Maternal And Child Health Care Research Articles

Understanding Differences in Behaviour Patterns of Healthcare Service Elements Among Regions Applying Data Mining

Maternal and child healthcare (MCH) has always been regarded as one of the important issues globally. The aim of this article is to find out all frequently occurring healthcare service elements along with their availability conditions and their interactions with other health system (HS) elements, when coverage of priority MCH intervention was either poor or moderate or good in any region. Association rule mining technique has been used to understand the probability of occurrences of different healthcare service elements among regions. Along with the proposed analytical framework, an interactive decision support system (DSS) has also been developed on a web platform, which would help healthcare policymakers to integrate the analytical framework easily in their processes of decision-making. The system has been developed by using Shiny package on R software. Data for all variables are collected for 584 Indian districts from the third phase of district-level household and facility survey. From results, it is observed that community healthcare services, sub-centre (SC)-level healthcare services and PHC-level healthcare services of a region are very much interlinked with each other, and their relationships define the healthcare condition of that region.

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review.

IntroductionEnsuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services.MethodologyA systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO).ResultsMaternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies.ConclusionThe findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.

Utilization of Maternal and Child Health Care Services among Pregnant Women in Slum Population of West Delhi

Utilization of maternal and child health (MCH) services remains poor in India. This study aimed to assess the utilization of MCH care services among pregnant women residing in an urban slum area of West Delhi. A household survey was conducted using questionnaire cum interview method for collection of sociodemographic information, obstetric history, and information on utilization of MCH care services. Pregnant women were followed within 72 h of delivery for obtaining information regarding delivery conditions. Although 96.6% of pregnant women have attended at least one antenatal care (ANC), whereas complete four ANC were attended by only one-fourth (25.3%) pregnant women. Nearly three-fourth (73.3%) pregnant women received; ANC from a government doctor and coverage for ANC components was highest in ANC provided by government doctor. Utilization of full ANC was reported by less than one-fifth pregnant women (19.18%). Only one-fifth of pregnant women (19.7%) received supplementary nutrition. Postnatal care (PNC) was received by 73.2% of women who had institutional deliveries during their stay in health facility only. Coverage of ANC components, number of ANC visits, utilization of full ANC, and PNC was found unsatisfactory. Participation in supplementary nutrition program was also poor. Intervention programs are needed for enhancing community awareness and improving the competence, confidence, and motivation of grass root health workers.

How and why do women’s groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature

BackgroundThis systematic review was undertaken to assist the implementation of the WOmen’s action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women’s group (WG)...

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.

Hesitancy for influenza vaccine among healthcare workers and mothers of preschool children: A cross-sectional study in Zagazig, Egypt.

BACKGROUND:Vaccine hesitancy is a worldwide issue. To intensify our efforts to find a solution to this problem, we need to comprehend its magnitude and underlying causes. This study aimed to determine the prevalence of influenza vaccine hesitancy and the reasons for it among healthcare workers (HCWs) and mothers of preschool children attending Zagazig Maternal and Child Healthcare (MCH) Center, Sharqia Governorate.MATERIALS AND METHODS:A cross-sectional study was conducted in the Zagazig MCH Center involving 77 HCWs and 210 mothers of preschool children. Two validated questionnaires (one for HCWs and one for mothers of preschool children) were used to collect data on hesitancy to influenza vaccine. Data analysis perfomed using SPSS v 25.0. For quantitative variables, statistical significance was determined using t-test, whereas Chi-square test was employed for quantitative variables. Poisson regression model was used to determine the independent predictors of influenza vaccine hesitancy. P < 0.05 was used as a level of statistical significance.RESULTS:The prevalence of hesitancy to the influenza vaccine was 46.8% among HCWs and 54.3% among mothers of preschool children. Fear of side effects (42.9%) and doubt in the usefulness of the vaccine (42.1%) were the most frequent barriers. Hesitancy was significantly more prevalent in the negative-attitude HCWs (62.0%) than positive-attitude HCWs (18.5%). According to Poisson regression analysis, the age of the index child, the mothers' source of information, and the frequency of vaccination were the critical indicators of influenza vaccine hesitancy in the studied mothers.CONCLUSION:Influenza vaccine hesitancy among the studied sample is high (46.8% among HCWs, and 54.3% among mothers of preschool children). Periodic health education campaigns to increase awareness and change the negative attitude about the influenza vaccine are recommended.

Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review.

Mobile health (mHealth) technology is being used predominantly in low- and middle-income countries. Developing countries with low level of investment in health infrastructure can augment existing capacity by adopting low-cost affordable technology. The aim of the review was to summarize the available evidence on mHealth interventions that aimed at increasing the utilization of Maternal and Child Health (MCH) care services. Further, this review investigated the barriers which prevent the use of mHealth among both health care workers as well as beneficiaries. A scoping review of literature was undertaken using the five-stage framework developed by Arksey and O'Malley. The articles published between 1990 and 2021 were retrieved from three databases (PubMed, Cochrane Reviews, and Google Scholar) and grey literature for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was followed to present the findings. A total of 573 studies were identified. After removing duplicates, studies not related to mHealth and MCH and publications of systematic reviews and protocols for studies, a total of 28 studies were selected for review. The study design of the research articles which appeared during the search process were mostly observational, cross-sectional, and randomized controlled trials (RCTs). We have classified the studies into four categories based on the outcomes for which the mHealth intervention was implemented: MCH care services, child immunization, nutrition services, and perceptions of stakeholders toward using technology for improving MCH outcomes. This brief review concludes that mHealth interventions can improve access to MCH services. However, further studies based on large sample size and strong research design are recommended.

Oxytocin Regimens for Labour Augmentation and Its Effect on Perinatal Outcomes: A Narrative Review

Background: The issue of childbirth, stimulation of labor is very important for successful childbirth and the birth of healthy babies. Obstetricians play main role in providing and rising Maternal and Child Health (MCH) care facilities. One amongst the goal of MCH care is safe delivery with smart feto-maternal outcome. The hormone plays vital role to cut back rates of caesarean birth once used for management of dystocia. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillousspaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. For augmentation of labour hormone regimens are low-dose (1-3 milli units/min) and high dose (4-7 milli units/min). Studies have shown high-dose of hormone causes hyperstimulation to womb. It's been mentioned that there's decrease in induction to delivery time at meta-analysis.&#x0D; Augmentation of labour is that the method of accelerating the frequency of contractions to facilitate a labour. The principal methodology for achieving augmentation of labour varies in the use and approach. Oxytocin is widely used for each induction and augmentation of labour. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillous spaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. These results reinforce the need to reflect on a change in care during delivery. Thus,this will help health care professional for better understanding on use and its effect during labour which will help in proper decision making for augmentation of labour.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol.

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Design of decision support system incorporating data mining algorithms for strengthening maternal and child health systems: Inclusion of systems-thinking approach

Reduction of maternal and infant mortality rates has been recognisedas one of the important goals of this century. Both coverageimprovement and inequity reduction have been set up asmillennium targets. Despite the availability of effective interventions,maternal and child healthcare conditions are not improvingin developing countries because of inefficiently functioninghealth systems. Knowledge generation about behaviors ofhealth system building blocks on the implementation of severalhealthcare interventions will help policymakers to design situation-specific and strategic interventions. A decision supportsystem has been devised incorporating data mining algorithmswhich would help to understand the condition of maternal andchild healthcare indicators; educational, socio, and economicsituations; healthcare status; and healthcare service blocksand their relationships with each other. In this paper, the designof the DSS has been discussed elaborately. To enhance a system-wide understanding of the healthcare system, all healthcare-related factors have been incorporated into this system.Three knowledge generation modules have been prepared byutilizing different visualization and data mining algorithms.

The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study

BackgroundThe world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones.MethodsWe pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15–49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness.ResultsRegression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women’s residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin.ConclusionsGeographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin.

Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

BackgroundHealth system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria.MethodsWe sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors.ResultsPBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05).ConclusionsOur findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery.Trial registrationClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.

Contrast in utilization of maternal and child health services between Himalayan region and rest of India: Evidence from National Family Health Survey (2015\u201316)

BackgroundMaternal and child health services, like antenatal care, skilled birth attendance and postnatal care, are crucial to improve maternal and neonatal health outcomes. Numerous studies have been conducted on the distribution of utilization of maternal and child healthcare (MCH) services in India with respect to socioeconomic and demographic characteristics. But no study has analyzed the utilization of MCH services with a focus on the topography of a given region (hilly/plain). The present study analyzes the utilization of MCH services in the hilly-Himalayan region of India in comparison to the rest of the country.MethodsData from India’s National Family Health Survey-4 (2015–16), on 190,898 women, was utilized for analysis in the present study. The association between the utilization of MCH services and the topography of the region of residence (hilly/plain) was analyzed by calculating adjusted odds ratios (AOR) with 95% confidence interval (95%CI) and predicted probabilities using a two-level random intercept logistic regression model.ResultsIt was found that the utilization of MCH services was significantly lower in the hilly regions compared to the plain regions. Women living in hilly areas (AOR: 0.42, 95%CI: 0.39–0.45) had 58% lower odds of receiving skilled birth attendance (SBA) than those living in plain areas. Similarly, the odds of receiving PNC, ANC, and full immunization were also lower in the hilly regions compared to the plain regions. The utilization of MCH services was alarmingly low in the rural-hilly regions. The odds of receiving two tetanus injections before birth were 71% lower for women in the rural-hilly areas (AOR: 0.39, 95% CI: 0.36–43) than those in the rural-plain areas. Predicted probabilities also showed that women in the hilly regions were less likely to receive MCH services compared to their counterparts in the plain regions.ConclusionExcept for the consumption of Iron Folic Acid (IFA) and the utilization of AWC services/ICDS (Integrated Child and Development Services), all other MCH services were significantly underutilized in the hilly regions compared to the plain regions. This calls for the attention of and concentrated efforts by policy makers and stakeholders, with a special focus on the rural-hilly regions. We firmly believe that the results of the present study have important policy implications.

Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study.

Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.

Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study

Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low.Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers.Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained.Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.

Èèwọ̀: Cultural issues mediating the coverage of maternal and child healthcare experiences in the Nigerian press

Although the Nigerian government appears committed to improving maternal and child healthcare (MCH), studies consistently show high maternal and child mortality in the country. Studies have also shown that a lack of awareness about symptoms and their severity prevents women from seeking medical attention until complications arise. The media can help address these issues by enlightening and empowering the public with relevant information. Unfortunately, even when published, critical information (about MCH) are usually buried in statistics and within ‘authority interviews’ which may not attract the attention of the target audience or provide them with the relevant information they need to protect the lives of women and children during pregnancy and childbirth. This study presents results from a content analysis of MCH-related contents in four national newspapers for a 12-month period and also interviews with ten health editors about the coverage of MCH-related issues in the Nigerian press. Major findings are that health journalists use statistics and stakeholder interviews mainly in producing health contents in the press because cultural ideologies around secrecy/silence about MCH experiences, the fatalistic acceptance of unfavourable outcomes as destiny, as well as patriarchy, have consistently discouraged women (and men) from sharing their MCH experiences in the media. The study recommends that the media should avoid the sensationalisation of MCH experiences to encourage more people to share their stories. This is because including the positive and challenging experiences of individuals in MCH-related contents in the media provides the human-interest angle that can increase readership of health contents, thus empowering citizens with the information they need to get adequate care and also seek redress when such care is denied.

Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study.

Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.

Patterns of Utilization of Maternal and Child Health Care among Tribals of H D Kote Taluk Mysore

Background: Maternal and child health (MCH) care services utilization is an important issue in the tribal area. It is very important to understand the pattern of utilization so as enable the policymakers to take initiatives to make the service provision more acceptable to the tribal population of India. Methodology: A community-based study was conducted in the tribal area of H D Kote taluk Mysore. Of 16 Primary Health Centers, five centers which cover nearly 50% of the population were chosen for the study. All the mothers who resided in those areas and delivered during January 2013 to December 2013, were chosen for study, which came to 215. Those who had migrated to areas outside our study area and those who were not found in home during data collection home visit were left out. Hence, the final sample size came to be 165. Results: Majority of mothers (74.5%) had antenatal registration done in the first trimester. Nearly 36.4% of mothers had &lt;3 antenatal check-up visits, 26.7% had 3–5 visits, and 32.7% of mothers had &gt;5 visits. About 95.2% of mothers had received two Tetanus toxoid injections, 3% had one injection, and 1.8% had no injections. About 42.4% of mothers had consumed &gt;100 iron and folic acid (IFA) tablets, 27.3% had 75–100 tablets, 13.3% had 50–75 tablets, and 14.5% had &lt;50 tablets, whereas 2.4% did not consume the IFA tablets. Conclusion: MCH care services utilization in the chosen tribal area was found to be satisfactory. It is a good sign as this reflects on the success of the reach of the government programs aimed at improving the mother and child health conditions in the tribal population.

Assessment of the facilities provided to patients in selected Basic Health Units (BHUs) of Peshawar, Pakistan

Introduction: Primary health care is essential healthcare made universally accessible to individuals and acceptable to them through their full participation and at an affordable cost. It can be effectively delivered at the Basic health unit (BHU). Assessment of its performance at regular basis is also crucial for the health care system.&#x0D; Objectives: To assess the services (EPI, antenatal care and basic healthcare) provided at selected BHUs of Peshawar with a view to determine service provision gaps in these BHUs.&#x0D; Materials &amp; Methods: It was a questionnaire based descriptive survey conducted from September to November 2019, in which simple random sampling technique was used to select 15 BHUs of district Peshawar for assessment and evaluation purposes. Data were collected using a checklist and an indigenous structured questionnaire where responses were recorded in yes/no format. Data analyzed using SPSS V.22 for descriptive statistics.&#x0D; Results: All vaccines of the EPI program were being provided in BHUs except for Hepatitis B. Regarding BHU staff, in 80% BHUs male medical officers were absent, and in 40% BHUs female medical officers were absent. For the Maternal and Child Health Care (MCHC) services, Tetanus Toxoid vaccine and Folic Acid supplements were present in all BHUs but status of malnutrition was unsatisfactory. About 80% of BHUs had a satisfactory infrastructure; the safety and sanitation precautions in BHUs were not up to the mark regarding disposal of hazardous waste and needles.&#x0D; Conclusion: Majority of the healthcare facilities were present in sampled BHUs including immunization services, MCHC services, infrastructure, safety, and sanitation. While the female staff was adequate in number, the attendance of male staff was poor.&#x0D; Primary health care; basic health unit; Immunization; Prenatal care