collection and analysis. The findings of this PhD research will contribute to the evidence base on pathways for achieving universal health coverage of maternal health outcomes in post-war countries like Somalia. This will facilitate development of effective health care policies and those addressing the social determinants, which if implemented will improve maternal health outcomes in Somalia and mark progress towards achieving the goal of universal maternal health coverage.

UNDERSTANDING ACCESS TO MATERNAL HEALTH SERVICES IN FUNTUA, NIGERIA

The study aimed at analysing the extent to which women access maternal health services in Funtua, Nigeria. Most births take place outside health facilities and without the presence of skilled attendants. Katsina State records a high level of maternal mortality with an estimated maternal mortality rate of over 1,000 maternal deaths per 100,000 live births, because a high percentage of births take place outside health facilities. This cross-sectional study sampled 384 mothers of under-fives through a quantitative method. The study found that 55.2% of the respondents found it challenging to access maternal health services, and 38% pointed out long waiting-time as the major problem they faced during their antenatal care visits. The tested hypotheses indicated a relationship between maternal education, independent income and antenatal care attendance. The study recommends women empowerment and improved political will to expand the coverage of maternal health services. Outreach programs to provide vital information on the importance of facility based deliveries should be reinforced.

Association between service readiness and PMTCT cascade effectiveness: a 2018 cross-sectional analysis from Manica province, Mozambique

BackgroundDespite high coverage of maternal and child health services in Mozambique, prevention of mother-to-child transmission of HIV (PMTCT) cascade outcomes remain sub-optimal. Delivery effectiveness is modified by health system preparedness. Identifying modifiable factors that impact quality of care and service uptake can inform strategies to improve the effectiveness of PMTCT programs. We estimated associations between facility-level modifiable health system readiness measures and three PMTCT outcomes: Early infant diagnosis (polymerase chain reaction (PCR) before 8 weeks of life), PCR ever (before or after 8 weeks), and positive PCR test result.MethodsA 2018 cross-sectional, facility-level survey was conducted in a sample of 36 health facilities covering all 12 districts in Manica province, central Mozambique, as part of a baseline assessment for the SAIA-SCALE trial (NCT03425136). Data on HIV testing outcomes among 3,427 exposed infants were abstracted from at-risk child service registries. Nine health system readiness measures were included in the analysis. Logistic regressions were used to estimate associations between readiness measures and pediatric HIV testing outcomes. Odds ratios (OR) and 95% confidence intervals (95%CI) are reported.ResultsForty-eight percent of HIV-exposed infants had a PCR test within 8 weeks of life, 69% had a PCR test ever, and 6% tested positive. Staffing levels, glove stockouts, and distance to the reference laboratory were positively associated with early PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.73 [95%CI: 1.24–2.40] and OR = 1.01 [95%CI: 1.00–1.01], respectively) and ever PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.80 [95%CI: 1.26–2.58] and OR = 1.01 [95%CI: 1.00–1.01], respectively). Catchment area size and multiple NGOs supporting PMTCT services were associated with early PCR testing OR = 1.02 [95%CI: 1.01–1.03] and OR = 0.54 [95%CI: 0.30–0.97], respectively). Facility type, stockout of prophylactic antiretrovirals, the presence of quality improvement programs and mothers’ support groups in the health facility were not associated with PCR testing. No significant associations with positive HIV diagnosis were found.ConclusionSalient modifiable factors associated with HIV testing for exposed infants include staffing levels, NGO support, stockout of essential commodities and accessibility of reference laboratories. Our study provides insights into modifiable factors that could be targeted to improve PMTCT performance, particularly at small and rural facilities.