Institutional Delivery Research Articles

Delay in Seeking Institutional Delivery Services and Associated Factors Among Immediate Postpartum Mothers in Public Health Facilities in Gondar Town, Northwest Ethiopia, 2022.

Maternal and neonatal mortality is a global problem that is highly prevalent in low- and middle-income countries, including Ethiopia. Maternal delay in seeking institutional delivery services utilization plays a significant role in determining maternal and neonatal health outcomes. Although studies have been conducted on institutional delivery service utilization in Ethiopia, little is known about factors for delays in seeking care for institutional delivery services. This study aimed to assess the delay in seeking institutional delivery services and associated factors among immediate postpartum mothers in public health facilities in Gondar, northwest Ethiopia. A facility-based cross-sectional study was conducted from July 15 to September 10, 2022. A total of 391 participants were selected using systematic random sampling. Data were collected through face-to-face interviews using structured, pretested, and interviewer-administered questionnaires. Data were entered into EpiData version 4.6, and the analysis was conducted using Statistical Package for Social Science version 26. The multivariable logistic regression model was fitted and the level of significance was set at p ≤ 0.05. The prevalence of delay in seeking institutional delivery was 49.10% (95% confidence interval [CI]: 44.13, 54.08). Rural residence (adjusted odds ratio [AOR] = 2.51; 95% CI: 1.43-4.41), no antenatal care visits (AOR: 2.87; 95% CI: 1.34-6.13), unplanned pregnancy (AOR: 2.98; 95% CI: 1.78-5.01), poor decision-making autonomy in maternity care services (AOR: 1.98; 95% CI: 1.15-3.40), and poor birth preparedness plan (AOR: 4.88; 95% CI: 2.79-8.53) were significantly associated with delays in seeking institutional delivery. Delays in seeking institutional delivery services were high. It is better to promote women's decision-making power in their own health care. In addition, it is better to arrange programs that will improve maternal and child health service utilization.

Improving health indicators of mothers and newborns by empowering communities in urban slums of Mumbai, Maharashtra, India

Abstract Background: Newborns represent the most vulnerable segment of our society, constituting nearly 30% of all under-5 mortality cases. Despite well-established healthcare systems in metropolitan areas, urban slum dwellers, comprising approximately 50%–60% of the population, often lack access to these services. The Society for Nutrition, Education, and Health Action (SNEHA) operates within urban slums, aiming to enhance health outcomes for mothers and children. At SNEHA, we firmly believe that a healthy society starts with the well-being of mothers and infants. Our organization is dedicated to empowering communities to improve the health status of newborns in urban slums. Material and Methods: As part of the intervention, 7819 households with a population of 35,000 were targeted. SNEHA’s field workers conducted regular visits to these households, providing counseling on breastfeeding immunization and identifying potential health risks. Married women of reproductive age were specifically identified and consistently educated about the significance of early pregnancy registration. Pregnant women received support for registering their pregnancies, attending regular antenatal care (ANC) check-ups, adhering to ANC visit schedules, and maintaining adequate iron, calcium, and nutrition intake. Additionally, they were informed about the advantages of institutional delivery and encouraged to prepare for childbirth. Mothers of children under 2 years were urged to bring them to primary health centers for routine immunizations. Furthermore, they were advised on contraception methods to ensure proper spacing between children. Results: Our endeavors have resulted in a 34% rise in early pregnancy registration, a 22% increase in the number of women attending four antenatal check-ups, an 11% uptick in institutional deliveries, a 24% improvement in exclusive breastfeeding rates, and a notable 67% surge in the prevalence of contraception. Conclusion: Our intervention has proven that it is possible to improve the health indicators of women and children through behavior change communication, regular home visits, and community awareness.

Impact of Institutionalisation of Births on Health Policies and Birth Registration in India.

Background: The Registration of Births and Deaths Act (RBD) of 1969 in India mandates continuous recording of vital events; however, after more than 50 years of its enactment, universality remains elusive. Birth registration, a fundamental right, is essential for demographic analysis and effective policy planning. Birth registration is closely linked to child development, access to healthcare, and other societal factors. Analysing its trends helps in designing targeted interventions and monitoring progress toward the Sustainable Development Goals (SDGs). Objectives: This paper aims to analyse the changes in birth registration across Indian states. This paper also examines the impact of institutionalization of births on registration and underscores its significance in policymaking. Methods: The study utilises data from the latest two rounds of National Family Health Survey (NFHS-4 & NFHS-5) to analyse birth registration trends in India. Multivariable logistic regression analysis was employed to examine the impact of place of delivery on birth registration. Findings: The comparison of NFHS-4 and NFHS-5 data demonstrates varying birth registration rates across Indian states, with notable progress in some regions and persistent challenges in others. Multivariable logistic regression analysis highlights the significant influence of place of delivery on registration likelihood. The interaction between wealth and place of delivery suggests a mitigating effect, indicating that increasing institutional births has a positive impact on birth registration, with this effect being more pronounced at different levels of household wealth. It highlights that wealthier households were more likely to register births due to the higher rate of institutional deliveries. Conclusion: India's journey towards universal birth registration under the SDGs presents progress and challenges. NFHS data shows improvements in birth registration, but disparities still persist. Socio-economic status, place of delivery, and maternal education have strong influences on birth registration. Institutional deliveries significantly increase registration likelihood, facilitated by programs like Janani Suraksha Yojana. Integrating birth registration with health services enhances health data accuracy and service delivery. By prioritising targeted interventions, addressing social barriers, and leveraging existing programs, India can ensure that every child's birth is registered, advancing towards a healthier, more equitable future.

Effectiveness of engaging religious leaders in maternal health education for improving maternal health service utilization in Ethiopia: cluster randomized controlled trial.

High mortality rates for pregnant women and their new-borns are one of Africa's most intractable public health issues today, and Ethiopia is one of the countries most afflicted. Behavioral interventions are needed to increase maternal health service utilizations to improve outcomes. Hence, this trial aimed to evaluate effectiveness of trained religious leaders' engagement in maternal health education on maternal health service utilization. The study employed a cluster-randomized controlled community trial that included baseline and end-line measurements. Data on end points were gathered from 593 pregnant mothers, comprising 292 and 301 individuals in the intervention and control groups, respectively. In the intervention group, the trained religious leaders delivered the behavioral change education on maternal health based on intervention protocol. Unlike the other group, the control group only received regular maternal health information and no additional training from religious leaders. Binary generalized estimating equation regression analysis adjusted for baseline factors were used to test effects of the intervention on maternal health service utilization. Following the trial's implementation, the proportion of optimal antenatal care in the intervention arm increased by 21.4% from the baseline (50.90 vs. 72.3, p ≤ 0.001) and the proportion of institutional delivery in the intervention group increased by 20% from the baseline (46.1% vs. 66.1%, p ≤ 0.001). Pregnant mothers in the intervention group significantly showed an increase of proportion of PNC by 22.3% from baseline (26% vs. 48.3%, p ≤ 0.001). A statistically significant difference was observed between in ANC4 (AOR = 2.09, 95% CI: 1.69, 2.57), institutional delivery (AOR = 2.36, 95% CI: 1.94, 2.87) and postnatal care service utilization (AOR = 2.26, 95% CI: 1.79, 2.85) between the intervention and control groups. This research indicated that involving religious leaders who have received training in maternal health education led to positive outcomes in enhancing the utilization of maternal health services. Leveraging the influential position of these religious leaders could be an effective strategy for improving maternal health service utilization. Consequently, promoting maternal health education through religious leaders is advisable to enhance maternal health service utilization.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05716178].

Mapping the spatial distribution of harmful umbilical cord stump care among neonates in Ethiopia: A spatial with multilevel analysis.

The umbilical cord (UC) serves as the main pathway for bacteria to reach the neonate's body, potentially causing local and severe infections, sepsis, and even death. Consequently, neonatal mortality remains a significant public health concern, particularly in Ethiopia. The World Health Organization (WHO) recommends that the umbilical cord stump be kept clean and dry, with the exception of applying topical antiseptics. However, various harmful substances are still applied to the umbilical cord of neonates. Data on the geographical distribution and risk factors for harmful umbilical cord stump (UCS) care are scarce. Therefore, this study aims to fill this gap. A secondary data analysis of the Ethiopian Demographic Health Survey (EDHS 2016) was conducted using a weighted sample of 7,168 live births. ArcGIS version 10.7.1 software was utilized to visualize the spatial distribution of harmful umbilical cord stump (UCS) care practices in Ethiopia. Additionally, a Bernoulli probability model-based spatial scan statistic was applied using Kulldorff's SaTScan version 9.6 software to identify significant clusters of harmful UCS care. A multilevel logistic regression model was used to determine the factors associated with UCS care practices in Ethiopia. Statistical significance was declared at a two-sided P-value of < 0.05. Overall, the prevalence of harmful UCS care in Ethiopia was 15.09% (95% CI: 13.9-16.3), with significant spatial heterogeneity across geographical areas. The hotspot areas of harmful US care were observed in the eastern (Somali) and northern (Tigray and Amhara) parts of Ethiopia. In spatial scan analysis, the most likely primary clusters were observed in South Nation Nationalities and Peoples region (SNNPR), secondary clusters in the Somali, tertiary clusters in Tigray, and the next clusters in the Amhara regions, respectively. In the final multilevel model, maternal age (Adjusted odds ratio/AOR 1.07, 95% CI: 1.02-1.12), institutional delivery (AOR 0.64, 95% CI: 0.42-0.97), female neonates (AOR 1.31, 95% CI: 1.04-1.61), rural residence (AOR 2.18, 95% CI: 1.05-4.52), living in Tigray region (AOR 3.79, 95% CI: 1.38-9.38), living in Somali region (AOR, 2.95% CI: 1.02-8.52), and living in Harari region (AOR 3.51, 95% CI: 1.28-9.60) were identified as a significant factors of harmful US care practice in Ethiopia. In Ethiopia, the distribution of harmful UCS care practices is non-random and highly clustered in the SNNPR, Somalia, Tigray, and Amhara regions. Both individual and community-level factors were significantly associated with the practice. Special emphasis needs to be provided for neonates from those hot-spot areas and to address the identified predictors of harmful umbilical cord stump care practices.

Socioeconomic and regional patterns of child nutritional inequality between tribal and non-tribal communities in India: An analysis based on National Family Health Survey 5 (2019–21)

Background: Despite India’s impressive economic growth and the implementation of a large-scale antimalnutrition program, the country continues to face the highest levels of child malnutrition globally. Among the affected children, half of those under the age of 3 years, in both tribal and nontribal populations, are underweight, while a third of the wealthiest children experience overnutrition. Economic inequality plays a significant role in contributing to malnutrition in both tribal and nontribal communities. Therefore, utilizing data from the fifth round of the National Family Health Survey (2019–21), the present study aims to examine the socioeconomic disparities in childhood malnutrition across all 640 districts of India, with a specific focus on tribal and nontribal populations. Methods: The analysis includes a sample of children aged 0 to 59 months from tribal and nontribal communities. Sociodemographic, personal, clinical, and environmental factors are considered as independent variables. The outcomes of interest include stunting, wasting, and underweight, which are assessed using binary variables. Linear modeling are used to determine the associations between the independent variables and child undernutrition. Results: The study reported a negative Z value (−4.763), indicating greater overall inequality in the tribal population compared to the nontribal population. In terms of odds ratios, females had lower odds of being underweight in both tribal and nontribal populations. Children aged 1 to 2 years had higher odds of being underweight compared to those aged 1 year. The duration of breastfeeding showed varying associations, with breastfeeding for 7 to 12 months increased the risk of underweight in nontribal areas, while longer durations (13–24 and &gt;24 months) were associated with higher chances of wasting in nontribal areas. Higher maternal age at first birth, higher education levels, and sufficient antenatal care visits were protective factors against underweight in both populations. A higher wealth index consistently correlated with reduced odds of underweight in both tribal and nontribal populations. Institutional delivery was associated with higher odds of underweight in tribal areas but lower odds in nontribal areas. Conclusion: The study concludes that in order to address the socioeconomic disparities contributing to stunting, wasting, and undernutrition among tribal populations, targeted interventions are required. These interventions should focus on improving access to education, healthcare, and economic opportunities, particularly among tribal communities. Additionally, policies should aim to reduce income inequality and promote inclusive economic development, ensuring that the benefits of progress are equitably distributed across all population groups. By addressing these socioeconomic factors, it is possible to improve the nutritional status and overall well-being of tribal populations.

Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria.

Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria. the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks. about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD. Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.

Inequality in Afghanistan in the use of prenatal healthcare services according to the sex of newborns.

The association between the sex of newborns and the utilization of prenatal healthcare services during pregnancy and childbirth has not been thoroughly studied. This study investigated the association between the sex of newborns and the extent to which women used prenatal healthcare services in Afghanistan. This study used data obtained from a nationally representative demographic and health survey. The participants in this analysis were women who had given birth in the last five years (n=19,126). Four indicators related to prenatal healthcare utilization were used: (1) number of antenatal care (ANC) visits, (2) number of ANC services provided by skilled professionals, (3) quality of ANC services, and (4) institutional delivery. Multivariate linear and logistic regression models were employed to examine the association between the sex of newborns and the use of prenatal healthcare services after adjusting for sociodemographic and decision-making autonomy variables. There was a significant association between the sex of newborns and use of prenatal healthcare services. Women with female newborns used ANC services fewer times (β =-0.10, 95% CI: -0.17, -0.03), used ANC services provided by skilled professionals fewer times (β=-0.11, 95% CI: -0.18, -0.04), were less likely to receive high-quality ANC (adjusted odds ratio (AOR)=0.78, 95% confidence interval (CI): 0.67, 0.90), and were less likely to deliver their babies at health institutions (AOR=0.83, 95% CI: 0.77, 0.91) than those with male newborns, after adjusting for other variables. The findings revealed a negative association between female newborns and the utilization of prenatal healthcare services among women of reproductive age in Afghanistan. It is important to pay attention to this issue and ensure that all women have equal access to healthcare services regardless of their newborn's sex.

Practice of key essential nutrition action messages and associated factors among mothers of children aged six months to two years old in Karat town, Konso zone, South Ethiopia, 2024: a community-based cross-sectional study.

Key essential nutrition actions (ENA) messages are a comprehensive and evidence-based nutritional package designed to improve the nutritional status during the critical first 1,000 days of life. The poor practice of ENA contributes significantly to mortality and morbidity related to malnutrition in young children. However, there is a dearth of studies focusing on the practice of key ENA messages among mothers and the factors associated with their practice. Therefore, this study aimed to assess the practice of key ENA messages among mothers of children aged 6 months to 2 years in Karat town, Konso zone, South Ethiopia in 2024. A community-based cross-sectional study involving 421 mothers of children aged 6 months to 2 years was conducted in Karat town, Konso zone, South Ethiopia from January 15 to February 29, 2024. Respondents were chosen using computer-generated random numbers. A structured, pretested, and interviewer-administered questionnaire was used to collect data. Following coding and entry into EpiData 3.1, the data were exported to SPSS version 25 for analysis. Logistic regression (bivariate and multivariable) was employed to identify factors influencing mothers' practice of key ENA messages, and statistical significance was set at p < 0.05 with a 95% confidence interval. The study found that 47.6% (95% CI: 42.8, 52.42%) of mothers demonstrated good practices. Having secondary education or higher, institutional delivery, receiving nutritional counseling during antenatal care (ANC), receipt of postnatal care (PNC) services, having good knowledge, and having a good attitude towards ENA all increase the likelihood of good practice. This study emphasizes the need for multifaceted interventions to improve ENA practice among mothers residing in Karat town. To effectively address this issue, it is crucial to implement targeted education programs, strengthen postnatal care services, and nutritional counseling into routine antenatal care, promote institutional deliveries, and enhance awareness.

Pedagogical Skills, Self-Efficacy and Content Knowledge Need For Shorthand Instructional Delivery of Lecturers in Public Tertiary Institutions in Niger State, Nigeria

This study assessed the pedagogical skills, self-efficacy and content knowledge need for shorthand instructional delivery of lecturers in public tertiary institutions in Niger State, Nigeria. Three specific objectives and three research questions guided the study. Similarly, three null hypotheses were formulated and tested at 0.05 level of significance. The study covered shorthand lecturers from sixty public tertiary institution offering shorthand in Northern Nigeria. The design for the study was descriptive survey and the population was 125 shorthand lecturers. The entire 125 shorthand lecturers were used for the study. The instrument for data collection was a 4-points structured questionnaire developed by the researcher titled “Pedagogical Skills, Self-Efficacy and Content Knowledge Need for shorthand instructional Delivery” (PSSECNSID). The instrument was validated by 4 experts. Pilot study was conducted using tertiary institutions in Osun state who were not part of the subjects. The data collected from pilot study was analyzed using Cronbach Alpha method for reliability test and reliability co-efficient of 0.70 was obtained. The instrument was administered to the target respondents using direct approach and the researcher was assisted by 18 research assistants. Mean and standard deviation were used to answer the research questions, while Analysis of Variance (ANOVA) was used to test the null hypotheses at 0.05 level of significance. The study concluded that shorthand lecturers need pedagogical skills, self-efficacy and content knowledge for effective shorthand instructional delivery in public tertiary institutions in Niger State, Nigeria. Based on the findings, the study recommended, among others, that government and professional organizations should organize workshops and seminars that will improve the pedagogical skills, self-efficacy and content knowledge of shorthand lecturers in Niger State, Nigeria. Implication of these findings, among others, is that pedagogical skills need of shorthand lecturers for effective instructional delivery may not improve if training and re-training programme are not organized in public tertiary institutions offering shorthand in Niger State, Nigeria.

Effect of Service Delivery Reforms on Access to Electricity in Rural Kenya

Background: Access to electricity in rural areas is critical for beneficiary households, local communities, and the economy as a whole. Indeed, access to electricity is one of the factors that will determine the realization of Kenya’s Vision 2030. In view of this, the Kenyan government has over the years, through regulatory bodies such as the Rural Electrification Authority, the Energy and Petroleum Regulatory Authority, and Kenya Electric Power, implemented various institutional and service delivery reforms to accelerate electricity adoption in rural areas. Objective: The study investigated the effect of service delivery reforms on access to electricity in rural Kenya. Methodology: The materials used in this study was part of the larger study that was looking at the effect of regulatory reforms in the electricity subsector on access to electricity in rural Kenya. In this paper, we present data generated from the quantitative component of the study that comprised 384 rural households in Kakamega, Uasin Gishu and Nyandarua counties. Data were collected using a questionnaire and analyzed by both descriptive and regression techniques. Findings: The study found that service delivery reforms notably; Stima Loans and Umeme Pamoja schemes as alternative ways of financing access to electricity, have no statistically significant association with access to electricity in the study areas. The results further indicate that most households (69.6%) do not have knowledge about these service delivery reforms. Conclusion: We have highlighted that most rural residents in the surveyed counties do not know of existing alternative ways to finance their access to electricity. Therefore, we suggest an increase in the awareness of rural residents about the existence and availability of these financing schemes to finance accelerate rural electrification in Kenya.

Prevalence of ineffective breastfeeding techniques and its associated factors among breastfeeding mothers in Ethiopia: A systematic review and meta-analysis.

Poor attachment, suckling, and positioning contribute to ineffective breastfeeding techniques. Poor weight gain, stunting, and decreased immunity are caused by insufficient breast milk intake owing to ineffective breastfeeding techniques. Numerous primary studies conducted in Ethiopia have revealed negative effects of ineffective breastfeeding techniques. However, inconsistencies have been observed among these studies, and no review has been conducted to report the amalgamated magnitude and associated factors. Therefore, this review aimed to estimate the national prevalence and factors associated with ineffective breastfeeding techniques in Ethiopia. Using PRISMA standards, we systematically reviewed and meta-analyzed articles from PubMed, Cochrane Library, and Google Scholar to investigate the prevalence and associated factors of ineffective breastfeeding techniques. Q and I2 tests were used to assess heterogeneity across studies. To evaluate the national prevalence and effect size of the linked covariates, a weighted inverse variance random-effects model was used. Subgroup analysis was performed based on the region, sample size, and year of publication. Funnel plots and Egger's regression tests were used to examine publication bias. A sensitivity analysis was also performed to determine the impact of the studies. The analysis included a total of eleven studies with 4,470 participants used in the analysis. The pooled prevalence of ineffective breastfeeding techniques in Ethiopia was 53.13% (45.49, 60.78) no formal education (AOR = 3.42; 95% CI:1.67-5.18; I2 = 72.2%; P = 0.0132), primipara (AOR = 2.72;95% CI:1.81-3.64; I2 = 46.7%; P = 0.131), postnatal care (PNC) (AOR = 1.84; 95% CI:1.35-2.32; I2 = 0%; P = 0.53), breastfeeding counseling (AOR = 1.93; 95% CI:1.23-2.63; I2 = 0%;P = 0.35), home delivery and having breast problem (AOR = 3.11; 95% CI:1.09-5.16; I2 = 0%;P = 0.877) and (AOR = 2.22; 95% CI:1.28-3.16; I2 = 0%;P = 0.80) respectively were significantly associated with ineffective breastfeeding techniques. The prevalence of ineffective breastfeeding techniques in Ethiopia remains high. Policymakers and program officials should focus on empowering women, increasing institutional delivery, and providing counseling on breastfeeding throughout the maternal continuum of care. These measures will improve breastfeeding techniques and lead to better health of both infants and women.

Factors associated with the intention to use maternity waiting homes among pregnant women in North Ethiopia.

Maternity waiting homes are residential facilities, located near a qualified healthcare facility, where pregnant women can await their delivery and be transferred to a nearby healthcare facility shortly before delivery, or earlier if complications arise. Although evidence has shown that maternity waiting homes reduce maternal and neonatal mortality, there is limited information about factors associated with the intention to use maternity waiting homes in the study area. Therefore, the aim of this study was to identify factors associated with intention to use maternity waiting homes among pregnant women. The study used a community-based cross-sectional study design. Simple random sampling was used to select 399 pregnant women. Data were collected using an interviewer-administered pre-tested structured questionnaire.A binary and multivariate logistic regression analysis was performed. Two hundred and eighty (70.2%) women indicated they intended to use a maternity waiting home during their current pregnancy. Participants' educational status, having experienced a previous institutional delivery, the affordability of food while staying at the maternity waiting home, placing a burden on their attendant, having children in the household who can be cared for by the community or family during the woman's absence, and having household chores covered by their family/community were the factors associated with the intention to use a maternity waiting home. Relatively few respondents intended to use maternity waiting homes. Empowering women and giving them agency by ensuring their needs are met are important measures necessary to increase the use of maternity waiting homes.

Nursing activities for health promotion in palliative home care: an integrative review

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear’s Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses’ actions and their moral responsibility to work towards the respect of patient’s values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Predictors of Institutional Delivery in Nepal: Analyzing Nepal Demographic and Health Survey 2016

Nepal has made remarkable progress in reducing the MMR and achieving the MMR-related goal of MDG-5A by 2015. Still, a substantial number of women deliver at home. Still, a significant number of women deliver at home. WHO estimated that 15% of women will suffer severe complications during delivery and pregnancy, leading to most maternal deaths. In Nepal, 1 out of 2 neonatal deaths and 2 out of 5 maternal deaths occur at home. Due to this, institutional delivery is considered the key and proven intervention to reduce maternal and neonatal mortality. The study aims to assess the trends in institutional delivery and its associated factors in Nepal. This study used the Nepal Demographic and Health Survey 2016 dataset to analyze a subset of 5060 women aged 15–49 who had given birth within the five years before the survey. The survey employed a three-stage cluster sampling method for the urban region and a two-stage cluster sampling method for the rural region, including the most recent birth in the study. The obtained data were weighted and analyzed using Chi-square, and the variables found to be significant in Chi-square were introduced with bivariate and multivariate logistic regression to identify the predictors. This study found that caste/ethnicity, place of residence, ecological zone, province, wealth quintile, mother’s education, occupation, birth order, ANC visit, and birth preparedness were independently associated with institutional delivery. To achieve the SDG target of 90% by 2030, we must address these factors and increase the institutional delivery rate.

Utilization of maternal health care services in a rural community of Nepal

Introduction: Nepal has made progress in declining maternal mortality; but not up to the target. One of the important aspects in this regard is to know about the base line maternal health care utilization among women and to develop intervention accordingly. This study aims to identify the utilization of maternal health care services among women of rural municipality of Nepal. Method: A cross sectional analytical study with purposive sampling among 323 married women having at least one child less than five years old was conducted in Bagnaskali rural municipality of Palpa district using face to face interview technique with self-developed structured interview schedule. Descriptive statistics frequency, percentage, mean and standard deviations were used and association between descriptive variables and utilization was done using Chi square and Fisher Exact test as applicable using Statistical Package for Social Sciences (SPSS) version 16. Result: The study showed 21.05% of respondents had completely utilized maternal health care services (four Antenatal Care (ANC) checkups, institutional delivery and three Postnatal Care (PNC) checkups), 78.94% of the respondents had partially utilized services. There was no significant difference in health care utilization between maternal age, education of both mothers and husbands, occupation, types of families and distance to nearest health facility as seen by Chi Square and Fisher Exact Test. Conclusion: Almost all the respondents had ANC checkup and institutional delivery. More than half of the respondents had PNC checkup and the demographic variables had no association with utilization of maternal health care services.

Prevalence and Risk Factors of Uterine Prolapse in Achham District, Nepal

Uterine Prolapse (UP) is one of the hidden morbidities that do not lead to death, but women suffer from severe lifelong disabilities. In Nepal, the prevalence of UP in women varies from 10 to 40% due to several underlying causes. Therefore, the main aim of the study was to identify the prevalence and associated risk factors of UP. This community-based descriptive cross-sectional study was conducted among 300 married women aged 18 and over in four villages of Kamal Bazar Municipality, Achham, who suffered from UP. The random sampling technique was used to collect the data. The samples were selected using multistage sampling technique. The structured interview questionnaire was used and the face-to-face interview was conducted. The data were analyzed using MS-Excel and SPSS version 23. The statistical tests used were binary logistic regression, univariate and multivariate logistic regression. The prevalence of UP was 33.7%. In the multivariate analysis, participants aged 20-30 were forty one times more likely to suffer from UP than older participants of 50-60 {aOR 41.86 (95% CI; 14.31-122.45)}, were seven times more likely to have not attended health facilities for Antenatal Checkup/Postnatal Checkup (ANC/PNC) {aOR 7.10 (95% CI; 3.53-14.26)}, were less likely to have institutional delivery {aOR 0.13 (95% CI; 0.05-0.31)} and were three times more likely to have high Body Mass Index (BMI) {aOR 3.97 (95% CI; 1.81-8.71)}. Thus, the participants who hadn’t attended ANC/PNC checkups, had given birth at home, or had a high BMI, were more likely to have suffered from UP. Education is necessary to make people aware of UP at an early age and its impact is seen among people of a lower age inthe area.

Evaluation of a Community-based Intervention to Improve Maternal New-born and Child Health Coverage in the Rural and Hard-to-reach Communities of Adamawa State Nigeria

The healthcare inequities in hard-to-reach (HTR) areas of developing countries, such as Nigeria, have significant implications for disease prevention and control, particularly in maternal and child health. The aim of this study is to look at how well mobile outreach and health facility outreach programs work to improve health outcomes in rural, underserved, and hard-to-reach (HTR) areas in Adamawa State, Nigeria. The focus is on key indicators of maternal, newborn, and child health. The key interventions include antenatal care (ANC), family planning, routine immunization, vitamin A supplementation, deworming of children under 5 years, and Diarrhea treatment. The study applied a cross-sectional design using before-and-after assessments to assess the outcome of the mobile outreach interventions using quantitative health facility-level data from the District Health Information System (DHIS 2.0) on the intervention. Following a successful intervention, the coverage of these indicators prior to and following the intervention was compared using the data. The study shows a cumulative improvement in ANC (21%), institutional delivery (18%), and Penta 3 coverage (28%). Mobile and hard-to-reach strategies utilizing community health workers and volunteers from the LGA, and health facilities can be effective in improving coverage of MNCH services and hold promise for better maternal and child survival in rural, HTR, and under-resourced parts of Adamawa State, Nigeria, and Sub-Saharan Africa at large. In addition, the mobile outreach interventions have contributed to improving MNCH services in hard-to-reach communities, so scaling up the strategy is highly recommended. Keywords: Hard-to-reach, Interventions, Outreach, Communities, Adamawa State, Nigeria.

Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions

Purpose Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function. Methods In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users. Results The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs’ potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders’ engagement, skills and teamwork.

The individual- and community-level women's empowerment and utilization of maternity care services in Afghanistan: a multilevel cross-validation study.

This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15-49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15-49 y.