Maternal And Neonatal Health Research Articles

Improving the quality of clinical training in maternal and neonatal health in undergraduate nursing students: a participatory action research

BackgroundImproving the quality of clinical training is synonymous with accomplishing nursing education goals and improving the quality of nursing care. This study aimed to improve the quality of clinical training in Maternal and Neonatal Health (MNH) in nursing students.MethodsThis action research was conducted in two cycles from June 2017 to June 2018. The study setting was the School of Nursing and Midwifery of Lorestan University of Medical Sciences in southwest Iran. The participants were nursing students, faculty members, clinical trainers, educational managers, and teaching personnel. In the first cycle, semi-structured interviews were held with stakeholders to identify clinical problems and improvement strategies. Based on the results of these sessions, the changes needed to improve the quality of clinical training were planned and implemented. The weaknesses and strengths of the implemented changes were then identified through group discussions with the stakeholders. In the second cycle, a second plan was carried out to correct the weaknesses of the changes planned in the first cycle, and the modifications were implemented and evaluated.ResultsThe main three categories extracted included an unsystematic curriculum and inadequate monitoring, inadequate resources and facilities, and the student’s lack of motivation. The measures taken for improvement included holding communication workshops, developing and internalizing logbooks, reducing the number of students in clinical training groups, using modern clinical training methods, and changing clinical evaluation methods.ConclusionImproving communication skills among the students, trainers, and hospital personnel and using modern clinical training methods, such as conceptual maps, triple jumps, and clinical skill centers, are the best strategies for improving clinical training in MNH nursing students.

Women's experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology.

Embracing women's experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women's continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences. The purpose of this article is to describe women's experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya. The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili. An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis. Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women's view on the MNH continuum. The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution:The embrace of women's experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

Approaching the SDG targets with sustained political commitment: drivers of the notable decline in maternal and neonatal mortality in Morocco

BackgroundBetween 2000 and 2017/2018, Morocco reduced its maternal mortality ratio by 68% and its neonatal mortality rate by 52%—a higher improvement than other North African countries. We conducted the Exemplars...

A network of care to improve the continuity and quality of maternal and perinatal services in Makueni County, Kenya: study protocol

Background Kenya’s high maternal and perinatal mortality rates exceeds its recommended 2030 targets. The lack of effective collaboration between health facilities and workers contributes to delays and uncoordinated provision of care, leading to negative maternal and neonatal health (MNH) outcomes. Network of Care (NOC) is an effective strategy to improve health facility network efficiencies and MNH outcomes. Utilizing NOC to improve health system coordination and MNH outcomes in Kenya has not been studied. We present a study protocol for implementation research to investigate the feasibility and acceptability of establishing a county-level NOC on relationships among health facilities and workers, the feasibility of NOC for the Makueni county health system, and the impact of NOC on the quality of MNH services and emergency referrals within the county health system. Levels of communication, collaboration, and trust between NOC health facilities and levels of preparedness for management of MNH complications are also evaluated. Methods The study employed a mixed methods design with quantitative data from health worker self-administered phone surveys, health facility referral forms, and facility registers collected at baseline, then every three months from September 2021 to July 2023. Health worker focus group discussions and county management key informant interviews were conducted at baseline, midline, and endline. The study purposively selected 60 public and private health facilities in Makueni. These facilities were a sub-sample of 344 facilities with the highest maternity caseloads. A descriptive and thematic analysis of communication, collaboration, and trust between NOC health facilities and workers, and referral system changes will take place. Trend analysis of MNH indicators for Makueni from the Kenya Health Information System will be done. Conclusion This study aims at informing decision-makers locally and globally on whether NOC is feasible and acceptable as a county-level model of care in Kenya with application to similar LMIC settings.

Quality of care in maternal and neonatal health in Jumla, rural Nepal: Women’s perspective

There has been a significant improvement in maternal and neonatal health in the last two decades around the world. However, many women still die during pregnancy and childbirth. Nepal is one of the United Nations (UN) Member States which is committed to achieving the Sustainable Development Goals (SDGs) to reduce maternal mortality Ratio (MMR) and Newborn Mortality Rate (NMR). Understanding the women’s perspective on the maternity health service is vital for improving the utilisation of the maternity care services. Hence, this study explored women’s perspective on quality of care in maternal and neonatal health (MNH) in the Jumla district of Nepal.This study employed a qualitative methodology which consists of semi-structured interviews with pregnant women and mothers with children under two years of age, from Jumla district, Nepal. Two main themes that occurred during the interviews were experience of care, expected quality of care and MNH service in federalisation.The participants in the study found that the communication and information were clear to them, and the waiting time was from no waiting time to half an hour. Some participants expressed concern about the health worker’s behaviour during their visit to the health facilities. The women also expressed that quality of care for them meant having accessible health services in their local settings.Women’s experiences of care play an essential role in improving the quality of care in maternal and neonatal health. The health system needs to consider women’s experiences while planning for maternal health system in order to improve the maternal and neonatal health outcomes.

Effect of an integrated maternal and neonatal health intervention on maternal healthcare utilisation addressing inequity in Rural Bangladesh

BackgroundAlthough Bangladesh has made significant improvements in maternal, neonatal, and child health, the disparity between rich and poor remains a matter of concern.ObjectiveThe study aimed to increase coverage of skilled maternal healthcare services while minimising the inequity gap among mothers in different socioeconomic groups.MethodsWe implemented an integrated maternal and neonatal health (MNH) intervention between 2009 and 2012, in Shahjadpur sub-district of Sirajganj district, Bangladesh. The study was quasi-experimental in design for the evaluation. Socioeconomic status was derived from household assets using principal component analysis. Inequity in maternal healthcare utilisation was calculated using rich-poor ratio and concentration index to determine the changes in inequity between the baseline and the endline time period.ResultThe baseline and endline surveys included 3,158 (mean age 23.5 years) and 3,540 (mean age 24.3 years) recently delivered mothers respectively. Reduction in the rich-poor ratio was observed in the utilisation of skilled 4+ antenatal care (ANC) (2.4:1 to 1.1:1) and related concentration index decreased from 0.220 to 0.013 (p < 0.001). The rich-poor ratio for skilled childbirth reduced from 1.7:1 to 1.0:1 and the related concentration index declined from 0.161 to -0.021 (p < 0.001). A similar reduction was also observed in the utilisation of skilled postnatal care (PNC); where the rich-poor gap decreased from 2.5:1 to 1.0:1 and the related concentration index declined from 0.197 to -0.004 (p < 0.001).ConclusionThe MNH intervention was successful in reducing inequity in receiving skilled 4+ ANC, delivery, and PNC in rural Bangladesh.

The Effects of Precipitation and Temperature on Birth Weight: A Cross-Sectional Study from the Republic of Benin

Climate change, particularly changes in temperature and precipitation, prevents the improvement of maternal and neonatal health (MNH) in low-and middle-income countries (LMICs). Pregnant women and newborns in LMICs are considered the most vulnerable to adverse climate conditions, including extreme heat, floods, and droughts. This study examined the effects of precipitation and temperature on birth weight in the Republic of Benin, emphasizing climatic differences between the southern and northern regions. As a cross-sectional study, we pooled four rounds of Benin Demographic and Health Survey (BDHS) data, identifying 19 646 live births. We investigated the effects of precipitation and temperature on birth weight and the likelihood of low birth weight (LBW) newborns using multivariate multilevel linear and logistic regression models. We found that the average precipitation amount during the nine months before birth was positively correlated with higher birth weight in the south and was associated with a lower likelihood of LBW in the north. During the nine months before birth, a heat wave reduced birth weight by 57.0 g in the north. Furthermore, women and newborns in the north were more susceptible to precipitation and temperature, possibly due to food insecurity. Evaluating the MNH consequences of climate change is imperative for many developing countries facing severe climate change threats. Our findings provide an essential benchmark for future policies in Benin.

Research priorities in maternal and neonatal health in Africa: results using the Child Health and Nutrition Research Initiative method involving over 900 experts across the continent

Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods: The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal and newborn health in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.

From direct engagement to technical support: a programmatic evolution to improve large community health worker programs in Bihar, India

IntroductionIn 2011, through a multipartner Integrated Family Health Initiative (IFHI), CARE started supporting maternal and neonatal health (MNH) improvement goals in 8 of 38 districts in Bihar, India. The programme...

Research priorities in maternal and neonatal health in Africa: results using the Child Health and Nutrition Research Initiative method involving over 900 experts across the continent.

Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods:The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal andnewbornhealth in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.

Environmental conditions in maternity wards: Evidence from rural healthcare facilities in 14 low- and middle-income countries.

Adequate environmental conditions, comprising sufficient environmental hygiene items (e.g. gloves, soap, and disinfectant), adequate infrastructure (e.g. sanitation facilities, water supply), a clean environment, and hygienic behaviors in healthcare facilities (HCFs) are necessary for safe care in maternity wards. Few data are available describing environmental conditions in maternity wards in rural areas of low- and middle-income countries (LMICs). We collected data on these conditions from 1547 HCFs with maternity wards in 14 countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). We described patterns and availability of essential environmental conditions, and a regression model was developed to explore predictive factors. 73% of HCFs offering maternal and neonatal health (MNH) services did not meet the guidelines for the World Health Organization 'six cleans' (clean perineum, clean bed surface, clean hands, clean blade, clean cord tie, and clean towels to wrap the baby and mother). The items with the lowest availability were clean towels (40%). In a multivariable logistic regression model, HCFs that provided maternity services were more likely to have all 'six cleans' available if they: had at least an improved water source; had an infection prevention and control (IPC) protocol; had a budget considered sufficient that included funding for water, sanitation, hygiene, and IPC; and emphasized the importance of IPC within the nearby community. Our results demonstrate substantial differences between countries in the availability of environmental hygiene items, facility cleanliness, and quality of environmental health infrastructure in HCF maternity wards. There are several low-cost, high-impact, context-relevant opportunities to enhance essential environmental conditions that would improve the quality of neonatal and maternal care in maternity wards in HCFs in LMICs.

Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision

AimTo explore indigenous communities’ responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon.MethodsMamás del Río is a community-based, MNH programme...

The Logarithmic Spiral of Networks of Care for Expectant Families in Rural Nepal: A Descriptive Case Study

ABSTRACT This case study utilizes the four domains of effective Networks of Care (NOC) as a lens to describe the suite of interventions of a biosocial approach to maternal and neonatal health services in rural Nepal: The Network of Safety model, created by the non-governmental organization One Heart Worldwide (OHW) in collaboration with the government health system in Nepal. This approach provides essential guidance in the areas of health financing, governance, sustainability, reflection of user preference, and scalability. OHW addresses the reproductive health needs of women living in remote areas of Nepal in collaboration with local-level health and government workers by emphasizing clinical skill development and mentorship in management and leadership. With Nepal’s shift to Federalism, the OHW approach proved flexible and able to deepen its support to leaders in new local-level government structures. The results on the ground were remarkable: using analytic skills gained from their OHW partnership, municipality leaders and health workers demonstrated effective communication and proactive responses to challenges, while maintaining fidelity to the Network of Safety model. The six-year commitment made by OHW to partner municipalities promoted active learning and adaptation and is a clear contributor to the scalability of the OHW Network of Safety. Observing the Network of Safety work through the domains of NOC highlights the interdisciplinary effort required to successfully transform Maternal and Neonatal Health (MNH) services in rural Nepal.

The knowledge versus self-rated confidence of facility birth attendants with respect to maternal and newborn health skills: the experience of Nigerian primary healthcare facilities.

Competent and skilled birth attendants are critical in the reduction of maternal and infant morbidity and mortality at delivery. This study aimed to determine the association between knowledge and self-rated confidence in facility birth attendants affiliated with maternal and neonatal health (MNH) interventions. A descriptive cross-sectional study was conducted in 24 primary healthcare facilities in Osun state, Nigeria among 128 consenting facility birth attendants who were selected via a multi-stage sampling technique. Each attendant received a semi-structured interviewer-administered questionnaire. The dependent variables included the respondent's level of knowledge in MNH interventions and their self-rated confidence in MNH skills such as the provision of antenatal care service, normal labour, use of a partograph and the management of obstetric complications and post-partum haemorrhage. Bivariate analysis of factors associated with knowledge and self-rated confidence in MNH skills was performed with statistical significance set at p<0.05. Only 48 (37.5%) of the respondents had good knowledge of all of the assessed interventions; worse performances were reported with regards to the respondent's knowledge of normal labour and partograph use. However, 96 (75%) of respondents were confident in performing 75% of the skills assessed. Our analysis identified two factors that were significantly associated with a good knowledge of MNH skills: the cadre of the birth attendants (p<0.001) and training in life-saving skills (p=0.001). The knowledge of our respondents relating to most of the MNH interventions assessed was not significantly associated with their self-rated confidence in the required skills. The confidence of facility birth attendants in MNH skills was not knowledge-based and could frustrate national efforts to reduce maternal and perinatal deaths. We recommend effective and evidence-based training of all cadres of facility birth attendants to ensure that the skills being practiced clinically are based on adequate knowledge.

Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh

BackgroundThis study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes....

A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia.

Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

BackgroundA community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved.MethodsA process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done.ResultsWe found that SMAGs implemented much of the intervention as was intended, particularly in the area of women’s education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention.ConclusionWe found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups.

Governance for maternal and neonatal health

PurposeThe purpose of this paper is to report on a postdoctoral research study examining the importance of multi-level leadership and health governance for ensuring the implementation of national and provincial health sector strategies that aim to improve maternal and neonatal health (MNH) in low- and middle-income countries (LMICs).Design/methodology/approachA descriptive-interpretive qualitative, institutional approach was undertaken to explore the impact of provincial and district governance mechanisms on the delivery of MNH services in two districts in East New Britain Province (ENBP), Papua New Guinea (PNG). Data were collected from 12 key informants. Informants were selected on the basis of their direct involvement in health system management and deployment of health at provincial and district health governance levels.FindingsThe analysis revealed alignment between global strategies and national and provincial policy, suboptimal provincial government support related to implementation of policy, divergent data between districts and a disconnect between the local governance mechanisms and a donor-funded initiative for raising midwifery education.Research limitations/implicationsThis qualitative study was limited by the small sample size and does not claim to be representative of ENBP or other provinces in PNG.Originality/valueThis paper contributes empirical evidence to the literature on health policy, leadership and governance for MNH, by recognising and exploring the formal and informal rules at play in a given context, and examining how they are made, changed, monitored and enforced. These insights are critical to understanding how the system actually functions (or not) to implement MNH strategies in LMICs.

Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East

BackgroundFragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings.MethodsThis systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants.ResultsOf 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally.ConclusionsFindings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the ‘targeted policy approach for vulnerable groups’ as a means of addressing MNH service usage inequities.

Quality of Maternal and Neonatal Health (MNH) care in for profit private sectors in urban Bangladesh

Quality of Maternal and Neonatal Health (MNH) care in for profit private sectors in urban Bangladesh