Maternal, Newborn And Child Health Services Research Articles

A Comparative Analysis of Healthcare Facilities: With and Without 24/7 Interventions.

Background: Maternal and neonatal mortality remains disproportionately high in low and middle-income countries, particularly in remote areas with limited healthcare accessibility. The Tharparkar district of Sindh, Pakistan, exemplifies such challenges, with basic utilities and healthcare services notably lacking. Objective: This study aimed to assess the impact of 24/7 availability of Maternal, Newborn, and Child Health (MNCH) services on healthcare delivery and patient outcomes in government healthcare facilities in the Tharparkar district. Methods: This action research followed a cross-sectional study design. Data collection commenced after receiving ethical approval and written consent from the Government District Health Officer of Tharparkar. Longitudinal data were collected using District Health Information tools from six healthcare facilities, three of which operated 24/7 and the remaining three for six hours daily. Data included indicators such as general outpatient department (OPD) visits, non-vaginal deliveries (NVD), antenatal, postnatal care, family planning, immunization, neonatal deaths, stillbirths, and live births. Statistical analysis was conducted using SPSS version 25, and results were visualized using Tableau 2024. Results: Facilities operating 24/7 reported a significant increase in healthcare utilization: general OPD attendance increased by 118.5% at THQ Kheeme Jo Par, 168.2% at GD Jese Jo Par, and 150.5% at GD Mehrna Vero. There were also notable improvements in NVD, antenatal, postnatal care, and family planning services. Immunization rates improved, stillbirths decreased, and there were zero neonatal deaths reported in these facilities following the intervention. Conclusion: The implementation of 24/7 MNCH services in Tharparkar significantly enhanced healthcare service delivery and improved maternal and child health outcomes. Continuous healthcare availability is crucial for improving health indicators and achieving global health targets in underserved populations.

Exploring the implementation of an SMS-based digital health tool on maternal and infant health in informal settlements

BackgroundThe rapid urbanization of Kenya has led to an increase in the growth of informal settlements. There are challenges with access to maternal, newborn, and child health (MNCH) services and higher maternal mortality rates in settlements. The Kuboresha Afya Mitaani (KAM) study aimed to improve access to MNCH services. We evaluate one component of the KAM study, PROMPTS (Promoting Mothers through Pregnancy and Postpartum), an innovative digital health intervention aimed at improving MNCH outcomes. PROMPTS is a two-way AI-enabled SMS-based platform that sends messages to pregnant and postnatal mothers based on pregnancy stage, and connects mothers with a clinical help desk to respond and refer urgent cases in minutes.MethodsPROMPTS was rolled out in informal settlements in Mathare and Kawangware in Nairobi County. The study adopted a pre-post intervention design, comparing baseline and endline population outcomes (1,416 participants, Baseline = 678, Endline = 738). To further explore PROMPTS's effect, outcomes were compared between endline participants enrolled and not enrolled in PROMPTS (738 participants). Outcomes related to antenatal (ANC) and postnatal (PNC) service uptake and knowledge were assessed using univariate and multivariate linear and logistic regression.ResultsBetween baseline and enldine, mothers were 1.85 times more likely to report their babies and 1.88 times more likely to report themselves being checked by a provider post-delivery. There were improvements in moms and babies receiving care on time. 45% of the 738 endline participants were enrolled in the PROMPTS program, with 87% of these participants sending at least one message to the system. Enrolled mothers were 2.28 times more likely to report completing four or more ANC visits relative to unenrolled mothers. Similarly, enrolled mothers were 4.20 times more likely to report their babies and 1.52 times more likely to report themselves being checked by a provider post-delivery compared to unenrolled mothers.ConclusionsThis research demonstrates that a digital health tool can be used to improve care-seeking and knowledge levels among pregnant and postnatal women in informal settlements. Additional research is needed to refine and target solutions amongst those that were less likely to enroll in PROMPTS and to further drive improved MNCH outcomes amongst this population.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022.

Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.

Developing a group Model of ANC-PNC through human-centered Design (HCD) to Improve MNCH of first-time Mothers (FTMs) in Bangladesh

Objective: First-time parenthood is a complex and emotional journey. The gap between demand and quality services for maternal, newborn and child health (MNCH) and family planning (FP) are significant. Lack of time, awareness, and social support are critical challenges of meeting the service requirement for the young and first-time mothers, especially working mothers in urban areas. Objective of the study was to design an intervention model for the young pregnant women and their partners for improving the quality and use of MNCH and FP services and information. Methods: Using a human-centered design (HCD) approach, we conducted 27 in-depth interviews, 10 focus group discussions, and eight mock sessions with first-time mothers, partners, family members, community influencers and service providers in Tongi, Gazipur. During phase 1, we explored the current realities of life and experience of services, both ideal and existing, from perspectives of a diverse set of stakeholders including both health care providers and care seekers. During phase 2, we designed, tested, and iterated the “group model” of antenatal Care through a series of mock sessions, interviews and consultation with service providers and authorities. We recorded, transcribed, and translated the data for collaborative synthesis and analysis process to generate insight and opportunities for optimizing service delivery and uptake. Results: The study findings spoke for the need of providing group sessions for first time parents, social support from peers and family members and capacity development of the service providers. After careful consideration of the stakeholder needs and preferences, the national guidelines and the local implementing partner’s available resources, we arrived at the recommended group model inclusive of five Group Antenatal Care (GANC) and two group Postnatal Care (GPNC) for mothers. All the pregnant women underwent through clinical checkups by medically trained professionals, mainly midwives and doctors. The group model also includes two GANC and one GPNC for fathers, as well as informative sessions for companions. The prototype model included five GANC and two GPNC sessions for mothers, two GANC and one GPNC session for fathers, and informative sessions for companions. The sessions included pregnant women of close gestational age, use of visual aids to support session facilitation, and activities to support group bonding and information retention. Conclusions: The Group Model offering 5 ANC and 2 PNC for women, 2 GANC and 1 GPNC for male partners, and sessions for caregivers was developed in line with the national and WHO recommendation. This model found a feasible approach that involved partners and caregivers in the process and increased MNCH and social support during the voyage of the pregnancy journey. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 14-23

Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis.

Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women. Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit. Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators. Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Background This study is a systematic review of barriers and facilitators of supply-side maternal, newborn, and child health (MNCH) service availability in the Democratic Republic of the Congo (DRC). Given gaps in understanding of the factors affecting supply-side service availability, authors reviewed the literature to describe the DRC’s landscape and inform future research and programming. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched two databases and grey literature, using the Quality Assessment with Diverse Studies tool to assess quality. Authors identified key themes and used a narrative approach to analyze extracted data. # Results The search identified 2160 articles, with 26 meeting the inclusion criteria. Authors grouped them according to the following key themes: facility readiness, human resources for health (HRH), geography and transportation, conflict, financing, and governance. MNCH service availability was hindered by lack of supplies, logistical challenges, weak infrastructure, unmet staffing needs, HRH turnover, poor HRH distribution, career and payment obstacles, long distances to facilities and poor transportation, system strain and disruption due to conflict, low government expenditure, high out of pocket costs, fragmented stakeholders, and low government prioritization. Authors found facilitating factors in each key theme, including parallel supply chains and buffer stocks, proactive staffing policies, motivated HRH, novel transportation methods, health posts, concentrations of stakeholders in conflict zones, universal health coverage policies, provider payment reforms, stakeholder coordination, and horizontal integration efforts. # Conclusions The DRC faces substantial supply-side barriers to MNCH service availability. Progress towards the Sustainable Development Goals and better MNCH outcomes requires additional work to build on existing facilitators and investments in service availability. Additional research on demand-side factors and quality of care could inform these efforts.

Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis

BackgroundEvidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy (‘SONU’: Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso.MethodsWe conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test.ResultsGratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01–0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13–2.47, p < 0.001), new consultations in children 1–4 years (Coeff 0.81; 95% CI 0.50–1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44–0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant.ConclusionsOur study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.

Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study

BackgroundIn 2016, the Gratuité policy was initiated by the Government of Burkina Faso to remove user fees for maternal, newborn, and child Health (MNCH) services. Since its inception, there has not been any systematic capture of experiences of stakeholders as it relates to the policy. Our objective was to understand the perceptions and experiences of stakeholders regarding the implementation of the Gratuité policy.MethodsWe used key informant interviews (KIIs) and focus group discussions (FGDs) to engage national and sub-national stakeholders in the Centre and Hauts-Bassin regions. Participants included policymakers, civil servants, researchers, non-governmental organizations in charge of monitoring the policy, skilled health personnel, health facility managers, and women who used MNCH services before and after the policy implementation. Topic guides aided sessions, which were audio recorded and transcribed verbatim. A thematic analysis was used for data synthesis.ResultsThere were five key themes emerging. First, majority of stakeholders have a positive perception of the Gratuité policy. Its implementation approach is deemed to have strengths including government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring. However, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks were highlighted as concerns that compromise the government's objective of achieving universal health coverage (UHC). However, many beneficiaries were satisfied at the point of use of MNHC services, though Gratuité did not always mean free to the service users. Broadly, there was consensus that the Gratuité policy has contributed to improvements in health-seeking behavior, access, and utilization of services, especially for children. However, the reported higher utilization is leading to some perceived increased workload and altered health worker attitude.ConclusionsThere is a general perception that the Gratuité policy is achieving what it set out to do, which is to increase access to care by removing financial barriers. While stakeholders recognized the intention and value of the Gratuité policy, and many beneficiaries were satisfied at the point of use, inefficiencies in its implementation undermines progress. As the country moves towards the goal of realizing UHC, reliable investment in the Gratuité policy is needed.

Uptake of reproductive, maternal and child health services during the first year of the COVID-19 pandemic in Uganda: A mixed methods study.

Use of reproductive health (RH), maternal, newborn and child health (MNCH) services in Uganda is suboptimal. Reasons for this are complex; however, service-delivery factors such as availability, quality, staffing, and supplies, contribute substantially to low uptake. The COVID-19 pandemic threatened to exacerbate existing challenges to delivery and use of high-quality RH and MNCH services. We conducted a mixed methods study, combining secondary analysis of routine electronic health management information system (eHMIS) data with exploratory key informant interviews (KII) to examine changes in health service uptake over the course of the pandemic and to understand service delivery adaptations implemented in response. We analyzed eHMIS data for four services (family planning, facility-based deliveries, antenatal visits, and immunization for children by one year), comparing them across four time periods: pre-COVID-19, partial lockdown, total lockdown and post lockdown. Additionally, KIIs were used to document adaptations made for continuity of health services. Use of services declined substantially during total lockdown; however, rebounded quickly to earlier observed levels, during the post lockdown for all four services, especially for immunization for children by one year. KIIs identified several health services delivery adaptations. At the community level, these included: community outreaches, training some mothers as community liaisons to encourage others to seek health services, and support from local leaders to create call centers to facilitate clients transport during travel restrictions. Health facilities creatively used space to accommodate social distancing and shifted providers' roles. District leadership reassigned health workers to facilities closest to their homes, provided vehicle passes to staff, and ambulances to transport pregnant women in critical need. WhatsApp groups facilitated communication at district level and enabled redistribution of supplies. Ministry of Health produced critical guidelines for continuity of health services. Implementing partners provided and redistributed commodities and personal protective equipment, and provided technical support, training and transport.

Effects of public financing of essential maternal and child health interventions across wealth quintiles in Nigeria: an extended cost-effectiveness analysis

Maternal and newborn mortality rates in Nigeria are among the highest globally, and large socioeconomic inequalities exist in access to maternal, newborn, and child health (MNCH) services in the country. Inequalities also exist in catastrophic health expenditure among households in Nigeria. We aimed to estimate the health and financial risk protection benefits across different wealth groups in Nigeria if a policy of public financing of MNCH interventions were to be introduced. We did an extended cost-effectiveness analysis to estimate the health and financial risk protection benefits, across different household wealth quintiles, of a public-financing policy that assumes zero out-of-pocket costs to patients at the point of care for 18 essential MNCH services. We projected health outcomes (deaths in children aged <5 years [under-5 deaths] and maternal deaths) and private expenditure averted using the Lives Saved Tool with data extracted from national surveys. We modelled three scenarios: 1) coverage expansion at a rate equal to the trend observed between 2013 and 2018 (status quo); 2) annual coverage expansion by 5% compared with the status quo (uniform scale-up scenario); and 3) annual coverage expansion by 10%, 8%, 6%, 4%, and 2% compared with the status quo from the poorest to the wealthiest quintiles, respectively (pro-poor scale-up scenario). Our analysis shows that, if an additional 5% increase in coverage was provided for all wealth quintiles between 2019 and 2030, this uniform scale-up policy would prevent more than 0·11 million maternal deaths and 1·05 million under-5 deaths, avert US$1·8 billion in private expenditure, and avert 3266 cases of catastrophic health expenditure. The incremental cost effectiveness ratio would be $44 per life-year gained, which is highly cost-effective when compared with the gross domestic product per capita of Nigeria for 2018 ($2028). The policy would prevent a higher number of under-5 deaths and catastrophic health expenditure cases in poorer quintiles, but would prevent more maternal deaths and private expenditure in wealthier quintiles. If poorer populations experienced a greater increase in service coverage (ie, the pro-poor scale-up scenario), more maternal and under-5 deaths would be prevented in the poorer quintiles and more private expenditure would be averted than would be under previous scenarios. Public financing of essential MNCH interventions in Nigeria would provide substantial health and financial risk protection benefits to Nigerian households. These benefits would accrue preferentially to the poorest quintiles and would contribute towards reduction of health and socioeconomic inequalities in Nigeria. The distribution would be more pro-poor if public financing of MNCH interventions could target poor households. WHO Partnership for Maternal, Newborn, and Child Health.

Evaluation of a WASH/MNCH targeted primary health care program in Uganda; a mixed methods study

ABSTRACT Background Evidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance (SBA) and neonatal sepsis remains unclear. We conducted this study in Amuru district to generate evidence. Methods A before-and-after study design was conducted. Interventions implemented included; training of HCWs, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and SBA, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on sepsis incidence, ANC, SBA and WASH status was obtained from six healthcare facilities. A total of 12 KIIs and 12 FGDs were conducted. Data were analyzed using STATA 15. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative data were analyzed using thematic content analysis. Results The number of women delivering at HCFs significantly increased from 41.4% to 63.0% (p < .0001). Incidence of neonatal sepsis reduced from 0.6% to 0.2% (p = .0687), although the difference was not significant. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% to 0.6%, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline. Conclusion This study revealed that integrated WASH/MNCH interventions can significantly increase ANC and SBA, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC and the capacity of HCWs to deliver safe MNCH services are realized.

Correlates of maternal, newborn and child health services uptake, including male partner involvement: Baseline survey results from Bangladesh

ABSTRACT South Asia bears a substantial proportion of the global maternal mortality burden, with adolescents disproportionately affected. Bangladesh has one of the highest adolescent pregnancy rates in the world, with low utilisation of maternal newborn and child health (MNCH) services. This hampers the country’s efforts to achieve optimal health outcomes as envisioned by the Sustainable Development Goals. Male partner involvement is a recognised approach to optimise access to services and decision-making. In South Asia data on male involvement in MNCH service uptake is limited. Plan International’s Strengthening Health Outcomes for Women and Children was implemented across four districts in Bangladesh between 2016 and 2020 and aimed to address these issues. Study results (N = 1,724) found higher maternal education levels were associated with use of MNCH services. After controlling for maternal education, service uptake was associated with male partner support level and perceived joint decision-making. The positive association between male support level and MNCH scale was robust to stratification by maternal education level, and by age group (i.e. adolescent vs. adult mothers). These findings suggest that one path for achieving optimal MNCH outcomes might be through structural-level interventions centred on women, combined with components targeting male partners or male heads of households.

Gaps and opportunities for the integrated delivery of mother-child care, postpartum family planning and nutrition services in Burkina Faso, Côte d’Ivoire and Niger

Background Maternal and infant deaths can be prevented through integrated service delivery during pregnancy, postpartum, and early childhood. Our study analyses the gaps and opportunities associated with integrating maternal, newborn, and child health (MNCH) services with postpartum family planning (PPFP) and nutrition services at different points of contact in health facilities in a preintervention context in west Africa. Methods We conducted a qualitative study from June to July 2018 in Burkina Faso, Côte d’Ivoire and Niger. The points of contact studied at the health facility level were the prenatal care, postpartum care and immunisation/growth monitoring services. Individual in-depth interviews were used to collect data from key informants (providers, community health workers and mother-child health programme managers). To measure the degree of service integration, we used the dimensions and indicators included in the Integra Initiative framework concerning four aspects of integration: physical (the availability of multiple services in the health facility), temporal (the availability of care more than one day per week), provider level, and functional (the receipt of integrated services by the client). Results The findings of this study show that the integrated delivery of MNCH, PPFP, and nutrition services is configured in similar ways in Burkina Faso, Côte d’Ivoire and Niger and is insufficient at all points of contact. Physical integration is high. However, the study found important gaps in temporal, functional and provider-level integration. The main barriers to integrated service delivery are the shortage of providers, the lack of training in integrated service delivery, and insufficient service organisation. However, the availability of multiple services throughout the week, the multiple points of contact between the mother-child pair and the health system, and the multiple skills of providers represent opportunities for functional integration through the establishment of a formal referral system between the different care units with follow-up and feedback among service providers. Conclusions The provision of training and the development of a well-organised referral system in different health facilities, taking into account the specific characteristics of each health facility (urban/rural, primary health facility/district hospital), can improve the delivery of integrated MNCH, PPFP, and nutrition care to the mother-child pair.

Impact of the COVID-19 pandemic on utilisation of facility-based essential maternal and child health services from March to August 2020 compared with pre-pandemic March–August 2019: a mixed-methods study in North Shewa Zone, Ethiopia

IntroductionHealth systems are often weakened by public health emergencies that make it harder to access health services. We aimed to assess maternal, newborn and child health (MNCH) service utilisation during...

Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study.

BackgroundThe uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services.ObjectiveThe main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs.MethodsA quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate.ResultsThe intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022.ConclusionsThis project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context.Trial RegistrationClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599International Registered Report Identifier (IRRID)DERR1-10.2196/35291

Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders.

Background:The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low- and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to ‘flatten the curve’ such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery.Objective:To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic.Methods:Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data.Results:Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery.Conclusion:Health facility leaders led the frontline of the COVID-19 response. While they took to implementing global and national guidelines within their facilities, they also pushed innovative facility-driven adaptations to address the indirect effects of COVID-19. Insights gathered provide lessons to foster resilient LMIC health systems for MNCH service provision in a post-COVID-19 world.

Factors Affecting Quality of Care in Maternal and Child Health in Timor-Leste: A Scoping Review.

Timor-Leste faces many challenges implementing quality maternal, newborn and child health (MNCH) services due to resource constraints and socio-cultural factors that disproportionately affect the health of women and children. A scoping review was conducted to map the quality of MNCH services against WHO quality standards on: 1. Provision of care, 2. Experiences of care, and 3. Cross-cutting standards. The literature search identified 1058 citations, from which 28 full-text articles met the inclusion criteria. The findings highlight health workers’ limited capacity to provide quality services and referrals. The major reasons for this are: a lack of essential supplies, poor infrastructure and transport, limited opportunities for ongoing learning, and gaps in health information systems. Provision of care standards and cross-cutting standards require attention at a broad systems level. Findings related to experiences of care highlight the importance of effective communication, respect, and emotional support, particularly for vulnerable women and children who have difficulty accessing services, and for those who have experienced violence. These experience-related standards could be addressed at an individual health worker and health service level, as well as at a systems level. This review provides direction to focus quality-improvement initiatives within local health facilities, as well as at municipal and national level.

Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study

BackgroundIndia, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India?MethodsThe study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC.ResultsNearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion.ConclusionThe major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.

Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study

BackgroundThe in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks.ObjectiveThis study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care.MethodsA mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment.ResultsIn total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes.ConclusionsThis study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs’ workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery.Trial RegistrationISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372