Coverage Of Maternal Health Services Research Articles

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.

Zero Inflated Poisson Regression Analysis in Maternal Death Cases on Java Island

The basic regression model used to analyze the count data is the Poisson regression.. However, applying the Poisson regression model is unsuitable for excess zero data because it can cause overdispersion where the variance data is greater than its mean. One of the developments of the Poisson regression model can overcome this condition, Zero Inflated Poisson Regression (ZIP). In the health sector, the death of pregnant women on the Java island is an event that still rarely occurs and forms an excess zero data structure. However, the analysis of cases of maternal mortality using ZIP regression has never been studied in more depth. In this article, the maternal mortality cases in Java were modelled using ZIP regression to specify the variables that had a significant effect. The initial analysis results indicated the occurrence of overdispersion due to excess zero where there are 52% zero values in the data. The ZIP regression applied in this research provides enhancements to the Poisson regression based on the Vuong test. The results showed that the variables that had a significant effect on the maternal death cases in Java in the count model are the percentage of maternal health service coverage and the percentage of coverage of postpartum visit coverage, while in the zero-inflation model, the percentage of deliveries in health facilities and the percentage of obstetric complications treatment

An analysis of RMNCH data quality on technological applications and methods to improve it

Abstract Background Health information management systems (HIMS) are used by most countries to record data on the coverage of reproductive, maternal, newborn and child health services (RMNCH). The HIMS in India manually collects data from primary health care facilities. Low and middle income countries (LMIC) are shifting to technological applications (apps) to improve reporting and real time tracking of RMNCH services. This study found high disparity of data between different sources. Yet governments and other stakeholders continue to use poorly reported data for daily monitoring, review and decision making. This study shares insight on the high degree of data variation, and proposes process and policy changes to improve it. Methods To quantify the extent of data variation, critical RMNCH indicators from apps and HIMS are compared for a given geography and time period. Workshops with the primary health workers and their supervisors were conducted to understand the challenges in reporting, based on which solutions to improve the efficiency of apps are proposed. Results Preliminary analysis in the state of Madhya Pradesh shows, in the year 2020-2021 live births, neonatal deaths and Infant deaths were 93%, 91% and 71% less respectively on apps as compared to HIMS. Major challenges of reporting on technological applications by primary health workers Conclusions Online data quality must be governed by policies that focus on implementing mechanisms to analyze and validate data from different sources and remove blockages to quality reporting. Online public health reports need to be demystified by building capacities of primary health workers and their supervisors to use data to reflect on their performance and plan for improvement. Key messages

Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India

BackgroundExpansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time.MethodsUtilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel ‘Maternal Health Service Coverage Index’ (MHSI) for 29 states and 5 union territories of India for the base (2017–18) and reference (2019–20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year.ResultsIndia registered the highest mean percentage coverage (93.7%) for ‘institutional delivery’ and the lowest for ‘treatment for obstetric complications’ (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015—0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition.ConclusionOverall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Measuring effective coverage of maternal and child health services in Cambodia: a retrospective analysis of Demographic and Health Surveys from 2005 to 2014

ObjectiveTo investigate effective, quality-adjusted, coverage and inequality of maternal and child health (MCH) services to assess progress in improving quality of care in Cambodia.DesignA retrospective secondary analysis using the three...

Does Digitally Enabling Frontline Health Workers Improve Coverage and Quality of Maternal and Child Health Services? Findings From a Mixed Methods Evaluation of TECHO+ in Gujarat.

IntroductionTechnology Enabled Community Health Operations (TeCHO+) is a mobile and web-based application (app) for frontline health workers. It includes features such as real-time data entry, automated generation of the work plan, and a decision support system generating alerts for high-risk cases. Since 2019, the programme is implemented across all 33 districts of Gujarat, catering to a population of over 60 million. This study aims to compare changes in the coverage, quality of data reporting maternal and child health services, and time spent in the documentation before and after the introduction of the TeCHO+ app.MethodsTo address the study aim, a mixed-method design with a realist evaluation approach was adopted. The survey was conducted with randomly selected beneficiaries from 32 sub-centers across two districts of Gujarat State in India. We surveyed 215 postpartum women and mothers of 102 children at baseline (pre) and 246 postpartum women and mothers of 119 children post 1 year of the TeCHO+ programme intervention in 2020. For qualitative data, total 29 Auxiliary Nurse Midwives, 12 Data Entry Operators and 10 Primary Health Center Medical Officers were purposively selected from 32 PHCs and interviewed to understand the pathways leading to the programme outcome.ResultsFollowing introduction of TeCHO+, the coverage of full antenatal care (ANC; 75.6% vs. 67.9%, p-value < 0.0001), consumption of at least 180 iron-folic acid tablets (93% vs. 77%, p-value < 0.001), early initiation of breastfeeding (42.7% vs. 24.2%, p-value < 0.001), five home-visits by ANM during the first month after delivery (36.2% vs. 27.9%, p-value = 0.056), HBV0 vaccination (67.2% vs. 35.3%, p-value < 0.0001) and Pentavalent 2 (100% vs. 95.1%, p-value = 0.015) improved. The overall concordance rate for routine maternal health indicators (a measure of data quality) improved from 69.1 to 80.5%, while that for routine child health indicators improved from 86.6 to 92.1%. The programme resulted in 1.7 h saving a day of ANM's productive time and 1.5 h (a day) of data entry operator's time.ConclusionsThe TeCHO+ programme has improved access to care. It impacted both coverage of maternal and child health services and data reporting quality of various maternal and child high-risk conditions. Considering the programme's success, other disease services might be added to the scope of TeCHO+ software.

High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

BackgroundAntenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visits are vital to improve the health of mothers and newborns. Despite improved access to these routine maternal and newborn health (MNH) services in Nepal, little is known about the cascade of health service coverage, particularly contact coverage, intervention-specific coverage, and quality-adjusted coverage of MNH services. This study examined the cascade of MNH services coverage, as well as social determinants associated with uptake of quality MNH services in Nepal.MethodsWe conducted a secondary analysis of data derived from the Nepal Demographic and Health Survey (NDHS) 2016, taking 1978 women aged 15–49 years who had a live birth in the 2 years preceding the survey. Three outcome variables were (i) four or more (4+) ANC visits, (ii) institutional delivery, and (iii) first PNC visit for mothers and newborns within 48 h of childbirth. We applied a cascade of health services coverage, including contact coverage, intervention-specific and quality-adjusted coverage, using a list of specific intervention components for each outcome variable. Several social determinants of health were included as independent variables to identify determinants of uptake of quality MNH services. We generated a quality score for each outcome variable and dichotomised the scores into two categories of “poor” and “optimal” quality, considering > 0.8 as a cut-off point. Binomial logistic regression was conducted and odds ratios (OR) were reported with 95% confidence intervals (CIs) at the significance level of p < 0.05 (two-tailed).ResultsContact coverage was higher than intervention-specific coverage and quality-adjusted coverage across all MNH services. Women with advantaged ethnicities or who had access to bank accounts had higher odds of receiving optimal quality MNH services, while women who speak the Maithili language and who had high birth order (≥ 4) had lower odds of receiving optimal quality ANC services. Women who received better quality ANC services had higher odds of receiving optimal quality institutional delivery. Women received poor quality PNC services if they were from remote provinces, had higher birth order and perceived problems when not having access to female providers.ConclusionsWomen experiencing ethnic and social disadvantages, and from remote provinces received poor quality MNH services. The quality-adjusted coverage can be estimated using household survey data, such as demographic and health surveys, especially in countries with limited routine data. Policies and programs should focus on increasing quality of MNH services and targeting disadvantaged populations and those living in remote areas. Ensuring access to female health providers and improving the quality of earlier maternity visits could improve the quality of health care during the pregnancy-delivery-postnatal period.

Insight into Nigeria’s progress towards the universal coverage of reproductive, maternal, newborn and child health services: a secondary data analysis

ObjectiveThis study investigated the progress towards the universal coverage of reproductive, maternal, newborn and child health (RMNCH) services in Nigeria after universal health coverage (UHC) adoption.DesignA descriptive observational approach was...

Comparison of Agglomerative Hierarchical and K-Means in Grouping Provinces Based on Maternal Health Services

D uring the Covid-19 period, there were barriers to access for pregnant women to health services that could interfere with maternal health. Therefore, it is necessary to know the achievement of maternal health service coverage in Indonesia during the Covid-19 period in 2020, especially at the provincial level so that it can help the government to determine regional priorities for the fulfillment of more adequate maternal health services. Determination of provincial priorities for the fulfillment of maternal health services can be achieved by grouping the regions according to the characteristics of maternal health services in the local province. Cluster analysis is able to group objects in the form of provinces into one cluster. The clustering methods that will be used are agglomerative hierarchical clustering and k-means clustering. The results of the clustering of the two methods will be compared with internal validation in the form of dunn index, connectivity index, ang silhouette index. The best clustering resuls are obtained by using agglomerative hierarchical clustering alghoritm using the complete linkage similarity function with the resulting five clusters. The results of the identification of cluster characteristics show that cluster 1 with 14 members is categorized as provinces with good coverage of maternal services. Cluster 2 which consists of 15 provinces is categorized as best coverage. Cluster 3 which member are NTT and Maluku is categorized as bad. Cluster 4 which member is East Kalimantan is categorized as sufficient coverage. Meanwhile cluster 5 which member are Papua and West Papua is still on concern because its categorized as worst coverage

Evaluations of effective coverage of maternal and child health services: A systematic review.

Conventionally used coverage measures do not reflect the quality of care. Effective coverage (EC) assesses the extent to which health care services deliver potential health gains to the population by integrating concepts of utilization, need and quality. We aimed to conduct a systematic review of studies evaluating EC of maternal and child health services, quality measurement strategies and disparities across wealth quantiles. A systematic search was performed in six electronic databases [MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, Web of Science and Maternity and Infant Care] and grey literature. We also undertook a hand search of references. We developed search terms having no restrictions based on publication period, country or language. We included studies which reported EC estimates based on the World Health Organization framework of measuring EC. Twenty-seven studies, all from low- and middle-income settings (49 countries), met the criteria and were included in the narrative synthesis of the results. Maternal and child health intervention(s) and programme(s) were assessed either at an individual level or as an aggregated measure of health system performance or both. The EC ranged from 0% for post-partum care to 95% for breastfeeding. When crude coverage measures were adjusted to account for the quality of care, the EC values turned lower. The gap between crude coverage and EC was as high as 86%, and it signified a low quality of care. The assessment of the quality of care addressed structural, process and outcome domains individually or combined. The wealthiest 20% had higher EC of services than the poorest 20%, an inequitable distribution of coverage. More efforts are needed to improve the quality of maternal and child health services and to eliminate the disparities. Moreover, considering multiple dimensions of quality and the use of standard measurements are recommended to monitor coverage effectively.

Indirect effects of the early phase of the COVID-19 pandemic on the coverage of essential maternal and newborn health services in a rural subdistrict in Bangladesh: results from a cross-sectional household survey

ObjectiveThis paper presents the effect of the early phase of COVID-19 on the coverage of essential maternal and newborn health (MNH) services in a rural subdistrict of Bangladesh.DesignCross-sectional household survey...

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data.

IntroductionQuality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women’s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan.MethodsWe used Pakistan Demographic and Health Survey 2017–18 (PDHS) data which comprises of 6,602 currently married women aged between 15–49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care.ResultsWe found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women’s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30–2.10) and 1.45 (95% CI 1.19–1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44–2.43) and 2.78 (95% CI 2.04–3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60–2.44) and 1.56 (95% CI 2.17–1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making.ConclusionThe quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women’s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

The Extent of Universal Health Coverage for Maternal Health Services in Eastern Uganda: A Cross Sectional Study

ObjectiveMonitoring essential health services coverage is important to inform resource allocation for the attainment of the Sustainable Development Goal 3. The objective was to assess service, effective and financial coverages of maternal healthcare services and their equity, using health and demographic surveillance site data in eastern Uganda.MethodsBetween Nov 2018 and Feb 2019, 638 resident women giving birth in 2017 were surveyed. Among them, 386 were randomly sampled in a follow-up survey (Feb 2019) on pregnancy and delivery payments and contents of care. Service coverage (antenatal care visits, skilled birth attendance, institutional delivery and one postnatal visit), effective coverage (antenatal and postnatal care content) and financial coverage (out-of-pocket payments for antenatal and delivery care and health insurance coverage) were measured, stratified by socio-economic status, education level and place of residence.ResultsCoverage of skilled birth attendance and institutional delivery was both high (88%), while coverage of postnatal visit was low (51%). Effective antenatal care was lower than effective postnatal care (38% vs 76%). Financial coverage was low: 91% of women made out-of-pocket payments for delivery services. Equity analysis showed coverage of institutional delivery was higher for wealthier and peri-urban women and these women made higher out-of-pocket payments. In contrast, coverage of a postnatal visit was higher for rural women and poorest women.ConclusionMaternal health coverage in eastern Uganda is not universal and particularly low for postnatal visit, effective antenatal care and financial coverage. Analysing healthcare payments and quality by healthcare provider sector is potential future research.

Trends of maternal health service coverage in the Democratic Republic of the Congo: a pooled cross-sectional study of MICS 2010 to 2018

BackgroundMaternal health services are essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC.Methods The 13,361 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children’s Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate adjusted coverage of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts.ResultsFrom 2010 to 2018, the overall weighted ANC coverage in the DRC declined from 87.3 % (95 % CI 86.1–88.0 %) to 82.4 % (95 % CI 81.1–84.0 %), while the overall weighted skilled birth attendance coverage increased from 74.2 % (95 % CI 72.5–76.0 %) to 85.2 % (95 % CI 84.1–86.0 %). Adjusted ANC coverage and adjusted skilled birth attendant coverage both declined in Kasai Oriental, but increased in Nord Kivu and Sud Kivu. In Kasai Occidental, ANC coverage declined, but skilled birth coverage increased. In the Kasai region, the largest decline in adjusted coverage of ANC was found among the poorest women. However, in the Kivu region, both the adjusted coverage of ANC and skilled birth attendance increased among the poorest women.ConclusionsDue to ongoing conflicts, there has been a systemic deterioration of maternal healthcare coverage in some regions of the DRC, particularly among people with low SES. However, in other regions, maternal healthcare services were not severely disrupted possibly due to substantial international health assistance.

Utilisation of Skilled Birth Attendant in Low- and Middle-Income Countries: Trajectories and Key Sociodemographic Factors.

Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24–1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31–1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.

Investment case approach for equitable access to maternal neonatal and child health services: Stakeholders' perspective in Nepal.

Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. This study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level. Investment Case approach helped stakeholders in planning systematically based on evidence through collaborative and participatory approach while in comparison areas previous year plan was mainly primarily considered as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in coverage of maternal and child health services in both groups. A few participants reported no difference due to the DIC program. The participants specified the improvement in access to information, access and utilization of health services by women. This has influenced the positive health care seeking behavior. The decentralized planning and management approach at the district level helps to ensure equity in access to maternal, newborn and child health care. However, quality evidence, inclusiveness, functional feedback and support system and local resource utilization should be the key consideration.