Maternal, Newborn And Child Health Research Articles

Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice

BackgroundDespite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda.MethodsFifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate priority setting for MNCH.ResultsThere were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity.ConclusionsStronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies.

"Because Even the Person Living With HIV/AIDS Might Need to Make Babies" - Perspectives on the Drivers of Feasibility and Acceptability of an Integrated Community Health Worker Model in Iringa, Tanzania.

Background: Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model. Methods: To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n=67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings. Results: Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability. Conclusions: Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.

PG-10 Implementation of tuberculosis service integration into ANC and PMTCT programs in Northern Nigeria

Background: Tuberculosis (TB) service integration into antenatal care (ANC) and prevention of mother-to-child transmission of HIV (PMTCT) can facilitate prevention and control of TB/HIV co-infection among HIV-positive pregnant women and their HIV-exposed infants. Such integration requires TB intervention roll-out across all Maternal, Newborn and Child Health (MNCH) points of care, and should include the engagement of ANC providers. Objective: To assess the feasibility and impact of TB service integration into ANC and PMTCT, and identify potential gaps. Methods: This retrospective study was conducted at 6 PEPFAR TB-MNCH pilot sites between February and April 2018. Facilities were selected based on monthly ANC attendance, and comprised rural and semi-rural health facilities (5 secondary, one tertiary). A TB integration manual, and TB screening algorithm and data-capturing tools were developed and deployed to facilities, along with healthcare worker engagement and training. TB prophylaxis and treatment services were to be provided to TB-negative and presumptively-infected pregnant women respectively, after universal screening. Data were collected from TB screening registers and cards and ANC general registers. TB-DOT clinic registers were reviewed to determine the number of presumptive cases that accessed GeneXpert testing. A survey was conducted among healthcare workers (HCWs) to explain gaps identified. Results: Out of 5767 ANC attendees presenting in the 3 month period 100% were screened for HIV, and 2993 (51.8%) were screened for TB. A total of 140/5767 (2.4%) women were HIV-positive, with 37/2993 (1.2%) TB-screened women determined active TB-presumptive, all of whom accessed Gene Xpert testing. Ultimately, 36/37 women tested TB-negative and 1 (0.12%) tested positive. One facility had no documentation of ANC-TB screening for the review period. Of the 139 HIV-positive pregnant women confirmed TB-negative, only 3 (2.2%) were placed on isoniazid prophylaxis. The sole TB/HIV+ woman was commenced on TB/HIV treatment, and ultimately, her TB/HIV-exposed infant was provided both isoniazid and HIV prophylaxis. Eleven key HCWs (4 doctors, 6 ANC nurses, and 1 pharmacist) were surveyed across the 6 sites. Only 7/11 (63.6%) HCWs indicated being trained on TB-MNCH integration. Excessive workload was universally reported as the reason for poor TB screening at ANC. Unavailability of Isoniazid was reported as the major reason for non-provision of prophylaxis to eligible HIV-positive pregnant women. Conclusions: Integration of TB services into ANC/PMTCT was inadequate, mainly due to screening and prophylaxis initiation gaps. Closing these gaps will require health systems strengthening to address training/knowledge deficiencies, task-shifting and supervision needs, drug/commodity stock-outs and leadership at the facility and state level. Linkage to confirmatory testing for the TB-presumptive cases was excellent, and maternal treatment initiation and infant prophylaxis were encouraging for the sole mother-infant pair identified. To complement gains and accelerate progress made in both PMTCT and TB program areas, universal TB screening coverage and prophylaxis initiation, confirmatory diagnosis and prompt treatment initiation must be achieved at MNCH facilities in Nigeria.

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation

Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

Is the Maternal and Child Health Handbook a Source of Information for Maternal and Child Health Continuum of Care?

To ensure continuum care for maternal, newborn, and child health (MNCH), home-based records (HBRs) are expected to promote communication between healthcare providers, pregnant women and children’ caregivers. WHO guidelines (2018) recommend HBRs use for MNCH, and request their effective implementation. However, information on HBRs global implementation is inadequate. This study aimed to identify implementation regarding Maternal and Child Health (MCH) handbook, an integrated HBR for ensuring continuum care. This study included literature review to explore components of MCH handbook usage, to identify researchers’ acknowledgment of the handbook as a feasible source of information, and to examine existing national/subnational level implementation information. Components of the handbook usage in this study focuses on distribute, explain, and record/multi-record by health personnel, and receive, retain, bring/multi-bring, and read by women/mothers. While existing nationally representative data of many countries allows us to measure distribution/receipt and retention of HBRs regarding child immunization, some countries have used MCH handbook in surveys to obtain more information (e.g., antenatal/birth records) for their health policies. The researches that have used the handbook for information on different stages of MNCH may have indicated its implementation maturity in their countries.

Improving Health Systems Response Through Women's Self-Help Groups in India: Repeated Cross-Sectional, Quasi-Experimental Study

Background: Maternal, newborn and child health (MNCH) interventions with women's self-help groups (SHGs) can improve its outcomes in rural communities through addressing health system barriers, and empowering women. We assessed the effect of large-scale implementation of health interventions integrated within SHGs compared with standard group settings, on group advocacy, women's self-determination, and norms around health care service delivery. Methods: Using a pre-post quasi-experimental design, 33 geographic blocks were divided into two groups: intervention and comparison. SHG women in comparison blocks received the usual microcredit program, and SHG members in intervention blocks received additional participatory training around MNCH issues through a community mobilizer who led at least one health meeting a month. Two cross-sectional surveys in 2013 (N= 2407) and 2016 (N=2974) were conducted among eligible women (i.e., 18-49 years, married, SHG member and had a live birth within 12 months). The outcomes in the study were: collective agency to negotiate with health center/workers, women's self-advocacy with health workers, self-confidence in accessing health services, and services from health workers including respectful care. Outcome effects were assessed using difference-in-differences (DID) methods. Findings: Of the 5089 women interviewed across the two-time points, the mean age was 26 (±4·7) years. The intervention improved women's collective agency to demand for services and improved key healthcare system related factors: self-advocacy with local health facility (DID: 16 percentage points[pp], p<0·001); improved health workers' response in providing: respectful care (DID: 3pp, p=0·035), getting appropriate referrals from frontline health workers (DID: 6pp, p=0·009), receiving help during emergencies (DID: 10pp, p=0·005); and postnatal care (DID:14pp, p<0·001). Interpretation: Self-help groups are important community institutions enabling poor women and their households to access finance and social services. Health interventions layered within these institutions enable women's participatory learning, collectivization, and ability to connect with health care providers in meaningful ways. Funding: This evaluation study was funded to Population Council by the Bill and Melinda Gates Foundation (#OPP1141832) and Project Concern International (061C-XX1ZZ-140700). The Population Council had designed and conducted the study on their own. The funders had no role in study design, data collection, data analysis or interpretation and decision to publish. Further, the paper was developed in support of The Lancet Series on Gender Equality, Norms and Health. We thank The Lancet Series leadership, and the Bill and Melinda Gates Foundation and the UAE government for their support to the publication of this paper as a supplemental paper to the Series. Declaration of Interest: None declared. Ethical Approval: All study procedures were reviewed and approved by the Institutional Review Board of the Population Council.

Can volunteer community health workers manage multiple roles? An interrupted time-series analysis of combined HIV and maternal and child health promotion in Iringa, Tanzania.

Community health workers (CHWs) play a critical role in health promotion, but their workload is often oriented around a single disease. Renewed interest in expansion of multipurpose CHWs to cover an integrated package of services must contend with the debate over how effectively CHWs can perform an increased range of tasks. In this study, we examine whether an existing cadre of HIV-focused paid volunteer CHWs in Iringa, Tanzania, can take on new maternal, newborn and child health (MNCH) promotion tasks without adversely affecting their HIV role. HIV household visits conducted per month were extracted from CHW summary forms covering up to 14 months pre-intervention and 12 months of intervention data. A comparative interrupted time series using a generalized estimating equation assessed population-averaged longitudinal trends in monthly HIV visit count in the intervention ('dual-role' CHWs) vs comparison group ('single-role' CHWs). Analyses were stratified by district, accounting for secular trends, seasonality and covariates. The time series consisted of 4022 observations for HIV visit count from 187 CHWs (41% dual role). Prior to MNCH training, dual-role CHWs averaged 25-30% more HIV visits per month compared with single-role CHWs, with no other significant pre-intervention differences between groups. CHWs began conducting MNCH visits shortly after receiving training, but in the initial month of intervention, there was a 6-9% drop in the mean number of HIV visits per month among dual-role CHWs. Otherwise, there was no significant difference between single- and dual-role CHWs in the trajectories of monthly HIV visits before and after adding MNCH tasks. Dual-role CHWs appeared able to maintain their HIV client workload after adding MNCH tasks to their routines, albeit with an initial slight decline in HIV workload. This dual-role CHW model suggests potential spare capacity in vertically oriented programmes, with productivity gains possible through integration.

Practice of emergency obstetric care signal functions and reasons for non-provision among health centers and hospitals in Lake and Western zones of Tanzania

BackgroundThe Lake and Western Zones of Tanzania that encompass eight regions namely; Kagera, Geita, Simiyu, Shinyanga, Mwanza, Mara Tabora and Kigoma have consistently been reported with the poorest Maternal Newborn and Child Health (MNCH) indicators in the country. This study sought to establish the provision of Emergency Obstetric Care (EmOC) signal functions and reasons for the failure to do so among health centers and hospitals in the two zones.MethodsAll the 261 public and private hospitals and health centers providing Obstetric Care services in Lake and Western Zones were surveyed in 2014. Data were collected using questionnaires adapted from the Averting Maternal Deaths and Disabilities (AMDD) tool to assess EmOC indicators. Managers in all facilities were interviewed and services, medicines and equipment were observed. Spatial Mapping was done using a calibrated Global Positioning System (GPS) Essential Software for Android and coordinates represented on digitalized map with Arc Geographical Information System (GIS) software. Population data were according to the 2012 Housing and Population National Census.ResultsIn total 261 health facilities were identified as providers of Obstetric care services, including 69 hospitals and 192 health centres which constitute an overall facility density of 8 per 500,000 population. The three most common EmOC signal functions available in the 3 months preceding the survey were oxytocics (95.7%), injectable antibiotics (88.9%) and basic newborn resuscitation (83.4%). The lowest proportions of facilities performed Cesarean section (25.7%) and blood transfusion (34.6%). Policy restrictions were the most frequent reasons given in relation to nonperformance of blood transfusion and Cesarean section when needed. Lack of training and supplies were the most common reasons for non availability of assisted vaginal delivery and uterine evacuation. Overall the Direct Case fatality Rate for direct obstetric causes was 3%. The referral system highly depended on hired or shared ambulance.ConclusionThe provision of EmOC signal functions in Lake and Western zones of Tanzania is inconsistent, being mainly compromised by policy restrictions, lack of supplies and professional development, and by operating under lowly developed referral services.

Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone.

The role of community health workers (CHWs) in the West Africa Ebola outbreak has been highlighted to advocate for increasing numbers of CHWs globally to build resilience, strengthen health systems, and provide emergency response capacity. However, the roles CHWs played, the challenges they faced, and their effectiveness during the outbreak are not well documented. This study assessed the impact of Ebola on community-based maternal, newborn, and child health (MNCH) services, documented the contribution of CHWs and other community-based actors to the Ebola response, and identified lessons learned to strengthen resilience in future emergencies. This mixed methods study was conducted in Guinea, Liberia, and Sierra Leone, with data collected in four Ebola-affected districts of each country. Qualitative data were collected through in-depth interviews and focus group discussions with stakeholders at national, district, and community levels. Quantitative program data were used to assess trends in delivery of community-based MNCH services. There was a sharp decline in MNCH service provision due to weak service delivery, confusion over policy, and the overwhelming nature of the outbreak. However, many CHWs remained active in their communities and were willing to continue providing services. When CHWs received clear directives and were supported, service provision rebounded. Although CHWs faced mistrust and hostility from community members because of their linkages to health facilities, the relationship between CHWs and communities proved resilient over time, and CHWs were more effectively able to carry out Ebola-related activities than outsiders. Traditional birth attendants, community health committees, community leaders, and traditional healers also played important roles, despite a lack of formal engagement or support. Service delivery weaknesses, especially related to supply chain and supervision, limited the effectiveness of community health services before, during, and after the outbreak. CHWs and other community-level actors played important roles during the Ebola outbreak. However, maintenance of primary care services and the Ebola response were hampered because community actors were engaged late in the response and did not receive sufficient support. In the future, communities should be placed at the forefront of emergency preparedness and response plans and they must be adequately supported to strengthen service delivery.

Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries

BackgroundUnited Nations Children’s Fund (UNICEF) designed EQUitable Impact Sensitive Tool (EQUIST) to enable global health community address the issue of equity in maternal, newborn and child health (MNCH) and minimize health disparities between the most marginalized population and the better-off. The purpose of this study was to use EQUIST to provide reliable evidence, based on demographic health surveys (DHS) on cost–effectiveness and equitable impact of interventions that can be implemented to improve MNCH outcomes in Benin, Burkina Faso, Ghana, Mali, Nigeria and Senegal.MethodsUsing the latest available DHS data sets, we conducted EQUIST Situation Analysis of maternal and child health outcomes in the six countries by sub-national categorization, wealth and by residence. We then identified the poorest population class within each country with the highest maternal and child mortality and performed EQUIST Scenario Analysis of this population to identify intervention package, bottlenecks and strategies to address them, cost of the intervention and strategies as well as the number of deaths avertible.ResultsUnder-five mortality was highest in Atlantique (Benin), Sahel (Burkina Faso), Northern (Ghana), Sikasso (Mali), North-West (Nigeria), and Diourbel (Senegal). The number of under-five deaths was considerably higher among the poorest and rural population. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Ante-partum, intra-partum, and post-partum haemorrhages, and hypertensive disorder, were responsible for highest maternal deaths. The national average for improved water source was highest in Ghana (82%). Insecticide treated nets ownership percentage national average was highest in Benin (73%). Delivery by skilled professional is capable of averting the highest number of under-five and maternal deaths in the six countries. Redeployment/relocation of existing staff was the strategy with highest costs in Burkina Faso, Nigeria and Senegal. Ghana recorded the least cost per capita ($0.39) while the highest cost per capita was recorded in Benin ($4.0).ConclusionEQUIST highlights the most vulnerable and deprived children and women needing urgent health interventions as a matter of priority. It will continue to serve as a tool for maximizing the number of lives saved; decreasing health disparities and improving overall cost effectiveness.

Improving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access.

BackgroundEthnic minority women (EMW) in Vietnam experience disproportionately high infant and maternal mortality rates due to low social status, poverty and remoteness from health centres. This project piloted and evaluated a low-cost mobile health (mHealth) intervention called mMom utilizing behaviour change communication (BCC) to improve access to maternal, newborn and child health (MNCH) services and health equity among EMW living in remote areas.MethodsThe mMom intervention built an integrated mHealth platform which sent timely MNCH information and BCC text messages to participants, and engaged health workers towards increasing their interaction and building demand for quality natal care. Mid-term and final qualitative evaluations were conducted to assess the intervention’s acceptability and impact.ResultsIn evaluations, all participants expressed satisfaction with the quality, timeliness and convenience of the messages, and health workers reported increased efficiency and quality of care. The use of BCC increased care-seeking from EMW and strengthened relationships with health providers.ConclusionThe mMom project demonstrated the acceptability of mHealth in a remote Vietnamese region with a high proportion of disadvantaged EMW. The messages promoted increased contact between participants and health providers, which holds potential to address the marginalization of EMW from the health system.

The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi.

Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.

Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone

BackgroundThe role of community health workers (CHWs) in the West Africa Ebola outbreak has been highlighted to advocate for increasing numbers of CHWs globally to build resilience, strengthen health systems, and provide emergency response capacity. However, the roles CHWs played, the challenges they faced, and their effectiveness during the outbreak are not well documented. This study assessed the impact of Ebola on community-based maternal, newborn, and child health (MNCH) services, documented the contribution of CHWs and other community-based actors to the Ebola response, and identified lessons learned to strengthen resilience in future emergencies.MethodsThis mixed methods study was conducted in Guinea, Liberia, and Sierra Leone, with data collected in four Ebola-affected districts of each country. Qualitative data were collected through in-depth interviews and focus group discussions with stakeholders at national, district, and community levels. Quantitative program data were used to assess trends in delivery of community-based MNCH services.ResultsThere was a sharp decline in MNCH service provision due to weak service delivery, confusion over policy, and the overwhelming nature of the outbreak. However, many CHWs remained active in their communities and were willing to continue providing services. When CHWs received clear directives and were supported, service provision rebounded. Although CHWs faced mistrust and hostility from community members because of their linkages to health facilities, the relationship between CHWs and communities proved resilient over time, and CHWs were more effectively able to carry out Ebola-related activities than outsiders. Traditional birth attendants, community health committees, community leaders, and traditional healers also played important roles, despite a lack of formal engagement or support. Service delivery weaknesses, especially related to supply chain and supervision, limited the effectiveness of community health services before, during, and after the outbreak.ConclusionsCHWs and other community-level actors played important roles during the Ebola outbreak. However, maintenance of primary care services and the Ebola response were hampered because community actors were engaged late in the response and did not receive sufficient support. In the future, communities should be placed at the forefront of emergency preparedness and response plans and they must be adequately supported to strengthen service delivery.

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

BackgroundThe Safe Motherhood Research Project studies the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in Jimma Zone, Ethiopia. This qualitative rapid assessment study was undertaken to explore community perceptions and experiences related to health, health inequality and other MNCH themes.MethodsWe conducted 12 focus group discussions and 24 in-depth interviews with community stakeholder groups (female and male community members, Health Extension Workers, members of the Women Development Army and Male Development Army, and religious leaders) across six rural sites in Jimma Zone. Data were analyzed through thematic coding and the preparation of content summaries by theme.ResultsParticipants described being healthy as being disease free, being able to perform daily activities and being able to pursue broad aspirations. Health inequalities were viewed as community issues, primarily emanating from a lack of knowledge or social exclusion. Poverty was raised as a possible contributor to poor health, however, participants felt this could be overcome through community-level responses. Participants described formal and informal mechanisms for supporting the disadvantaged, which served as a type of safety net, providing information as well as emotional, financial and social support.ConclusionsUnderstanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including MNCH promotion. The findings of this study enable the development of audience-centered MNCH promotion activities that closely align with community priorities and experiences. This research demonstrates the application of rapid qualitative assessment methods to explore the context for MNCH promotion activities.

Impact of Muslim opinion leaders’ training of healthcare providers on the uptake of MNCH services in Northern Nigeria

ABSTRACTExpanding access to maternal, newborn and child health (MNCH) services in traditional societies is a public health challenge, often complicated by cultural and religious beliefs about what is permitted or not permitted within a faith group. This is particularly true in the Muslim majority North of Nigeria, where deep suspicions of Western public health programmes, coupled with failing and underfunded health system, have led to the emergence of a new generation of Muslim Opinion Leaders (MOLs) with counter-narratives against family planning, immunisation and nutrition programmes. This paper reports on an innovative project implemented under the Saving Lives at Birth global partnership programme, where conservative MOLs transformed as champions were engaged as health communicators to train health providers on correct religious precepts related to MNCH. A matched subject type of study design was used to compare healthcare providers’ performance in control and intervention health facilities. The result indicates a significant difference both in perception and in practices between healthcare providers in intervention and control facilities, with respect to MNCH uptake. This paper highlights the need for renewed focus on engaging faith leaders and organisations in health communication and service delivery and presents a model of sustainable engagement of champions in MNCH.

Evaluating the impact of an SMS-based alert system (RapidSMS-MCH) on uptake of maternal, newborn and child healthcare services in Rwanda: a quasi-experimental design using Rwanda demographic and health survey

Background: In an effort to improve access to proven maternal, newborn and child health (MNCH) interventions and, ultimately, improve their health outcomes, Rwanda has been using an SMS based alert system (RapidSMS-MCH) to facilitate a real time two-way communication between community health workers – tasked to follow-up pairs of mother-infant in their villages – and the rest of Rwandan health system (health ambulance system, health facility staff, district hospital and the central level) for action to improve access to antenatal care, postnatal care, health facility delivery, and emergency obstetrical and …

Community-based maternal, newborn, and child health surveillance: perceptions and attitudes of local stakeholders towards using mobile phone by village health volunteers in the Kenge Health Zone, Democratic Republic of Congo

BackgroundIn early 2016, we implemented a community-based maternal, newborn, and child health (MNCH) surveillance using mobile phones to collect, analyze, and use data by village health volunteers (VHV) in Kenge Health Zone (KHZ), in the Democratic Republic of Congo (DRC). The objective of this study was to determine the perceptions of households, attitudes of community health volunteers, and opinions of nurses in Health center and administrative authorities towards the use of mobile phones for MNCH surveillance in the rural KHZ in the DRC.MethodsWe used mixed methods combining phenomenological and descriptive cross-sectional study. Between 3 and 24 March 2016, we collected the data through focus group discussions (FGD) with households, and structured interviews with VHV, local health and administrative authority, and nurses to explore the perceptions on MNCH surveillance using mobile phone. Data from the FGD and interviews were analyzed using thematic analysis techniques and descriptive statistics respectively.ResultsHealth issues and services for under-five children were well known by community; however, beliefs and cultural norms contributed to the practices of seeking behavior for households. Mobile phones were perceived as devices that render quick services for people who needed help; and the community’s attitudes towards the mobile phone use for collection of data, analysis, and use activities were good. Although some of community members did not see a direct linkage between this surveillance approach and health benefits, majority believed that there would be better MNCH services with the use of mobile phone. In addition, VHV will benefit from free healthcare for households and some material benefits and training. The best time to undertake these activities were in the afternoon with mother of the child, being the best respondent at the household.ConclusionHealth issues and services for under-five children are well known and MNCH surveillance using mobile phone by VHV in which the mother can be involved as respondent is accepted.

Core factors promoting a continuum of care for maternal, newborn, and child health in Japan.

Providing a continuum of care (CoC) is important strategy for improving maternal, newborn, and child health (MNCH). Japan's current very low maternal and infant mortality rates suggest that its CoC for MNCH is good. In this paper, we attempt to clarify how CoC and low mortality rates are being maintained in Japan, by examining the entire MNCH service provision system. First, we examine two important tools for integrated service provision, the Maternal and Child Health (MCH) Handbook and registration of pregnant women with local governments, both introduced in 1942. Second, we explore the incentives provided by the MNCH system that prompt actors to participate in it. The three actors identified are service users (e.g., mothers and babies), medical professionals, and local governments. Through system design, all three actors benefit in ways that incentivize them to use MNCH services, which consequently connects service users with resources: all service users regardless of financial status, nationality, and location can receive free MNCH services such as antenatal care, assistance with childbirth, postnatal care, and immunizations; using the handbook, service users obtain health information, and medical professionals obtain the health records of pregnant women and their children as well as access examination fees from the local government by submitting vouchers in the handbook; local governments can then identify pregnant women for follow-up and provide health information and administrative services. As a result, the coverage rate of the MCH Handbook has reached 100% and MNCH services coverage could potentially reach the same level.

Analisis Faktor Perilaku Kaitannya dengan Permasalahan Pelayanan Kesehatan Ibu dan Anak (KIA) di Provinsi Riau

The low of health community status for this time is still health problems in Indonesia, marked with the high maternalmortality and infant mortality rate. According to health survey, there are still many indicators of maternal, newbornand child health (MNCH), show low achievement. The aim of this study was to find the situation of MNCH servicesand to describe determining factors of the problems in Riau Province. Method of this research was a descriptive designwith quantitative and qualitative data. Result obtained in this research described that some indicators of MNCH servicesperformance were achievable and some were not. The profile of community on health behavior about maternal healthwas shown with good knowledge, neutral attitude, and good practice. Then, the profile of community health behaviorabout newborn and child health was shown with middle level of knowledge, positive attitude, and good practice. Keyperson, mostly categorized as a decision maker for health action was husband/wife. Viewed from quickly action onresponse of sick/unhealthy family members for MNCH services indicated that there was not late decision. There werestill many communities’ beliefs, not match with health value, especially for MNCH.

Cross-National Systematic Review of Neonatal Mortality and Postnatal Newborn Care: Special Focus on Pakistan.

The latest nationwide survey of Pakistan showed that considerable progress has been made toward reducing all child mortality indicators except neonatal mortality. The aim of this study is to compare Pakistan’s under-five mortality, neonatal mortality, and postnatal newborn care rates with those of other countries. Neonatal mortality rates and postnatal newborn care rates from the Demographic and Health Surveys (DHSs) of nine low- and middle-income countries (LMIC) from Asia and Africa were analyzed. Pakistan’s maternal, newborn, and child health (MNCH) policies and programs, which have been implemented in the country since 1990, were also analyzed. The results highlighted that postnatal newborn care in Pakistan was higher compared with the rest of countries, yet its neonatal mortality remained the worst. In Zimbabwe, both mortality rates have been increasing, whereas the neonatal mortality rates in Nepal and Afghanistan remained unchanged. An analysis of Pakistan’s MNCH programs showed that there is no nationwide policy on neonatal health. There were only a few programs concerning the health of newborns, and those were limited in scale. Pakistan’s example shows that increased coverage of neonatal care without ensuring quality is unlikely to improve neonatal survival rates. It is suggested that Pakistan needs a comprehensive policy on neonatal health similar to other countries, and its effective programs need to be scaled up, in order to obtain better neonatal health outcomes.