Maternal Services Research Articles

The cost of maternity and neonatal care in Aotearoa New Zealand: A cost analysis by plurality and gestation using a population-based cohort.

Maternity services in New Zealand are largely delivered by autonomously practising community midwives. This model of care is unique and may result in differences in the distribution of maternity healthcare utilisation and costs compared to other countries. New Zealand-specific cost data are needed to inform economic analyses, local policy and healthcare resource planning. To provide estimates of the average total cost of maternity and neonatal healthcare for New Zealand women and infants, including cost impacts of multiple and preterm births. A whole-of-population linked dataset, including 262 687 pregnancies resulting in a live birth (from 1 January 2016 to 30 June 2020), was created by combining several sources of healthcare data to calculate an average per-pregnancy cost of healthcare, taking a public health system perspective, during antenatal, intrapartum, and postnatal periods to one year after birth. The mean cost of public healthcare was NZ$19 795 for both maternal and infant care to one year post-birth. The bulk of this cost was incurred during pregnancy and birth. Mean total cost to one year was NZ$69 895 for twin and NZ$201 448 for higher order multiple compared to singleton pregnancies at NZ$19 098. Mean total healthcare cost decreased as gestation increased. Most of the costs associated with pregnancy and childbirth were incurred during the birth and in the early neonatal period. Costs were disproportionately higher for multiple and preterm births. These cost data can usefully inform policy and assist healthcare decision-making around reproductive and neonatal technologies.

ANALISIS KINERJA MANAJEMEN KONSTRUKSI PADA PROYEK PEMBANGUNAN GEDUNG PELAYANAN KESEHATAN IBU DAN ANAK RSUP PROF. DR. I GOESTINGOERAH GDE NGOERAH

Construction management is a field of study that focuses on the application of various managerial and innovative practices in the construction industry. It covers the principles of Planning, Organizing, Driving, and Controlling (POAC) to effectively manage construction projects and achieve desired results. The nature of construction work often presents potential challenges and obstacles that can impact the overall success of the project. Because of this, it is very necessary to implement construction project control measures, such as quality control, cost control, and time control, throughout the planning, organizing, driving, and process control stages. This research focuses on the Prof. Maternal and Child Health Services Building Construction Project. Dr. I Goesti Ngoerah Gde Ngoerah Hospital, highlighted the problem of adding a new floor which was not initially included in the detailed engineering design (DED). The main objective is to examine various factors that influence construction management performance in this project. This research uses a quantitative approach, utilizing Microsoft Excel software for analysis. Findings revealed that the Planning factor, with a mean value = 3.97, was the most significant factor influencing construction management performance in this particular project.

Indigenous Practices of Women during Pregnancy, Labour and Puerperium among Cultural Groupings at Selected Hospitals in Limpopo Province, South Africa

Indigenous practices are performances that occur naturally in a region. Most women believe in Indigenous practices because of their cultures and social structure. In South Africa, regardless of the availability and accessibility of maternal and child health services, 50% of women still consult traditional birth attendants as their first choice during pregnancy, labour, delivery and postnatal care. A qualitative research approach was applied with an explorative and descriptive design to explore the Indigenous practices of women during pregnancy, labour and puerperium among cultural groupings. Non-probability purposive sampling was used to select 25 participants and data was collected through semi-structured interviews with a guide until data saturation was reached. Data was analysed using tech’s open coding method. The study showed most women use Indigenous practices for protection against witchcraft and a fear of caesarean section. This study will help pregnant women to be aware of the harmful Indigenous practices that can affect their own health and that of their baby. It will also help nurses provide holistic nursing care, taking into consideration pregnant women’s cultures and beliefs. The study recommends that nursing education include Indigenous practices in the curriculum so that healthcare practitioners know about them. This could reduce maternal and child morbidity and mortality.

Geographic disparities and determinants of full utilization of the continuum of maternal and newborn healthcare services in rural India

BackgroundTo further reduce maternal and neonatal mortality, it is essential for mothers and newborns to fully utilize all essential services within the continuum of maternal and newborn care. However, research on maternal and child health services in India has not sufficiently examined geographical disparities in the full utilization of these services and the factors influencing the full utilization, particularly in rural areas. This study aims to address this critical gap.MethodsUtilizing data from 130,312 mothers collected in the National Family Health Survey-5 (2019–21), this study employed spatial analysis to uncover geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services in rural India. Additionally, binary logistic regression was used to identify the factors associated with this utilization.ResultsIn rural India, 54.3% mothers recieved four or more antenatal care visits, 88.6% received skilled birth attendance, and 75.5% of mothers and 79.8% of newborns received postnatal care within 48 hours of birth. However, only 43.5% mothers-newborn dyads in rural India utilized all four services of the continuum of maternal and newborn healthcare. There were significant geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services. Hotspots were primarily identified in districts of southern states, western Maharashtra, and central Odisha, while cold spots were evident in the northeastern states of Arunachal Pradesh, Meghalaya, Assam, and Nagaland, as well as in the Empowered Action Group states of Bihar, Uttar Pradesh, and Jharkhand. Key determinants influencing the full utilization of the continuum of care in rural India included maternal education, household wealth, parity, health insurance coverage, and exposure to mass media. Specifically, the odds of fully utilizing the continuum of care were significantly lower among women without formal education (adjusted odds ratio = 0.60, 95% CI = 0.56–0.65), those from the poorest wealth quintile (0.65, 0.61–0.69), and mothers with six or more children (0.42, 0.37–0.47), compared to mothers with higher education, those in the richest wealth quintile, and mothers with a single child, respectively. Additionally, mothers from the southern region were more than twice as likely (2.11, 1.99–2.20) to fully utilize the continuum of healthcare services compared to mothers from the northern region.ConclusionThe significant geographical disparities in the full utilization of maternal and newborn healthcare services in rural India highlight the necessity for tailored, region-specific interventions. Future programs should focus on addressing the barriers to care by prioritizing vulnerable groups, including those who are poor, uninsured, less educated, adolescents, and women with high parity.

Evidence from maternal healthcare services in South Asia: Demography vs. healthcare

ABSTRACT The maternal mortality ratio (MMR) remains alarmingly high in South Asian countries. However, maternal healthcare service utilization (MHCSU) can significantly reduce maternal mortality and morbidity, while improving child health. Therefore, this study identifies the socio-economic and demographic factors influencing MHCSU in Afghanistan, Bangladesh, India, Maldives, Nepal and Pakistan, using data from the Demographic and Health Survey (DHS). Women who were mature (35–49 years) at the time of childbirth were more likely to receive adequate antenatal care (ANC) in Pakistan and postnatal care (PNC) in Afghanistan. Additionally, women who were educated, working, belonged to wealthier households, were aware of family planning, and had mass media exposure had higher odds of receiving MHCSU in South Asia, except in Afghanistan, where listening to the radio reduced the odds of receiving standard ANC and PNC. Notably, working mothers had lower odds of receiving ANC in Afghanistan and delivery care in Bangladesh. Additionally, women with higher childbirth orders and those lacking decision-making autonomy were less likely to receive MHCSU. A woman whose husband was educated and mature at the time of childbirth was more likely to avail MHCSU. Based on our findings, policymakers should focus on regular health education, financial incentives, adolescent-friendly health services, and enhanced e-health communication to promote MHCSU in South Asia and thereby improve maternal and child health in the region.

Intrapartum maternal risks of group B streptococcus carriage in premature rupture of membranes

BACKGROUND: Group B streptococcal infection remains the epicenter of attention for maternal and child health services around the world. Premature rupture of membranes requires adaptation of obstetric tactics and intrapartum antibiotic prophylaxis. AIM: The aim of this study was to identify maternal intrapartum risks of group B streptococcus colonization of the birth canal and the lack of antepartum screening for group B streptococcus in cases of premature rupture of membranes in full-term pregnancy. MATERIALS AND METHODS: This retrospective cohort study was conducted in the Perinatal Center of City Clinical Hospital No. 31 named after Academician G.M. Savelyeva (Moscow, Russia) in 2023–2024. We selected women with premature rupture of membranes at full-term pregnancy, whose birth canals were subsequently divided into those colonized by group B streptococcus and those not colonized and who underwent antenatal group B streptococcus screening at 35–37 weeks of pregnancy or not. In the absence of group B streptococcus screening upon admission to the hospital, vaginal discharge was collected and sent off for bacteriological testing. Two tactics for labor management were selected: expectant, and active. Intrapartum antibiotic prophylaxis was performed in case of group B streptococcus isolation during screening. RESULTS: With premature rupture of membranes in full-term pregnancy, only 57.14% of group B streptococcus carriers have prenatal group B streptococcus screening; therefore, in 42.86% of group B streptococcus carriers, intrapartum antibiotic prophylaxis was delayed by 18 hours. Group B streptococcus carriage is not associated with the gestational age of premature rupture of membranes, but has intrapartum features such as a trend of younger age (less than 30 years) and attendance at the hospital earlier than six hours after premature rupture of membranes with the opportunity for induction or effective pre-induction of labor with a single dose of an antigestagen (in more than 70% of women). These women had a blood leukocyte count of ≥12.5 × 109/l and higher C-reactive protein levels. They were most often delivered by cesarean section, with characteristic indications for chorioamnionitis and fetal distress. The absence of prenatal group B streptococcus screening distinguishes the age of women under 30 years old, the threshold C-reactive protein level being 19.5 g/l, with a tendency towards a less frequent spontaneous onset of labor and a higher frequency of its induction, hypotonic hemorrhage, and chorioamnionitis. CONCLUSIONS: There are intrapartum maternal risks of group B streptococcus carriage and the presence of group B streptococcus screening, which are conditionally controlled in the Moscow. Intrapartum antibiotic prophylaxis and the metropolis resource “equalize” the outcome of births in cases of group B streptococcus carriage and absence, with the presence and absence of group B streptococcus screening. Modern medicine allows for minimizing the risks of chorioamnionitis and hypotonic hemorrhage in group B streptococcus carriers after premature rupture of membranes, even in the absence of group B streptococcus screening in more than half of women or deferment of intrapartum antibiotic prophylaxis for 18 hours.

The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

BackgroundAn effective strategy to reduce perinatal mortality requires an active surveillance system. This includes monitoring cases, organizing multidisciplinary local audits, conducting Confidential Enquiries, identifying avoidable factors, and facilitating changes in the healthcare system. In 2017, the Italian Obstetric Surveillance System launched the SPItOSS pilot Perinatal Surveillance System. The aim of this paper is to describe the results of the SPItOSS Confidential Enquiries on perinatal deaths focusing on the emergent critical aspects in obstetric and neonatal care, as well as on the healthcare facilities organization.MethodsSPItOSS, a population-based surveillance system, collected and analysed incident perinatal deaths from July 2017 to June 2019 in three Regions encompassing 32.3% of Italian births. Cases were defined according to WHO definition as fetuses born dead ≥ 28 weeks of gestation and live newborn died within 7 days from birth. The International Statistical Classification of Diseases and related Health Problem-Perinatal Mortality was adopted for coding causes of death and contributing maternal and placenta-related conditions. Confidential Enquiries, prioritized according to perinatal deaths preventability, were conducted by expert committees at Regional and National level.ResultsA total of 830 incident perinatal deaths were notified, with 58.3% classified as antepartum, 4.3% as intrapartum, and 37.3% as neonatal deaths. According to the SPItOSS protocol, Confidential Enquiries evaluated only the most preventable deaths, including 19 intrapartum and 70 neonatal deaths. Of these, 43.8% were assessed as unavoidable with appropriate care; 29.2% as unavoidable with improvable care, and 15.7% as avoidable due to inappropriate care. Most intrapartum deaths were attributed to intrauterine hypoxia, while neonatal deaths recognized a multifactorial aetiology. Different aspects of inappropriate care were highlighted, such as failure to recognise maternal or fetal problems before labour, delayed or inappropriate neonatal resuscitation, and poor or suboptimal neonatal monitoring.ConclusionsThe SPItOSS Confidential Enquires provided insights for improving maternity and perinatal services. By targeting key areas of obstetric and neonatal care, the surveillance can generate recommendations and actions to prevent avoidable perinatal deaths.

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

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

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review.

Mathematical modelling is a commonly utilised tool to predict the impact of policy on health outcomes globally. Given the persistently high levels of maternal and perinatal morbidity and mortality in sub-Saharan Africa, mathematical modelling is a potentially valuable tool to guide strategic planning for health and improve outcomes. The aim of this scoping review was to explore the characteristics of mathematical models and modelling studies evaluating the impact of maternal and/or perinatal healthcare interventions or services on health-related outcomes in the region. A search across three databases was conducted on 2nd November 2023 which returned 8660 potentially relevant studies, from which 60 were included in the final review. Characteristics of these studies, the interventions which were evaluated, the models utilised, and the analyses conducted were extracted and summarised. Findings suggest that the popularity of modelling within this field is increasing over time with most studies published after 2015 and that population-based, deterministic, linear models were most frequently utilised, with the Lives Saved Tool being applied in over half of the reviewed studies (n = 34, 57%). Much less frequently (n = 6) models utilising system-thinking approaches, such as individual-based modelling or systems dynamics modelling, were developed and applied. Models were most applied to estimate the impact of interventions or services on maternal mortality (n = 34, 57%) or neonatal mortality outcomes (n = 39, 65%) with maternal morbidity (n = 4, 7%) and neonatal morbidity (n = 6, 10%) outcomes and stillbirth reported on much less often (n = 14, 23%). Going forward, given that healthcare delivery systems have long been identified as complex adaptive systems, modellers may consider the advantages of applying systems-thinking approaches to evaluate the impact of maternal and perinatal health policy. Such approaches allow for a more realistic and explicit representation of the systems- and individual- level factors which impact the effectiveness of interventions delivered within health systems.

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

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

Service availability and readiness to provide maternal and newborn healthcare services in Kilimanjaro region, Tanzania: a cross sectional study

ObjectiveTo assess service availability and readiness of health facilities to provide maternal and newborn care in the Kilimanjaro region, northern Tanzania: a study conducted between August to October 2022.DesignThe study...

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

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

L’accompagnement de la relation mère-enfant lors d’un déni de grossesse total: point de vue des sages-femmes

Objectives: Total pregnancy denial is a phenomenon where the woman does not recognize her pregnancy until a late stage, sometimes just before childbirth. These complex situations raise many questions about the support of the mother-child dyad. This qualitative study aims to describe the experiences and strategies of midwives when dealing with cases of total pregnancy denial, as well as the relational dynamics within these particular dyads, in order to identify avenues for appropriate care.Methodology: Eight semi-structured interviews were conducted with midwives practicing in Île-de-France (hospital, private practice, home hospitalization, and maternal and child protection services). The data were analyzed using grounded theory with the help of the Quirkos software.Results: The midwives' experiences show that the mother-child relationship evolves favorably in most cases, even in anonymous childbirth situations. The results are organized into several themes: the description of the mother-child relationship, the proposed care approaches, and the midwives' experiences. For the first theme, five sub-themes emerged: maternal investment, psychological ambivalence, childbirth circumstances, the influence of the social environment, and maternal guilt. The second theme highlights the importance of multidisciplinary and personalized support, respecting the pace of the dyad.Conclusion: This study emphasizes the importance of not stigmatizing women in total pregnancy denial when establishing the mother-child bond. A personalized and gradual care approach, based on empathetic, non-judgmental, and multidisciplinary support, fosters the mother-child bond.

Acute confusion in pregnancy

If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. Useful resources are available to support assessing pregnant women that present acutely, however confusion is beyond them. This article discusses important aspects to consider when assessing pregnant women and places emphasis on a systematic approach to ensure obstetric and non-obstetric causes of confusion have been considered. Certain life-threatening diagnosis’ have been further discussed in more detail (Wernicke's encephalopathy, hyponatreamia, hypercalcamia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.

Impact of the COVID-19 lockdown on the O'Sullivan test and gestational diabetes mellitus diagnosis in pregnant Spanish women

ObjectiveTo analyze the impact of COVID-19 lockdown on serum glucose levels of pregnant women. DesignA retrospective analysis of O'Sullivan test in pregnant women who underwent COVID-19 lockdown compared to controls. SitePoniente Primary Health Care center in Córdoba (Spain). Participants235 pregnant women from 23+0 to 25+0 weeks of gestation without diabetes mellitus. InterventionsGestational diabetes mellitus screening with O'Sullivan test and 3-h oral glucose tolerance test. Main measurementsPregnant women who underwent gestational diabetes mellitus screening with O'Sullivan test before (control group) and during COVID-19 Lockdown (Lockdown group) in Córdoba (Spain) were investigated. Lockdown group was divided in early and late lockdown. An additional, control group from data of the same months of the Lockdown in the previous year were recorded to discarded seasonally (adjusted seasonally control) this group was also divided in early and late seasonally adjusted.A logistic regression model for O'Sullivan test has been performed to analyze potential cofounders. Kolgomorov–Smirnov and Kruskal–Wallis test comparing pregnant women who underwent COVID-19 lockdown with the two types of controls. ResultsStatistically significant differences were found in serum glucose after O'Sullivan test between lockdown group and control group (123.51±26.02mg/dL and 112.86±31.28mg/dL; p=0.017). When early lockdown group and control group were compared no differences were found (119.64±26.18mg/dL vs. 112.86±31.28mg/dL; p>0.05) whereas differences were observed in late lockdown group and control group (127.22±25.59mg/dL vs. 112.86±31.28mg/dL; p=0.009). Statistical trends were also found between lockdown group and seasonally adjusted group and between lockdown and late seasonally adjusted group (p=0.089). A higher proportion of positive O'Suvillan pregnant women who were subsequently diagnosed with GDM were found in lockdown group compared to the seasonally adjusted control group (60% vs. 26.06% respectively; p<0.05). ConclusionsThe COVID-19 lockdown was associated with an increase in serum glucose levels after the O'Sullivan test as well as a higher GDM diagnosis risk in pregnant women. The findings of our study emphasize the essential requirement for comprehensive maternal services and the accessibility to community's health assets during future lockdown scenarios to pregnant women.

Vaccine effectiveness against mild and severe covid-19 in pregnant individuals and their infants in England: test negative case-control study

ObjectiveTo estimate real world vaccine effectiveness against symptomatic disease and hospital admission with the delta and omicron variants of the SARS-CoV-2 virus in pregnant individuals, and to estimate the protection...

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

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

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

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

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

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

Exploring Midwives’ Roles on Managing Perinatal Mental Health: Insights into Scientific Perspective on Care Practices and Psychosocial Support

Perinatal Mental Health is prominent for the well-being of the mother and child, so consideration provides effective support and care for women in the perinatal period given by Midwives can be helped. The study aimed to synthesize primary research on midwives’ experiences of caring for women who experience perinatal mental health and well-being. Using mixed methods systematically combined with quantitative and qualitative studies. This study analys was searched on three databases, ProQuest, Pubmed, and ScienceDirect, from 2021 to 2024. The population in this study were midwives who experienced PMH in the care of pregnant. Critical Appraisal Skills Programs (CASP) were used to determine the study’s methodological quality. By contrast, the synthesis method uses the modified PEOS method. Data extraction, quality assessment, and thematic analysis were conducted using PRISMA-P guidelines. 2926 records were returned, with 10 articles meeting inclusion criteria. Participants included midwives. The findings indicate that there is a need for a sustainable development program for midwives to increase knowledge, attitudes, communication, collaboration, and assessment skills for pregnant women who experience PMH by a scientific perspective. All maternity services must provide specific services to assess and identify Perinatal Mental Health problems. Indeed, the emotional well-being of pregnant women is the goal of debriefing midwives.