Institutional Delivery Research Articles

Minimum acceptable diet and its predictors among children aged 6-23 months in Ethiopia. A multilevel cloglog regression analysis.

Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log-log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6-23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log-log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p-value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90-12.15) of the children meet the minimum acceptable diet. Child aged (18-23 month) (AOR = 1.78, 95CI:1.14-2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51-5.15), number of children three and above [(AOR = 0.78,95CI: 0.53-0.94], institutional delivery [AOR = 1.77,95CI: 1.11-3.11], having postnatal-check-up [AOR = 2.33,95CI: 1.59-3.41] and high community poverty level (AOR = 0.49,95CI: 0.29-0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check-ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children.

RetLLM-E: Retrieval-Prompt Strategy for Question-Answering on Student Discussion Forums

This paper focuses on using Large Language Models to support teaching assistants in answering questions on large student forums such as Piazza and EdSTEM. Since student questions on these forums are often closely tied to specific aspects of the institution, instructor, and course delivery, general-purpose LLMs do not directly do well on this task. We introduce RetLLM-E, a method that combines text-retrieval and prompting approaches to enable LLMs to provide precise and high-quality answers to student questions. When presented with a student question, our system initiates a two-step process. First, it retrieves relevant context from (i) a dataset of student questions addressed by course instructors (Q&A Retrieval) and (ii) relevant segments of course materials (Document Retrieval). RetLLM-E then prompts LLM using the retrieved text and an engineered prompt structure to yield an answer optimized for the student question. We present a set of quantitative and human evaluation experiments, comparing our method to ground truth answers to questions in a test set of actual student questions. Our results demonstrate that our approach provides higher-quality responses to course-related questions than an LLM operating without context or relying solely on retrieval-based context. RetLLM-E can easily be adopted in different courses, providing instructors and students with context-aware automatic responses.

Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study.

Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.

Assessing the Impact of the COVID-19 Pandemic on Maternal and Child Health Services: A Comprehensive Analysis of Government Initiatives in Northern India.

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs. Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019. Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program. The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.

Awareness and healthcare seeking behavior of neonatal danger signs, and predictor variables among mothers/caregivers in four developing regional state of Ethiopia

Introduction: Mothers/caregivers should be aware of a newborn’s danger signs and promptly seek medical attention. Hence, this study assessed mothers’/caregivers’ awareness, healthcare seeking behaviors for neonatal danger signs and their determinants in the developing regional state of Ethiopia.MethodsA community-based cross-sectional study was employed among mothers/caregivers of neonates in the developing regional state of Ethiopia. The sample was determined in collaboration with the Central Statistics Agency of Ethiopia. Stratified multi-stage cluster sampling was used to recruit the sample. Data were collected through an interviewer administered structured questionnaire using a tablet computer. Descriptive statistics and binary logistic regression were applied to identify determinants of awareness and treatment-seeking behavior for neonatal danger signs.ResultsThe result of the study showed that nearly one-third (32.7%) of the respondents had a good level of awareness of neonatal danger signs, and 69.0% of the respondents had good healthcare-seeking practice about neonatal danger signs. Regional state (Benishangul-Gumuz) [AOR = 1.61; 95% CI (1.09, 2.39)], Muslim’s [AOR = 1.75; 95% CI (1.20, 2.55)] and permission to travel to a health facility [AOR = 0.48; 95% CI (0.37, 0.63)] were determinants of mothers’/caregivers’ awareness about neonatal danger signs. Antenatal care (ANC) attendance and institutional delivery were shown to have a positive association with neonatal healthcare seeking (AOR = 2.14 and AOR = 2.37, respectively).ConclusionIn Ethiopia’s developing regional states, mothers/caregivers were remarkably unaware of neonatal danger signs. Region, religion, mothers’/caregivers’ age, and need for permission to travel to a health facility were predictor variables for neonatal danger sign awareness. Better healthcare seeking practices, which are determined by ANC attendance and institutional delivery, are observed in these regions. Federal and regional governments should give these regions due attention. Moreover, regional health bureaus and health professionals should tackle the problem by focusing on the identified factors.

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.

Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia.

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements.

Comparison of Janani Suraksha Yojana (JSY) and augmented Arogya Laxmi scheme (ALS) in improving maternal and child health outcomes in urban settlements of Hyderabad, South India

BackgroundIndia accounts for the largest number of global neonatal deaths with around 20 per 1000 live births. To improve the utilization of government services for institutional deliveries, Augmented Arogya Laxmi Scheme (ALS) was launched in Telangana state of southern India. This study assessed the effectiveness of the Janani Suraksha Yojana (JSY), which combines cash assistance with delivery and post-delivery care, in comparison to ALS in improving the outcomes related to antenatal, natal, and postnatal care in urban settlements of Hyderabad, Telangana, southern India.MethodsThis was a two-year cross-sectional study conducted in 14 urban settlements of Hyderabad city from September 2017- August 2019. All mothers delivered during the 18 months preceding the survey were enrolled after a written informed consent. Field investigators collected data on variables related to socio-demographic characteristics, awareness, and utilization of JSY and ALS programs. Variables related to antenatal history, antenatal care, complications during birth, delivery outcomes, newborn care, and postnatal care till 28 days were assessed. We used multivariable logistic regression model to examine the association between the different maternal, child, and socio-demographic characteristics of the two study groups.ResultsA total of 926 mothers were beneficiaries of Janani Suraksha Yojana (JSY) program while 933 mothers were beneficiaries of augmented Arogya Laxmi Scheme (ALS). Mothers in ALS group (AOR 1.71; 95% CI 1.21–2.43) were at increased odds of having more than eight antenatal care (ANC) visits compared to the mothers availing JSY. Mothers in ALS group were at decreased odds of having complications like severe pain in the abdomen (AOR 0.43; 95% CI 0.22–0.86), swelling of legs or feet (AOR 0.59; 95% CI 0.44–0.80) compared to mothers in JSY group. Children of mothers in the ALS group had increased odds of receiving breastfeeding within 30 minutes of birth (AOR 1.46; 95% CI 1.13–1.88) compared to children of mothers in JSY group.ConclusionsThe newly launched augmented ALS led to the increased utilization of the government health facilities and improved the maternal and child health outcomes.

Immunization coverage and its associated factors among children aged 12-23 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies.

Immunization estimated to prevent 2 to 3 million children deaths every year from vaccine preventable disease. In Ethiopia, limited and inconclusive studies have been conducted on immunization coverage so far. Therefore, this umbrella review was intended to estimate the pooled national immunization coverage and its associated factors among children age 12-23 months in Ethiopia. This umbrella review included five systematic reviews and meta-analyses through literature search from PubMed, Science direct, and web of science, CINHALE, and data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and Prospero, the International Prospective Register of Systematic Reviews from May 1 to 30/ 2023. Only systematic reviews and meta-analyses published in English from inception to May 1, 2023, were included. The quality of each study was assessed using Assessment of Multiple Systematic Reviews. Data were extracted using Microsoft excel 2016 and analyzed using STATA 17.0 statistical software. Heterogeneity among studies was assessed using the Cochran Q statistics and I2 test. The pooled effect sizes were determined using pooled proportion for the full vaccination coverage and odds ratios for the associated factors with the corresponding 95% confidence interval were used to declare statically significance. Five studies with 77,161 children aged 12-23 months were included. The overall pooled full vaccination coverage was 57.72% (95% CI 50.17, 65.28). Institutional delivery (OR: 2.12, 95% CI: 1.78-2.52), travel to vaccination site for <2 hours (OR: 2.43, 95%CI: 1.97-3.00), received at least one antenatal (ANC) visit (OR: 3.2, 95%CI: 2.46-4.1), good maternal knowledge of immunization (OR: 3.63, 95%CI: 2.82-4.67), being informed on immunization schedule (OR: 2.54, 95%CI: 2.02-3.2), living in urban areas (OR: 2, 95% CI: 1.54-2.6), and a household visit by health-care providers (HCP) during the postnatal period (OR: 2.23, 95%CI: 1.22-4.09) were the independent predictors of immunization coverage. This study showed the full immunization coverage in Ethiopia was lower compared to the WHO-recommended level. Besides, the current umbrella review identifies several factors that contribute to higher immunization coverage. These includes; institutional delivery, near to vaccination site, having ANC visit, being urban residence, household visited by HCP, having good knowledge and informed on immunization schedule. Thus, the government should intensify the growth of immunization services by emphasizing outreach initiatives to reach remote areas and professionals must combine child immunization service with other medical services offered by health institutions.

Institutional delivery rate and associated factors among women in rural communities: analysis of the 2017–2018 Bangladesh Demographic and Health Survey

BackgroundInstitutional delivery rate among women in rural communities in Bangladesh remains low after several governmental interventions. A recent analysis of maternal mortality in Bangladesh revealed that women in rural communities...

Family and facility care variables attributing to postnatal depression among women in two tribal-dominated districts of Odisha: Log model analysis to suggest intervention.

It is a proven fact that women are affected by poor mental health predominantly in the postnatal period. This is authenticated by the use of a validated and tested Edinburg Postnatal Depression scale (EPNS), which is a simple tool to measure depression among women after delivery by posing 10 questions and this is also validated in Odia language. Odisha has made laudable progress in delivering Maternal and Child Health care to women even in tribal-dominated districts through its robust Comprehensive Obstetrics care network restricting home delivery almost to a mere 4%-5% and reducing maternal deaths by 60%-70% as per the National Family Health Survey (NFHS-5). As a part of an Indian Council of Medical Research (ICMR) extramural project to enhance contraceptive acceptance among males in districts that had a total fertility rate (TFR) higher than 3, a qualitative objective to measure mean postnatal depression in the early postpartum period (who are also the target to advocate contraceptive acceptance) was undertaken. A secondary objective was to compare family care vs. facility care as greater attributing factors for higher EPNS scores. Due to time constraints, the study was done on a fast-track mode wherein two villages each from the sampled blocks of Koraput and Boudh (with one of the highest birth rates) were selected. All women in villages who had a baby aged between 1 and 6 months, were the sampling frame and only those were selected who consented. A questionnaire was used that elicited information on familial sociodemographic details and also facility-based antenatal care (ANC) and postdelivery services that were availed for the last-born child. General Health Questionnaire-12 (GHQ-12) scores were used as an independent variable and a proxy measure of cumulative familial stress. Descriptives and log regression were used to measure the odds of family vs. facility-based services. A total of 98 women, 50 from Boudh and 48 from Koraput, participated in the study. Koraput's mean EPNS scores were 6 points higher than Boudh indicating much higher postnatal poor mental health. Log models showed that there was no difference between facility-based care in both districts as both reported 96%-97.3% institutional delivery, with out-of-pocket expenditure (OOP) being less than 520 Indian rupees on average and nearly 100% reported receipt of iron folic acid and calcium as well as streamlined Janani Suraksha Yojana (JSY) services. However, the odds of men's participation in Family planning was 2.77 times less in Koraput (SD = 2.582), fourth birth order 1.33 odds, and female gender 5.66 odds higher for the district as a result of which GHQ 12 score mean was 21.00 (CI: 19.18-22.82) hinting very high psychological stress as compared with Boudh where the mean was 17 (CI: 14.59-19.41). This clearly indicates that a robust healthcare delivery alone will not be able to address the holistic health of women in the childbearing age group. Familial stressors compound poor mental health and hence counseling of the family as a whole is necessary to achieve sound mental health in women in the postnatal period. The spousal role is emerging as a strong determinant, especially in terms of nonacceptance or casual approach to contraceptive use. Interestingly, a skewed gender bias is noted for the female child, which is also a contributor to postnatal depression (PND) in both districts, though a bigger sample would be needed to statistically prove it.

Adverse pregnancy outcome and its association with the various determinants of current pregnancy in a district hospital, urban Bengaluru, India

Background: Maternal health is a crucial aspect of public health, directly influencing pregnancy outcomes. Adverse outcomes, such as miscarriage, stillbirth, cesarean delivery, and abortion, reflect poor maternal health and contribute to maternal mortality and infant mortality rates. Antenatal care (ANC) and institutional delivery are pivotal strategies to mitigate maternal and fetal complications. However, the escalating rates of cesarean sections in India, surpassing the WHO-recommended threshold, present a severe public health challenge. Methods: This retrospective cross-sectional study, conducted in urban Bengaluru from January to July 2023, aimed to identify adverse pregnancy outcomes and their determinants among women aged 15 to 49 in India. Data from maternal birth and labor records were analyzed, encompassing sociodemographic factors, obstetric characteristics, and adverse outcomes. Results: The study revealed a 20.8% magnitude of adverse pregnancy outcomes. It was found to be higher among women in the age group above 30 years, multigravida, have low blood pressure (BP) both systolic and diastolic, B blood group, positive Rh type, a male baby. In bivariate analysis, higher odds were observed among women in the 30-49 age group, body mass index overweight category, active management of the third stage of labor, and delayed cord clamping were found to be statistically significant. Conclusions: The study underscores the urgency for an expanded action plan to enhance maternal healthcare in India. While governmental initiatives exist, there remains a pressing need to address unnecessary caesarean deliveries and associated complications. The findings advocate for heightened awareness, community health worker training, and stringent guidelines on the necessity of caesarean sections.

Exploring how non-clinical factors in childbirth care shape users’ experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework

IntroductionMany Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user’s perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women’s birthing experiences in public health institutions in Chiapas.MethodsWe conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the “universally legitimate expectations of individuals” and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology.ResultsWe identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women’s comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers’ interpersonal behaviors affect the birthing experience.ConclusionsWe have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.

Assessing Impediments to Healthcare Access for Children Under Five in Larkana, Pakistan Using the Three Delays Model

Abstract:&#x0D; Background: Despite national improvements, Larkana district in Pakistan suffers from high under-five child mortality. This study employs the Three Delays Model (TDM) to identify impediments to healthcare access for children under five in Larkana, informing interventions to combat preventable deaths.&#x0D; Methods: A cross-sectional survey (January-April 2021) in Larkana hospitals recruited 390 parents/guardians via simple random sampling. Semi-structured interviews explored sociodemographics, care-seeking behaviors, and barriers across the TDM's three delays: 1) recognizing and acting on illness, 2) reaching care, and 3) receiving adequate care. Data was analyzed in SPSS v22 using frequencies, percentages, and chi-square tests for associations between sociodemographic factors and care-seeking patterns.&#x0D; Results: 47% of mothers and 29% of fathers lacked formal education. 49.7% of children were born at home. Delay 1 barriers included preference for traditional healers (36%). Delay 2 barriers included lack of transportation (17%) and long travel times (&gt;3 hours for 84%). Delay 3 barriers included high healthcare costs (43% spending &gt;1000 rupees). Illiterate mothers predominantly gave birth at home (44% vs. 13% matriculate mothers, p&lt;0.001) and were less likely to recognize danger signs (61% vs. 89%, p&lt;0.001). Rickshaws were the primary mode of transport (86%).&#x0D; Discussion: This TDM-based study reveals multiple intertwined barriers hindering child healthcare access in Larkana. Maternal education significantly influences care-seeking behavior and danger sign recognition, highlighting the need for targeted community education programs. High prevalence of home births necessitates interventions promoting institutional deliveries. Lack of transportation and high costs demand affordable options like government-subsidized transport or expanded health insurance coverage.&#x0D; Keywords: child health, access to care, Pakistan

Evaluating Decadal Changes in Determinants of Early Childhood Stunting and Assessing Their Contribution to Socio-economic Disparity in Child Nutritional Status Across India

Various efforts have been made over the years to bring about reduction in child malnutrition; the latest among them involves Goal 2 of the SDGs. The SDG Target 2.2 recognizes the global dimension of the nutrition issue and aims to end all forms of malnutrition by 2030, including achieving, by 2025, (WHO, 2015). The present evidence on childhood malnutrition suggests that while improvement in maternal and child covariates have resulted in decline of childhood stunting over time. The present study aims to investigate how the effect of maternal and child covariates on early childhood malnutrition have changed over the last decade and examining the socio-economic disparity in the nutritional status of children across India. The present study utilizes data from the last two rounds of the National Family Health Survey, NFHS-3 in 2005-06 and NFHS-4 in 2015-16 of children in the age group 6-23 months for whom data on height-for-age was available from the last two rounds of the National Family Health Survey (NFHS-3 and NFHS-4). After dropping the missing and flagged cases, the total sample size was 12,507 and 68,246 children from NFHS-3 (2005-06) and NFHS-4 (2015-16), respectively. The selected indicator of childhood under nutrition for this study is stunting. The exposure variables selected for the study were child factors such as sex, age, birth order, size at birth, place of delivery, diet diversity, meal frequency and early initiation of breastfeeding. Maternal factors such as maternal education, media exposure, and mother’s BMI were taken into account. For healthcare service utilization we considered the variable of complete antenatal care. Other background characteristics like religion, caste, wealth index, place of residence and geographical region were also considered. We utilized chi-square test to test for the association of various factors with early childhood stunting followed by t-test to assess the changes in prevalence by each factor. We also carried out bivariate and multivariate logistic analysis to effect of various factors on childhood stunting. Lastly, we carried out Oaxaca decomposition to examine the contribution of the determinants of childhood stunting towards the changes in its prevalence over the last ten years. Concentration Index was calculated to examine the disparity in early childhood stunting across India for both rounds of the National Family Health Survey. The predictive probabilities were calculated for each category of the wealth index after fitting a logistic model to control for other determinants of early childhood stunting to assess the change in prevalence of stunting across each socio-economic group in the last ten years. The study reveals an overall decline in prevalence of early childhood stunting across India over the last ten years from 2005-16. However, high levels of variation continue to exist across all the states in India. The study reveals institutional delivery as the highest contributing factor for this decline. Maternal education, body mass index and complete antenatal care during pregnancy also contribute significantly to the improvement in childhood stunting

Perspectives on Online Education in Higher Education

This inquiry explores the opinions of lecturers and students on the advantages and difficulties of switching from traditional face-to-face mode to online mode of delivery in Ugandan higher education institutions during and even after the COVID-19 pandemic. The study investigates participants' perspectives and experiences regarding the benefits and downsides of online learning. The study's results shed light on the advantages of online learning, such as its adaptability and accessibility, more learning chances, improved engagement and interaction, and promotion of self-directed learning abilities. The inquiry also reveals concerns with technology, pedagogical adaptation, motivation and engagement, evaluation and academic integrity, equity, and inclusiveness. Based on the findings, suggestions are made for improving online education in Uganda's higher education institutions, including investing in technological infrastructure, fostering pedagogical adaptation, encouraging student engagement and motivation, improving assessment procedures and academic integrity, promoting equity and inclusion, and continuously assessing and improving the online learning environment. These suggestions can help higher education institutions in Uganda maximize the advantages of online learning while minimizing its drawbacks, resulting in a more inclusive, interesting, and productive learning environment for students in online settings.

Clustering of home delivery in Bangladesh and its predictors: Evidence from the linked household and health facility level survey data.

Around half of births in Bangladesh occur at home without skilled birth personnel. This study aims to identify the geographical hot spots and cold spots of home delivery in Bangladesh and associated factors. We analyzed data from the 2017/2018 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The outcome variable was home delivery without skilled personnel supervision (yes, no). Explanatory variables included individual, household, community, and healthcare facility level factors. Moran's I was used to determine hot spots (geographic locations with notably high rates of home delivery) and cold spots (geographic areas exhibiting significantly low rates of home delivery) of home delivery. Geographically weighted regression models were used to identify cluster-specific predictors of home delivery. The prevalence of without skilled personnel supervised home delivery was 53.18%. Hot spots of non-supervised and unskilled supervised home delivery were primarily located in Dhaka, Khulna, Rajshahi, and Rangpur divisions. Cold spots of home delivery were mainly located in Mymensingh and Sylhet divisions. Predictors of higher home births in hot spot areas included women's illiteracy, lack of formal job engagement, higher number of children ever born, partner's agriculture occupation, higher community-level illiteracy, and larger distance to the nearest healthcare facility from women's homes. The study findings suggest home delivery is prevalent in Bangladesh. Awareness-building programs should emphasize the importance of skilled and supervised institutional deliveries, particularly among the poor and disadvantaged groups.

Socioeconomic inequalities in utilizing maternal health care in five South Asian countries: A decomposition analysis.

High maternal mortality rates still today remain a significant public health concern in South Asian countries. The majority of maternal deaths occur during pregnancy, and these deaths may typically be avoided by ensuring that women have access to reliable maternity care such as antenatal care (ANC) and facility delivery. The objectives of this research were to assess socioeconomic disparities in the utilization of health care services by mothers and to determine the factors influencing this utilization among women aged 15 to 49 in five South Asian countries. For this study, nationally representative data from the Demographic and Health Survey (DHS) were analyzed. This research included a total of 262,531 women between the ages of 15 and 49. To determine the likely causes of maternal health care utilization, simple bivariate statistics and binary logistic regression were applied, and decomposition analysis and the concentration curve were used to quantify disparity (Lorenz curve). ANC and institutional delivery were both prevalent in 59.27% and 86.52% of cases, respectively. Among the five nations, Maldives has the greatest ANC (96.83%) and institutional delivery (99.39%), while Bangladesh has the lowest ANC (47.01%) and institutional delivery (49.81%). Women's and husbands' education, household wealth status, BMI, and urban residents are the most important factors influencing maternal health service utilization, whereas higher education level, affluent wealth quintiles, and place of residence are the major contributors to socioeconomic inequalities in access to maternal health care that favor the wealthy. Maternal health care services must be utilized properly in order to promote optimal health and prevent maternal mortality. Several socioeconomic and sociodemographic variables of the individual population, as well as policy issues, all have an impact on maternal mortality. This research recommends for concerted action to enhance how successfully women use maternity care services.

HIV counseling, testing, and test result receipt among East African women of reproductive age using recent national health surveys.

One of the most important public health concerns is still the Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS), particularly in developing countries. Although HIV testing is an important step in both prevention and treatment, its uptake remains low, and no study has looked into the scale of HIV counseling, testing, and test result receipt among East African women all at the same time. Therefore, this study aimed to investigate HIV counseling, testing, and test result receipt, as well as the factors that influence them, among East African women. This analysis used Demographic and Health Survey data collected from 10 East African countries between 2011 and 2022. We examined the coverage of HIV counseling, testing, and test result receipt among East African women, as well as other characteristics. To select candidate factors and identify significant explanatory variables related to the outcome variable, binary and multiple logistic regression analyses were conducted, and the results were presented using adjusted odds ratios (AORs) with 95% confidence intervals. In the binary and multiple logistic regression analyses, P values of less than or equal to 0.2 and <0.05 were used to assess significant variables, respectively. A total of 41,627 weighted women included to this study. HIV counseling, testing, and test result receipt among East African women were found to be 77.86% (95% CI = 77.46, 78.26). Being 25-34 years old (AOR = 1.13, 95% CI, 1.06, 1.21), 35-49 years old (AOR = 1.15, 95% CI, 1.05, 1.26) as compared to 15-24 years old women, primary education (AOR = 1.75, 95% CI, 1.64, 1.86), secondary/higher education level (AOR = 1.96, 95% CI, 1.82, 2.13) as compared to not educated women, poor, (AOR = 1.22, 95% CI, 1.14, 1.29), middle wealth (AOR = 1.12, 95% CI, 1.04, 1.21) as compared to rich wealth index, mass media exposure (AOR = 1.29, 95% CI, 1.22, 1.35), 3-5 parity (AOR = 1.29, 95% CI, 1.21, 1.37), more than 5 parity (AOR = 1.46, 95% CI, 1.33, 1.61) as compared to <3 parity, health institution delivery (AOR = 1.65, 95% CI, 1.53, 1.76), were associated positively with the outcome variable respectively. However, being married (AOR = 0.79, 95% CI, 0.72, 0.87), not using contraceptive (AOR = 0.58, 95% CI, 0.51, 0.61), and traditional contraceptive method user (AOR = 0.47, 95% CI, 0.41, 0.54) as compared to modern users were associated negatively with outcome variable respectively. This study found that HIV counseling, testing, and test result receipt are still unsatisfactory. Strengthening maternal health services such as institutional delivery, family planning, and women's empowerment, as well as changing mass media and taking advantage of these opportunities, will boost the region's coverage of HIV counseling, testing, and obtaining results.

Awareness About Maternal and Child Health among the Tribal Women in Two Villages of North Bengal, West Bengal

Despite the implementation of various national programs in India, maternal and neonatal mortality and morbidity remain persistently high in tribal areas, primarily due to a lack of awareness about Maternal and Child Health (MCH) services among tribal women. This study was strategically designed to evaluate the knowledge levels of married tribal women in the reproductive age group regarding MCH services. The focus of this investigation is to understand the awareness about mother and child health services among tribal women in the reproductive age group in two villages, Shikarpur of Jalpaiguri and Hatighisa of Darjeeling district in West Bengal. A total of 100 (50 from each village) married women of reproductive age group were selected. All the participants were interviewed using a survey schedule. Among 100 respondents, 68% completed primary education. A significant proportion of child-birth/deliveries (81%) occur at home, prompting the need for safer institutional deliveries. Prenatal and postnatal care practices vary, with 68% receiving two Tetanus Toxoid doses. Healthcare consultations during sickness show diversity and 57 individuals did not seek any. Breastfeeding initiation within 24 hours was observed. Introducing complementary foods occurred mostly between 0-6 months. The study underscores the necessity for targeted interventions to improve vaccination coverage and healthcare-seeking behaviors, and emphasizes promoting exclusive breastfeeding for enhanced maternal and child well-being.