Institutional Delivery Research Articles

Data quality of out-of-pocket payment on institutional delivery in India

Data quality of out-of-pocket payment on institutional delivery in India

Vaccination delay and associated factors among children of age 12–23 months in Gomma district, Oromia, Ethiopia, 2022

Baby vaccination on time is still a concern, despite the fact that timely and full immunization of children could avert 90% of child mortality attributable to infectious diseases and nutritional problems that are preventable by vaccines. Although numerous research has been conducted on vaccination coverage, only a few studies have highlighted immunization delay and its associated factors in Ethiopia. Additionally, most of them were produced using data from urban populations. Therefore, this study aimed to determine the magnitude of vaccination delay and its associated factors among children aged 12–23 months in the Gomma district, which is one of the prevalently rural districts in Ethiopia. A community-based cross-sectional study was conducted at selected kebeles in the Gomma district from April 1 to 30, 2022, among 528 mother/caregiver-child pairs. A multistage sampling procedure was applied to select the study kebeles and households. Data were collected by face-to-face interviews using a structured questionnaire. The statistical software SPSS version 26 was used for analysis. Bivariable and multivariable binary logistic regression were fitted. Finally, an adjusted odds ratio (AOR) with a 95% CI and a p value < 0.05 was used to describe an association. A total of 528 participants were included in the study. The proportion of delayed vaccination was 40.50% (95% CI 36–44%). Home delivery (AOR 4.32; 95% CI 1.30–14.70), lack of post-natal follow-up [AOR 3.13; 95% CI (1.56–6.47)], and birth order of third and above (AOR 3.20; 95% CI 1.12–9.14) were found to be risk factors for vaccination delay. While a maternal age of above 31 years (AOR 0.40; 95% CI 0.10–0.80) was found to be a protective factor against vaccination delay. The proportion of delayed vaccination was considerable. Implementation of interventions that promote institutional delivery, post-natal service utilization, and increasing knowledge of vaccination schedules are important to minimize the proposition of vaccination delay among children in the study area.

En Route to Midwifery Professionalisation: Contextualising Midwifery Care in the Indian Public Health System

Background The ‘Guidelines on Midwifery Services Initiative, 2018’ introduces the Nurse Practitioner in Midwifery (NPM) cadre to improve maternal mortality rates, quality of care, and reduce overmedicalisation in the Indian public health system. The paper examines how the NPM cadre is envisioned in the guidelines, positioned within the medical hierarchy, and aligned within the existing maternal health context. It also looks at how existing midwives and midwifery advocates perceive the changes introduced and the accompanying professionalisation process. Methodology The study employed two methods: (a) qualitative document analysis (QDA) of the midwifery guidelines and (b) semi-structured in-depth interviews with 14 nurse-midwifery leaders and advocates. Findings The QDA uncovers the underlying themes of task shifting and institutional deliveries as dominant, discussions on professional autonomy and primary health care receiving less importance and even less reflection on the history of midwifery in India. The interview findings highlight (a) tensions around carving out a separate profession, (b) the implications of midwifery at the primary healthcare level and (c) the need for an enabling environment for midwives. This paper reveals how the guidelines frame midwifery as a cost-effective, specialised nursing care within the institutional delivery framework and distanced from its traditional connotations. Discussion It elucidates tensions around autonomous midwifery involving professional boundaries, negotiations with medical professionals, institutional perceptions, and historical stereotypes. It builds on the broader literature on ‘professions’ in sociology by identifying aspects of ‘professional boundary work’ embedded in policy documents and experiences of participants – thereby unpacking the midwifery professionalisation process in the Indian context.

Associated factors for the utilization of institutional delivery services in Nepal: Findings from the Nepal Demographic Health Survey, 2022.

Institutional delivery provides skilled obstetric health care, postnatal care, and essential medical timely intervention to enhance the health of mothers and children. In Nepal, the proportion of institutional deliveries has increased from 8 percent in 1996-79 percent in 2022, although it is not satisfactory. This study investigates disparities in the utilization of institutional delivery service across associated factors related to residential factors, socio-economic factors, health service-related factors, and bio-demographic factors. We used secondary data from the Demographic and Health Survey (DHS) 2022 of Nepal. It involves a sample of 1977 eligible women aged 15-49 who had given birth within two-year preceding the survey. We considered institutional delivery as an outcome variable, while residential, socio-economic, bio-demographic, and health service-related factors as independent variables. Descriptive analysis and binary logistic regression analysis for crude and adjusted odds ratios (AOR) along with 95% confidence interval (CI) were utilized. Of the total 1977 women, 1569 (79.4%) opted for institutional delivery. Women belonging to the Muslim ethnic group had lower odds (AOR:0.500, 95% CI: 0.259-0.966, p < 0.050) compared to their reference group. Similarly, the likelihood of opting for institutional delivery was significantly lower among women who required more than 30 minutes time to reach a health facility (AOR:0.626, 95% CI: 0.491-0.800, p < 0.001) and those having 6 + parity (AOR:0.080, 95% CI: 0.032-0.205, p < 0.001) compared to their reference group. In the contrary, women from Terai region (AOR:2.428, 95% CI: 1.194-4.937, p < 0.050), Bagmati Province (AOR:2.327, 95% CI: 1.179-4.593, p < 0.050), secondary and higher education level (AOR:3.161, 95% CI: 2.141-4.668, p < 0.001), richest wealth group (AOR:13.451, 95% CI: 5.231-34.589, p < 0.001), and antenatal care (ANC) visits 4 and more times (AOR:5.084, 95% CI: 2.7963-9.242, p < 0.001), were noticed more likely to choose for institutional delivery compared to their reference group, respectively. The result shows the ecological region, province, ethnic group, distance to reach health facility, parity, respondents' education level, wealth index and ANC visits, and mother's age in 5-year groups are the associated factors for the utilization of institutional delivery service in Nepal. It highlights the need for targeted interventions to enhance the utilization of institutional delivery services. Addressing socio-economic and geographical disparities, economic barriers, advancing education, promoting antenatal care visits, and ensuring nearer healthcare accessibility are crucial to achieving the equitable maternal and neonatal health care through institutional delivery in Nepal. It is concluded that more attention needs to be paid to areas where the severity persists by professionals and policymakers as well.

Doctor Booking Management

Abstract - Health management systems play a crucial role in modern healthcare by enabling efficient handling of patient records, appointments, medical histories, billing, and communication between patients and healthcare providers. This project focuses on the development of a web-based Health Management System using PHP and MySQL to streamline healthcare services. The system is designed to cater to clinics, hospitals, and independent healthcare providers by offering an integrated platform for managing patients' information securely and effectively. It provides modules for patient registration, doctor scheduling, appointment booking, diagnosis tracking, medical prescriptions, and billing management. Security measures are incorporated to ensure that sensitive patient data remains protected, complying with data protection regulations. PHP was selected for development due to its flexibility, ease of use, and strong support for database interactions, while MySQL was used for storing structured medical data. Testing revealed that the system significantly reduces paperwork, minimizes errors, speeds up administrative processes, and improves service delivery in healthcare institutions. The user-friendly interface ensures that both patients and healthcare providers can navigate the system effortlessly. Feedback from initial users indicated high levels of satisfaction with the system's speed, reliability, and functionality. Future enhancements may include integration with wearable health monitoring devices and mobile app extensions for remote access. The proposed Health Management System represents a scalable, secure, and cost-effective solution for modern healthcare institutions aiming to digitize their services. Key Words: Health Management System, PHP, MySQL, Patient Records, Appointment Scheduling, Healthcare Digitization, Data Security, Medical Billing, Web Application, Hospital Management.

Student Satisfaction and the Quality Service Delivery of Cashier Section in Higher Education Institution

Students' overall experiences and satisfaction levels are greatly influenced by the cashier section's quality of service delivery in educational institutions. Ensuring the quality of services provided to students benefits not only the institution but also contributes to the overall development and success of individual students. The purpose of this research is to investigate student satisfaction with the quality of service provided by the cashier section in educational institution. And also, to find out the relationship between service quality and student satisfaction, as well as to understand students’ perspectives, expectations, and preferences about their encounters with the cashier area by investigating multiple characteristics of service quality, such as inquiries and assistance, their satisfaction with accuracy, how they handle the transaction, and professionalism. The study was quantitative research. And for this investigation, the researcher will employ a descriptive correlation and causal research design. The respondents of the study were the first-year to fourth-year students enrolled during the second semester of the academic year 2023-2024 (with a total of 6,477 students enrolled respectively based on the automated record). From this population of the students a sample size of 363 was determined using Slovin’s formula. The questionnaire items were assessed using a 5-point rating scale. The research instrument will be pilot tested on a subset of 30 students who will not be part of the study. As a result, for cashier service level, payment service, inquiry service, and assistance service are considerably higher, which show very strong positive associations, there is a considerable correlation between overall contentment and satisfaction with the support and service quality received. However, for inquiries, payments and assistance the results indicated that respondents generally agree and rate their experiences as good, suggesting that these areas meet customer expectations. The overall ratings are positive, there is always room for improvement. Additionally, in the level of cashier professionalism, proper mannerism and accuracy, result shows that respondents are highly satisfied, all receiving high ratings. Overall, by focusing areas requiring improvement, organizations can better align their services to the factors that have the greatest impact on customer satisfaction.

Socio-Economic Determinants Shaping Institutional Delivery in Gandaki Province, Nepal

Institutional delivery services are crucial for improving maternal and neonatal health. Their utilization is influenced by diverse socio-economic and geographical determinants, as seen in Gandaki Province, Nepal. The study assessed the determinants of institutional delivery using 206 observations drawn from primary sampling unit which has used NDHS, representing different demographics. Age, birth-order, religion, caste/ethnicity, education, residence, and the wealth index were among the factors that were analyzed by employing logistic regression to assess how they actually influenced institutional delivery rates. The results show that within-birth cohort differences were largely in social status, and wealth index considers using institutional delivery services, while younger (20-24 years) women showed lower odds of using institutional delivery (OR = 0.33432, p = 0.046). Access to educational attainment was the most associated factor positively affecting service utilization because women with higher education have significantly higher odds (OR = 12.92771, p = 0.021), thus signifying the incredible transformational effect of education. Socio-economic factors reflective through wealth index show that middle-income and richer households were more likely to use institutional delivery services. The difference among castes/ethnic groups was big, however. Brahmin/Chhetri (OR = 0.269745, p = 0.044) and Janajati women (OR = 0.170093, p = 0.02) were much less likely to deliver in an institution than other groups. While living in a rural area was not statistically significant in the impact, the geographical factor and poor health infrastructure were vital concerns. The study was directed towards the very focus of attending to socio-economic inequalities, quality health care, and the sensitization of institutional deliveries. It stresses the much-needed multi-dimensional approaches-reforms in policy, education, and infrastructure development that will facilitate the access of maternal healthcare into the Gandaki Province. This study also brings some understanding to the helpful for specific involvements aimed at closing gaps between institutional delivery services and maternal and newborn results. Future research necessitates inquiries to assess the effectiveness of these strategies towards achieving equitable access health care across the boundaries of Nepal. The study implies that targeted policy reforms and multi-dimensional strategies addressing socio-economic disparities, educational access, and healthcare infrastructure are essential to improving institutional delivery rates and achieving equitable maternal and neonatal health outcomes in Gandaki Province, Nepal.

Exploring Factors Influencing Wealth‐Related Disparities in Institutional Delivery: A Decomposition Analysis Using Bangladesh Multiple Indicator Cluster Survey (MICS) 2019

ABSTRACTInstitutional delivery, defined as giving birth in a health facility with skilled delivery assistants, is essential for reducing maternal mortality in low‐ and middle‐income countries. Bangladesh has historically had high maternal mortality rates, with 452 maternal deaths per 100,000 live births in 1993, which declined to 123 per 100,000 live births in 2020. Despite this progress, the maternal mortality rate remains high, and achieving the Sustainable Development Goal (SDG) target of 70 per 100,000 live births requires further improvements in maternal healthcare, particularly in institutional delivery services. This study aimed to assess wealth‐related disparities in the use of institutional delivery services in Bangladesh using data from the Multiple Indicator Cluster Survey (MICS) 2019. We applied a Wagstaff‐type decomposition approach using the Erreygers‐corrected concentration index (CIX) to explore wealth‐related inequality in institutional delivery. Multiple logistic regression was used to identify factors associated with institutional delivery, and a CIX measured wealth‐related disparities. Decomposition analysis helped identify key contributors to these disparities. Results showed that 52% of deliveries were institutional deliveries. Women from rich‐ and middle‐income households had a 94% adjusted odds ratio (AOR = 1.94; 95% confidence intervals [CI]: 1.62–2.34) and 32% (AOR = 1.32; 95% CI: 1.12–1.56) higher likelihood, respectively, of delivering in a health institution compared to poor women. The CIX value of 0.170 indicated institutional delivery was more common among wealthier women. Decomposition analysis revealed that antenatal care (ANC) visits (33.1%), parity (11.8%), and wealth index (11.1%) were significant contributors to wealth‐related disparities. In conclusion, institutional delivery remains underutilized in Bangladesh, with only half of all births occurring in health facilities. To accelerate progress in reducing maternal mortality, targeted pro‐poor strategies are essential, particularly in rural and underserved areas like Mymensingh. Efforts should focus on expanding healthcare access, improving maternal education, and strengthening ANC services.

Maternal satisfaction in health facilities during childbirth and Newborn survival in Bihar State of India

India has made significant strides in reducing neonatal mortality rate (NMR) from 52 per 1000 live births in 1990 to 20 per 1000 live births in 2020. Nevertheless, the decline is not uniform across the states including Bihar the state of India. Even though Bihar has seen a considerable increase in institutional deliveries, a crucial health intervention to reduce NMR, the decline is gradual with 21 per 1000 live births in 2020, accounting almost 78% of infant deaths. This underscores the disparities in standard of care provided at health facilities which could have an adverseimpact on NMR. Using a mixed method approach in eight selected districts of Bihar, the present study explores mothers’ satisfaction through care provided in facilities and examines the association between maternal satisfaction from the quality of services and neonatal survival. The study finds that improved quality of institutional care is significantly associated with lower neonatal deaths. The study also identifies gaps in providing quality care, including long waiting times, inappropriate staff behavior, and provision of poor postnatal care. Addressing these gaps through appropriate policy measures is essential to accelerate progress towards reducing neonatal mortality in the state and achieving the Sustainable Development Goals. Efforts to improve the public health system in Bihar should prioritize enhancing the quality of services to ensure better maternal and neonatal outcomes.

Study on external consistency of health management information system data at district level across India

ABSTRACT Background: The WHO has provided toolkit for data quality review of Health Management Information System (HMIS) data, with external consistency of coverage rate being one dimension. Objective: To assess the level of external consistency of HMIS data compared with National Family Health Survey-5 (NFHS-5) data at district level across India. Methods: We used secondary data on health service delivery indicators across districts at meso-level collected from HMIS and NFHS-5 website. We collected data on 7 indicators: Mothers registered within trimester I, mothers with at least 4 antenatal visits, mothers last birth protected against tetanus, institutional births, births delivered by Caesarean section, sex ratio at birth, and pregnant women aged 15–49 years who are anaemic. We evaluated the agreement between HMIS and NFHS data for the above indicators using Pearson’s correlation co-efficient, intraclass correlation coefficient, and Bland–Altman plot. Results: Data were available from both HMIS and NFHS-5 for 695 districts for the above indicators, except for pregnant women with anaemia, for whom data were available for 564 districts. Pearson corelation co-efficient showed a strong correlation between the two datasets for institutional births and delivery by caesarean section, while weak to moderate correlations were observed for the other indicators. Intraclass correlation coefficient showed discordance between the two datasets, and poor agreement was observed between the data for sex ratio at birth and mothers with at least 4 antenatal visits in Bland–Altman plot. Conclusion: Poor agreement was observed between HMIS and NFHS data for certain indicators, and steps can be taken to improve the quality of HMIS data for these indicators.

COMMUNITY PERCEPTIONS AND USE OF REPRODUCTIVE HEALTH SERVICES IN RURAL INDIA

This study aimed to explore the perceptions, barriers, and usage patterns of reproductive health services among women in rural areas of Uttar Pradesh and Bihar. A mixed-method cross-sectional study was conducted with 420 women aged 18–45. Quantitative data were collected through structured surveys, while qualitative insights were gathered via in-depth interviews and focus group discussions with local stakeholders. Descriptive statistics and logistic regression were used to analyze quantitative data, and thematic analysis was applied to qualitative data. While 84.3% of participants were aware of antenatal care, only 61.2% completed the recommended visits. Similarly, institutional delivery awareness was high (91.5%), yet only 67.8% utilized it. Key barriers included distance to health facilities, need for spousal permission, fear of mistreatment, and cultural taboos. Trust in ASHA workers was high, but confidence in the formal healthcare system remained low. The study reveals a clear mismatch between awareness and utilization of reproductive health services in rural India. Culturally sensitive, community-led strategies are necessary to enhance trust, reduce barriers, and improve equitable access to maternal and reproductive care.

Geospatial Assessment of Health Indicators and Public Healthcare Services in Maharashtra, India

Good health is vital for the well-being of individuals and societies. Health indicators such as family planning, child health, and maternal health play a crucial role in determining population health outcomes. This study examines these indicators in Maharashtra, focusing on changes before and after the COVID-19 pandemic. Family planning, child health, and maternal health are critical areas affected by the pandemic’s disruptions. The research uses Geographic Information Systems (GIS) to analyze regional disparities in healthcare accessibility and effectiveness, utilizing secondary data from sources like the National Family Health Survey (NFHS), Health Management Information System (HMIS), and Maharashtra State Health Department. Maharashtra, with its diverse socio-economic and geographical conditions, experiences significant health disparities, with urban areas exhibiting better healthcare access compared to rural regions. The study reveals several trends. Family planning in districts like Osmanabad and Solapur showed a decline in the Medical Termination of Pregnancy (MTP) ratio post-COVID, while sterilization rates remain higher in economically weaker districts. Maternal health indicators show a mixed response, with some districts exhibiting delays in early pregnancy registration, while others show improvements in institutional deliveries. Child health indicators highlight improvements in birth weight outcomes in certain districts but also show challenges in immunization coverage and the sex ratio at birth. Healthcare services are unevenly distributed, with rural areas suffering from a shortage of primary healthcare centers and medical professionals. This research emphasizes the need for targeted interventions in rural and underserved areas, focusing on enhancing healthcare infrastructure, maternal and child health services, and family planning programs. It also underscores the importance of using geospatial analysis for efficient resource allocation and policymaking.

Situation of Institutional Delivery in Aatharai Rural Municipality

The highest number of maternal deaths occurs during labor, delivery, and the first day after delivery, highlighting the critical need for good quality care during this period. This study examines the situation of institutional delivery at Aatharai Rural Municipality in Terhathum district using empirical research methodology. Data was collected from four birthing centers of Aatharai Rural municipality. The analysis shows that the number of mothers delivering in health institutions is gradually increasing as compared to the past years but not at the pace that is necessary in the present context. Various factors need to be considered to maximize the number of institutional deliveries in rural areas of Nepal.

Determinants of incomplete immunization among 12-23 months old children in Ethiopia: A multilevel analysis.

Vaccinations saved over 37 million lives between 2000 and 2019. Despite this, Ethiopia's Expanded Program of Immunization has struggled to meet its goals, and little has been studied on the community and individual level determinants of incomplete immunization. Therefore, this study aimed to assess the predictors of incomplete immunization among Ethiopian children aged 12-23 months using Ethiopian Mini Demographic Health Survey 2019 (EMDHS 2019). The study used data from EMDHS 2019 and about 1029 children aged 12-23 months were included in the study. STATA version 17.0 statistical software was used to manage and analyze data. Multilevel binary logistic regression analysis was conducted. An AOR with 95%CI, and P < 0.05 were used to determine strength of association and declare significance level, respectively. The factors maternal age ranges of 15-24 (AOR: 4.23; 95%CI: 2.17-8.26) and 25-34 (AOR: 2.68; 95%CI: 1.56-4.61), family size ≥5 (AOR: 2.03; 95%CI: 1.24-3.30), ≤3 antenatal care visits (AOR: 2.32; 95%CI: 1.43-3.75), no postnatal care (AOR: 2.20; 95%CI: 1.23-3.95), rural residence (AOR: 2.54; 95%CI: 1.08-6.25), low (AOR=3.55; 95% CI: 1.32-9.55) and moderate (AOR: 3.29; 95% CI: 1.55-7.00) community-level antenatal care services utilization, and low community-level institutional delivery (AOR: 3.93; 95%CI: 1.35-11.50) were the significant determinant factors of incomplete immunization in Ethiopia. Young maternal age, family size, inadequate ANC, rural residence, not utilizing PNC services, and poor wealth status were the individual level determinants of incomplete immunization. Low and moderate level of ANC services utilization, and low community level institutional delivery service utilization were the factors determining incomplete immunization at the community level. Therefore, the health decision makers better to be committed to design strategies to enhance complete immunization coverage and maternal and child health services.

Unraveling the hidden expenses of free delivery services: a cross-sectional analysis of the public health facilities of the Harari Region, Ethiopia

BackgroundFacility-based delivery services are a critical intervention for improving maternal and infant health and reducing mortalities. However, in Ethiopia, high costs have been reported to hinder access to care, particularly for low-income families. Despite the importance of institutional delivery services, little is known about the true cost of using these services in public health facilities. As such, there is a pressing need for evidence to shed light on this issue and identify potential solutions to improve access to care for all women and infants in need. This study aims to estimates the cost of delivery services and associated factors on women attending public health facilities in the Harari Region, Eastern Ethiopia.MethodsA facility-based cross-sectional study design was used to collect data from January 01, 2022, to February 15, 2022, among 446 randomly selected mothers who delivered at selected facilities. A pretested and structured questionnaire was used to collect data through face-to-face interviews and participant record reviews. The total median cost of delivery services was estimated from the patient perspective using microcosting and human capital approaches and predictors of median costs was identified using a quantile regression model considering skewed cost data.ResultsThe current study revealed that the median cost of delivery services was US$ 27.3 (with an interquartile range, IQR, of 14.1 to 61.8 US$). Among these costs, direct nonmedical expenses held notable significance, constituting 77.46% of the direct costs. This proportion was largely influenced by food-related expenses, with a median cost of US$ 15.16 (IQR: 6.97–32.34). Direct medical costs accounted for 22.54% of the direct costs, primarily attributed to pharmaceutical expenses, forming the majority of the medical expenditure (IQR, US$ 0.00–8.49). The median indirect cost of delivery services was US$ 0.79 (IQR, 0.00–4.49US$). Types of facility visited (β = 30.17; 95% CI: 21.71, 38.62), distance from facility (β = 0.58; 95% CI: 0.26, 0.91), pharmaceutical providers (β = 20.42; 95% CI: 7.93, 32.90), modes of delivery (β = 16.53; 95% CI: 7.54, 25.53), length of stay (β = 7.21; 95% CI: 0.29, 14.14), and number of accompanying persons (β = 4.48; 95% CI: 2.61, 6.35) were predictors of the median total cost of delivery service.ConclusionsThis study highlights the considerable out-of-pockets payments that families incur when delivering in public health facilities. Despite the policy of providing delivery services free of charge in public facilities, significant out-of-pocket costs were incurred by women, with direct non-medical expenses accounting for a substantial portion of the total cost, underscoring the need for evidence-based policies to address this challenge. Ensuring the financial risk protection of women is a critical step toward achieving universal health coverage.

Uptake of second dose measles containing vaccine and associated factors among children aged 24–35 months in central Ethiopia: a community based cross-sectional study

BackgroundMeasles is a highly contagious viral disease that remains a significant public health issue worldwide. Two doses of measles-containing vaccines are required to prevent it effectively. Evidence is limited on measles containing vaccination second-dose (MCV2) in Ethiopia in general, and in Merhabete district in particular. Therefore, this study aimed to assess the uptake of MCV2 and associated factors among children aged 24–35 months in Merhabete district, Central Ethiopia.MethodsA community-based cross-sectional study was conducted in Merhabete district, North Shoa zone, from June 1–30, 2022 on 732 children aged 24–35 months. The collected data was entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression models were used to identify factors associated with the uptake of MCV2. Adjusted odds ratios with 95%CI and P < 0.05 were used to measure the strength of association and declare statistically significant factors, respectively.ResultsThe uptake of MCV2 was 63.3% (CI: 60–67%). Knowledge of MCV2 schedule (AOR: 2.151, CI: 1.05, 4.40), institutional delivery (AOR: 3.50, CI: 1.58, 7.77), ≥ 4 antenatal care visits (AOR: 2.56, CI: 1.25, 5.23), availability of immunization card (AOR: 9.96, CI: 4.26, 23.30), and mother’s age between 25 and 34 years (AOR: 2.95, CI: 1.30, 6.72) were statistically significant factors for the uptake of MCV2.ConclusionThe uptake of MCV2 in Merhabete District was lower than the measles elimination target. Number of antenatal visits 4 or more, place of delivery, knowledge of MCV2 schedule, immunization card availability, and maternal age were found to be statistically significant factors for the uptake of MCV2. Therefore, health decision makers better to strengthen periodic monitoring and evaluation of the implementation of the MCV2 delivery programs.

Prevalence and determinants of mother and newborn skin-to-skin contact: an assessment from the 2017-18 BDHS data

BackgroundEvidence shows that skin-to-skin contact (SSC) enhances children’s well-being. More information is needed on the prevalence and determinants of SSC in Bangladesh. This study aimed to estimate the prevalence and associated factors of mothers and their newborns’ skin-to-skin contact in Bangladesh.MethodsData extracted from a cross-sectional survey, (Bangladesh Demographic and Health Survey (BDHS) 2017-18), where 5304 (unweighted) women who gave birth in the last 3 years preceding the survey were included in the final analysis. Multivariable logistic regression analysis was used to identify the determinants of SSC practice. Adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs) were reported.ResultsThe prevalence of SSC practice in Bangladesh was 15.6% (95% CI [14.3, 17.0]). The adjusted regression model showed that the SSC practice was significantly associated with the geographic region, place of delivery, mode of delivery, and number of antenatal care visits. The SSC practice was 50% lower (aOR = 0.5, 95% CI [0.3, 0.8]) in the Rajshahi Division compared to the Dhaka Division. Women who had an institutional delivery had 2 times higher odds (aOR = 2.0, 95% CI [1.6, 2.5]) of SSC practice than women who had experienced a non-institutional delivery. Compared to women who delivered by cesarean section, the odds of SSC practice were 2.1 times higher (aOR = 2.1, 95% CI [1.6, 2.6]) for women who had a normal delivery. Women who completed at least four antenatal visits had 20% higher odds (aOR = 1.2, 95% CI [1.0, 1.4]) of SSC practice than women who completed fewer than four antenatal visits.ConclusionGiven that only approximately one-sixth of the surveyed women are engaged in SSC practice, informal instructional and awareness programs are necessary in Bangladesh to promote the importance and extent of SSC practice.

Breastfeeding practices among institutionally delivered newborns: a single centre experience

With the rise in institutional deliveries, the responsibility of timely initiation and maintaining optimum breastfeeding practices has shifted from families and community health workers to doctors and nursing personnel. According to the National Family Health Survey - 5, there is significant rise in institutional births from 78.9 % to 88.6 % while early initiation of breastfeeding (EIBF) still ranges from 41.6% to 41.8%. The present study aimed to gain insights into the breastfeeding practices among institutionally delivered newborns, and determine the factors affecting it. This was a hospital based analytical cross-sectional study. After obtaining Institutional Ethics Committee approval and written informed consent, 375 postnatal mothers were interviewed within 24 hours of delivery. Breastfeeding practices were recorded and logistic regression analysis was performed to identify the determinants of EIBF and exclusive breastfeeding (EBF). Out of 375 respondents, only 143 mothers (39.2%) followed EIBF. Pre-lacteal feed was given by 112 mothers (30.7%), while EBF was practiced by 197 mothers (54%). On logistic regression analysis, mothers belonging to upper socio-economic status (p=0.001; AOR, 13.31; 95% CI, 2.8-62.5), normal vaginal delivery (p&lt;0.001; AOR, 0.089; 95%CI,0.1-0.2) and multiparous mothers (p=0.006; AOR,2.494; 95% CI 1.3-4.7) were more likely to follow EIBF. Determinants of exclusive breastfeeding observed in this study was health seeking behavior of mothers as reflected through number of antenatal clinics attended (p=0.001; AOR, 5.298; 95%CI 0.3-0.7) and Caesarean delivery (p&lt;0.001; AOR, 0.410; 95% CI, 0.3-0.7). Breastfeeding practices like timely initiation of breastfeeding and exclusive breastfeeding among the institutionally delivered newborns are comparatively low as opposed to the nation’s average value. Socio-economic profile, mode of delivery, parity, and health seeking behaviour of mothers proved to be the significant factors determining the breastfeeding practices. Antenatal counselling needs to be strengthened with identified bottlenecks like primiparous women, economically underprivileged mothers and mothers with caesarean delivery.

Quality Care Assessment of Maternal and Child Health Services Among Women in Sagar City: A Cross-Sectional Study.

Ensuring high-quality maternal and newborn healthcare is crucial for improving health outcomes in low- and middle-income countries such as India. This study aimed to assess the quality of maternal and child health (MCH) services in Sagar city, Madhya Pradesh, India, and their associations with beneficiaries' knowledge. A cross-sectional study was conducted among 400 postnatal women. Data on sociodemographic characteristics, obstetric history, and MCH service utilization were collected. A scoring system was developed to evaluate the quality of MCH services, including antenatal care (ANC), intranatal care (INC), and postnatal care (PNC). While most women were aware of early registration, institutional delivery, and breastfeeding benefits, knowledge gaps existed in areas such as ANC visits, TT immunization, and exclusive breastfeeding. Only 25 (6.25%) of the participants received good-quality care, whereas 201 (50.25%) received poor-quality care. A significant association was found between the knowledge score and quality of care (ꭕ²=43.131, p=0.000). This study highlights the need for interventions to improve knowledge and awareness about MCH services among beneficiaries and to increase the quality of care provided. Improving the quality of MCH services is essential for reducing maternal and child mortality and achieving better health outcomes in India.

Women’s Financial Inclusion and Sequential Continuum of Care for Maternal and Child Health in India: An Intervention Approach

We estimate the causal impact of financial inclusion of women on the sequential continuum of care for maternal and child health in India. Using data from the fifth round of the National Family Health Survey, 2019–2021, considering financial inclusion to be a treatment/intervention and employing endogenous treatment effects as our methodology to address self-selection bias, we find that the propensity for availing antenatal care is 17 percentage points higher among women who are financially included. Further, usage of antenatal care and institutional delivery, along with postnatal care for mother and child as well as full immunisation of a child, is 17, 18, 10 and 5 percentage points greater, respectively, among women with access to formal financial services. Therefore, increasing women’s financial inclusion is vital to ensuring greater access to critical healthcare services and lowering maternal and child mortality. To avoid dropouts, policies must be devised that connect all aspects of maternal and child health. Further, efforts must be made not only within the financial inclusion community but also across sectors to address gender norms. Access to formal money can provide greater negotiating leverage both inside and outside the house, resulting in greater gender equality and economic growth and development of the country.