Provision Of Maternal Services Research Articles

Impact of COVID-19 pandemic on maternal and child health services in Uttar Pradesh, India

Background:In the wake of the Covid-19 Pandemic, parts of the public health system at increased risk of reduced efficiency include healthcare services for women and children. This in turn could reverse all the progress achieved over the years in reducing maternal and child mortality. In this study, an attempt has been made to assess the indirect effect of the pandemic on maternal and child health services in public health facilities.Methods:Data pertaining to maternal and child health services being provided under specific Government programmes, were collected from public health facilities of District Sant Kabir Nagar in Uttar Pradesh, India. Comparative analysis of the data from the pandemic phase with data from the year 2019 was done to determine the impact on services.Results:Reduced coverage across all maternal and child health interventions was observed in the study. There was an overall decrease of 2.26 % in number of institutional deliveries. Antenatal care services were the worst affected with 22.91% decline. Immunization services were also dramatically decreased by more than 20%.Conclusion:The response of the public healthcare delivery system to the Covid-19 Pandemic is negatively affecting both the provision and utilization of maternal and child healthcare services. It is deterrent to the progress achieved in maternal and child health parameters over the years. Better response strategies should be put in place to minimize lag in service deliwvery.

Pemberian Informasi Pelayanan Maternal di Era Covid-19 Pada Mahasiswa Kebidanan

Background: WHO China Country Office on December 31, 2019 reported that there had been pneumonia cases in Wuhan City - China, with global death cases in May 2020 reaching 4.23 million with 290 thousand deaths, 14,729 in Indonesia with 1007 deaths. Seeing that the number of exposure to COVID 19 has increased significantly, the Central Government issued a circular to limit and stop activities that touch the crowds, including teaching and learning activities, whether carried out in the classroom or in the field, this rule can affect students who are preparing their final project reports. The purpose of this community service activity is so that students can find out about the provision of maternal services in the era of COVID-19 and can complete their final project reports. Methods: providing health education online through zoom meetings. Results: The results showed a 100% assement student has been informed of maternal care in the era of Covid-19. Conclusion: The court of the participants numbered 21 people have received information in the Age COVID Maternal care - 19 and documentation of midwifery

Technical Efficiency of Maternal Health Services Provision in Public Hospitals of Northwest Ethiopia: A Two-Stage Data Envelopment Analysis.

IntroductionEthiopian health expenditure as a share of total government expenditure increased from 7.6% in 2013/14 to 8.1% in 2016/17. But it remained low even for the low-income country average expected share of 8.7%. It signifies the efficient use of scarce resources in the health sector is still critical to achieving sustainable development goals. But little evidence is available about public hospitals’ technical efficiency in providing maternal health services. Therefore, the aim of this study was to assess the technical efficiency of maternal health services provision of public hospitals in Northwest Ethiopia.MethodsFacility-based cross-sectional study was conducted among twelve randomly selected public hospitals. Input data (salary expenditure, non-salary expenditure, and the number of beds) and maternal health services output data (antenatal care, skilled delivery, and postnatal care) for a 2011 Ethiopian fiscal year (July 2018 to June 2019) were collected and entered into Epi-Data 3.1. We used both primary and secondary data collection procedures to determine independent variables and the dependent variable, respectively. We also used a two-stage input-oriented data envelopment analysis with variable returns to scale assumption.ResultsThe study showed that hospitals included in this study wasted US$ 6833.50 for salary and US$ 3886.8 for non-salary expenditures. The study also revealed that the mean pure technical efficiency of public hospitals for maternal health service provision was 0.92±0.142, and their scale efficiency was 0.795±0.24. The hospital manager’s experience year, the educational level of the manager, and the hospital service year associated positively with the technical efficiency. However, the catchment population and distance of another health facility associated negatively with technical efficiency.ConclusionThe public hospitals’ pure technical efficiency in the provision of maternal health services in Northwest Ethiopia was high. More than half of the public hospitals were technically efficient. The wasted amount of expenditures could be used for satisfying the unmet health services need of the population. Therefore, it is better to monitor the health facilities for the wise use of the existing resources for their best performance.

Provider perspectives in implementing the Postpartum Intrauterine Device Initiative in Sri Lanka: a qualitative study

BackgroundIntegration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models...

Health care professional knowledge and attitude towards the use of digital technologies in provision of maternal health services at Tumbi regional referral hospital in Tanzania

Objectives: In recent years Tanzania introduced digital technologies in health industry where several initiatives such as Government of Tanzania, Hospital Management Information System (GoT-HoMIS) along other digital devices are taken to ensure quality services delivery. The purpose of this study was to assess Health Care Providers (HCPs) knowledge and attitude towards the use of Digital Health Technology (DHT) in provision of maternal health services at Tumbi Regional Referral Hospital (TRRH).
 Methods: Descriptive cross-sectional design involving 50 purposively selected HCPs from obstetrics and gynecology department was used. A self-administered questionnaire and direct field observation was used to collect data from respondents. Data were analyzed using SPSS V.20 and presented by using tables, percentages and frequencies.
 Results: We found that, DHT are highly used by HCPs 49(98%). Also, DHT devices are available and functioning properly thus used in providing maternal health services by enhancing effective patient management. 43(86%) of HCPs were aware on DHT practice and about 46(92%) understood the use of DHT in provision of maternal health services despite of varying knowledge level. On the side of attitude, we found that, 43(86%) of the HCP had a positive attitude on the use of DHT.
 Conclusion: Knowledge, attitudes and rate of use of DHT by HCP was found to be good, despite notable challenges such as dependent on the internet signals for their proper functioning. More initiatives should be undertaken by the Ministry of Health, Community and other stakeholders to promote DHT practices in the health facilities.

Article Current Status of Nosocomial COVID-19 Cases in Delivery Facilities in Japan

Background: In Japan, there are more than 2000 maternity facilities that provide delivery services for approximately 860 thousand deliveries per year. More than half of all deliveries are managed in private clinics which medical resources are limited and maternal transport is often required. In such condition, we aimed to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services that have recorded cases of nosocomial infection with SARS-CoV-2, which causes (COVID-19).Methods: A nationwide questionnaire survey about nosocomial COVID-19 was conducted in July 2020. A case-control study was conducted by including medical facilities with (Cases) and without (Control) nosocomial COVID-19.Findings: Responses from 1,418 medical facilities were assessed (65% of all delivery facilities in Japan). Seventy-five COVID-19-positive pregnant women were treated in 48 facilities. Nosocomial infection was reported in 4.1% of the facilities. Nine patients developed a nosocomial infection in the maternity ward or obstetric department. Variables that contributed to nosocomial COVID-19 were chest CT on admission (adjusted odds ratio [95% confidence interval], 4.76 [2.44–9.27]), PCR test for SARS-CoV-2 before delivery (2.27 [1.21–4.25]), transfer of pregnant women with fever to another hospital (0.21 [0.06–0.71]), and private clinics (0.17 [0.05–0.60]).Interpretation: Nosocomial infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do. Nosocomial infection can occur even in medical facilities performing COVID-19 screening tests, such as chest CT and PCR test.Funding Statement: Nationwide survey associated with COVID-19 infection, The Japan Association of Obstetricians and Gynecologists (JAOG).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the JAOG (No. 80, July 1st, 2020). This investigation was conducted according to the principles of the Declaration of Helsinki. Informed consent was not obtained from patients or their families because this study was based on the analysis of facility forms, and the patient records/information was anonymized prior to the analysis.

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world

Community Perception Regarding Maternity Service Provision in Public Health Institutions in 2018 and 2019: A Qualitative Study.

BackgroundIn the perspective of health care, community perception is defined as a combination of experiences, expectations and perceived needs. The community and client’s perception of health services seem to have been largely ignored by health-care providers in developing countries. There is a knowledge gap about communities’ perception and perspective of maternal health. If the community’s perception is known, the quality of maternity care may be improved, maternal morbidity and mortality could be decreased, and the overall health of the mother can be improved. The aim of this study was to explore community’s perception of maternity service provision in public health institutions.MethodsA qualitative study with the underpinning philosophy of phenomenology was conducted in five subcities of Mekelle city, Ethiopia. Focus group discussions (FGDs) and in-depth interviews (IDSs) with participants who are residing in Mekelle city and who experienced maternity service as a client or as attendants were conducted to collect the necessary information. Using a semi-structured tool that has been translated into the local language, collected data were analyzed thematically using computer-assisted qualitative data analysis software ATLAS version 7. Qualitative data were transcribed through replaying the tape recorded interview from IDIs and FGDs. The text was carefully read and similar ideas were organized together. The participant's inductive meanings were extracted verbatim and described in narratives. The researcher and research assistants independently transcribed participant's comments verbatim to confirm the reliability of the findings.ResultsParticipants reported that maternal health services in public health institutions were negative. Participants described experiencing poor staff attitude, lack of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment made them develop a negative perception towards public health institutions. Despite these complaints, participants acknowledged public health facilities for affordable, accessible, qualified personnel and usually stocked with quality medications and equipment.ConclusionThis study revealed that the community has a negative perception of the maternal health services in the public health institutions. The main reasons for their negative perception were poor staff attitude, unavailability of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment.

\u201cIf you are on duty, you may be afraid to come out to attend to a person\u201d: fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective

BackgroundMaternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria.MethodsStudy was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology.ResultsThe presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff.ConclusionHealth facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.

The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

ObjectiveIn 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17.Research design and methodsData from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling.ResultsThe overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 (p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) (p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals (p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally.ConclusionsWe found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.

Involvement and practice of community pharmacists in maternal and child health services: A systematic review.

Community pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown. The objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services. Seven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors. A total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision. Community pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.

Illicit financial flows and the provision of child and maternal health services in low- and middle-income countries

BackgroundIllicit financial flows (IFFs) drain domestic resources with harmful social effects, especially in countries which are too poor to mobilise the revenues required to finance the provision of essential public goods and services. In this context, this article empirically examined the association between IFFs and the provision of essential health services in low- and middle-income countries.MethodsFirstly, a set of indicators was selected to represent the overall coverage of essential health services at the country level. Next, a linear multivariate regression model was specified and estimated for each indicator using cross-sectional data for 72 countries for the period 2008–2013.ResultsAfter controlling for other relevant factors, the main result of the regression analysis was that an annual 1 percentage point (p.p.) increase in the ratio of IFFs to total trade was associated with a 0.46 p.p. decrease in the level of family planning coverage, a 0.31 p.p. decrease in the percentage of women receiving antenatal care, and a 0.32 p.p. decrease in the level of child vaccination coverage rates.ConclusionsThese findings suggest that, for the whole sample of countries considered, at least 3.9 million women and 190,000 children may not receive these basic health care interventions in the future as a consequence of a 1 p.p. increase in the ratio of IFFs to total trade. Moreover, given that family planning, reproductive health, and child immunisation are foundational components of health and long-term development in poor countries, the findings show that IFFs could be undermining the achievement of the 2030 Agenda for Sustainable Development.

Preparing maternity for COVID-19: A translational simulation approach.

COVID‐19 has posed major challenges for health care. Hospitals around the world have needed to rapidly prepare for the emerging pandemic. Translational simulation – simulation that is integrated and focused on emerging clinical priorities – offers numerous opportunities to aid in pandemic preparation. We describe our approach to preparing our institution’s maternity services for the COVID‐19 pandemic using translational simulation. We suggest lessons for providers of maternity services, and for those who support them through simulation activities.

Healthy weight services in England before, during and after pregnancy: a mixed methods approach

BackgroundMaternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle.MethodsA mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data.ResultsA total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas.Several themes were identified from qualitative data including “equity and variation in service provision”, “need for rigorous evaluation”, “facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, “barriers” encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and “the need for additional support”.ConclusionsThere is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

Declined use of cervical ripening balloon did not reduce the incidence of umbilical cord prolapse in Japan.

To clarify whether the incidence of umbilical cord prolapse (UCP) at delivery is related to the cervical ripening balloon (CRB). A postal questionnaire study was conducted in 2018 in institutions providing maternity services across Japan. Questions on the number of deliveries, labor inductions, used CRB and cases of UCP in 2017 were included. Because a similar questionnaire survey was conducted in 2012, the incidence of UCP and frequency of the use of CRB were compared. A total of 1354 answers were assessed (57% of all delivery institutions). The total number of deliveries was 490 279. Of these, 78% were transvaginal; 74 cases of UCP were reported (0.015%), while 13 cases were reported from obstetric facilities never using CRB (0.008%). The incidence of UCP (odds ratio [95% confidence interval]) was 0.036% in the intracervical type (4.3 [1.6-11.3]), 0.091% in the disk-type (11.0 [4.2-29.0]) and 0.067% in the ball-type (8.1 [2.8-22.8]). Frequencies of the use of CRB were 7.3% and 6.6% in the 2012 and 2018 surveys, respectively. The use of the intracervical type increased from 2.8% in the 2012 survey to 3.5% in the 2018 survey, while that of the disk-type and ball-type declined. However, the incidence of UCP was not different between the two surveys regardless of the use of cervical ripening balloons (0.014% vs 0.015% with CRB, 0.005% vs 0.008% without CRB). Although the frequency of CRB use significantly declined, the incidence of UCP did not significantly reduce in the last 5 years.

\u201cI cannot say no when a pregnant woman needs my support to get to the health centre\u201d: involvement of community health workers in Rwanda\u2019s maternal health

BackgroundIn Rwanda, maternal community health workers (M-CHWs) are involved in the country’s overall health system. In maternal health, their role includes the provision of preventive and promotional health services at the community level. They provide services such as health education on maternal health wellbeing, advice and information on access and timely utilization of health facilities for prenatal, delivery and postpartum care. The contribution of M-CHWs in the health sector combined with other government initiatives led the country to achieving the fifth Millennium Development Goal (MDG) - target 5A- that aimed to improve maternal health through the reduction of maternal mortality ratio by 75% between 1990 and 2015). The objective of this study was to explore M-CHWs’ perceptions and experiences on access and provision of maternal health services.MethodsWe used a case study methodology, a qualitative research approach to explore M-CHWs’ experiences and perceptions on access and provision of maternal health services at the community level in Rwanda. For the period of June–August 2014, in-depth interviews were conducted with sixteen M-CHWs who had been providing maternal health services in the Eastern Province of Rwanda. Participants shared their experiences and perceptions on access and provision of maternal health service in their communities.ResultsThe results of this research highlight the role of M-CHWs in promoting the use of health facilities for prenatal care and delivery and the ways they use to reach out to women. Several challenges prohibit M-CHWs to deliver adequate maternal health services and these are related to the poor resources settings in which they operate.ConclusionThe results of this study highlight the experiences and perceptions of M-CHWs on the provision and access to maternal health services in their communities. The fact that M-CHWs are volunteers operating in limited resources settings with no formal training in maternal health and with considerable workloads translates into challenges regarding the quality and quantity of services they provide in their communities. Such challenges create an impact on M-CHWs service provision, satisfaction and retention. The voices of M-CHWs and the communities they serve are needed to explore areas that are specific to each community context that would contribute to making the M-CHW program sustainable to achieve equitable access to maternal health services.

English

The study aim to determine the factors that make women deliver at home after attending antenatal care, to determine the awareness of women on risks associated with home delivery, to determine the type of birth attendants’ available during home delivery, and to explore the opinions of women on various strategies to prevent home delivery. A non- experimental cross-sectional design was used, with a target population of 960 people and systematic random sampling technique was employed to select the sample of 132 subjects out of the target population. Participation was voluntary and the principle of informed consent was ensured. Questionnaire was used as an instrument for data collection but only 121 were retrieved and analyzed, using SPSS Version 23. The findings of the study revealed that, women deliver at home due to cost of hospital services, male attendant during delivery, distance of the health facility from their home, poor attitude of health care provider and fear of surgical procedure. Also, according to the findings, the strategies of preventing home delivery includes provision of free maternal and child services, good health care provider attitude, health education on danger associated with home delivery, and adequate man power. In conclusion, majority of respondents were aware on factors that make them deliver at home. Recommendations were made that, health services should be subsidized and made available to women of child bearing ages and health education as well as improvement of community awareness on the importance of institutional delivery should be planned and implemented. Key words: Determinants, home-delivery, antenatal care.

Quality-Adjusted Coverage of Nutrition Interventions Across the Continuum of Care: Insights from Household and Health Facility Data in Bangladesh

Abstract Objectives Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjust crude health coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, across the continuum of care in Bangladesh. Methods We used data from Bangladesh Demographic and Health Surveys 2014 to assess use of maternal and child health services and Service Provision Assessments 2014 to determine facility readiness to deliver nutrition interventions during antenatal (ANC), institutional delivery, and postnatal care (PNC). Service readiness was computed as the mean availability of four nutrition-specific inputs, capturing human resources and training, equipment, diagnostics, and medicines. Crude coverage was combined with service readiness to create a measure of input-adjusted nutrition coverage at the national and regional levels, across place of residence, and by maternal educational and household socio-economic quintiles. Results Crude coverage varied, with greater use of any ANC (79%) and postnatal care (61–81%), than institutional delivery (37%). Nutrition service readiness was lower than crude coverage at each time point, such that nutrition input-adjusted coverage was 45% for ANC, 25% for institutional delivery, and 38–49% for preventive and sick child postnatal care, respectively. Input-adjusted coverage varied by 10–22 percentage points (pp) between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (12–17 pp between urban and rural areas, ∼17pp between low and high education, and 30–36pp between highest and lowest wealth quintiles), and less variable for postnatal care (<10%). Conclusions Nutrition input-adjusted coverage was suboptimal and varied sub-nationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals. Funding Sources Bill & Melinda Gates Foundation through A4NH.

SOCIAL DETERMINANTS OF HEALTH AFFECTING UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A NARRATIVE REVIEW

Despite improvements in maternal health, Sub-Saharan Africa countries still experience high maternal deaths. The provision of quality maternal health services has been adopted as a key strategy to reduce maternal mortality. However, low utilization rates and inequitable access to maternal health services across the region continue to hinder progress. The objective of the study was to synthesize evidence on the social determinants of maternal health services utilization in sub-Saharan Africa. A narrative review of peer-reviewed articles published between 2010 and 2019 was conducted. Peer-reviewed published studies were electronically searched from databases using search terms covering access and use, social determinants, maternal health services and sub-Sharan Africa. Data were qualitatively analyzed, and results summarized using the World Health Organization’s Social Determinants of Health Framework. A total of 36 studies were reviewed. The study identified several social determinants that act as barriers or facilitators to maternal health utilization. Factors identified include socioeconomic status, educational level, women’s autonomy, urban residence, gender norms, geographical proximity, access to media, high social capital, social support, exposure to media and functional health system. Maternal healthcare utilization is still low in sub-Saharan Africa and it reflects disparities according to socioeconomic status and rural/urban residence. Programs and interventions to improve maternal health should target social determinants that create inequalities in society.

Shift length and working practices in UK hospital settings: An online survey of heads of midwifery

ObjectiveThere is currently a lack of data that records how midwives are expected to work in hospital settings. The aim of this study was to determine the prevalence of 12-h shifts and current working practices of hospital-based midwives. DesignAn online survey conducted between December 2018 and March 2019. Descriptive data are summarised regionally and nationally. SettingNHS Trusts providing maternity services in hospital settings in the UK ParticipantsThe link to the survey was emailed to Heads of Midwifery in 155 NHS Trusts FindingsResponses were received from 94 of the 155 NHS Trusts (60.65%). Some responses included data for more than one hospital, so results are summarised for 97 hospitals. 12-h shifts were the most prevalent shift length, with only 4.1% of hospitals still routinely operating shorter shifts. 55% of hospitals limit the maximum number of consecutive shifts to three, but this can be influenced by different factors. More than half of midwives (55.67%) will be rostered to start a day shift within 24-h of finishing a night shift. 70% of hospitals do not currently record the number of midwives working beyond their contracted hours but 68% report formal methods of recording missed rest breaks. Regional differences were seen in the use of other personnel to support the midwifery workforce. ConclusionsShift schedules and the lack of formal methods to record the number of midwives working beyond their contracted hours may be a cause for concern due to the potential impact on recovery times. Further research is required to explore how working practices may affect midwives and their ability to provide care for women and their babies.