Child Health Care Delivery Research Articles

Maternal Risk Factors and Birth Outcomes of Pregnancies Complicated by Preeclampsia: A Case–control Study in a Tertiary Care Hospital of Central India

Background: Preeclampsia contributes substantially to maternal and perinatal mortality. Reduction of maternal and perinatal mortality is a global priority, particularly in low- and middle-income countries like India. Preeclampsia is often overlooked during pregnancy and emerges as a significant contributor to mortality if not addressed proactively. Hence, the present study planned to explore maternal risk factors and birth outcomes in women with preeclampsia admitted for delivery in a tertiary care hospital. Materials and Methods: The present case–control study, including 100 matched cases and a similar number of controls, was carried out. For cases, pregnant women admitted for delivery, diagnosed with preeclampsia, while controls included all pregnant women admitted for delivery without preeclampsia were interviewed. A structured interview questionnaire, patient documents, and maternal and child protection (MCP) cards were used for data collection. Results: Family history of hypertension (odds ratio [OR] = 2.90, 95% confidence interval [CI] = 1.65–5.31), history of chronic hypertension (OR = 6.00, 95% CI = 1.97–18.27), and primiparity (OR = 1.28, 95% CI = 0.72–2.26) were significantly associated with preeclampsia. Preterm birth occurred in 58.1% of cases and 41.8% of controls. No associations were found between preeclampsia and the mode of delivery, gender, and birth weight of the baby. Conclusion: Women with a family history of hypertension, primiparous women, and those with a chronic history of hypertension have more tendency to adverse consequences of pregnancy and its outcomes like preterm births. Recognizing high-risk cases promptly and implementing effective management strategies are essential for planning and executing women’s health programs ultimately enhancing nationwide maternal and child health-care delivery.

Experiences of healthcare providers and caregivers regarding health system bottlenecks affecting child healthcare service delivery in a rural district: Empirical qualitative study.

To explore the experiences of nurses and caregivers about the health system bottlenecks to the delivery of child healthcare services in a rural district in Ghana. The study employed a qualitative approach using an exploratory, descriptive design. Collection of data was through semi-structured, face-to-face interviews with 26 participants in the Nkwanta South Municipality, Ghana. Audio recordings of interviews were transcribed verbatim and analysed qualitatively. Inductive codes generated were organised into themes and sub-themes. The main health system bottlenecks that emerged were the poor state of in-patient facilities, inadequate basic logistics and persistent shortage of essential medicines needed for child healthcare delivery. Health system bottlenecks have the tendency to affect the treatment and hospitalisation outcomes of sick children and eventually impact the state of child healthcare negatively. Concerted efforts by government and local authorities to remove these barriers will help to improve child health and child health outcomes. A total of 26 participants comprising nurses and caregivers, agreed and participated in this study. Interviews with these participants were conducts either in the health facilities or in the communities where they live. Their responses contributed significantly to the content of this article.

Advancing pediatric perioperative care in India: Acontemporary overview.

In the last 30 years, significant advances have been made in pediatric medical care globally. However, there is a persistent urban-rural gap which is more pronounced in low middle-income countries than high-income countries, similar urban-rural gap exists in India. While on one hand, health care is on par or better than healthier nations thriving international medical tourism industry, some rural parts have reduced access to high-quality care. With this background, we aim to provide an overview of the present and future of healthcare in India. With the cumulative health experience of the authors or more than 100 years, we have provided our experience and expertise about healthcare in India in this narrative educational review. This is supplemented by the government plans and non government plans as appropriate. References are used to justify as applicable. With the high percentage of pediatric population like other low to middle-income countries, India faces challenges in pediatric surgery and anesthesia due to limited resources and paucity of specialized training, especially in rural areas. Data on the access and quality of care is scarce, and the vast rural population and uneven resource distribution add to the challenges along with the shortage of pediatric surgeons in these areas of specialized care . Addressing these challenges requires a multi faceted strategy that targets both immediate and long-term healthcare needs, focusing on improving the facilities and training healthcare professionals. Solutions could include compulsory rural service, district residency programs, increasing postgraduate or residency positions, and safety courses offered by national and international organizations like Safer Anesthesia from Education Pediatrics, Vital Anesthesia Simulation Training, and World Federation of Society of Anesthesiologists pediatric fellowships. India has achieved great strides in perioperative health care and safety. It has become the major international medical industry due to high-quality care, access and costs. Crucially, India needs to establish local hubs for pediatric perioperative care training to enhance healthcare delivery for children.

Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty.

Children with medical complexity (CMC) may be at increased risk of rural-urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural-urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery. This retrospective cohort study of 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC <18years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification. Of 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with >20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR]=0.95, 95% confidence interval [CI]: 0.94-0.96), more emergency visits (RR=1.12, 95% CI: 1.08-1.16), and fewer hospitalization days (RR=0.90, 95% CI=0.85-0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects. Rural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural-urban disparities.

Identifying determinants of under-five child mortality in northern Togo.

Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo. We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models. Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care. Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.

Analysis of defects in health care delivery for children based on the data of commission forensic medical examinations performed in the Republic of Uzbekistan

To perform a retrospective analysis of the commission forensic medical examinations' data of pediatric profile with identification of defects in health care delivery and establishment of their connection with unfavorable outcome. The data of 3854 commission forensic medical examinations performed in the period from 2012 to 2021 regarding the evaluation of quality of health care delivery for children with the establishment of nature and type of defects in health care delivery, determination of disease (injury) outcome, identification of cause-effect relationship between the defect in health care delivery and negative disease (injury) outcome. Defects in health care delivery were equal 9% in the studied commission forensic medical examinations. Studied data included all types of defects in health care delivery: defects of diagnosis, treatment and health care delivery. The structure of defects in various age groups differed: diagnosis defects prevailed in the age group of children aged from 29 days to 1 year; treatment defects were most frequent in children group of neonatal period and in children group aged 1-17 years. Child disability and death were negative consequences in all age groups. A direct cause-effect relationship was established between the defect in health care delivery and the negative outcome in all cases. The pathogenetically expectable correlation between the defect in health care delivery and negative outcome, represented by disability or death of a child, was considered to be the medical equivalent of this relationship.

Client’s Satisfaction with Child Health Care Delivery in Tamale Teaching Hospital

Background: Studies conducted in public hospitals in Ghana have provided empirical evidence of an inadequate level of quality of health care services, both in terms of objective measures of client opinions and those of health care providers.&#x0D; Aim: The purpose of this study was to assess client satisfaction with the quality of healthcare delivery at the Child Health Department of the Tamale Teaching Hospital (TTH).&#x0D; Methods: A mixed-methods cross-sectional study design using purposeful and convenience sampling techniques were used to obtain 385 parents or caregivers and 6 health professionals at the Tamale Teaching Hospital (TTH) from July, 2021 to April, 2022. Structured questionnaires were used to collect quantitative data, and a semi-structured interview guide was used to collect qualitative data.&#x0D; Results: Most (90.9%) of the respondents are of the view that their children’s health needs were catered for in the facility while only 0.2% of respondents strongly disagreed that their child’s health needs were catered for in the facility. The study indicates that the 1st most ranked important satisfactory factor to the client’s healthcare service quality is tangibility with an RII of 1.20 and the least ranked was priority and responsiveness of RII of 0.40 respectively.&#x0D; Conclusions: Child healthcare service patronage in TTH is generally high. Although the needs of the people are met, we recommend that the management of the hospital should prioritize medical and surgical conditions in the hospital by providing equipment and logistics.

Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study.

BackgroundDigital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems.ObjectiveWe aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs.MethodsWe used the ToC approach for the whole implementation’s life cycle to guide the pilot study and identify the preconditions needed to realize the study’s long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach.ResultsThe initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project’s laptops to collect aggregate data for the District Health Information System 2–based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management.ConclusionsThis study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics.

Health Care Delivery System and the Reduction of Maternal and Child Mortality in Hospitals of Makurdi Benue State Nigeria

The objectives of this publication are to find the historical background of maternal and child health care delivery, the incidence of maternal and child mortality, causes of maternal and child mortality, challenges in accessing maternal health care services of Nigeria. Data for the study were sourced from both primary and secondary means. Primary data was drawn through questionnaire and hospital records. Questionnaire was distributed to a sample of 369 respondents out of 4,740 population of staff of four purposely selected largest hospitals in Makurdi, Benue State. The sample size was determined through Taro Yamane’s formula, while the Bourley’s proportional allocation formula was used to determine the sample size per each hospital. Data were analyzed using descriptive statistics like tables, percentages, mean and standard deviation, while the test of hypotheses were done through Chi-square. The analyzed result shows that; the availability of maternal and child health care services in the hospitals were poor; accessibility of maternal and child health care services was also poor; Furthermore, Maternal and infant mortality is essentially high and increasing in hospitals of Makurdi, Benue State Nigeria. Several challenges are militating against effective healthcare delivery, therefore, the study recommended, among others, that government and other stakeholders should make conscious efforts to ensure that adequate facilities, tools, and equipment are provided for the hospitals to enhance the quality of maternal and child healthcare services in the Benue State of Nigeria.

Communication Challenges Faced by Spanish-Speaking Caregivers of Children with Medical Complexity: a Qualitative Study.

BackgroundCommunication between caregivers and healthcare providers is important in the delivery of high-quality healthcare for children with medical complexity (CMC). Hispanic children face many challenges in access to healthcare services. Our objective was to describe the communication challenges faced by Spanish-speaking parents with limited English proficiency (SSP-LEP).MethodsThis was a qualitative study of 70 children of Spanish-speaking caregivers, enrolled in a complex care program of a tertiary care children’s hospital in North Carolina. Secondary source data were abstracted logs of care coordination tasks maintained by the program’s two bilingual care coordinators for a median observation period of 45 months, and complemented by data from care coordinator interviews. Data were entered and coded in ATLAS.ti. Using thematic content analysis and an iterative process, we identified recurrent themes related to communication challenges of Spanish-speaking caregivers.ResultsMedian age of children was 5 years; 51% were girls; 97% had Medicaid; and 3% were uninsured. Seven children died during the observation period. Three major themes were identified as follows: (1) caregivers faced many communication challenges primarily because of language barrier. (2) Multiple factors at caregiver, provider, and system levels, in addition to language barrier, contributed to communication challenges. (3) Communication challenges had serious consequences for CMC. These consequences were lessened by bilingual coordinators.ConclusionSSP-LEP face unique communication challenges resulting in negative impact on the healthcare of their CMC. Bilingual coordinators can help improve communication between SSP-LEP and their healthcare providers. Interventions to address communication challenges of Spanish-speaking caregivers are warranted.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-01161-x.

Oral Health Care Delivery for Children During COVID-19 Pandemic-A Retrospective Study.

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

An Observational Study of Telemental Care Delivery and the Context for Involuntary Commitment for Mental Health Patients in a Group of Rural Emergency Departments

Background: Rates for all-cause U.S. emergency department (ED) visits to rural critical access hospitals (CAHs) have increased by 50% since 2005. During the same time period, total number of U.S. hospital admissions for a mental health (MH) crisis has increased by 12.2%, with rural counties demonstrating the largest suicide rate increases overall.Introduction: Increasing number of rural patients are reporting need for MH care in the region's four rural EDs. Characteristics of ED telemental health services were evaluated, including MH diagnostic category, voluntary vs. involuntary commitment (IC), forensic vs. nonforensic presentation, ED throughput, disposition, and payor reimbursement.Materials and Methods: Observational 2.5-year program evaluation of telemental health care delivery for children (n = 114) and adults (n = 417) who were evaluated by a rural ED physician and received an MH diagnosis. Participants (N = 531) were treated by a licensed psychiatrist through telemental care delivery from September 2017 to April 2020.Results: Noncommitted ED MH patients (86%; n = 455) were distributed across three major diagnostic groups: (1) depression, anxiety, or other mental illness (35%); (2) substance abuse (33%); or (3) suicide risk (32%), with 47% admitted inpatients (IPs), 47% referred outpatient (OPs), and 6% admitted to CAH. Fourteen percent (n = 76/531) of ED MH patients were subsequently IC, with 67% of those assessed as needing IP care. Forty-nine percent (n = 37) of IC patients presented in police custody. Most common diagnosis for IC patients was suicidal ideation/attempt (χ2 [2, N = 452] = 12.884, p = 0.002). Admitted patients experienced significantly longer length of stay than those with OP referral (p = 0.001). Mean total payor reimbursements for ED MH care were significantly lower than actual ED costs (p < 0.001).Discussion: Innovative approaches to telemental care for IC and non-IC patients need to be piloted and comparatively evaluated in rural CAHs.Conclusion: As the gateway to critically needed MH care, rural CAHs and public services pivotal to care access (e.g., law enforcement) need additional resources and support.

The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings

The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings

Factors resulting in non-utilization of Antenatal Care Services from Public Sector Hospitals in the rural area of Bahawalpur

Background: Knowledge regarding the factors impeding the using antenatal care would help in effective maternal and child health care delivery. Objective: To enlist the barriers resulting in the non-utilization of antenatal care in public sector hospitals in Bahawalpur. Methodology: This was cross-sectional study conducted in the catchment area of public sector healthcare facilities of Bahawalpur, from 20th February to 20th September 2019. The study population comprised of 152 females of childbearing age selected by systematic multistage random sampling technique. A pre-designed and pre-structured questionnaire was the tool for data collection from the study population. Data were analyzed using SPSS version 20. Results: Non-utilization of antenatal care services was found in 44% of women. Barriers resulting in non-utilization of antenatal care were found to be as follows; permission not granted by husband in 25.37%, no awareness about the availability of health services in 17.91%, the distance of the residence from a health facility in 14.93%, no awareness about the existence of health facility in 13.43%, unavailability of medicines in 11.94%, unavailability of staff in 8.96% and unfriendly staff in 7.46% women. Conclusion: This study concluded that the main barriers experienced by consumers of public sector antenatal care services were permission not granted, distance from the residence, and awareness regarding health facility.

Advanced practice for children and young people: A systematic review with narrative summary

To critically appraise and synthesise the current evidence related tothe advanced practice nurse (APN) in the children and young people's healthcare setting. A complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care. Systematic review and narrative summary. CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria. The selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers. Nine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy. This review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators. The findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research.

Scaling up Maternal and Child Healthcare Delivery among Mission Hospitals in Southeast Nigeria: An Empirical Application of Data Envelopment Analysis for Setting Benchmarks and Targets.

The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time.

Complications of Serious Pediatric Conditions in the Emergency Department: Definitions, Prevalence, and Resource Utilization

To define and measure complications across a broad set of acute pediatric conditions in emergency departments using administrative data, and to assess the validity of these definitions by comparing resource utilization between children with and without complications. Using local consensus, we predefined complications for 16 acute conditions including appendicitis, diabetic ketoacidosis, ovarian torsion, stroke, testicular torsion, and 11 others. We studied patients under age 18years using 3 data years from the Healthcare Cost and Utilization Project Statewide Databases of Maryland and New York. We measured complications by condition. Resource utilization was compared between patients with and without complications, including hospital length of stay, and charges. We analyzed 27 087 emergency department visits for a serious condition. The most common was appendicitis (n=16 794), with 24.3% of cases complicated by 1 or more of perforation (24.1%), abscess drainage (2.8%), bowel resection (0.3%), or sepsis (0.9%). Sepsis had the highest mortality (5.0%). Children with complications had higher resource utilization: condition-specific length of stay was longer when complications were present, except ovarian and testicular torsion. Hospital charges were higher among children with complications (P<.05) for 15 of 16 conditions, with a difference in medians from $3108 (testicular torsion) to $13 7694 (stroke). Clinically meaningful complications were measurable and were associated with increased resource utilization. Complication rates determined using administrative data may be used to compare outcomes and improve healthcare delivery for children.

Service providing scenario of urban primary health care services delivery project working in selected municipality

Background: The urbanization and urban growth is going through very rapid in Bangladesh. This growth is being fuelled by rising incomes due to rapid expansion of commerce and industry. The rapid and incessant growth of urbanization on Kushtia district is creating continuous pressure on urban health care services. Urban poor people are also a vital factor for promoting urban primary health care services delivery project (UPHCSDP) to provide health care facilities.Methods: A cross sectional survey was carried out among 576 patients in 3 selected urban primary health care centres in Kushtia Municipality with a major concentration of people residing in urban areas. Data were collected using questionnaires regarding type of care or treatment patients demanded and type of care they received from the clinic.Results: Study results showed that total of 46.5% of the subjects demanded maternal and obstetric health services and 8.6% demanded child health diagnosis and care. It was found that a total of 22.0% of the subjects received physical diagnosis from the centres. About 7.1% clients received advice or suggestions and 8.0% received normal delivery service from the centres.Conclusions: The result shows that these clinics provide a lot of health care services to the clients especially on maternal and child health care delivery system. These services are provided to the patient with less or free of cost. Study exhibited that the overall health care services of health care centres are good. The clients come to these centres for the good quality of treatment.

Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children's Health.

Objective The medical home has been promoted as an optimal model of health care delivery for children. The purpose of this study was to examine the association between having access to a medical home and the health care experiences of children with and without special health care needs (SHCN) in the United States. Methods We analyzed data from the 2016 National Survey of Children's Health. We modeled logistic regressions to assess associations of having access to a medical home with health care experiences for 11,392 CSHCN and 38,820 non-CSHCN. Results We found that not having access to a medical home was negatively associated with preventive medical and dental care visits, greater unmet medical and dental needs, and hospital emergency room visits. Additionally, not having access to a medical home was negatively associated with the physical and oral health among CSHCN and oral health among non-CSHCN. However, we found no significant association between improved physical health status and having access to a medical home among non-CSHCN. Conclusions Results from our analysis suggest that having access to a medical home remains key determinant of improved health care experiences by CSHCN and non-CSHCN in the United States. Our findings underscore the need to develop policies and implement a more concerted program to increase access to health care delivered under the medical home model for CSHCN and non-CSHCN. Policymakers, health care administrators and physician groups can use these findings to inform future policy decisions and service delivery reforms.

A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: baseline survey on maternal health.

Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.