Maternal Health Services Research Articles

Characteristics of Women, Intrapartum Interventions, and Maternal and Neonatal Outcomes Among Users of Intrapartum Water Immersion: The UK POOL Cohort Study.

The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022. Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis-(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among "low-risk" women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth. Among 869,744 included births, 10% (n = 87,040) used water immersion during labour or birth and 4.6% (n = 39,627) gave birth in water, with rates falling over time. Being of white or multi-ethnicity, fluent in English, non-smokers or ex-smokers, from more affluent areas, and nulliparous were associated with higher rates of water use. Overall, 39.6% of nulliparous and 9.9% of parous women at low risk at labour onset, and who used water immersion during labour, received obstetric or anesthetic care during the intrapartum period. Physiological third stage management was used following 27.1% (n = 10,737) of waterbirths and following 8.6% (n = 2260) of waterbirths the placenta was delivered into water. The rate of recorded blood loss ≥ 1000 mL was not significantly different when the placenta was delivered in water compared to placental delivery out of water. This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence-based rates of obstetric interventions that take into account their risk status and birth choices. ISRCTN13315580.

Strengthening the role of community health assistants in delivering primary health care: the case of maternal health services in Zambia

IntroductionMany low-and middle-income countries, including Zambia experience a huge deficit of human resource for health, which affects the delivery of primary health care services such as maternal and child health (MCH), nutrition, HIV and gender-based services. The Clinton Health Access Initiative in collaboration with the Zambian Ministry of Health implemented a community health systems (CHS) strengthening project to enhance the capacity of community health assistants (CHA) to provide MCH services from 2019 to 2021. The project activities included capacity building in supervision, provision of financial incentives and logistics. This study explores how these interventions strengthened the role of the CHAs in delivering MCH services.MethodologyThis was a qualitative study consisting of 189 KIIs and IDIs as well as 20 FGDs conducted in all the 10 provinces of Zambia with the CHAs, and their supervisors, health workers, neighbourhood health committees and community members. Data were analysed using thematic analysis.ResultsThe CHS strengthening interventions including provision of training manuals, streamlined recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration contributed to improved delivery and acceptability of MCH services. Further, the leveraging of community networks, linkages and partnerships when delivering these services, including the traditional and religious leaders contributed to improved coverage and acceptability of MCH services. Meanwhile, health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide by the CHA recruitment and selection criteria affected delivery and acceptability of MCH services.ConclusionThis study builds on existing evidence on the importance of building a stronger community–based primary health care to effectively address maternal and child health related issues. We emphasize the need to integrate strategies such as provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA program to enhance the provision and acceptability of health services.

Job motivation and associated factors among health workers providing maternal and child health services in Wolaita Zone public hospitals, Southern Ethiopia; A mixed-method study.

The quality of services provided to women, and children is significantly impacted by a lack of motivation and a shortage of competent healthcare staff.Low motivation has a negative impact on the performance of individual healthcare institutions, health workers, patient safety, and the health system as a whole. To assess job motivation and associated factors among health workers providing maternal and child health services in Wolaita Zone public hospitals, Southern Ethiopia, 2023. A facility-based cross-sectional mixed-method study was conducted on randomly selected 319 maternal and child health service providers followed by a purposive sampling technique for the qualitative study. A pretested, structured, self-administered questionnaire obtained from previously conducted studies and in-depth interviews were used to collect quantitative and qualitative studies, respectively. EpiDataV4.6 and Statistical Package for Social Science version 26 were used for quantitative data entry and analysis, respectively, and both bivariable and multivariable logistic regression were done. For qualitative data, OpenCode 4.03 software was utilized to conduct thematic content analysis. A total of 319 maternal and child health service providers participated in this study, with a 100% response rate. Of them, 142 (44.5%) (95%, CI: 39% - 50%) were motivated. Female gender, payment other than salary not paid on time [AOR (95% CI) 0.159 (0.046-0.549)], work overload[AOR (95% CI) 0.264 (0.083-0.836)], shortage of resources[AOR (95% CI) 0.385 (0.172-0.860)], limited training opportunities[AOR (95% CI) 0.104 (0.030-0.356)], and poor management and leadership of the organizations were statistically significant association between provider's job motivations. In this study, nearly forty-five percent of maternal and child health service providers weremotivated. Female gender,payment other than salary not paid on time, work overload, shortage of resources, limited training opportunities, and poor management and leadership of the organizations were significantly associated with providers' job motivation.Therefore, timely paid other benefitpayments, accessing training opportunities, implementing work force strategy, and availing of resources are very important actions that should be taken.

Beyond 'Go and bring your husband': a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon.

Maternal and infant mortality remains a major public health concern in sub-Saharan Africa. While male involvement in pregnancy and child birth has proven to be an effective intervention that can significantly reduce these deaths, low-income settings like Cameroon continue to encounter obstacles in engaging men in maternal and child health services. This study seeks to examine andcontextualizebarriers to male partner involvement in antenatal care in order to inform the development of an intervention aimed at promoting male participation in maternal and child health in Cameroon. We employed a qualitative approach drawing upon 68 semi-structured interviews (SSIs) and three focus group discussions (FGDs). This involved purposively selected pregnant women (SSIs-38; FGD-01), male partners (SSIs-30; FGD-01) and health workers (FGD-01). Semi-structured interviews and group discussions were audio-recorded, transcribed and organized using Nvivo. Guided by the Capability, Opportunity and Motivation (COM-B) model of behaviour and Theoretical Domains Framework, we coded and analyzed data using directed content analysis, followed by inductive thematic analysis. Our findings suggest that, thebehaviourof expectant fathers during pregnancy is shaped by the dynamic interaction between limited awareness on the role of men in pregnancy care and limited maternal agency to initiate or involve their partners in antenatal care. We also noted that the low motivation of male partners to participate in antenatal care is at the intersection of limiting health system approaches that have not moved beyond mandating women to go and bring their husbands, restrictive gender norms on masculinity-underpinned by the perception that antenatal care is a woman's affair and the fear of judgement/HIV testing. Based on our findings, we recommend that health system approaches specifically take into account existing knowledge gaps on male partner role, culture-specific gender norms and restructure the health system to promote male participation in maternal and child health services.

Socio-Demographic Factors Associated with Postpartum Depression Among Woman Delivering in Banadir hospital Mogadishu, Somalia

Background: Postpartum depression (PPD) is a significant global mental health issue, affecting 10-15% of women after childbirth. While its prevalence is well documented worldwide, the socio-demographic factors influencing PPD in Somalia remain understudied. This study explores the impact of socio-demographic variables on PPD among women delivering at Banadir Hospital, Mogadishu, Somalia, a setting influenced by distinct socio-economic and cultural factors.  Methods: A mixed-methods approach was employed to investigate the relationship between socio- demographic variables and PPD. Quantitative data were collected using the Edinburgh Postnatal Depression Scale and structured questionnaires, while qualitative data were gathered through focus group discussions. Stratified random sampling was used for participant selection, and data analysis involved descriptive statistics (SPSS V20.0 and MS Excel) and thematic analysis for qualitative insights.  Results: The findings revealed that the majority of respondents were aged between 24-29 years (74 women, 44.04%), followed by those aged 18-23 years (62 women, 36.9%), while the least represented age group was 42-47 years (5 women, 2.38%). In terms of marital status, 81 women (48.21%) were married, 69 women (41.01%) were single, 16 women (9.52%) were divorced, and 2 women (1.19%) were widowed. Regarding education, most had primary education (92 women, 54.76%), followed by secondary education (39 women, 23.21%), while 28 women (16.67%) had no formal education, and only 9 women (5.36%) had attained college or university education. Occupation-wise, 98 women (58.33%) were housewives, 36 (21.43%) were students, 22 (13.1%) were teachers, and the least represented were health workers (4 women, 2.38%).  Conclusion and Recommendations: This study examines the link between postpartum depression and sociodemographic factors among women at Banadir Hospital, Somalia. Younger mothers aged 18–29 years, single women, divorced women, those with lower education levels, and housewives experienced higher prevalence. Targeted mental health interventions, including screening, psychosocial support, and awareness programs, are crucial for early identification and support. Strengthening maternal health services through enhanced screening, counseling, and community-based initiatives can improve postpartum care and overall well-being in this population.

Assessing antenatal care service satisfaction and associated factors among pregnant women at health facilities in East Shewa Zone, Ethiopia: a facility-based cross-sectional study

BackgroundAntenatal care (ANC) is a critical component of maternal health services, playing a vital role in ensuring the well-being of both mothers and their unborn children. Particularly in Ethiopia, where maternal and child health indicators remain concerning, improving the quality of antenatal care is essential for reducing maternal morbidity and mortality rates. Understanding mothers’ satisfaction is vital for enhancing maternal health services and building trust in the healthcare system.ObjectiveThis study aimed to assess Antenatal care service satisfaction and identify associated factors among pregnant women in East Shewa Zone, Ethiopia.MethodsA facility-based cross-sectional study was conducted with 534 pregnant women attending ANC at health facilities. Participants were recruited using stratified sampling, and data were collected through structured face-to-face interviews. Binary logistic regression was employed to identify factors associated with satisfaction, with statistical significance set at p < 0.05.ResultsAmong 534 pregnant women during their first antenatal care (ANC) visit, the overall satisfaction rate was 81.09% (95% CI 77.50%–84.32%). Women with secondary education were 88% less likely to be satisfied (AOR = 0.12), while those with higher education were 96.6% less likely (AOR = 0.034). Ratings of service quality significantly influenced satisfaction, with women rating service as fair and good being five times (AOR = 5.01) and nearly four times (AOR = 3.85) more likely to be satisfied, respectively. Furthermore, ratings of provider knowledge as fair (AOR = 3.81) and good (AOR = 4.05) significantly increased satisfaction. Respect from providers (AOR = 10.34) and involvement in decision-making (AOR = 3.03) also positively influenced satisfaction levels.ConclusionThe study indicates that a significant proportion of pregnant women reported satisfaction during their first antenatal care (ANC) visit, though those with secondary and higher education levels showed lower satisfaction rates. Key predictors of ANC satisfaction included educational status, quality of service, provider knowledge and skills, respect, clarity of explanations, involvement in decision-making, waiting time, helpfulness, and confidentiality. To improve patient satisfaction, healthcare providers should focus on enhancing service quality, ensuring timely care, and fostering respectful interactions, ultimately enriching the ANC experience for women.

Immunization status and its determinants among children aged 12–23 months at community health centers in Mogadishu, Somalia: a cross-sectional study

BackgroundRoutine vaccination is essential in reducing child mortality. This study assessed the determinants of vaccination status and its determinants for children aged 12–23 months in community health centers in Mogadishu, Somalia.MethodsThe study involved 417 mothers, systematically selected from those attending community health centers in Mogadishu for antenatal care between March 25 and June 15, 2024. Data was collected through a structured questionnaire, and SPSS was used for the analysis. Logistic regression analyses of both bivariate and multivariate were conducted to examine the association between dependent and independent variables. The findings were reported as adjusted odds ratios (AOR) with 95% confidence intervals, and a p-value of less than 0.05 determined statistical significance.ResultsVaccination rates showed that 53% of children were fully vaccinated, while 47% had received partial vaccinations. Findings revealed that higher household income was associated with increased odds of partial vaccination status, with families earning $300–$400 monthly being most likely to be partially vaccinated (AOR: 3.247, 95% CI: 1.784–5.910, p = 0.002). Additionally, children whose mothers had no antenatal care (ANC) visits were significantly less likely to be fully vaccinated (AOR = 20.075, 95% CI: 7.385–54.572, p = 0.001) compared to those whose mothers attended four or more ANC visits.ConclusionOur findings revealed that 53% of children were fully vaccinated, with higher household income and regular antenatal care visits associated with increased vaccination rates. Future research should focus on interventions to improve maternal health services and increase access to antenatal care (ANC) to raise vaccination rates in Somalia. Further investigation should explore barriers to vaccination in low-income areas and innovative community engagement strategies.

Improving Access to and Delivery of Maternal Health Care Services to Prevent Postpartum Hemorrhage in Selected States in Nigeria: Human-Centered Design Study.

A significant cause of postpartum hemorrhage (PPH) is access to and delivery of maternal health care services. Several multisectoral strategies have been deployed to address the challenges with little success, thereby necessitating the use of human-centered design (HCD) to enhance health care delivery, particularly in PPH management. This study aims to develop facility-level solutions for optimizing uterotonic supply chain systems and health service delivery in PPH management through an HCD approach in selected Nigerian states. The research used a four-phase HCD methodology: (1) co-research, (2) co-design, (3) co-refinement, and (4) implementation. However, this paper focused on the first 3 phases. In the co-research phase, 203 interviews were conducted, involving 80 pregnant women and nursing mothers, 97 health care workers, and 26 key stakeholders. Additionally, 33 sites were observed across a 3-level continuum of care. Interviews and focus group discussions revealed insights into the distribution of health workers and observed PPH cases, alongside knowledge and administration of uterotonics. Data analysis was carried out using three key steps: (1) identifying key themes from the collected data, (2) developing insight statements that encapsulate these themes, and (3) translating each insight statement into actionable design opportunities. About 150 ideas were produced and translated into 12 solution prototypes in the co-design phase. Progressive refinement following feedback from 140 stakeholders led to the selection of three final solutions: (1) implementing a referral linkage system to improve the transportation of pregnant women to nearby health facilities, (2) increasing demand for antenatal care services among pregnant women and their families, and (3) delivering a comprehensive uterotonic logistics management program for streamlined uterotonic storage and management. This approach aligns with global health trends advocating for HCD integration in health care programming and aims to empower local champions to drive sustainable improvements in maternal health outcomes. Judicious implementation of the developed prototypes across the states can strengthen clinical care and potentially reduce maternal health service delivery gaps.

Mothers on the Frontline

The ongoing armed conflict in Sudan, which began in April 2023, has had devastating effects on maternal health services across the country. More than 1.1 million pregnant women are now in urgent need of medical care as health care infrastructure crumbles under the strain of violence. Hospitals and health centers have been destroyed or rendered inaccessible, and shortages of medical supplies and the widespread loss of health care workers have left many women without access to essential maternal services, including antenatal care, safe delivery assistance, and postnatal care. Consequently, countless women are forced to give birth in unsafe conditions without the presence of skilled health care personnel, dramatically increasing the risk of complications such as sepsis, hemorrhage, and obstructed labor. The conflict also has contributed to a surge in preterm births due to heightened stress, insecurity, and malnutrition affecting expectant mothers. In addition to the physical dangers, the psychological toll on pregnant women is profound. The trauma of living in war-torn regions, displacement, and the constant threat of violence have led to rising levels of anxiety, depression, and other mental health disorders. Furthermore, the conflict has exacerbated incidents of sexual and gender-based violence, further endangering the lives of women and compounding their psychological trauma. This article examines the diverse aspects of the maternal health crisis in Sudan, calling for immediate humanitarian aid, including medical, nutritional, and psychosocial support. Long-term solutions also are needed to rebuild maternal health services and address the ongoing physical and psychological suffering of Sudanese women and their children.

Improving Access to Skilled Maternal Health Services among Pregnant Women with Disabilities in Uganda: what are disability-responsive maternal health services?

Improving Access to Skilled Maternal Health Services among Pregnant Women with Disabilities in Uganda: what are disability-responsive maternal health services?

The Impact of Mobile Health (mHealth) in Maternal Health Services [Response to Letter

The Impact of Mobile Health (mHealth) in Maternal Health Services [Response to Letter

Facilitators, barriers and service availability for delivering integrated care for the triple elimination of HIV, syphilis and hepatitis B vertical transmission in Uganda: a multi-site explanatory mixed methods study

BackgroundElimination of vertical transmission of HIV, syphilis and hepatitis B is part of the global aspiration to end the three infections as public health threats by 2030. Whereas global and national policy guidelines recommend integration of screening, prevention and treatment for the three infections in maternal and child health (MCH) service delivery points, progress has been slow. We aimed to explore the health system factors that facilitate and hinder optimal integration of triple elimination services within the MCH platforms.MethodsThis was a cross-sectional, explanatory mixed methods multi-site study implemented in two regions of Uganda, conducted in July – August 2024. Firstly, we used an observation checklist to assess for the availability of services and commodities required for provision of triple elimination care at 20 health facilities (two regional referral hospitals, two general hospitals, two specialized outpatient TASO clinics, five HCIVs, eight HCIIIs and one HCII), and computed a percentage service and commodity availability score for each site, and average for the sites. We then used findings from this assessment to guide open-ended probing during key informant interviews and focus group discussions among ten key informants and 43 focus group discussion participants. Interviews and discussions were recorded, transcribed verbatim, and then analysed manually. We categorized responses as either facilitators or barriers and extracted quotes, by theme, based on the World Health Organization’s health systems building blocks framework.ResultsThe average percentage score of service and commodity availability was 61.8% (range: 46.4–78.6%) in Acholi region and 66.1% (range: 53.6–78.6%) in Teso region. We found that presence of trained focal persons, district accountability fora, routine data collection and utilization, and availability of motivated community health workers facilitated triple elimination service integration. Key barriers included limited district health team engagement, frequent stock-outs of diagnostic and treatment commodities, health personnel shortages and high reporting burden.ConclusionsHealth facility service readiness and availability percentage scores differed across facilities and between the two regions. Several health system factors facilitate integrated service provision for elimination of HIV, syphilis and hepatitis B vertical transmission. This integration is, however, constrained by a number of health system barriers. Further implementation research could contribute to addressing the various health system constraints and adoption of strategies for service integration tailored to site contexts.

Factors that Contribute to Neonatal Mortality at a Community Hospital.

The prevalence of intrauterine fetal demise (IUFD) in the United States is 5.74 per 1000 live births. In Maryland, the prevalence is 6.75 per 1000 and occurs nearly twice as frequently in Black than in white populations. At MedStar Franklin Square Medical Center (MFSMC), Electronic Medical Records (EMR) show that IUFDs are 2.5 times greater in Black than white women. This analysis aims to identify factors that contribute to this health disparity. We performed a retrospective chart review of deliveries at MFSMC between 2018 and 2020. Literature-supported variables were collected for all pregnancies that ended in IUFD. Using logistic regression models, these factors were analyzed to isolate predictors for IUFD and association with race. The same predictors were compared to those of women who delivered live infants during this period. Without adjustment, the odds of having an IUFD are 2.21 times higher for Black mothers than for white mothers at MFSMC. No other unadjusted odds ratios between comorbid risk factors and the chance of IUFD were significant. After adjusting for diabetes, growth restriction, substance abuse, and hypertension, the odds of having an IUFD are 2.31 times higher for Black than white mothers. Black mothers experience increased risk for IUFD, after controlling for other pertinent factors. This disparity should be addressed by reducing healthcare provider bias, increasing maternal health services, and providing comprehensive patient education.

Geospatial Assessment of Health Indicators and Public Healthcare Services in Maharashtra, India

Good health is vital for the well-being of individuals and societies. Health indicators such as family planning, child health, and maternal health play a crucial role in determining population health outcomes. This study examines these indicators in Maharashtra, focusing on changes before and after the COVID-19 pandemic. Family planning, child health, and maternal health are critical areas affected by the pandemic’s disruptions. The research uses Geographic Information Systems (GIS) to analyze regional disparities in healthcare accessibility and effectiveness, utilizing secondary data from sources like the National Family Health Survey (NFHS), Health Management Information System (HMIS), and Maharashtra State Health Department. Maharashtra, with its diverse socio-economic and geographical conditions, experiences significant health disparities, with urban areas exhibiting better healthcare access compared to rural regions. The study reveals several trends. Family planning in districts like Osmanabad and Solapur showed a decline in the Medical Termination of Pregnancy (MTP) ratio post-COVID, while sterilization rates remain higher in economically weaker districts. Maternal health indicators show a mixed response, with some districts exhibiting delays in early pregnancy registration, while others show improvements in institutional deliveries. Child health indicators highlight improvements in birth weight outcomes in certain districts but also show challenges in immunization coverage and the sex ratio at birth. Healthcare services are unevenly distributed, with rural areas suffering from a shortage of primary healthcare centers and medical professionals. This research emphasizes the need for targeted interventions in rural and underserved areas, focusing on enhancing healthcare infrastructure, maternal and child health services, and family planning programs. It also underscores the importance of using geospatial analysis for efficient resource allocation and policymaking.

Socio-demographic factors influencing the use of free maternal health services among pregnant women

Background: Maternal health remains a major public health challenge, particularly in low- and middle-income countries. Despite Kenya’s efforts to provide free maternal healthcare, maternal mortality rates remain high in Turkana Central Sub-County due to socio-cultural, economic, and infrastructural barriers. Methods: A cross-sectional study was conducted in Turkana Central Sub-County to assess factors influencing the uptake of free maternal health services. Data were collected using structured questionnaires and focus group discussions. Quantitative data were analyzed using SPSS version 29, employing chi-square tests and logistic regression to examine associations between socio-demographic factors and service utilization. A significance level of p&lt;0.05 was applied. Results: The study included 210 participants, most aged 20-24 (16.2%) and married (49.0%). The majority were Christians (82.5%) and self-employed (63.3%), with 79.5% having no or only primary education. Age (p=0.012), parity (p=0.011), and household income (p=0.013) were significantly associated with service utilization, while marital status, religion, income source, and education level were not. Women aged 25-29 were less likely to utilize free maternal health services (OR=0.141, p=0.007), whereas lower-income women (Ksh. 0-2,500) were more likely (OR=2.584, p = 0.036). Higher income levels correlated with decreased uptake. Conclusions: Age, parity, and household income significantly influenced the utilization of free maternal health services. Financial constraints remain a key determinant, with lower-income women more reliant on free services. Efforts to improve maternal health should prioritize increasing awareness and accessibility.

Socio-economic and geographic equity in maternal health services utilization in Ethiopia: a community-based cross-sectional study

BackgroundAddressing disparities in reproductive, maternal, newborn, and child health services is crucial in achieving the Sustainable Development Goal of universal health coverage. The persistence of social and geographic disparities in maternal health service coverage and utilization poses significant challenges. Ensuring equity in health service access and utilization as part of universal health coverage requires evidence whether these inequities exist. This study aimed to measure socio-economic and geographic equity in coverage and effective coverage of both antenatal care and skilled birth attendance.MethodsWe conducted a secondary analysis of data collected from the Performance Monitoring for Action Ethiopia from 2019 to 2020, including 2714 postpartum women at around six weeks and service delivery point assessment data from 462 health facilities. We measured inequities in the utilization of four or more antenatal care visits and skilled birth attendance using equiplots and concentration index. Moran’s I, Getis-Ord Gi statistics and Kriging interpolations were employed to analyze geographic variations of maternal health service utilization.ResultsIn this study, 40% (95%CI: 36, 45) utilized four or more ANC visits, and 12% (95%CI: 11, 14) received quality antenatal care. Over half (54%, 95%CI: 48, 59) of women utilized skilled birth attendance, but only 7% (95%CI: 4, 8) received quality delivery care. The absolute equity gap between the least poor and the poorest women was 43 percentage points for ANC visits and 65 percentage points for skilled birth attendance. A higher proportion of women in Central and Northern parts of Ethiopia had four or more ANC visits and utilized skilled birth attendance, while most parts of the Eastern part of the country and most areas in the South had low levels of utilization.ConclusionThe coverage of four or more antenatal care visits and skilled birth attendance was low and inequitable, with the poorest women receiving fewer services. The coverage varied across different parts of the country. Interventions that target groups of women and geographic areas with low coverage of services are crucial for reaching the goal of universal health coverage.

The Role of Waqf in Strengthening Primary Healthcare Services in Gombe State Rural Communities

This activity examines the practical role of Waqf (Islamic endowment) in improving primary healthcare services within rural communities of Gombe State, Nigeria. Although primary healthcare is still essential for long-term community well-being, rural areas in Gombe State continue to face obstacles such as inadequate medical personnel, limited infrastructure, and a lack of affordable medications. Utilizing a qualitative case study methodology, data was gathered through interviews with healthcare professionals, Waqf administrators, community leaders, and beneficiaries in three selected rural communities. The study also analyzed existing Waqf-based health projects and explored the administrative systems and legal frameworks of Waqf in Gombe State. The results show that Waqf, when properly institutionalized, has a revolutionary effect on community health education, drug subsidization, the construction of community clinics, and the provision of free maternity and child health services. Waqf's efficacy in the healthcare industry is, however, constrained by the research's discovery of awareness, regulatory enforcement, and stakeholder coordination deficiencies. The report suggests policy frameworks that incorporate Waqf into Gombe State's main healthcare development plan, the establishment of a state-recognized Waqf commission with a focus on healthcare, and the strengthening of local Waqf administrators' capacity. The study concludes that Waqf is a workable Islamic social finance instrument that can relieve the strain on public health resources, empower marginalized rural communities, and help the state achieve universal health care.

Intention to use mobile healthin antenatal care service: Among primary health care unit workers, Bench-Sheko zone, southwest Ethiopia.

The use of mobile health (mHealth) technology has the potential to enhance maternal and child health care, particularly in low-income countries. However, evidence regarding its practicality and effectiveness remains limited. In Ethiopia, research on health workers' intention to adopt mHealth technology for maternal health services is notably scarce, emphasizing the need for thoughtful evaluation and further studies to explore its real-world application. This study aims to assess the intention of primary health care unit workers towards using mobile health technology in antenatal care services in Bench-Sheko Zone, Southwest Ethiopia. A cross-sectional study was conducted from June 27, 2023, to July 27, 2023. Data were collected from 316 primary health care unit workers using a simple random sampling technique. SPSS version 25 was used for data analysis, including multivariable linear regression modeling. The response rate was 98.7%. The mean age of participants was 29.2 years, and the mean score for behavioral intention to use mobile technology in ANC services was 65%. Predictors included perceived mobile self-efficacy (β=0.318, p<0.001), perceived compatibility (β=0.601, p<0.001), mobile ownership (β=1.173, p=0.041), eHealth training (β=0.768, p=0.008), and mobile use experience (β=0.176, p<0.001). Local health managers should facilitate training to boost health workers' mobile self-efficacy, and policymakers should consider the compatibility of mHealth technology with existing practices.

Delivery Health Service Utilization and Barriers to Access in Lao People’s Democratic Republic (PDR): An Analysis of MICS Data 2023

Technological advances and accessibility influence the utilization of health services in today's world, but barriers still exist. This study aims to comprehensively analyze the utilization of maternal health services and the barriers that hinder access in the Lao People's Democratic Republic (PDR). This study analyzed 2023 MICS data from 3,754 women in the Lao People's Democratic Republic, examining maternal health service utilization. The dependent variable was categorized as utilization or non-utilization, while the independent variables included demographics, geography, decision-making power, and health system factors. Descriptive statistics, chi-square tests, and binary logistic regression were used for data analysis. This study found that of the 3,754 respondents, 2,930 people used health services to give birth. The chi-square test showed that age, education, residence, region, decision making, insurance ownership, and wealth index were significantly associated with using maternal health services. Multivariate analysis showed that higher education was the strongest predictor of health service use (OR = 20.90), with geographic factors, wealth inequality, and shared decision-making. Areas without road access and the poorest wealth groups were less likely to use services, while shared decision-making increased the likelihood by 45%. It is recommended that higher education be promoted, road access improved, and shared decision-making be encouraged to increase the utilization of maternal health services, especially among the poorest communities and those living in rural areas.

Patterns of care-seeking for postpartum symptoms in urban Karachi, Pakistan: implications for intervention design

BackgroundIn Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with mortality and severe maternal outcomes, including septicemia, neonatal deaths, infertility, etc. In this study, we aim to explore patterns of care-seeking of maternal health services by recently delivered women (RDW) in semi-urban Karachi, Pakistan. Insights of this study will help in identifying and addressing the barriers in care-seeking to minimize delay to improve clinical outcomes.MethodsWe conducted 32 semi-structured qualitative interviews with RDW with PP sepsis, traditional birth attendants (TBAs), health care providers, and family relatives of RDW to characterize the patterns of care-seeking behaviors, sources of care, and treatment modalities. Community interviews were conducted in Bilal Colony, an urban squatter settlement, and facility interviews were conducted at a high-volume tertiary care facility in Karachi, Pakistan. All interviews were conducted face to face by trained data collectors which were then audio recorded. A codebook was developed manually by reviewing all transcripts and identifying emerging themes. Coded transcripts were entered into NVivo software to develop quotation summaries and models that identified subthemes.ResultsThis study utilized a 3-delay model to determine care utilization in RDW with PP sepsis. Phase 1 indicated limited awareness about PP symptoms, cultural norms, and lack of decision autonomy led to delayed care-seeking, as women depended on male or older female relatives for approval. Two of the most common symptoms of PP sepsis were high-grade fever and foul-smelling discharge, which were deemed as non-severe. Phase 2 findings implied that women initially sought care from TBAs, chemists, and faith healers, or self-medication and tertiary care was their last resort. Financial constraints were also determining care-seeking; Phase 3 indicated that women who sought care at the hospitals were in critical conditions due to prior unskilled care or traditional treatment choices.ConclusionIncreasing awareness of PP sepsis and its symptoms via educational programs is essential for not only women but also their family members who play roles in decision-making, Training community health workers and TBAs to recognize signs of PP sepsis and promptly refer women to appropriate facilities could also significantly reduce reliance on inappropriate care sources and ensure timely treatment.