Maternal And Child Health Services Research Articles

A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs.

Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examines the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.

Impact of COVID-19 on the Utilization of Maternal and Child Health Services at a Regional Referral Hospital in Kenya

Background and Objective Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. Methods In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. Results The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. Conclusion and Global Health Implications This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.

Continuum of care in maternal and child health in Indonesia.

This paper aims to empirically analyze the socioeconomic and demographic correlates of maternal and child health (MCH) care utilization in Indonesia using the continuum of care (CoC) concept. The concept of CoC has emerged as an important guiding principle in reproductive, maternal, newborn, and child health. Indonesia's maternal mortality rate, neonatal mortality, and under-five mortality rates are among the highest in the Southeast Asian region. Using pooled data from four successive waves of the nationally representative Indonesian Demographic and Health Survey (IDHS) conducted in the years 2002, 2007, 2012, and 2017, we use multivariate regression models to analyze care across four components of the continuum: antenatal care (ANC), institutional delivery, postnatal care for children, and full immunization (IM). CoC at each stage of MCH care has improved continuously over the period 2002-2017 in Indonesia. Despite this, just less than one out of two children receive all four components of the CoC. The overall coverage of CoC from its second stage (four or more ANC visits) to the final stage (full child IM) is driven by the dropouts at the ANC visit stage, followed by the loss of postnatal checkups and child IM. We find that the probability of a child receiving CoC at each of the four stages is significantly associated with maternal age and education, the household's socioeconomic and demographic characteristics, and economic status. Complete CoC with improved, affordable, and accessible MCH care services has the potential to accelerate the progress of Sustainable Development Goal 3 by reducing maternal and childhood mortality risks. Our findings show that in Indonesia, the CoC continuously declines as women proceed from ANC to other MCH services, with a sharp decline observed after four ANC visits. Our study has identified key socioeconomic characteristics of women and children that increase their probability of failing to access care.

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

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

Associations between Difficulty in Accessing Maternal and Child Health Services and Stress Responses among Mothers Raising Young Children during the COVID-19 Pandemic in Japan.

In Japan, maternal and child health (MCH) services were canceled or limited during the COVID-19 pandemic, potentially damaging the mental health of mothers raising young children. This study aimed to examine associations between difficulty in accessing MCH services and various stress responses among such mothers in Japan. An Internet-based questionnaire survey was conducted in November 2022 targeting mothers raising young children who had registered with a Japanese online research company (n = 1032). The questionnaires included items from the Public Health Research Foundation Stress Checklist (Short Form) (PHRF-SCL(SF)), sociodemographic variables, and questions about difficulty accessing MCH services due to COVID-19. Chi-squared tests and multivariate logistic regression analysis were performed. In total, 45.7% of mothers experienced difficulty in accessing MCH services due to COVID-19. Mean PHRF-SCL(SF) scores were 4.9 for anxiety, 7.3 for tiredness, 2.8 for autonomic symptoms, and 5.2 for depression. These scores indicated worse stress responses than the general population and mothers raising young children before the COVID-19 pandemic. Mothers who experienced difficulty in accessing MCH services due to COVID-19 were 1.47-1.53 times more likely to be associated with high stress responses (PHRF-SCL(SF) scores). Given the difficulty mothers faced accessing MCH services due to COVID-19 and the negative impact this had, careful follow-up and support are necessary for mothers affected by the COVID-19 pandemic.

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

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

The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.
 Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.
 Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.
 Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis.

Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.

Factors Affecting the Utilization of Maternal and Child Health Services in Urban Primary Health Care Centers in Enugu State (Abakpa and Uwani)'

10.18103/mra.v12i1.5064 Background/Aim: Poor Maternal and Child Health service indicators have been a recurring Public Health challenge in Nigeria since the documentation of National Maternal, Newborn, and Child Health (NMNCH) statistics began in the early 1990s. This study was aimed at identifying the factors that affect the utilization of Maternal and Child Health services among women of childbearing age attending urban Primary Health Care centers in Enugu State (Abakpa and Uwani). Methodology: This was a retrospective and descriptive cross-sectional study and data was collected through a self-administered questionnaire. 296 respondents participated and analysis of data was done using Statistical Package for Social Sciences (SPSS) version 20.0. The findings revealed that the number of deliveries in the health centers was highest in 2018 with a total of 378 deliveries compared to 2016 & 2017 with 280 and 254 deliveries respectively. The total number of under 5 children receiving yellow fever/ measles vaccine in the health center increased throughout the years with a total of 1493 vaccinations in 2016, 1510 in 2017, and 2083 in 2018. Results: It was also observed that the main factors that enhanced Maternal and Child Health (MCH) services in the health centers were decreased maternal age, maternal educational status, affordability of services rendered, good attitude of health workers, and the proximity of both health centers to the homes of the respondents. On the other hand, increased maternal age, poor maternal education, high parity, and long waiting hours experienced by the patients were the major factors hindering the utilization of services rendered in the health centers. Conclusion: To improve utilization of MCH services as identified by the women include; advocacy and sensitization campaigns, community dialogue, and upgrading of the existing health care centers.

Perspectives of Healthcare Providers in Maternal and Child Health Services in BokeoProvince, Lao People’s Democratic Republic: A Qualitative Study

In Bokeo province, Lao People’s Democratic Republic, the high rates of poverty and poor health outcomes are striking. According to data collected from the Lao government, the area has a high mortality rate among mothers and children under five years old. Consequently, there is an urgent need for significant enhancements in maternal and child health (MCH) services. This study aims to investigate the perspectives of healthcare providers on the MCH situation, difficulties, challenges, and potential solutions for the growth and implementation of MCH services. We conducted in-depth interviews with 45 healthcare providers from varying healthcare system levels using qualitative methods. The key findings are as follows: Healthcare providers demonstrate a strong understanding of MCH policies, acknowledgment of national objectives, and dedication to personal growth. However, significant obstacles exist, including access barriers for ethnic minorities, transportation complications, inadequate healthcare personnel, and insufficient equipment and infrastructure. Healthcare providers have also indicated a need for more training and opportunities for professional development to improve MCH outcomes. To enhance MCH outcomes in Bokeo province, addressing these challenges and supporting healthcare providers in their quest for self-improvementis essential. The findings of our study can aid in creating targeted interventions and policies to improve MCH outcomes in Bokeo province and similar regions. By focusing on critical areas such as antenatal care, skilled birth attendance, postnatal care, immunizations, nutrition, family planning, health education, and access to healthcare, we can strive towards improved health outcomes and reduced mortality rates.

Addressing Disparities in Maternal and Child Health Services: A Focus on Uttar Pradesh, India

Background: India faces a critical challenge in maternal and child health, having reported the highest maternal and child deaths globally in 2010 and 2009, respectively. Despite a 70% decline in maternal mortality from 1990 to 2015, India still accounts for 15% of global maternal deaths. This study focuses on Uttar Pradesh, India's most populous state, where under-five child mortality rates are alarming, particularly in rural areas. Despite governmental efforts, accessibility, availability, and affordability of maternal and child health services remain problematic. Data and Methods: This study utilizes publicly available multi-level data from the HMIS portal of the Ministry of Health and Family Welfare, focusing on Uttar Pradesh. The HMIS is a crucial tool for monitoring and implementing national health programs. Examining data from 2018 to 2020, the study assesses the spatial distribution of Maternal and Child Health (MCH) coverage at the district level using descriptive statistics. The findings contribute to understanding MCH service utilization in Uttar Pradesh. Result and Discussion: This research investigates maternal health service utilization across districts in Uttar Pradesh, India, analyzing key indicators from 2018 to 2020. The study reveals significant variations in early registration, antenatal care, vaccination, and delivery preferences. Positive changes, notably in Basti and Kanpur Dehat, contrast with negative trends in Meerut and Varanasi. The findings underscore the need for targeted interventions to address disparities and enhance maternal health outcomes in Uttar Pradesh. Conclusion: Maternal health service utilization is vital for community well-being. Despite increased awareness, persistent gaps exist due to barriers like inadequate infrastructure and cultural norms. Addressing these demands a multi-faceted approach, including policy reforms, education, and innovative technologies. Optimizing maternal health requires holistic efforts to bridge socio-economic gaps and build resilient communities.

The COVID-19 pandemic and disruptions to maternal and child health services in public primary care Malaysia: a retrospective time-series analysis

IntroductionThe COVID-19 pandemic has posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This...

I-MoMCARE: Innovative Mobile Technology for Maternal and Child Health Care in Cambodia—study protocol of a cluster randomized controlled trial

BackgroundThe Government of Cambodia established the village health support groups (VHSGs) in 2003 to facilitate primary healthcare activities, including maternal and child health (MCH) services. However, VHSGs face several challenges that hinder them from performing optimally, including a lack of regular structured training and remuneration and limited and inconsistent support and supervision from the health centers (HCs). This implementation research aims to develop, implement, and evaluate a digital health intervention to improve the performance of VHSGs through better support and supervision and increase the MCH service coverage in rural Cambodia.Methodsi-MoMCARE, a two-arm cluster randomized controlled trial, will be conducted between 2022 and 2025. Five operational districts (ODs) have been randomized to an intervention arm and the other five ODs to the control arm. The intervention will last for 24 months. Around 200 VHSGs in the intervention arm will be equipped with a mobile application as a job aid and 20 HC staff with a web interface to improve support and supervision of VHSGs. The potential beneficiaries will include pregnant women, mothers, and children under 2 years old. We will measure the outcomes at baseline and endline. The primary outcomes will consist of a composite MCH index constructed from maternal and newborn care indicators, child immunization, and treatment of under-two children. Secondary outcomes will include coverage of selected MCH services. We will conduct the intention-to-treat and per-protocol analyses. We will conduct qualitative interviews with selected beneficiaries and stakeholders to evaluate the intervention’s acceptability, feasibility, and scalability. We will also conduct a cost-effective analysis using decision-analytic modeling incorporating a societal perspective that explores different time horizons, intervention effects, and when scaled up to the national level.Discussioni-MoMCARE is expected to increase MCH service access and coverage in rural Cambodia. It will contribute to advancing digital health use in primary healthcare interventions, which remains in its infancy in the country. Furthermore, the study findings will be a valuable addition to a growing body of literature on the effectiveness and feasibility of mobile health to improve coverage of MCH services in rural low- and middle-income country settings.Trial registrationClinicalTrial.gov NCT05639595. Registered on 06 December 2022.

A Cross-sectional study to evaluate maternal health care services utilization among women residing in an urban slum area, Ahmedabad

Background: Reducing the global Maternal Mortality Ratio to less than 70 per 1,00,000 live births is the first target of Sustainable Development Goal-3. Adequate utilization of Maternal and Child Health (MCH) services is essential for improved maternal and neonatal health outcomes. The utilization of MCH services is a complicated phenomenon, and several factors have an impact on it. This study aims to assess the current status of utilization of antenatal, intranatal, and postnatal maternal health services and determinants of utilization. Methods: This cross-sectional study was conducted in an urban slum during 1st January and February 2020 using a pre-tested, semi-structured questionnaire. A total of 126 women who delivered after 1st January 2018 were included as study subjects after getting informed oral consent. Data entry and analysis were done in Microsoft Excel. P-value<0.05 was considered statistically significant. Result: In all, 64% of study subjects had adequate Antenatal care (ANC) services utilization. The majority (94.5%) had institutional delivery. In all, 62% of women breastfed their child within four hours after birth. The reason for inadequate utilization was mainly due to lack of unawareness of MCH services. Conclusion: Overall, MCH services are good in this area. Efforts should be made to improve the quality of services for ANC registration within first trimester, Iron and Folic Acid tablet consumption, initiation of early breastfeeding, and postnatal care services, and the major determinants that influence utilization of MCH services including mother's education and parity

Effect of COVID-19 pandemic on maternal and child health care in a medical teaching hospital, Bengaluru, India

Background: Maternal and child health (MCH) care is a fundamental service of the public health delivery system of a nation, especially in low and middle-income countries like India. As the Covid-19 pandemic continued throughout the world, the health services such as maternal and child health (MCH) remained in inertia. Stringent lockdown measures and fear of contracting Covid-19 infection made accessing these services extremely hard. Methods: A cross sectional study was conducted in a tertiary care maternity hospital in Bengaluru from July to September 2021 among the post-natal mothers using a semi-structured questionnaire about the utilization of MCH services. Results: A total of 316 mothers were interviewed. Among them, 72.8% mothers had completed 4 or more antenatal visits. Among high-risk pregnancies, only 66.3% had completed adequate antenatal visits. 63% of infants had low birth weight and 83.4% of children were immunized up to date. Conclusions: This study revealed that, more than 1/4th of mothers had not completed 4 or more antenatal visits and about 1/3rd of the high-risk mothers had not completed adequate antenatal visits. More than 2/3rd of infants had low birth weight. This shows that there was a marked reduction in the utilization of MCH services during the Covid-19 pandemic.

Utilization of Maternal Healthcare Services Among Tribal Women in Empowered Action Group States in India

Maternal and Child Health (MCH) care services mainly focus on the utilization among tribal women in Empowered Action Group (EAG) states in India. For this study, the NFHS-4 (2015–2016) data were used. Analysis was performed on 54,448 women aged between 15–49, who have a child below 5 years of age, by using bivariate logistics regression, chi-squared test and the Moran-I (Univariate) statistical techniques. Results show that only 11% of tribal women accessed full Antenatal Care (ANC), and 54% of women received Postnatal Care (PNC) in EAG states. More than one-third (34%) of tribal women delivered in their homes compared to institutional delivery (66%). Women with higher education are significantly more likely to utilize ANC and have institutional delivery compared to the women with no-education. Also, mothers from the most abundant wealth status are significantly more likely to receive ANC and PNC and have institutional delivery compared to women with poorest wealth quintile. Considering the inter-EAG states comparison, state like Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh and Uttarakhand are performing poorly. Hence, out of all EAG states districts almost 3–7 districts from (low–high) and 8–11 districts from (high–low) groups show negative autocorrelation or outliers to received MCH care services. Despite continuous and improving efforts of the government, the utilization of MCH services is very low among tribal women in the EAG states of India.

Does armed conflict lead to lower prevalence of maternal health-seeking behaviours: theoretical and empirical research based on 55 683 women in armed conflict settings

BackgroundWomen and children bear a substantial burden of morbidity and mortality due to armed conflict. Life-saving maternal and child health (MCH) services are low-quality in most conflict-affected regions. Previous studies...

Analysis of the Efficiency of Maternal and Child Health Services (MCH) at Public Health Centers in the Banyumas District

Maternal and Child Health (MCH) service programs as an indicator of the status of community's health status are available at every Public Health Center (PHC) in Banyumas District. However, these services are still inadequate to improve the health status of mothers and children. The condition of the COVID-19 pandemic in early 2020 caused several MCH services not to run as previously planned. This study aimed to describe the implementation and efficiency of MCH services in PHC in Banyumas Regency. The method used in this study was a quantitative approach using secondary data on health workers and the output of MCH services at the PHC. Data were analyzed using the Data Envelopment Analysis (DEA) method, with the unit of analysis being aggregate data at 10 selected PHCs using a purposive sampling technique. The results showed that 60% of the PHCs were technically efficient (VRS value 1,0), and 40% of the PHCs were technically inefficient (VRS value < 1,0). The analysis's findings indicated there were differences between efficient and inefficient PHCs in terms of the input (health personnel) and output (service use). The inefficiency of the PHC is caused by the less optimal utilization of health workers and the low utilization of PHC health services by the community. Additionally, to meet the coverage of service criteria set by the government, MCH services at the PHC in the Banyumas Regency region have been provided following the current standard operating procedures. Public Health Centers must maximize the utilization of health personnel to improve technical efficiency and condition service activities during the pandemic by adjusting regional policies while still complying with health protocols.

Decomposing inequality in Maternal and Child Health (MCH) services in Nepal

BackgroundAbout 75.5% of women in Nepal’s urban areas receive at least four ANC visits, compared to 61.7% of women in the country’s rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016.MethodsInequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods.ResultsInequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women’s literacy, place of living, mother’s employment status, and problem of distance to reach nearest health facility were the main contributors.ConclusionWe find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women’s education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.

Distance to healthcare facilities, healthcare use and health outcomes: The case of Papua New Guinea

AbstractPapua New Guinea (PNG) has among the worst maternal and child health (MCH) outcomes in the Asia–Pacific region. Improving population access to and use of health services is a key government priority. However, it is unclear from the international evidence whether the observed inverse relationship between distance to health facilities and health outcomes is due to health service use. This article first seeks to estimate the relationship between distance to health facilities, the use of MCH services and health outcomes in PNG. The second goal is to assess whether the observed relationship between distance to health services and health outcomes occurs due to health service use. Cross‐sectional data from the Demographic and Health Survey 2016–18 for PNG were used to estimate the association between distance to health facilities, indicators of health service use and indicators of child health outcomes, using regression methods. Causal mediation methods were used to assess whether the observed associations between health outcomes and distance to health facilities were explained by health service use, or not. We find an inverse association between distance to health facilities and utilisation of MCH services; and between distance to health facilities and child health. However, our analyses do not support causal mediation via impact of distance on health service use. At odds with a large literature that implicitly assumes that health service use improves health outcomes, our findings reflect broader concerns about quality of care in PNG.