Maternal Health Services Research Articles

Social determinants of the mental health of pregnant women in Nepal: Stakeholder perspectives.

Women during pregnancy are at a greater risk of experiencing poor mental health, which is one of the major global public health issues, and more so in many developing countries like Nepal, but limited evidence of research on this topic is evident. In this paper, we are focused on exploring the social determinants of the mental health of pregnant women in Nepal from the stakeholder perspectives. This paper utilises eight stakeholder perspectives collected through open-ended in-depth interviews. All the interviews were analysed thematically using an inductive approach. This paper presents three major findings: Inadequate social support, Limited availability and accessibility of maternal health services, and Restricted socioeconomic and cultural context. The inadequate social support from family/relatives, neighbours, community and national policies such as maternity leave, alongside the absence of NGOs/INGOs support, put women at risk of poor mental health. In addition to the inadequate support, limited availability and accessibility of maternal health services potentially cause immense distress among pregnant women. Furthermore, in the context of a patriarchal society, the impact of socioeconomic and cultural context on pregnant women's mental health is also presented as a major determinant of poor mental health among pregnant women. Based on the findings, we conclude that pregnant women are at risk of poor mental health experiences in Nepal and recommend that promoting mental health among pregnant women needs a multifaceted approach that should be considered in all the policies and practices involved in promoting the mental health of pregnant women.

Cultural Humility in Action: Learning From Refugee and Migrant Women and Healthcare Providers to Improve Maternal Health Services in Australia.

Access to culturally appropriate healthcare is vital to ensure refugee and migrant women receive optimal care, particularly during the perinatal period. Refugee and migrant women report lower satisfaction with pregnancy care due to language barriers and a perceived lack of understanding of their needs. The aim of this study is to explore how to improve the experiences of migrant and refugee women with maternal health services through the lens of cultural humility. Working collaboratively with maternal health service providers and managers and local refugee and migrant women, this research project used a World Café methodology to provide these stakeholders with an opportunity to discuss maternal healthcare in the region. World Café participants (n = 34) included women from multicultural backgrounds (n = 20), maternal healthcare providers such as midwives, social workers and management (n = 5) multicultural healthcare providers (n = 7) and a community-based birth educator (n = 1). Data were analysed thematically. A key finding of the World Café was the need for staff training that is co-designed and co-delivered with members of multicultural communities and healthcare providers to enhance the practice of cultural humility. Training should focus on women's stories that capture the cultural nuances around pregnancy and birthing, their support needs including trauma-informed care, and the importance of effective cross-cultural communication. This research gave refugee and migrant women a voice in future decision-making, specifically in maternal health staff training. The refugee and migrant women shared their perspectives on how to enhance cultural humility practices in maternity services for them. The research has led to opportunities such as community-based antenatal classes and improvements in maternity services development strategies. The project actively engaged with maternal healthcare providers, multicultural and refugee healthcare providers and women from multicultural communities in the design of the project and as participants. Their expertise and experience have been invaluable and have informed pilot programmes that emerged from this study.

Traditional beliefs and practices of postpartum care in rural East Nusa Tenggara, Indonesia

Maternal mortality remains a pressing public health issue in Indonesia, particularly for mothers residing in rural regions who often forego postnatal health services due to traditional beliefs and practices. This qualitative research delved into the cultural perspectives of the local community to gain insight into the care practices of postpartum mothers in rural areas of NTT Province, Indonesia. The study involved in-depth interviews with nine participants, including four postpartum mothers, four family members, and one village midwife, with the interview data analyzed thematically. The research revealed that cultural beliefs and practices revolving around the postpartum period in NTT align with shared beliefs and traditional practices found in various Asian societies. This includes behavioral taboos and food restrictions. The study also identified two primary postpartum traditions aimed at restoring the postpartum mother's body heat and strength. All postpartum mothers adhere to traditional care practices because they believe in their benefits, pressure from family members, and fear of non-compliance consequences. However, postnatal mothers and their families have low postnatal care visits and do not receive adequate information about postpartum care. Health literacy for postpartum women and their families in rural areas needs to be improved and health workers should provide culturally sensitive maternal health services.

Maternal Health Service Utilization and Women’s Health Care Decision-Making Autonomy in Ethiopia

Maternal Health Service Utilization and Women’s Health Care Decision-Making Autonomy in Ethiopia

Early postnatal care uptake and its associated factors following childbirth in East Africa—a Bayesian hierarchical modeling approach

BackgroundThe postnatal period is a critical period for both mothers and their newborns for their health. Lack of early postnatal care (PNC) services during a 2-day period is a life-threatening situation for both the mother and the babies. However, no data have been examined for PNCs in East Africa. Hence, using the more flexible Bayesian multilevel modeling approach, this study aims to investigate the pooled prevalence and potential factors for PNC utilization among women after delivery in East African countries.MethodsWe retrieved secondary data from the Kids Record (KR) demographic and health surveys (DHS) data from 2015 to 2022 from 10 East African countries. A total of 77,052 weighted women were included in the study. We used R 4.3.2 software for analysis. We fitted Bayesian multilevel logistic regression models. Techniques such as Rhat, effective sample size, density, time series, autocorrelation plots, widely applicable information criterion (WAIC), deviance information criterion (DIC), and Markov Chain Monte-Carlo (MCMC) simulation were used to estimate the model parameters using Hamiltonian Monte-Carlo (HMC) and its extensions, No-U-Turn Sampler (NUTS) techniques. An adjusted odds ratio (AOR) with a 95% credible interval (CrI) in the multivariable model to select variables that have a significant association with PNC was used.ResultsThe overall pooled prevalence of PNC within 48 hrs. of delivery was about 52% (95% CrI: 39, 66). A higher rate of PNC usage was observed among women aged 25–34 years (AOR = 1.21; 95% CrI: 1.15, 1.27) and 35–49-years (AOR = 1.61; 95% CrI: 1.5, 1.72) as compared to women aged 15–24 years; similarly, women who had achieved primary education (AOR = 1.96; 95% CrI: 1.88, 2.05) and secondary/higher education (AOR = 3.19; 95% CrI: 3.03, 3.36) as compared to uneducated women; divorced or widowed women (AOR = 0.83; 95% CrI: 0.77, 0.89); women who had currently working status (AOR = 0.9; 95% CrI: 0.87, 0.93); poorer women (AOR = 0.88; 95% CrI: 0.84, 0.92), middle-class women (AOR = 0.83; 95% CrI: 0.79, 0.87), richer women (AOR = 0.77; 95% CrI: 0.73, 0.81), and richest women (AOR = 0.59; 95% CrI: 0.55, 0.63) as compared to the poorest women; women who had media exposure (AOR = 1.32; 95% CrI: 1.27, 1.36), were having 3–5 children (AOR = 0.89; 95% CrI: 0.84, 0.94), had >5 children (AOR = 0.69; 95% CrI: 0.64, 0.75), had first birth at age < 20 years (AOR = 0.82; 95% CrI: 0.79, 0.84), had at least one ANC visit (AOR = 1.93; 95% CrI: 1.8, 2.08), delivered at health facilities (AOR = 2.57; 95% CrI: 2.46, 2.68), had average birth size (AOR = 0.94; 95% CrI: 0.91, 0.98) and small birth size child (AOR = 0.88; 95% CrI: 0.84, 0.92), had twin newborns (AOR = 1.15; 95% CrI: 1.02, 1.3), and fourth and above birth order (AOR = 0.88; 95% CrI: 0.82, 0.95) were individual-driven women who have been independently associated with PNC, respectively. Regarding community-level variables, rural women (AOR = 0.76; 95% CrI: 0.72, 0.79), high media exposure communities (AOR = 1.1; 95% CrI: 1.04, 1.18), communities with high wealth levels (AOR = 0.88 95% CrI: 0.83, 0.94), communities with high antenatal care (ANC) utilization (AOR = 1.13, 95% CrI: 1.07, 1.19), and long distance to health facilities (AOR = 1.5; 95% CrI: 1.38, 1.63) were among the community factors associated with PNC, respectively.ConclusionOne of the significant public health priorities in East Africa continues to be the underutilization of immediate PNC. The government ought to prioritize improving maternity and child health services, collaborating with interested parties in the area, reducing health disparities, educating mothers about child health, and other connected issues that are very beneficial.

Effect of community health education on mothers' knowledge of obstetric danger signs and birth preparedness and complication readiness practices in southern Ethiopia: A cluster randomized controlled trial.

Increasing knowledge of obstetric danger signs (ODS) and encouraging birth preparedness and complication readiness (BPCR) practices are strategies to increase skilled maternal health service utilization in low-income countries. One of the methods to increase mothers' knowledge about ODS and promote BPCR practice is through health education intervention (HEI). However, the effect of context-specific community-based health education led by women's groups on these outcomes has yet to be comprehensively studied, and the existing evidence is inconclusive. Thus, we aimed to evaluate the effect of a context-specific community-based HEI led by women's groups on mothers' knowledge regarding ODS and BPCR practices in southern Ethiopia. An open-label, two-arm parallel group cluster-randomized controlled trial was conducted from January to August 2023 on pregnant women from 24 clusters (kebeles) (12 interventions and 12 controls) in the northern zone of the Sidama region. The Open Data Kit smartphone application was utilized to collect data. The intention-to-treat analysis was used to compare outcomes between groups. We fitted multilevel mixed-effects modified Poisson regression with robust standard error to account for between and within cluster effects. One thousand and seventy pregnant women (540 in the intervention and 530 in the control clusters) responded to this study, making the overall response rate 95.02%. Excessive vaginal bleeding (94.3% in the interventional group vs. 88.7% in the control group) was the commonest ODS mentioned during childbirth. Overall, 68.7% of women in the intervention group and 36.2% of mothers in the control group had good knowledge of ODS (P-value < 0.001). Saving money and materials (97.1% in the interventional group vs. 92.7% in the control group) was the most frequently practiced BPCR plan. Overall, 64.3% of women in the intervention group and 38.9% of mothers in the control group practiced BPCR (P-value < 0.001). HEI significantly increased overall knowledge of ODS (adjusted risk ratio [ARR]: 1.71; 99% CI: 1.14-2.57) and improved overall BPCR practice (ARR: 1.55; 99% CI: 1.02-2.39). A community-based HEI led by women's groups improved mothers' knowledge regarding ODS and BPCR practices in a rural setting in southern Ethiopia. Interventions designed to increase women's knowledge of ODS and improve BPCR practice must implement context-specific, community-based HEI that aligns with World Health Organization recommendations. NCT05865873.

Factors influencing provider deviation from national HIV and nutritional guidelines for HIV-exposed children in western Kenya: a qualitative study

BackgroundMalnutrition and HIV interact in a vicious cycle for HIV-exposed infants (HEIs), increasing vulnerability and the severity of each condition and contributing to poor health outcomes. We identified multi-level factors influencing provider adherence to Kenyan HIV and nutrition guidelines for HEIs.MethodsWe conducted six focus group discussions and seven in-depth interviews using a semi-structured question guide. Participants were selected through purposive maximum variation sampling of health workers involved in maternal and child health services and outpatient nutrition programs at two facilities in western Kenya. Data collection and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were coded by two primary coders using both deductive and inductive thematic analysis.ResultsTDF domains that drove guideline adherence included: environmental context and resources, beliefs about capabilities, and social influences. While participants praised attempts to integrate HIV and nutritional services through teamwork and service colocation, challenges in the successful referral of patients between services persisted. Participants described siloed HIV and nutrition-related knowledge across staff, leading to missed or delayed care if certain providers were unavailable. Participants emphasized understaffing as a major contributor to gaps in care. Inconsistent material resource availability also disrupted linkages between HIV and nutrition services for patients. While participants frequently expressed high intention and internal motivation to link children between services, they described minimal structured supervision or positive reinforcement from supervisors and feeling demoralized when resource constraints interfered with care provision. Lastly, participants described patient-level factors that made it challenging for families to seek or remain in care, including poverty and HIV and malnutrition-related stigma. Participants made several recommendations, including training multiple cadres in the fundamentals of both HIV and nutritional care to address siloed services and understaffing.ConclusionsThis study details the factors that facilitate or hinder health workers as they implement national guidelines and link HEIs between HIV and nutritional services, including the impact of physical integration of service sites, human and material resource constraints, and health worker motivation. Future interventions can address these challenges by expanding access to needed resources, task sharing, and testing implementation strategies that increase the efficiency of service delivery to improve linkages in care for vulnerable infants.

Integration of family planning into the primary health care in Ethiopia: results from national assessment

BackgroundFamily planning (FP) is part of Ethiopia’s essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.MethodsThis was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.ResultsThis national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.ConclusionData from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Effectiveness of a community-based intervention package in maternal health service utilization: A cross-sectional quasi-experimental study in rural Ghana.

We examined the effectiveness of a community-based intervention package that targeted pregnant women for increasing utilization of maternal health services. The intervention package was implemented in Suhum Municipality, Ghana, from March 2019 to April 2022. The package consisted of: (i) maternal health education by female and male peers; (ii) training existing health workers on maternal health; and (iii) strengthening the local community health management committees. A cross-sectional household survey was conducted in May 2022. We sampled four groups of women: (i) intervention at baseline; (ii) intervention at follow-up; (iii) control at baseline; and (iv) control at follow-up. Three outcome variables were set, i.e., the proportions of women having utilized: (i) at least four antenatal care (ANC) services; (ii) facility-based delivery (FBD) services; and (iii) post-partum care (PPC) services. To estimate the effectiveness of the intervention package in increasing the service coverages, both crude and adjusted difference-in-differences (DID) estimates were calculated. Significance levels were set at the values of 0.10, 0.05, and 0.01, since the aforementioned service coverages had already been too high to have room for an increase at the significance level of 0.05. The proportion of women completing at least four ANC services displayed significant DID in both crude and adjusted analyses. The proportions of women utilizing facility-based delivery services and post-partum care services did not display significant DID. Of the three outcome variables set, only the proportion of women having utilized at least four ANC services significantly increased in the intervention group, compared with the control group. Ghana has been in the transition process of shifting the minimum number of ANC visits from four to eight. Thus, nationwide scaling up of the intervention package is expected to help the transition be smooth by increasing the number of ANC visits.

Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences.

Women’s Experiences Regarding Maternity Care in a Selected Hospital in Vhembe District, Limpopo Province: A Qualitative Approach

Introduction: A pregnant woman’s life and that of her child largely depend on the care they receive during the critical stage of pregnancy, labour, and the postpartum period. Some women question their decisions regarding future pregnancies as well as where and from whom they will receive their pregnancy care because of negative experiences that they have had. Aim: The aim of this study was to explore and describe the experiences of women regarding maternity care services in a selected hospital in Vhembe District, Limpopo Province. Methods: A qualitative approach using a phenomenological research design was adopted in this study. The study population included pregnant women who were admitted to the maternity ward of the selected hospital. A total of 18 participants and 1 hospital were purposively sampled. Pre-testing was conducted to check if the central question was clear and to test the researcher’s interviewing skills. Face-to-face interviews were conducted with all sampled participants in April and May 2024. Interpretive analysis was used to analyze the data collected from the participants. Results: Four themes emerged during data analysis: women’s experiences regrading the provision of maternal healthcare; environmental factors affecting maternal health services; lack of resources; and the attitude of nurses towards patients. Conclusions: This study concludes that the majority of the women stated that they were not happy about the maternity care services provided at the selected hospital. Issues such as trained nurses being verbally and physically abusive towards women in labour, as well as the infrastructure and lack of resources of the hospital contributed towards women not being happy about the provision of maternity care services being provided. This study recommends that in order for maternity care services to improve at the selected hospital, there should be workshops for staff on how to improve patient care principles and improvements in the standard of cleanliness in and around the selected hospital.

Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis.

The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic. Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019). Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery. The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

Managing medicines in decentralisation: discrepancies between national policies and local practices in primary healthcare settings in Indonesia.

In Indonesia, primary health centres (PHCs) are mandated to provide essential medicines to ensure equal access to medication for all Indonesians, as stated in the national medicine policy. However, limited information is available regarding the actual practices of health workers within the context of decentralised governance. This paper investigates the discrepancies between national policies and local practices in two Indonesian districts, shedding light on coping mechanisms employed in each phase of medicine management within PHCs. The mixed-method study began by identifying pertinent policies addressing medicine management in PHCs. Subsequently, panel data on patient visits to tuberculosis, maternal and neonatal health (MNH) and non-communicable disease (NCD) services were collected from 2019 to 2022. After analysing the panel data, interviews were conducted with 56 health workers including physicians, nurses, pharmacists, midwives, and public health programme managers regarding their views on fluctuations in medicine stocks and the patient visits data. These participants included pharmacists and programme managers specialising in tuberculosis, MNH, and NCD care and were affiliated with PHCs and district health offices (DHO). Our findings highlight the occasional unavailability of essential medicines in PHCs, with stockouts being attributed to supplier shortages at provincial and national levels and to variations in the capacity of the local health system. Low-skilled pharmaceutical staff are a contributing factor in each phase of medicine management. Additionally, health workers employ coping mechanisms, such as deviating from policy on the use of capitation funds to purchase medicines, to manage temporary stockouts. To tackle systemic stockouts, central government should prioritise capacity-building among health workers, by establishing a continuous and easily accessible local learning system.

Population-level trends over a decade in geographical inequality for opportunity in access to maternal care services: a cross-sectional analysis from the National Family Health Surveys in India

ObjectivesThe objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage...

Factors Affecting the Accessibility of Maternal Healthcare Facilities in Punjab Province, Pakistan

The study was conducted to identify the hidden factors that influence maternal health services in the Punjab region of Pakistan. The study was conducted in Punjab province, Pakistan. A multi stage sampling technique was used to cover the large area. The area was separated into three stages. In the first stage, one division of Gujranwala out of nine divisions was selected through a random sampling technique. In the second stage, two districts were selected Sialkot and Gujranwala through a random sampling technique. In the third stage, four hundred respondents were selected 200 from each district through a convenient sampling technique. The findings of the research demonstrate that most of the respondents were living in rural areas. The majority of the respondents were high school pass and the respondent’s husband's education was intermediate level. Most of the respondent’s total household monthly income was 20001-30000. The majority of the respondents have less awareness about pregnancy problems and respondents faced complications during pregnancy. Most of the mothers faced difficult access to maternal health care services and had a long distance to health care center from home while most of the respondents hardly had access to transport. The majority of the respondents could not afford any maternal health care services and were waiting long hours for checkup sat the maternal health centers. The majority of the respondents adopted a traditional method and they delivered the baby at home and most of the respondents agreed that patriarchy impacts maternal health care services. It is recommended that the government ensure basic education, particularly in rural areas of Punjab, Pakistan

Good practices to optimise the performance of maternal and neonatal quality improvement teams: Results from a longitudinal qualitative evaluation in South Africa, before, and during COVID-19.

Many maternal and neonatal deaths can be avoided if quality healthcare is provided. To this end, the South African National Department of Health implemented a quality improvement (QI) programme (2018-2022) to improve maternal and neonatal health services in 21 public health facilities. This study sought to identify good practices aimed at improving QI teams' performance by identifying optimal facility-level contextual factors and implementation processes. We purposively selected 14 facilities of the 21 facilities for a longitudinal qualitative process evaluation. We interviewed 17 team leaders, 47 members, and five QI advisors who provided technical support to the teams. The data were analysed using framework analysis. We choose the Consolidated Framework for Implementation Research as framework given that it explicates contexts and processes that shape programme implementation. Six quality improvement teams were assessed as well-performing, and eight as less well-performing. This research conceptualises a 'life course lens' for setting up and managing a QI team. We identified eight good practices, six related to implementation processes, and two contextual variables that will optimise team performance. The two most impactful practices to improve the performance of a QI team were (i) selecting healthcare workers with quality improvement-specific characteristics, and (ii) appointing advisors whose interpersonal skills match their technical quality improvement competencies.

Effect of Male Partner-Targeted Breastfeeding Education and Support Interventions on Optimal Breastfeeding Practices in Central Ethiopia: A Cluster Randomized Controlled Trial.

A male partner or husband is the most influential person in the family, especially in Ethiopia. The role of a male partner or husband in promoting and supporting breastfeeding has hardly been investigated in low- and middle-income countries, including Ethiopia. Therefore, the objective of this study was to evaluate the effect of breastfeeding education and support interventions that focus on male partners, with the goal of promoting optimal breastfeeding practices in central Ethiopia. A two-arm parallel design cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, Central Ethiopia. Fathers and mothers in the intervention group received breastfeeding education and support via social events, home visits and using printed materials, while those in the control group received existing routine care. A total of 408 couples from 16 clusters were randomly assigned to either the intervention group (n = 204) or the control group (n = 204). A Generalized Estimating Equation (GEE) model was used to evaluate the effectiveness of the interventions. At the end of the interventions, the proportion of optimal breastfeeding practice increased by 19.5% in the intervention group and by 2% in the control group. The differences-in-difference in optimal breastfeeding practice between the intervention and control groups was 17.5% [95% CI: 13.8%-21.2%; p = 0.001]. In the GEE model, babies born to mothers in the mother-father pair group had a 38% higher likelihood [RR = 1.38, 95% CI (1.106, 1.723)] of being optimally breastfed at the sixth month compared with babies born to mothers who received standard care. Breastfeeding education and support interventions targeting male partners in low-resource settings improve optimal breastfeeding practices, highlighting the need to give due emphasis to integrating breastfeeding promotion and counselling for male partners into existing maternal and child health services. Trial Registration: ClinicalTrials.gov identifier (NCT number): NCT05173454, First registered on 30/12/2021.

Trends in the Prevalence and Factors Associated with Undernutrition in Tunisian Children Aged 0-23 Months.

In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months. The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Postpartum modern family planning among women living with HIV attending care at health facilities in Busia County, Kenya

BackgroundFor women living with the human immunodeficiency virus (WLHIV), preventing untimed pregnancies during the postpartum period reduces vertical transmission and improves other maternal and child health outcomes. In Kenya, Busia County’s HIV prevalence and mother-to-child transmission rate are higher than the national average yet uptake of postpartum family planning (PPFP) is generally low. This study examined health system factors influencing the consistent use of PP modern FP methods among WLHIV in Busia County.MethodsA retrospective study involving 314 WLHIV with children aged 12–24 months who were chosen using systematic random sampling was conducted from February to March 2024 from outpatient clinics in Busia County. Additionally, 14 health providers were purposively sampled as key informants. Quantitative data was collected using a pretested questionnaire, while qualitative data was gathered through key informant interview guides. Quantitative data was analyzed using STATA 15 with descriptive statistics, logistic regression, and Chi-square tests, while a deductive thematic analysis was used for qualitative data.ResultsThe mean age of the participants was 32.06 (± 6.00) with the majority (51.27) aged between 25 and 34 years, married (74.84%) and unemployed (77.39%). Overall, 73.25% had used postpartum (PP) modern family planning (FP) methods, but only 52.55% reported consistent use throughout the first year postpartum. The only factors found to increase the odds of PPFP use were being married (aOR 3.34, 95% CI 1.58–7.07, p = 0.002), being escorted by a preferred person during seeking maternal and child health services (aOR 2.29, 95% CI 1.36–3.83, p = 0.002), and perceiving that they were provided information on all types of FP (aOR 2.33, 95% CI 1.19–4.16, p = 0.012). Persistent stock-outs and inadequate counseling hindered consistent PPFP use.ConclusionThe study identified gaps in the consistent use of PP modern FP methods among WLHIV in Busia County, influenced by the availability of FP information and health system factors. Addressing stock-outs and improving counseling during clinic visits and pregnancy are crucial for improving FP service delivery and reducing maternal and child health risks in high HIV-incidence areas like Busia County.

Evaluation of the causal effect of maternal education on the utilisation of maternal health services in Bangladesh using an observational study - a comparison of different propensity score methods and covariate adjustment

BackgroundAssessing maternal health care utilisation is imperative for the health of both mother and her child. Maternal education is an important determinant in subsequent maternal health care usage, according to research. There is a dearth of research on the causal relationship between maternal education and maternal health services as well as examining the performance of different propensity score methods for estimating absolute effects. Therefore, this study aims to estimate the effect of maternal education on usage of maternal health services minimising the confounding effect and to compare different propensity score approaches to estimate absolute effects of maternal education on usage of maternal health services.MethodsWe used data from a cross-sectional study conducted by icddr,b in Bangladesh. A total of 1300 recently delivered mothers were included in this study. We used different propensity score (PS) methods to estimate the causal effect of maternal education on receiving maternal health services, including PS matching, PS weighting, covariate adjustment using PS, as well as used modified log-Poisson regression with and without multiple covariates.ResultsThe study revealed highly imbalanced possible confounding factors for mother's educational level, which might lead to erroneous estimates. All methods indicated a significant effect of higher maternal education, whether measured as a continuous scale or a binary variable (secondary or higher vs. below secondary) on maternal health services, significantly increased the likelihood of receiving four or more ANC, delivered at facility, PNC within 42 days and receiving all maternal health services compared to the mothers with lower level of education. The PS weighting provided precise estimates with a low range of confidence interval.ConclusionsThe results provided important insights on how well these techniques worked to reduce effect of confounding variables and achieve precise estimates. Propensity score weighting method performed better in terms of providing more precise estimates with a narrower range of confidence intervals, indicating that this method may be a reliable approach for estimating the causal effect of maternal education on maternal health service utilisation. However, careful consideration should be given to selecting the most appropriate method.