Maternal, Neonatal And Child Health Research Articles

Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018-2021.

Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs' targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.

Reframing the Three Delays framework: factors influencing referrals to facilities by matrones in rural Haiti

In Haiti, there has been limited research on the experiences of traditional birth attendants/matrones when they decide to refer and accompany pregnant women to the facility for giving birth. Understanding...

Impact evaluation of KOICA MNCH project in Jimma Ethiopia using a difference in differences analysis

Abstract Background The maternal mortality ratio in Ethiopia is 412, which is higher than its neighboring countries. To address this issue and improve the health of women of childbearing age, the Maternal Neonatal and Child Health (MNCH) project was implemented in Jimma zone, Oromia, Ethiopia with support from the Korea International Cooperation Agency (KOICA). The objective of this study is to measure the impact of the project on maternal health in Jimma, Ethiopia. Methods The study employed DID analysis to measure the impact of the project on five key variables, including ANC 4, institutional delivery, satisfaction with MCH-related services, pregnancy-related knowledge, and delivery-related knowledge. A total of 789 participants were randomly selected for the baseline survey from both the intervention and control groups in 2017. The same groups were surveyed again one year later using the same study design for the endline survey. Results The study found that the trends in ANC4 and the level of satisfaction with the MCH service provided were similar in both the intervention and control groups. However, significant impacts were observed in terms of institutional delivery, pregnancy-related knowledge, and delivery-related knowledge. The odds ratio for institutional delivery was 2.83 (p < 0.01) for women in the intervention group compared to the control group. Similarly, the odds ratio for pregnancy-related knowledge was 0.67 (p < 0.01), and the odds ratio for delivery-related knowledge was 1.70 (p < 0.01) for women in the intervention group compared to the control group. Conclusions The study concludes that the KOICA MNCH project partially achieved its objective, as the intervention had a positive impact on institutional delivery and maternal knowledge levels. However, the insignificant impact on ANC4 and the level of satisfaction with MCH services suggest the need for further intervention to fully address maternal health issues in Ethiopia. Key messages • This study is significant because it has provided empirical evidence that maternal health projects implemented in the Jimma Zone of Ethiopia can positively impact various aspects of maternal health. • The results of this study can serve as a valuable reference for policymakers and healthcare professionals involved in designing and implementing maternal health interventions.

Curating maternal, neonatal and child health (MNCH) datasets from a hospital’s catchment area in Nigeria between 2014 and 2019

In this Data Note, we present details regarding Maternal, Neonatal, and Child Health (MNCH) datasets sourced directly from patients' medical records. These datasets consist of 538 maternal, 720 neonatal, and 425 child records, all collected at St Luke’s General Hospital in Anua, Uyo, Nigeria, spanning from 2014 to 2019. Variables included in the datasets are:  Maternal {patient number, date of visit, gender, age, class of patient, address, LGA, diagnose, symptom, prescription, blood pressure (mm Hg), temperature (degree centigrade), weight (Kg), latitude, longitude, elevation, (MSL), date record, GPS Accuracy (m)}; Neonatal {patient number, date of visit, gender, age, class of patient, address, LGA, symptom, health status, height (cm), weight (Kg), latitude, longitude, elevation (MSL), date record, GPS Accuracy (m)}; and Child Health {patient number, date of visit, gender, age, class of patient, address, LGA, diagnose, health history, temperature (degree centigrade), weight (Kg), latitude, longitude, elevation (MSL), date record, GPS accuracy (m)}. The purpose of sharing these datasets is to provide a resource for researchers interested in their potential reuse, whether for analysis, research, quality assurance, policy formulation, decision-making, patient safety, or other purposes. The datasets also include location information obtained through GPS (Global Positioning System) data from the study area, facilitating spatiotemporal analysis. We outline the methods used for curating the datasets, including the protocol for selecting and processing variables. To protect patient privacy, certain personal details such as names were replaced with unique patient numbers generated using Microsoft Excel. Furthermore, specific patient information, including addresses/locations, date of visit, latitude, longitude, elevation, and GPS accuracy, has been restricted for privacy reasons. Readers interested in accessing restricted data can make a formal request to the corresponding author (see data restriction statement). The curated datasets are available at the Open Science Framework.

Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan.

Population growth in Pakistan necessitates the implementation of comprehensive family planning (FP) initiatives. The adoption of modern contraceptives, especially long-acting reversible contraceptives (LARC), and permanent family planning methods in the country is challenging and has yet to reach an optimal level. These challenges are deeply rooted in the lack of informed decision-making, as well as demographic and maternal obstetric history. Interventions tailored according to women's needs can address the challenges faced by FP programs. This paper presents the findings of the implementation of a client-centered counseling and facilitation approach in an urban slum in Karachi, Pakistan. Such an approach has the potential to inform women and help them make better decisions regarding their health. In Rehri Goth, a slum located in Karachi, client-centered counseling along with facilitation at the facility was implemented to encourage the adoption of any modern contraceptive methods, with a specific emphasis on promoting the use of LARCs and permanent methods (where needed) among married women of reproductive age (MWRA). This approach was integrated into the existing Maternal, Neonatal, and Child Health (MNCH) services established in 2014. During the routine delivery of services, data were collected on various aspects including demographic characteristics, obstetric history, motivation to adopt LARCs, and reasons for refusal. A total of N = 3079 eligible MWRA received client-centered counseling, and 60.3% accepted modern contraceptive methods after counseling. Furthermore, 32.5% of these MWRA adopted LARCs or permanent methods. Factors explaining reluctance to adopt any method by MWRA despite specialized counselling were: age >25 years (AOR:1.28, 95% CI:1.08-1.51), no formal education (AOR:1.58, 95% CI:1.36-1.89), having no decision making role at household (AOR:1.60, 95% CI:1.36-1.89), the desire of female or male progeny (AOR:1.86, 95% CI:1.59-2.25) and age of youngest alive ≥3 years (AOR:1.50, 95% CI:1.22-1.84). Factors explaining adoption of short-term methods instead of LARCs or permanent method were: being resident in high under-five mortality clusters (AOR:1.56, 95% CI:1.14-2.14), maternal age > 25 years (AOR:1.88, 95% CI: 1.47-2.40), no decision-making role (AOR:11.19, 95% CI:8.74-14.34), no history of abortions (AOR:2.59, 95% CI:1.79-3.75), no female child (AOR:1.85, 95% CI:1.30-2.65) and ≤ 2 children (AOR:1.74, 95% CI:1.08-2.81). Considering the obstacles mothers face when it comes to accessing extended contraception, public health officials can devise effective strategies that empower MWRA to make well-informed and empowered choices regarding their families and reproductive health.

Aspirations and realities of intergovernmental collaboration in national- level interventions: insights from maternal, neonatal and child health policy processes in Nigeria, 2009–2019

In Nigeria’s federal government system, national policies assign concurrent healthcare responsibilities across constitutionally arranged government levels. Hence, national policies, formulated for adoption by states for implementation, require collaboration. This study...

Strategies for promoting male partner involvement in maternal, newborn and child health care in Kiambu County.

the 1994 International Conference on Population and Development (ICPD) recommended that men should share responsibility and be actively involved in sexual and reproductive health. The level of male partner involvement in Kenya remains low despite growing evidence showing its benefits in maternal and newborn health. This study sought to explore strategies for encouraging male partners to accompany their spouses to Maternal and Child Health (MCH) department. a qualitative exploratory study was used to gather the views of nurse-midwives and invited men on mechanisms to encourage men to accompany their spouses to MCH clinic. Three and two focused group discussions (FGDs) composed of six to eight participants from nurse-midwives and men were conducted respectively. The FGDs were audio recorded and lasted 60-90 minutes. Content analysis was used to generate themes using MAXQDA 2022 software. seven categories emerged as strategies that can encourage male partner participation in the Maternal Neonatal and Child Health (MNCH) services: creating community awareness and sensitization, engaging men in the MCH department, reducing waiting time, provision of health services that address male health needs, inviting male partners to the MCH clinic, encouraging MCH staff to be receptive to couples and re-scheduling of MCH working days as well as extension of hours. evidence-based strategies that adopts multi-level interventions with greater focus on community sensitization and re-organization of the MCH services are important in encouraging men accompany their spouses to clinic and actively participate in the MNCH.

Magnitude of Modern Contraceptive Utilization and its Associated Factors Among Postpartum Women in Bench Sheko Zone, Southwest Ethiopia, 2021: Community-Based Cross-Sectional Study

Despite the significant benefit of postpartum modern contraceptives to avert the problems related to short interpregnancy intervals and unintended pregnancy, still the uptake remains low in Ethiopia. The aim of the study was to assess the magnitude of family planning use during the puerperium period and the factors associated with it in the Benchi Sheko zone of Southwest Ethiopia. From 10th March to 10th May/2021, 385 mothers were enrolled in a community-based cross-sectional study. Participants were nominated using simple random sampling. To collect the data, an interviewer-administered questionnaire was used. To identify the factors associated with the utilization of postpartum contraceptives, bivariate and multivariable logistic regression analyses were used. The statistical significance level was determined at p-value < .05. The overall utilization of postpartum modern family planning utilization was 50.4% (95% CI: 45.3, 55.3). Maternal education (AOR = 2.26, 95% CI; 1.03–4.95), informed on family planning (AOR = 0.34, 95% CI; 0.13–0.91), counseled on contraceptives during Antenatal Care (ANC) (AOR = 1.82, 95% CI: 1.05–3.17), previous family planning utilization (AOR = 0.45, 95% CI: 0.28–0.73), counseled on contraceptives at the time of PNC (AOR = 1.70, 95% CI: 1.07–2.71), and resumption of sexual intercourse after delivery (AOR = 4.17, 95% CI: 1.57–11.08) were the major factors hindering the utilization of modern contraceptives. the overall magnitude of modern contraceptive utilization during the puerperium period was low. Having counseling, information, and previous experience in family planning, and time to sexual intercourse resumption were clinical predictors of family planning utilization. A concerted effort to incorporate contraceptive services into maternal, neonatal, and child health (MNCH) service units should strengthen much, and counseling gives due emphasis.

Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya.

Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of the United Nations Sustainable Development Goal 3. Value-based healthcare (VBHC) has the potential to outperform traditional supply-driven approaches in changing this dismal situation, and significantly improve maternal, neonatal and child health (MNCH) outcomes. We developed a theory of change and used a cohort-based implementation approach to create short and long learning cycles along which different components of the VBHC framework were introduced and evaluated in Kenya. At the core of the approach was a value-based care bundle for maternity care, with predefined cost and quality of care using WHO guidelines and adjusted to the risk profile of the pregnancy. The care bundle was implemented using a digital exchange platform that connects pregnant women, clinics and payers. The platform manages financial transactions, enables bi-directional communication with pregnant women via SMS, collects data from clinics and shares enriched information via dashboards with payers and clinics. While the evaluation of health outcomes is ongoing, first results show improved adherence to evidence-based care pathways at a predictable cost per enrolled person. This community case study shows that implementation of the VBHC framework in an LMIC setting is possible for MNCH. The incremental, cohort-based approach enabled iterative learning processes. This can support the restructuring of health systems in low resource settings from an output-driven model to a value based financing-driven model.

Continuum of care in maternal, newborn and child health in Indonesia: Evidence from the Indonesia Demographic and Health Survey.

Background:Maternal and child health improved considerably due to the Sustainable Development Goals of the United Nations. However, the rate of preventable death worldwide remains high. Nevertheless, implementation was insufficient in low- and middle-income countries, including Indonesia. The study aims to assess the relationships between continuum of care (CoC) in maternal, neonatal and child health (MNCH) services and levels of care in Indonesia, examine the distribution of utilisation and investigate the associations between CoC in MNCH.Design and methods:Data were derived from the recent 2017 Indonesia Demographic and Health Survey. Fieldwork took place from July 24 to September 30, 2017. The sample included ever-married women aged 15–49 years who had given birth in the last 5 years prior to the survey. The total sample size is 15,288.Results:Only 52.6% (n = 8038) continued to receive the three levels of MNCH services. Multivariate analysis revealed that variables, such as socioeconomic status, parity and distance from health facilities were statistically significantly associated with the continuum from antenatal to postnatal care (PNC). The use of each level of MNCH care is correlated with the next level of care. Antenatal care is associated with delivery care which is subsequently associated with postnatal care.Conclusions:Identifying populations that contribute significantly to overall health inequalities and a well-established follow-up system from pregnancy to PNC may enhance maternal and child health and equity outcomes.

Community Perceptions of Facilitators and Barriers to Post Natal Care access in Rural Laos

Abstract Background The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic. Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project. This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming. Methods From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted. Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province. Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD. Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders. Results Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC. Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice. Economic, road conditions, and transport challenges were also identified as significant barriers. Conclusions Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care. Thus, quality outreach with home visits are critical. Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access. Key messages

English

High maternal, neonatal and child mortality rate constituting about 70% of the population in Zimbabwe. Zimbabwean rural women have faced challenges in accessing and utilizing Maternal, Neonatal and Child Health (MNCH) services. Rural areas in Zimbabwe have had high prevalence of home deliveries and pregnancy related complications associated with lack of access to and utilization of MNCH services, resulting in high maternal, stillbirths, new-born, neonatal and infant mortality rates. Access to and utilisation of MNCH services and facilities by rural based pregnant women has been limited by several issues that have been explored and assessed in the Primary Health Care clinics. However, the 3 delays (seek, access and receive health service) effects on the factors affecting health care and outcomes remain largely unclear in rural settings. Qualitative and quantitative methods research was conducted in Mutare district, Manicaland Province, Zimbabwe. Data collection tools including interviews questionnaires and focus group discussion guides were used to show how the three delays affected health service access in the district. GraphPad InStat Software and Statistical Package for Social Science were used for data analysis. Religious and cultural beliefs contributed to patient delays in seeking healthcare. With long distances and lack of transport attributed to Delays 1 and 2 with, drug unavailability, up-to date equipment and delay causing Delay 3. The patient, the provider and health systems were critical in accessibility, utilization and linkages of MNCH with other health services being crucial for achieving 4th and 5th Millennium Development Goals the targets. Key words: Maternal, Neonatal and Child Health Services, new-born; neonatal-infant mortality, three-delay model, Mutare District, child bearing Age.

Multilevel analysis of continuation of maternal healthcare services utilization and its associated factors in Ethiopia: A cross-sectional study.

Continuum of care (CoC) has been recognized as a crucial strategy for minimizing maternal, neonatal, and child mortality. CoC promotes integrated Maternal Neonatal and Child Health (MNCH) services by linking together three aspects of maternal health care antenatal care, skilled birth attendance, and postnatal care. The study aimed to assess continuation of maternal healthcare services utilization and its associated factors among reproductive age women at pregnancy, delivery and postnatal stages in Ethiopia. Cross-sectional study design conducted using Ethiopian 2016 Demographic and Health Survey data. All women with the most recent live birth in the last five years preceding the 2016 survey were the study population. The sample size was 7590, 2415, and 1342 at service entry (ANC use), COC at a delivery level, and CoC at Postpartum level respectively. COC was measured at three levels of maternal health care (during pregnancy, delivery, and postpartum). The CoC is constructed from four or more antenatal care visits (ANC4+), skilled birth attendance (SBA), and postnatal care (PNC). About 9.1% of women received all components of CoC. Educational attainment, wealth quintile, and media exposure were associated with four or more antenatal care visits and COC at the delivery level. Perception of getting money for healthcare, having blood pressure measured and urine sample taken during ANC was associated with continuity of care at the delivery level and continuity of care at a postpartum level. Birth order, residence, and region were common factors associated with each outcome of interest. The proportion of women who received all ANC4+, SBA, and PNC across the CoC was low in Ethiopia. Effort needed to increase CoC at each stage. The study shows that focusing on place of residence and regional state variation is necessary to improve CoC at each level. Thus, contextualizing the strategies and further research are critical.

Population-Based Study on the Maternal-Newborn-Child Health Continuum of Care: Evidence From Lower-Middle-Income Countries in Southeast Asia.

This article aimed to assess the relationships within the continuum of care for maternal, neonatal, and child health (MNCH) at four service levels, the utilization distribution, and its contributing factors in six lower-middle-income countries in Southeast Asia. It was based on data from the Demographic and Health Survey, a nationally representative and repeated cross-sectional survey, on 50 619 ever-married women aged 15-49 years. Only 21.9% of women (n = 10 252) obtained all four levels of continuing MNCH services. Women and husbands' education and employment, parity, mass media consumption, and wealth quintiles were the strongest determinants for the continuation of care, apart from access to health care, decision-making autonomy in health care, and women's age. Identifying populations that experience health inequalities, prominent policy intervention, and better health promotion and advocacy systems regarding pregnancy, delivery, and postnatal and immunization care might help to enhance maternal and child health and equity outcomes.

Curating maternal, neonatal and child health (MNCH) datasets for spatiotemporal data analytics

We provide in this Data Note the details of maternal, neonatal and child health (MNCH) datasets curated directly from patients’ medical records; comprising 538 maternal, 720 neonatal and 425 child records, captured at St Luke’s General Hospital, Anua, Uyo, Nigeria, from 2014 to 2019. Variables included in the datasets are gender, age, class of patient (mother/infant/child), LGA (local government area), diagnosis, symptoms, prescription, blood pressure (mm Hg), temperature (degree centigrade), and weight (Kg). The purpose of this publication is to describe the datasets for researchers who may be interested in its reuse (for analysis, research, quality assurance, policy formulation/decision, patient safety, and more). The curated datasets also involved the capturing of location information (GPS: global positioning system data) from the study area, to aid spatiotemporal and informed demographic analysis. We detail the methods used to curate the datasets and describe the protocol of variables selection and processing. For reasons of data privacy, some patients’ personal information such as names were replaced with patient numbers (a sequence generated using Microsoft Excel). Furthermore, the addresses/locations of the patients, date of visit, latitude, longitude, elevation, and GPS accuracy are restricted. Restricted data can be made available to readers after a formal request to the corresponding author (see data restriction statement). The curated datasets are available at the Open Science Framework.

Barriers and determinants of postpartum family planning uptake among postpartum women in Western Ethiopia: a facility-based cross-sectional study

BackgroundDespite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health (MNCH) services in public health facilities of western Ethiopia.MethodsA facility-based cross-sectional study design with a quantitative method was conducted on 989 postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05.ResultIn this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28), skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum family planning.ConclusionPost-partum family planning utilization among study participants was low. Given the associated factors, it is recommended that health facilities should make postpartum family planning one of their top priorities and focus on these factors to improve its utilization.

Development of Machine Learning-Based Model for Quality Measurement in Maternal, Neonatal and Child Health Services: A Country Level Model for Tanzania

Background: The high maternal and neonatal mortality in developing countries is frequently linked to inadequacies in the quality of maternal, neonatal, and child health (MNCH) services provided. Quality measurement is among the recommended strategies for quality improvement in MNCH care. Consequently, developing countries require a novel quality measurement approach that can routinely facilitate the measurement and reporting of MNCH care quality. An effective quality measurement approach can enhance quality measurement and improve the quality of MNCH care. This study intends to explore the effectiveness of approaches available for MNCH quality measurement in developing countries. The study further proposes a machine learning-based approach for MNCH quality measurement. Method: A comprehensive literature search from Pub Med, HINARI, ARDI, and Google Scholar electronic databases was conducted. Also, a search for organizations' websites, including World Health Organization (WHO), USAID's MEASURE Evaluation Project, Engender Health, and Family Planning 2020 (FP2020), was included. A search from databases yielded 324 articles, 32 of which met inclusion criteria. Extracted articles were synthesized and presented. Findings: The majority of quality measurement approaches are manual and paper-based. Therefore are laborious, time-consuming and prone to human errors. Also, it was observed that most approaches are costly since they require trained data collectors and special data sets for quality measurement. It is further noticed that the complexity of the quality measurement process and extra funds needed to facilitate data collection for quality measurement puts an extra burden on developing countries that always face constraints in health budgets. The study further proposes a machine learning-based approach for measuring MNCH quality. In developing this model, financial and human resource constrain were considered. Conclusion: The study found a variety of quality assessment approaches available for quality assessment on MNCH in developing countries. However, the majority of the existing approaches are relatively ineffective. Measuring MNCH quality by a machine learning-based approach could be advantageous and establish a much larger evidence base for MNCH health policies for Tanzania.

Maternal and Child Health Care Quality Assessment: An Improved Approach Using &amp;lt;i&amp;gt;K&amp;lt;/i&amp;gt;-Means Clustering

High maternal and child deaths in developing countries are frequently linked to poor health services provided to pregnant women and children. To improve the quality of maternal, neonatal and child health (MNCH) services, the government and other stakeholders in MNCH emphasize the importance of quality assessment. However, effective quality assessment approaches are mostly lacking in most developing countries, particularly in Tanzania. This study, therefore, aimed at developing a quality assessment approach that can effectively assess and report on the quality of MNCH services. Due to the need for a good quality assessment approach that suits a resource-constrained environment, machine learning-based approach was proposed and developed. K-means algorithm was used to develop a clustering model that groups MNCH data and performs cluster summarization to discover the knowledge portrayed in each group on the quality of MNCH services. Results confirmed the clustering model’s ability to assign the data points into appropriate clusters; cluster analysis with the collaboration of MNCH experts successfully discovered insights on the quality of services portrayed by each group.

Husband Involvement in Maternal, Neonatal, and Child Health Care among Women who Have a Child Less Than one Year in Gondar City, Northwest Ethiopia, 2021.

BackgroundImproving maternal, neonatal and child health is one of the major components of Sustainable Development Goal and countries implement different strategies to achieve this goal. In spite of this, maternal, neonatal and child mortality remains a public health burden in the developing countries, including Ethiopia. World Health Organization recommend active involvement of men during pregnancy, child birth and the postpartum period as an effective strategy to improve maternal as well as newborn health. Therefore, this study aimed to assess husband involvement in maternal, neonatal and child health care among women who have child less than one year in Gondar city, northwest Ethiopia.MethodsA community-based cross-sectional study was conducted among 870 married women who have a child less than one year in Gondar city. A cluster sampling technique was employed to select study participants. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable logistic regression was done and adjusted odds ratio with a 95% confidence interval was used to report the association between covariates and the outcome variable.ResultsHusband involvement in Maternal, Neonatal and Child Health (MNCH) care was 66.2% (95%CI: 63, 69.3). Maternal age (18-25years) and (26-35years), having diploma and above education, husband occupation (government employee), (merchant) and (self-employed), planned pregnancy and cesarean delivery were significantly associated with husband involvement in MNCH care.ConclusionIn this study, nearly two thirds (66.2%) of women had husband involvement in MNCH care. Therefore, it is important to improve women's educational attainment and actions should be taken to prevent unplanned pregnancy.

Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial.

BackgroundAlthough most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills.ObjectiveThis trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality.MethodsThe study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting.ResultsThe trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol.ConclusionsThe results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings.Trial RegistrationClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237International Registered Report Identifier (IRRID)DERR1-10.2196/28644