Maternal And Child Health Clinic Research Articles

Integration of HIV care into maternal and child health services in the global IeDEA consortium.

The WHO recommends the integration of routine HIV services within maternal and child health (MCH) services to reduce the fragmentation of and to promote retention in care for pregnant and postpartum women living with HIV (WWH) and their infants and children exposed to HIV (ICEH). During 2020-2021, we surveyed 202 HIV treatment sites across 40 low- and middle-income countries within the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We determined the proportion of sites providing HIV services integrated within MCH clinics, defined as full [HIV care and antiretroviral treatment (ART) initiation in MCH clinic], partial (HIV care or ART initiation in MCH clinic), or no integration. Among sites serving pregnant WWH, 54% were fully and 21% partially integrated, with the highest proportions of fully integrated sites in Southern Africa (80%) and East Africa (76%) compared to 14%-40% in other regions (i.e., Asia-Pacific; the Caribbean, Central and South America Network for HIV Epidemiology; Central Africa; West Africa). Among sites serving postpartum WWH, 51% were fully and 10% partially integrated, with a similar regional integration pattern to sites serving pregnant WWH. Among sites serving ICEH, 56% were fully and 9% were partially integrated, with the highest proportions of fully integrated sites in East Africa (76%), West Africa (58%) and Southern Africa (54%) compared to ≤33% in the other regions. Integration was heterogenous across IeDEA regions and most prevalent in East and Southern Africa. More research is needed to understand this heterogeneity and the impacts of integration on MCH outcomes globally.

Health-related quality of life measured by SF-36 among postdelivery mothers attending maternal and child health clinic in Eastern Nepal: a cross-sectional study.

This was a cross-sectional study using nonprobability sampling conducted at a Maternal and Child Health (MCH) Clinic in Nepal. The study participants were 129 women postdelivery to 12 months who visited the MCH Clinic from 2 September 2018 to 28 September 2018. Outcome measures were sociodemographic, clinical indicators, obstetric indicators, and their relation with the overall HRQoL score of postdelivery mothers using the Short Form Health Survey (SF-36) Version 1. Of 129 respondents, 68.22% were in the 21-30 age group, 36.43% were upper caste, 88.37% were Hindu, 87.60% were literate, 81.39% were homemakers, 53.49% with income less than 12 months, 88.37% had family support, and 50.39% with vaginal deliveries. HRQoL was significantly more in employed women (P=0.037), those with family support (P=0.003), and those who had a cesarean section (P=0.02) and wanted pregnancy (P=0.040). HRQoL in women postdelivery can be influenced by employment status, family support, type of delivery, and desirability of pregnancy.

Strategies for promoting male partner involvement in maternal, newborn and child health care in Kiambu County.

the 1994 International Conference on Population and Development (ICPD) recommended that men should share responsibility and be actively involved in sexual and reproductive health. The level of male partner involvement in Kenya remains low despite growing evidence showing its benefits in maternal and newborn health. This study sought to explore strategies for encouraging male partners to accompany their spouses to Maternal and Child Health (MCH) department. a qualitative exploratory study was used to gather the views of nurse-midwives and invited men on mechanisms to encourage men to accompany their spouses to MCH clinic. Three and two focused group discussions (FGDs) composed of six to eight participants from nurse-midwives and men were conducted respectively. The FGDs were audio recorded and lasted 60-90 minutes. Content analysis was used to generate themes using MAXQDA 2022 software. seven categories emerged as strategies that can encourage male partner participation in the Maternal Neonatal and Child Health (MNCH) services: creating community awareness and sensitization, engaging men in the MCH department, reducing waiting time, provision of health services that address male health needs, inviting male partners to the MCH clinic, encouraging MCH staff to be receptive to couples and re-scheduling of MCH working days as well as extension of hours. evidence-based strategies that adopts multi-level interventions with greater focus on community sensitization and re-organization of the MCH services are important in encouraging men accompany their spouses to clinic and actively participate in the MNCH.

Barriers to male partner accompaniment and participation in maternal and child health care in Thika and Kiambu Level Five Hospital, Kenya.

the 1994 International Conference on Population and Development (ICPD) recommended that men should share responsibility and be actively involved in responsible parenthood, sexual and reproductive health. The level of male involvement in Kenya remains low despite growing evidence showing its benefits in maternal and newborn health. This study sought to determine factors influencing male partner involvement in maternal and child health with focus on accompaniment to maternal and child health (MCH) department. a qualitative study utilizing exploratory design was used to gather the views of men and nurse-midwives working in the MCH department of Thika and Kiambu County Teaching and Referral hospitals in January 2022. Qualitative data were collected from focused group discussions from nurses and men respectively. The number of participants per Focused Group Discussion (FGD) ranged between six to eight. The principal author moderated the FGD that were audio recorded and lasted between 60-90 minutes. Content analysis was used to analyse data following the five steps to yield themes using MAXQDA 2022 software. five categories emerged as factors influencing male accompanying their spouses to MCH clinic: traditional gender norms, roles and beliefs, unfavorable MCH environment, work commitment, fear of HIV testing and men's work commitment. traditional gender roles and norms, work commitment by men and unfavourable MCH set-up were key barriers identified that hinder men from accompanying their spouses to MCH clinic. There is need to develop an effective, feasible and sustainable intervention that will encourage male partners to accompany their spouses and participate in MCH services.

Preventive Health Service Coverage Among Infants and Children at Six Maternal-Child Health Clinics in Western Kenya: A Cross-Sectional Assessment.

Despite the substantial reduction of child mortality in recent decades, Kenya still strives to provide universal healthcare access and to meet other international benchmarks for child health. This study aimed to describe child health service coverage among children visiting six maternal and child health (MCH) clinics in western Kenya. In a cross-sectional study of Kenyan children who are under the age of 5years presenting to MCH clinics, child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, and deworming. Among 78 children and their caregivers, nearly 70% of children were fully vaccinated for their age. We found a significant disparity in full vaccination coverage by gender (p = 0.017), as males had 3.5 × higher odds of being fully vaccinated compared to females. Further, full vaccination coverage also varied across MCH clinic sites ranging from 43.8 to 92.9%. Health service coverage for Kenyan children in this study is consistent with national and sub-national findings; however, our study found a significant gender equity gap in coverage at these six clinics that warrants further investigation to ensure that all children receive critical preventative services.

Prenatal oral health: geo-spatial analysis of access to care

Introduction: Prenatal oral care is important for both the oral and general health of the woman and the offspring and it should be maintained throughout the life course. Objectives: To determine the distribution of both hospital and community dental care facilities for the provision of oral healthcare to antenatal mothers referred to the maternal and child health (MCH) clinics, in the district of Gampaha, Sri Lanka Methods: All the MCH clinics and all available public dental care facilities were mapped using Geographic Information System (GIS) software, and the minimum referral distance was measured from each MCH clinic to the nearest public dental clinic using the distance-based GIS tools. Results: The referral distance reported from an MCH clinic to a public dental clinic varied between 0- 8.5 km. About 22% (n=37) of the MCH clinics had an in-house or proximate dental facility not more than 1 km away. About 41% (n=69) of MCH clinics had a public dental clinic within a 2.5 km distance, and it increased up to 81% (n=136) when the referral distance expanded up to 5km. The average referral distance for pregnancy oral healthcare in the entire district was 3 km. Conclusions: The study identified service disparities in pregnancy oral healthcare in the district using geo-spatial techniques. It could contribute to future planning of hospital and community based dental clinic locations for antenatal mothers, emphasising the importance of referral distance in improving the dental attendance among pregnant women.

Factors associated with low male partners’ involvement in maternal and child health services in Suba sub county, Western Kenya

Objective: Male involvement (MI) in maternal and child health (MCH) services such as pre-conception care, antenatal care (ANC), prevention of mother-to-child transmission (PMTCT) of HIV, skilled delivery is an integral intervention that improves MCH outcomes. Suba sub County in western Kenya has the highest prevalence of HIV in Kenya. Moreover, data is skewed on men’s knowledge and perceptions regarding their involvement in MCH services. Methods: This mixed method cross-sectional study, collected data using questionnaire among 354 male participants, and conducted 4 focus group discussions (FGDs) and 6 key informant interviews (KIIs). STATA version 11 was used for quantitative data analysis. The thematic content analysis was used to analyze qualitative data. Results: The majority of the participants (52.3%) were aged >30 years, 44.9% had primary level of education and 63.1% engaged in fishing activities. About 54.5% of the participants were not aware of the Ministry of Health’s effort to enhance men’s attendance to MCH clinics, while men’s age, various cultural taboos and provider’s attitude were perceived as influencing MI in MCH services. Overall 16.3% of the participants were involved in MCH services. Health worker provider’s attitude towards men (OR 0.5, 95% Cl 0.3 to 0.8), men’s preferred time of attending MCH clinic (OR 6.7, 95% Cl 1.1-43.5), the frequency of men accompanying spouse to MCH clinic (OR 0.1, 95% Cl 0.04-0.3), duration taken to reach MCH clinic (OR 5.6, 95% Cl 1.3-24.6), use of family planning methods (OR 0.36, 95% Cl 0.18-0.72) and awareness about the methods used to reduce HIV mother to child transmission (MTCT) (OR 35, 95% Cl 0.19-0.65) were independently associated with men’s attendance of the MCH clinics. Conclusion: Significantly there was low male involvement in MCH services (16.3% compared to the > 30% targets by Kenya PMTCT guidelines, 2012) in this high HIV prevalent region. Enhanced dissemination and awareness creation on the importance of MI in MCH services could improve male involvement Key words : Male Involvement, Maternal and Child Health Services, Knowledge, Perceptions and Correlates, Suba sub county western Kenya DOI : 10.7176/JHMN/60-15 Publication date :March 31 st 2019

Incremental treatment costs for HIV-infected women initiating antiretroviral therapy during pregnancy: A 24-month micro-costing cohort study for a maternal and child health clinic in Kenya.

BackgroundTo date, little information exists on the costs of providing antiretroviral therapy (ART) within maternal and child health (MCH) clinics in Kenya. The main objective of this analysis was to estimate the annual incremental cost of providing ART within a MCH clinic for adult women initiated on ART during pregnancy over the first one and two years on treatment. The study site was the District Hospital in Kericho, Kenya.MethodsA micro-costing approach from the provider’s perspective, based on a retrospective review of patient medical records, was used to evaluate incremental costs of care (2012 USD). Cost per patient in two cohorts were evaluated: the MCH clinic group comprised of adult women who initiated ART at the site’s MCH clinic during pregnancy between 2008–2011; and for comparison, the ART clinic group comprised of adult, non-pregnant women who initiated ART at the site’s ART clinic during 2008–2011. The two groups were matched on age and baseline CD4 count at initiation. Retention at year one/two on ART was defined as having completed a clinic visit at 365/730 days on ART +/- 90 days.ResultsFor patients defined as retained in care at year one, average incremental costs per patient were $234 for the MCH clinic group (median: 215; IQR: 186, 282) and $292 in the ART clinic group (median: 227; IQR: 178, 357). ARV and laboratory costs were less on average for the MCH clinic group compared to the ART clinic group (due to lower cost regimens and fewer tests), while personnel costs were higher for the MCH clinic group.ConclusionsThe annual incremental cost per patient of providing ART were similar in the two clinic settings in 2012. With shifts in recommended ARV regimens and lab monitoring over time, annual costs of care (using 2016 USD unit costs) have remained relatively constant in nominal terms for the MCH clinic group but have fallen substantially for the ART clinic group (from nominal $292 in 2012 to nominal $227 in 2016).

An exploratory study on knowledge and practice regarding family planning and immunization among women attending MCH clinic

<p class="abstract"><strong>Background:</strong> Globally, an estimated 300,000 maternal deaths occur annually owing to causes associated with pregnancy, of which nearly 75% were preventable. Each year, modern contraceptives help women prevent 215,000 pregnancy-related deaths (including 66,000 from unsafe abortions), 2.7 million infant deaths and the loss of 60 million years of healthy life. Vaccination is one of the most cost-effective health interventions available, saving millions of children from illness, disability and death each year. The burden of infectious diseases has been reduced primary due to immunization.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional study regarding knowledge and practice of family planning and immunization was conducted in a Maternal and Child health (MCH) clinic of Western Regional Hospital, Pokhara. The sample consists of 100 married women of reproductive age group (15-49) years having under five children coming to the clinic using purposive sampling technique. </p><p class="abstract"><strong>Results:</strong> Knowledge regarding family planning methods were oral contraceptive pills/depot/implant (84%) followed by intrauterine contraceptive device (77%), condom (65%), natural methods (80%), permanent method (92%). Condom was most commonly used among temporary methods. More than 4/5<sup>th</sup> of the respondents were aware about vaccines as per schedule of Nepal. But 5% of the respondents had neither given any vaccine to their baby and nor taken any dose of tetanus toxoid vaccine during their previous pregnancy.</p><strong>Conclusions:</strong> Still 14% of the respondents were not aware about any methods of family planning and 19% does not know about the vaccines as per schedule of Nepal. So there is a need to increase awareness about the different types of family planning methods and immunization.

Intimate Partner Violence Prevalence, Recurrence, Types, and Risk Factors Among Arab, and Jewish Immigrant and Nonimmigrant Women of Childbearing Age in Israel.

This research set out to determine prevalence, recurrence, types, and risk factors for intimate partner violence (IPV) among women of childrearing age across Israel, attending to diversity in these factors by ethnicity and immigration status. The first nationwide study of its kind, this research was based on a stratified proportional cluster sample of 1,401 Arab, and Jewish immigrant and nonimmigrant women (aged 16-48 years) who visited 63 maternal and child health (MCH) clinics between October 2014 and October 2015. Female research staff interviewed women face-to-face in a private room at the MCH clinics using a structured questionnaire in the women's main language (Arabic or Hebrew). We measured IPV using a 10-item questionnaire used for screening at some MCH clinics. Response rate was 74%. In the multivariate analysis, we used generalized estimating equations (GEEs) to adjust for the MCH clinic cluster effect. We found marked differences in the prevalence of IPV among Arab, and Jewish immigrant and nonimmigrant women (67%, 30%, and 27%, respectively). Types (physical, verbal and social) and recurrence of IPV were significantly higher among Arab women compared with the other two groups. In the GEE analysis, compared with IPV among Jewish nonimmigrants, IPV among Arab women persisted after considering socioeconomic, sociodemographic, and reproductive factors (odds ratio = 3.83; 95% confidence interval = [2.55, 5.72]). Low family income was the main risk factor for IPV for all women. Among Arab women, younger age, high religiosity, and living in urban settings were associated with higher IPV. These results suggest that diversity (ethnicity and immigration status) should be considered when developing tailored policies and interventions to protect women from IPV.

Association between noise exposure and mild hypertension in pregnant women

Background: Noise exposure in an urban environment has become an integral part of our lives in recent decades. The population of pregnant women is one of the most vulnerable populations to the health impact of environmental damage to both the mother and the fetus. Study goal: To examine the association between traffic-related noise exposure and blood pressure during pregnancy. Methods: In this prospective study 240 women with singleton low risk pregnancies, were recruited during routine follow up prenatal visits at Maternal and Child Health Clinic (MCHC), or outpatient clinic of hospital. Women were interviewed about their socio-demographic, medical and obstetric background. Assessment of home noise exposure was performed using a previously validated self-reported score of 0 to 10. Noise score above 5 (median) was defined as "high noise exposure". Borderline hypertension during pregnancy was defined as systolic pressure >120 mmHg and/or a diastolic blood pressure >80 mmHg. Data of blood pressure during pregnancy was extracted from MCHC medical records. Results. Mean maternal age was 31+5.04 years, with 14+2.7 education years. Only 8.8% consumed alcohol while 30.8% smoked during pregnancy. 8.9% reported chronic diseases and 16.7% had borderline hypertension. 41.5% of the parturients reported high traffic noise exposure. 22.7% of women with high noise exposure vs. only 11.7% of women with low noise exposure had borderline hypertension during pregnancy (OR=2.2; 95% CI; P=0.025). Using multivariate logistic regression analysis, high noise exposure was noted as an independent risk factor for mild hypertension during pregnancy after controlling for BMI, gestational age, chronic illness, smoking and alcohol use during pregnancy (adjusted OR=2.2, 95% CI 1.1- 4.7, p=0.035). Conclusions. Self-reported exposure to traffic noise was found as an independent risk factor for mild hypertension during pregnancy.

Maternal perceptions of social context and adherence to maternal and child health (MCH) clinic recommendations among marginalized Bedouin mothers.

National maternal and child health (MCH) care systems often deliver universal health care recommendations that do not take into consideration the social context of infant care (IC) for marginalized groups. We examined associations between maternal perceptions of social context (MPSC) and adherence by minority Bedouin mothers in Israel to three commonly recommended IC practices. We conducted personal interviews with 464 mothers visiting 14 MCH clinics using a structured questionnaire based on findings from a previous focus-group study, and guided by constructs of the Health Beliefs Model. Items were tested for validity and reliability. We used multivariate analysis to identify MPSC constructs associated with adherence to MCH clinic recommendations (timely postnatal first visit, sustaining breastfeeding, and use of infant car seat). Social context, when perceived as a barrier to IC, was negatively associated with adherence to timely first postnatal MCH clinic visit (odds ratio, 95 %, confidence intervals (OR 1.45, 95 % CI 1.24, 1.70) and use of infant car seat (OR 1.43, 95 % CI 1.21, 1.69). However, social context was positively associated with sustained breastfeeding (OR 0.54, 95 % CI 0.37, 0.79). Perceptions of the severity of infant health problems, and family financial and relationship problems had less significant associations with adherence to MCH clinic recommendations. Adherence by marginalized mothers to MCH clinic recommendations is related to their perceptions of social context. When there are higher financial and other living conditions barriers mothers tend toward lower adherence to these recommendations. MCH policy makers and service providers must consider MPSC in planning and delivery of MCH recommendations.

No asymptomatic malaria parasitaemia found among 108 young children at one health facility in Dar es Salaam, Tanzania

BackgroundAsymptomatic malaria parasitaemia has been reported in areas with high malaria transmission. It may serve as a reservoir for continued transmission, and furthermore complicates diagnostics, as not all individuals with a positive malaria test are necessarily ill due to malaria, although they may present with malaria-like symptoms. Asymptomatic malaria increases with age as immunity to malaria gradually develops. As mortality and morbidity of malaria is higher among younger children it is important to know the prevalence of asymptomatic malaria parasitaemia in this population in order to interpret laboratory results for malaria correctly.MethodsA total of 108 children that had neither been treated for malaria nor had a fever the previous four weeks were recruited consecutively at a maternal and child health clinic (MCHC) in Dar es Salaam, Tanzania. A rapid diagnostic test (RDT) for malaria and dried blood spot (DBS) on filter paper were taken from each child. Social and clinical data were recorded. DNA was extracted from the DBS of study participants by a method using InstaGene™ matrix. PCR targeting the Plasmodium mitochondrial genome was performed on all samples.ResultsMedian age was 4.6 months (range 0.5-38). All the RDTs were negative. PCR was negative for all study subjects.ConclusionThe study suggests that asymptomatic malaria may not be present in apparently healthy children up to the age of three years in Dar es Salaam, Tanzania. However, because of the small sample size and low median age of the study population, the findings cannot be generalized. Larger studies, including higher age groups, need to be done to clarify whether asymptomatic malaria parasitaemia is present in the general population in the Dar es Salaam area.

Utilization of Antenatal Care Services by a Semi-Nomadic Bedouin Arab Population: Evaluation of the Impact of a Local Maternal and Child Health Clinic

The objective of this study was to evaluate changes in antenatal care (ANC) utilization among semi-nomadic Bedouin Arab women living in the Negev desert of Israel before and after the establishment of a local Maternal and Child Health (MCH) Clinic. Retrospective record review of ANC utilization by pregnant women in two successive pregnancies, one before and one after the establishment of a local MCH Clinic. The study population was comprised of all 85 women who registered their newborns for care at MCH Clinic A, regardless of whether or not they had registered at the clinic for ANC. Records of their care in previous pregnancies were obtained from other MCH Clinics previously utilized by the family. There was a significant increase in the percent of women receiving ANC from 31.8% to 57.6% with the establishment of the local MCH Clinic (p = 0.004), increase in the percent of pregnant women who had at least one physician examination from 27% to 45% (p = 0.003), in the percent who had at least 3 nursing visits from 25% to 39% (p = 0.011) and in the compliance with screening tests. There was no significant change in birth week and birth weight between pregnancies before and after the establishment of Clinic A. The study demonstrated improvement in utilization of ANC in the study population. However, after the establishment of a local MCH clinic, over 40% of pregnant women still received no ANC. Non-geographic barriers to ANC are important and need to be addressed through community-based intervention programmes.

THE ROLE OF NUTRITIONAL INFORMATION IN ADDRESSING UNDER-FIVE CHILD MALNUTRITION IN TANZANIA

The paper discusses the role of nutritional information for addressing under-five child malnutrition in Tanzania. The paper is based on a master's dissertation whose objective was to determine the sources of nutritional information used to provide nutritional information to mothers in Maternal and Child Health (MCH) clinics, to investigate variables that determine accessibility and use of nutritional information and the sources of information routinely consulted by mothers when seeking nutritional information. Questionnaires and interview guides were used to collect data from 150 mother-child pairs and 25 health workers randomly selected from selected MCH clinics around Morogoro Urban District. The study found that although the MCH health and nutrition education sessions are an important aspect in disseminating nutritional information to mothers, these sessions were seldom conducted and the attendance of mothers to these sessions was poor. Radio and oral communication from friends and colleagues were the most commonly used sources of information and education is the most important variable that determines use and access to nutritional information. The study concludes that access to reliable nutritional information is an important aspect in addressing child malnutrition and therefore efforts should be made to ensure that mothers have access to adequate and reliable nutritional information through establishment of information units within the MCH clinic and paying more attention to less educated women when providing information. University of Dar es Salaam Library Journal Vol.5(2) 2003: 82-92

Paediatric referrals in rural Tanzania: the Kilombero District Study - a case series.

BackgroundReferral is a critical part of appropriate primary care and of the Integrated Management of Childhood Illness (IMCI) strategy. We set out to study referrals from the aspect both of primary level facilities and the referral hospital in Kilombero District, southern Tanzania. Through record review and a separate prospective study we estimate referral rates, report on delays in reaching referral care and summarise the appropriateness of pediatric referral cases in terms of admission to the pediatric ward at a district hospitalMethodsA sample of patient records from primary level government health facilities throughout 1993 were summarised by age, diagnosis, whether a new case or a reattendance, and whether or not they were referred. From August 1994 to July 1995, mothers or carers of all sick children less than five years old attending the Maternal and Child Health (MCH) clinic or outpatient department (OPD) of SFDDH were interviewed using a standard questionnaire recording age, sex, diagnosis, place of residence, whether the child was admitted to the paediatric ward, and whether the child was referred.ResultsFrom record review, only 0.6% of children from primary level government facilities were referred to a higher level of care. At the referral hospital, 7.8 cases per thousand under five catchment population had been referred annually. The hospital MCH clinic and OPD were generally used by children who lived nearby: 91% (n = 7,166) of sick children and 75% (n = 607) of admissions came from within 10 km. Of 235 referred children, the majority (62%) had come from dispensaries. Almost half of the referrals (48%) took 2 or more days to arrive at the hospital. Severe malaria and anaemia were the leading diagnoses in referred children, together accounting for a total of 70% of all the referrals. Most referred children (167/235, 71%) were admitted to the hospital paediatric ward.ConclusionsThe high admission rate among referrals suggests that the decision to refer is generally appropriate, but the low referral rate suggests that too few children are referred. Our findings suggest that the IMCI strategy may need to be adapted in sparsely-populated areas with limited transport, so that more children may be managed at peripheral level and fewer children need referral.

Alternative medical services in rural Tanzania: A physician's view

A physician evaluating health status among rural Tanzanian children as well as working in a Lutheran hospital, evaluates use of traditional and hospital-based medical care in the Usambara Mountains. Most rural Tanzanians use both traditional and hospital-based services, even for one disease episode. Local attendance at the Maternal and Child Health Clinic (MCHC) is increasing. 82% of the eligible children of the village attend. Of those who are eligible but do not attend, most have a sibling who had attended the clinic. Poor relations between hospital-based and traditional practitioners increase villagers' discomfort at attending the hospital or clinic, including the MCHC. Relations can be bettered by: (a) having both MCH aides and village women discuss problems at the village health committee; (b) encouraging traditional healers to participate fully on the committee and be trained to hold village health posts: (c) encouraging women to attend the clinic and eliminating the disparagement of traditional medicines in all clinics.