Maternal And Child Health Care Research Articles

Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.

BackgroundPay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs.MethodsA systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist.Results and discussionThere were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P’s positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality.ConclusionP4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P’s impact on MCH and their causal pathways in LMICs.Trial registrationPROSPERO registration number CRD42014013077.

Missed opportunities for breast awareness information among women attending the maternal and child health services of an urban tertiary hospital in Northern Nigeria.

Breast cancer is the most common cancer that affects women worldwide. Many women, however, are not exposed to information that will promote awareness and early detection of this disease. We undertook this study to determine the missed opportunities to breast awareness information at the maternal and child health (MCH) services of our hospital. Between July and September 2011, we conducted a cross-sectional survey of women attending the postnatal and immunization clinics (ICs) of our hospital. Data were collected using a structured interviewer-administered questionnaire. A total of 492 respondents were randomly selected. Data were analyzed using SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). The mean age of the respondents was 27.67 years (standard deviation 5.92 years). Only 56.1% (276/492) had a postsecondary education, and 58.7% (289/492) were multiparous. Among the respondents, 81.7% had been exposed to breast awareness information at the antenatal clinic, 6.55% at the postnatal clinic, and 5.24% at the IC. There was a statistically significant association (P < 0.05) between missed opportunity for breast awareness information and family income (P = 0.019) and also with the level of education (P = 0.007). Most of the opportunities to educate women on breast awareness were missed at the postnatal and ICs of our hospital. Integrating breast health education into MCH care programs in developing countries will assist in the early detection of breast pathologies.

Integration of mental health into priority health service delivery platforms: maternal and child health services.

Maternal and child health (MCH) programmes are the most logical and appropriate platforms for integration of mental health care in an equitable, accessible and holistic manner. Such integration has the potential to improve both mental and physical health synergistically. Key steps to successful integration include a) recognition, at the highest international and national policy forums, that mental health and well-being is a generic component of MCH that does not compete with MCH programmes but instead complements them; b) tailoring the training and supervision of MCH and primary care personnel so they can recognize and assist in the management of common maternal and child mental health problems, recognizing that this, in turn, will enable them to be more effective health-care workers; c) adapting effective interventions to local contexts; and d) investing in implementation research so that these approaches are refined and scaled-up, leading to improved outcomes for all MCH programmes.

Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial.

BackgroundMothers are at risk of domestic violence (DV) and its harmful consequences postpartum. There is no evidence to date for sustainability of DV screening in primary care settings. We aimed to test whether a theory-informed, maternal and child health (MCH) nurse-designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care.MethodsCluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up.The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia.Eight eligible teams were recruited. Team randomisation occurred at a public meeting using opaque envelopes. Teams were unable to be blinded.The intervention was informed by Normalisation Process Theory, the nurse-designed good practice model incorporated nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care involved government mandated face-to-face DV screening at four weeks postpartum and follow-up as required.Primary outcomes were MCH team screening, disclosure, safety planning and referral rates from routine government data and a postal survey sent to 10,472 women with babies ≤ 12 months in study areas. Secondary outcomes included DV prevalence (Composite Abuse Scale, CAS) and harm measures (postal survey).ResultsNo significant differences were found in routine screening at four months (IG 2,330/6,381 consultations (36.5 %) versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96–2.52) but data from maternal health checklists (n = 2,771) at three month IG consultations showed average screening rates of 63.1 %. Two years post-intervention, IG safety planning rates had increased from three (RR 2.95, CI 1.11–7.82) to four times those of CG (RR 4.22 CI 1.64–10.9). Referrals remained low in both intervention groups (IGs) and comparison groups (CGs) (<1 %).2,621/10,472 mothers (25 %) returned surveys. No difference was found between arms in preference or comfort with being asked about DV or feelings about self.ConclusionA nurse-designed screening and care model did not increase routine screening or referrals, but achieved significantly increased safety planning over 36 months among postpartum women. Self-completion DV screening was welcomed by nurses and women and contributed to sustainability.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12609000424202, 10/03/2009

Inequity in access to health services between migrants and natives of Chandigarh, India

Purpose – People often migrate from rural to urban areas within a country or from less developed to more developed countries for better life opportunities but may remain outside the range of health services. The purpose of this paper was to find out the socio-economic and health system factors that may affect the utilization of health services by the migrants. Design/methodology/approach – Five villages and three slums were randomly selected from 23 villages and 18 slums of Chandigarh, a northwest Indian city. Using stratified random sampling, 145 migrants and 63 native women, who were pregnant or had delivered a baby from April 1, 2009 to March 31, 2012 were interviewed using semi-structured interview schedule. χ2 was used for testing statistical significance of the differences, and logistic regression was utilized to evaluate the “independent effect” of migration on Maternal and Child Health (MCH) service utilization. Findings – The level of education was higher among migrants than the natives but their income was less than that of natives. Majority of the migrant women had registered themselves for antenatal care (ANC) in the first trimester of pregnancy (55 percent) compared to the natives (21 percent), but only few had availed more than three ANC check-ups (18 percent) as compared to the natives (44 percent). Knowledge about danger signs of childhood diarrhea and pneumonia was low among migrants compared to the natives (p &lt; 0.0001). Health workers interacted less often with migrants (29 percent) than the natives (67 percent). After controlling the effect of socio-economic and -demographic variables, utilization of MCH care services were significantly higher among natives than the migrants. Inadequate community support among migrants led to the lower utilization of MCH care. Research limitations/implications – Present study reflects early ANC registration among migrants but the number of ANC visits much less than the natives. This could be further be investigated using qualitative methods. Practical implications – Specific strategies are required to address the health needs of migrants such as formation of community-based support groups. Health services and health workers need to be oriented to support migrants to the special needs of migrants. Social implications – Reduction in inequality in accessing health between natives and migrants can be addressed with social support. Originality/value – The study supports the fact that migration is one of the social determinants of health. Lack of community support to migrants is the major barrier in accessing the health services.

A Review of e-Health Interventions for Maternal and Child Health in Sub-Sahara Africa

To review e-health interventions for maternal and child health (MCH) and to explore their influence on MCH practices in sub-Sahara Africa (SSA). Keyword searches were used to retrieve articles from four databases and the websites of organisations involved in e-health projects for MCH in SSA. A total of 18relevant articles were retrieved using inclusion and exclusion criteria. The researchers reveal the prevalence of the application of mobile phones for MCH care and the influence of the use of information and communication technology (ICT) for delivering MCH information and services to target populations. There is a need to move the application of ICT for MCH care from pilot initiatives to interventions involving all stakeholders on a sub-regional scale. These interventions should also adopt an integrated approach that takes care of the information needs at every stage along the continuum of care. It is anticipated that the study would be useful in the evolution and implementation of future ICT-based programmes for MCH in the region.

Perceived value of applying Information Communication Technology to implement guidelines in developing countries; an online questionnaire study among public health workers.

IntroductionPractice guidelines can be used to support healthcare decision making. We sought to identify the use, and barriers to the implementation, of electronic based guidelines to support decision-making in maternal and child healthcare (MCH) and the rational use of medicines, in developing countries.MethodsGraduates who had gained the Master of Public Health degree through the Peoples-uni (postgraduate public health education in developing countries) were sent an online survey questionnaire which had been piloted. Two reminders were sent to non-respondents at intervals of 10 days. Results were explored using descriptive analyses.Results44 of the potential 48 graduates from 16 countries responded – most were from Africa. 82% and 89% of respondents were aware of guidelines on MCH and the rational use of medicines respectively. Electronic guidelines were more available in university hospitals than in provincial hospitals or rural care. All respondents thought that guidelines could improve the delivery of quality care, and 42 (95%) and 41 (93%) respectively thought that computers and mobile or smartphones could increase the use of guidelines in service delivery. Lack of access to computers, need to buy phone credit, need for training in the use of either computerized or phone based guidelines and fear of increased workload were potential barriers to use.ConclusionThere is support for the use of electronic guidelines despite limited availability and barriers to use in developing countries. These findings, and other literature, provide a guide as to how the further development of ICT based guidelines may be implemented to improve health care decision making.

Missed Opportunities for Breast Awareness Information Among Women Attending the Maternal and Child Health Services of an Urban Tertiary Hospital in Northern Nigeria

Background: Breast cancer is the most common cancer that affects women worldwide. Many women, however, are not exposed to information that will promote awareness and early detection of this disease. We undertook this study to determine the missed opportunities to breast awareness information at the maternal and child health (MCH) services of our hospital. Materials and Methods: Between July and September 2011, we conducted a cross-sectional survey of women attending the postnatal and immunization clinics (ICs) of our hospital. Data were collected using a structured interviewer-administered questionnaire. A total of 492 respondents were randomly selected. Data were analyzed using SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: The mean age of the respondents was 27.67 years (standard deviation 5.92 years). Only 56.1% (276/492) had a postsecondary education, and 58.7% (289/492) were multiparous. Among the respondents, 81.7% had been exposed to breast awareness information at the antenatal clinic, 6.55% at the postnatal clinic, and 5.24% at the IC. There was a statistically significant association (P Conclusion: Most of the opportunities to educate women on breast awareness were missed at the postnatal and ICs of our hospital. Integrating breast health education into MCH care programs in developing countries will assist in the early detection of breast pathologies.

Determinants of postnatal maternity care service utilization in rural Belgaum of Karnataka, India: A community based cross-sectional study

Background: The postnatal period is critical to the health and survival of a mother and her newborn. Lack of care in this period may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women and newborn children. Hence, the study was carried out to explore determinants of postnatal maternity service utilization in the rural area of Belgaum. Materials and Methods: Community based cross-sectional study was carried out from August 2012 to January 2013 in rural Belgaum. Total 630 mothers with less than 1 year child were interviewed using pretested questionnaire with her written consent. Analysis was done in Statistical Package for Social Sciences (SPSS) version 20 applying appropriate statistics. Results were presented in tabular and narrative forms. Results: Among 630 mothers, 54.6% were 20-24 years of age, 61.6% were having secondary level of education, 89.8% house wives and 91.6% Hindus. About 69.7% were from joint family with low economic status. Regarding postnatal service use; 79.0% use properly. Almost; three-fifth met with nurse/health workers at least three times, four-fifth got advice about breast/nipple care, 92.5% about breast-feeding, 67.9% about post-natal exercise, 89.0% on nutrition education, and 85% got the advice of uterus care. About 29.8% perceived some health problems. Education, income, awareness, and delivery places were found most significant determinants ( P Conclusion: More than three quarters of mothers had used the proper postnatal maternity services. Education, family income, awareness, and delivery place were found as most significant factors. Sustainable maternal and child healthcare (MCH) programs and awareness will support to achieve furthermore better results.

Health care in sub-Saharan Africa: an explorative study of photography as a healing art

Background and Purpose: Therapeutic art plays an important role in patient recovery in hospitals. Art therapy in prescribed terms captures the use of arts and words to express ones feelings. Unlike many developed parts of the world, art rarely plays a significant role in the healing processes at hospitals in sub-Saharan Africa. While waiting to see medical officers or during admissions in the hospital, patients often find themselves either staring at blank walls or looking at health informational images — two extremes of the imagery spectrum. This may psychologically have a positive or negative impact on the health of the patient. However, research shows the importance of art in the healing process as well as in comfort and the perceived level of care. Research conducted on patients who have undergone surgery indicates that patients who had photographs mounted in their wards recovered faster than their counterparts. Similarly, researchers have also found that digital storytelling is one of the viable ways to facilitate self-healing. With the availability of Information and Communication Technologies (ICTs), there is a possibility of improving healing, facilitated within this form of cognitive-behavioural and psychodynamic process of therapy. This on-going case study, explores the use of digital photography in facilitating healing process in a hospital. It explores the use of ICT-enabled therapeutic art installation in the medical wards to aid in clinical care and practice. Methods: A qualitative approach is employed to gain deeper insight and understanding of ICTs in therapeutic art. The study focuses on maternal and child healthcare (MCH). The research is being conducted in a private-general hospital in Ghana where most of the patients are middle-income earners. Through participatory processes, images created from the input of patients and health workers were installed in the female wards and waiting areas. Interviews and observations were used to obtain impressions from patients and hospital staff about the installation in the clinic. Twenty key informants comprising doctors, nurses and patients conveyed their views. Results: Preliminary results show that, patients prefer hospital environments with therapeutic art. It relieves them of boredom and makes them feel more comfortable and relaxed. Subsequently, artistic intervention takes their mind of their ailment. It may be realised that the use of ICT- enabled therapeutic art installation has potential in facilitating healing. Conclusions: The preliminary results suggest that through simple photos created from ICTs, patients and health workers mood could be improved in the hospital. This form of phototherapy also makes patient’s appreciate art. Further research could be conducted in other private and public hospitals in cities and rural areas in other sub-Saharan African countries to validate the study. Keywords: healing; ICT; maternal healthcare; photography; sub-Saharan Africa; therapeutic art

Individual Characteristics and Use of Maternal and Child Health Services by Adolescent Mothers in Niger

Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is known about factors that affect access of teenage mothers to maternal and child health (MCH) services in Niger. This paper explores potential factors associated with the utilization of MCH care services by adolescent mothers. Using the third wave of the Niger demographic and health survey (NDHS) 2006, we estimate three multivariate logistic regression models to assess individual characteristics associated with the utilization of antenatal care (ANC) and safe delivery care services among adolescent women, as well as full immunization received by children born to adolescent mothers. The analytical sample includes 934 adolescent mothers out of 1,835 respondents aged 15-19, and within this group, 493 mother-child dyads for children aged 12-59 months. Possessing any level of education was found associated with the increased use of all three selected MCH services, while urban residence and higher income were associated with the increased use of two of three MCH services studied. Higher birth order plus a birth interval more than 2 years for the most recent birth appeared associated with the lower probability of antenatal care visits and safe delivery care. This study finds that women who attended at least four ANC visits were more likely to experience safe delivery care, and the children whose mothers had safe delivery care were more likely to receive full immunization. Therefore, an effective program should be designed to promote a continuum of MCH care with special attention to adolescent women who are uneducated, poor and residing in rural areas.

A review of maternal mortality in Malaysia

There has been a significant decline in maternal mortality from 540 per 100,000 live births in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from 6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths. IeJSME 2012: 6 (Suppl 1): S142-S151

Task shifting in maternal and child health care: An evidence brief for Uganda

There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers ("task shifting") is one strategy to address the shortage and maldistribution of more specialized health professionals. (i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options. A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers' knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.

Health care for all mothers and infants by 2000 AD.

Although the future health of a nation depends largely on the health care provided for mothers and infants, little emphasis is placed on maternal and child health (MCH) care in the health programs of most countries. In some developing countries up to 70% of women fail to receive any form of health care during pregnancy and childbirth, and the newborns are left to the care of their mothers. Even in developed countries there are pockets of population which remain untouched by such programs. In Singapore, increased literacy, greater health consciousness, and a successful family planning program have contributed to a decline in the crude birth rate from 42.7 to 16.9 between 1967-78 and a decrease in the mean birth order to 1.75. Maternal mortality rates, like infant and perinatal mortality rates, vary widely in different countries and within countries, and leave room for improvement almost everywhere. Childbrith remains the main cause of death in women aged 14-45 years in the developing world, where anemia and intercurrent infections contribute to obstetric complications. Nearly 1 billion people in the developing world are trapped in a vicious circle of poverty, malnutrition, disease and despair. There are 4 major reasons for the failure of countries to provide MCH care: 1) shortage of resources 2) maldistribution of existing manpower 3) poor utilization of existing facilities, and 4) inadequate or inappropriate training of health manpower. Because of perceived health manpower shortages, 493 new medical schools were established throughout the world between 1955-75, 350 of them in developing countries. 608 of the world's 1124 medical schools are now in developing countries, but despite the effort and money invested, the ratio of physicians to population has not imporved significantly and the gross maldistribution of available health personnel within countries continues. The total health manpower available is 1/130 population in developed countries, 1/500 in developing countries, and 1/2400 in the least developed countries. Migration of physicians has aggravated the shortage in some countries. The infant mortality rate in most developing countries ranges from nearly 100 to 200/1000, compared to 10-20 in developed countries. Malnutrition, infectious diseases, and high fertility are 3 major causes of high infant and child mortality. Community participation is crucial if MCH care is to be available to rural communities. Health care should become a part of the total socioeconomic development of a country. All existing health personnel including traditional practitioners should be utilized and, if necessary, retrained. Training should be objective and task of oriented.

Rural-oriented maternity services

The delivery of maternity and neonatal care in rural areas is extremely difficult for many reasons, the most critical being the serious shortages of doctors and other health personnel who are willing to work outside the cities. The problems are particularly serious in countries in Asia, Africa, and Latin America, the so-called “developing world”. In Thailand new regional maternal and child health (MCH) centers have been developed as a first step in attempting to bring about improvements in MCH care. Each of the 3 centers opened so far consists of a 60 to 80 bed maternity hospital and a school for auxiliary midwives. In spite of a history in which most rural women seem to prefer to be delivered at home, these centers have been heavily utilized by predominantly rural women. The improved maternity care has, in turn, led to a uniquely successful postpartum family planning program. Based on these successes, a plan is presented to begin to expand such services to the more than 80 per cent of rural women who presently do not receive maternity care. This, in turn, should result in reduced maternal and neonatal mortality and morbidity rates and in a significant increase in the percentage of eligible women accepting family planning services.

Reducing Infant Mortality

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.