Postnatal Check-up Research Articles

Determinants of suboptimal breastfeeding in Haryana - An analysis of national family health survey-4 data.

Infant and child feeding practices are a prevalent challenge in Haryana. The present study aimed to determine factors associated with non-initiation of breastfeeding within 1 h of birth, no exclusive breastfeeding (EBF) and no continued breastfeeding in Haryana. National Family Health Survey-4 data for the state of Haryana was used for analysis. The outcomes were non-initiation of breastfeeding within 1 h of birth, no EBF, and no continued breastfeeding. Independent variables were categorized as sociodemographic, maternal, and child level factors. Each category of factors was added step-by-step to the logistic regression model for multivariable analysis. Delayed initiation of breastfeeding was higher among poorer wealth quintiles. Home deliveries (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI]-1.27-2.84), cesarean section (AOR = 2.22, 95% CI-1.46-3.40), body mass index (BMI) >25 kg/m2 (AOR = 1.62, 95% CI-1.13-2.33), and not receiving postnatal check-up (AOR 1.36, 95% CI-1.40-1.78) increases likelihood of delayed initiation of breastfeeding beyond 1 h of birth. Increased risk of non-EBF was associated with no postnatal check-ups and BMI >25 kg/m2. Risk of discontinuation of breastfeeding was significantly high with birth interval of <2 years (AOR = 1.52, 95% CI-1.08-2.14) and if babies did not receive postnatal check-up (AOR = 1.54, 95% CI-1.04-2.27). The study highlighted need for focused approach to counsel overweight/obese mothers, cesarean section, and home delivered mothers. Community awareness, adequate birth spacing, and postnatal visits are vital for improving exclusive and continued breastfeeding practices. Communities and health-care providers should provide adequate support to mothers for breastfeeding during the antenatal and postnatal periods.

Dietary Diversity among Children Aged 6-23 Months in Aleta Wondo District, Southern Ethiopia.

Background Dietary diversity (DD) is among the core infant and young child feeding (IYCF) indicators. However, in many developing countries, meeting the minimum standards of DD is challenging and information concerning its determinants is limited. Objective To assess the level and predictors of DD among children aged 6–23 months in rural communities of Aleta Wondo district, Sidama zone, Southern Ethiopia. Method A community-based cross-sectional study was conducted in rural Aleta Wondo in February 2016. Multistage sampling was employed to recruit 502 children aged 6–23 months. DD was assessed by asking the mother whether the index child had received food from the standard seven food groups in the previous day, without setting minimum intake restrictions. Ultimately, the dietary diversity score (DDS) was rated on a 7-point scale, and it was modeled using linear regression analysis. The outputs are presented using adjusted regression coefficients (β). Results Only 12.0% (95% confidence interval: 9.0–15.0%) of the children met the minimum recommended DD, receiving from four or more from seven food groups. The analysis identified eleven significant predictors of DDS. As the maternal knowledge of IYCF increases by a unit, DDS raised by 0.21 units (p = 0.004). Unit increment in the husband's involvement in the IYCF score was linked with 0.32 units improvement in DDS (p = 0.016). One unit change in the ordinal category of household food insecurity was associated with 0.13 reduction in DDS (p = 0.001). Similarly, household wealth index (β = 0.54, p = 0.041), father's literacy (β = 0.48, p = 0.002), ownership of home garden (β = 0.38, p = 0.01), mother's participation in cooking demonstrations (β = 0.19, p = 0.036), and child age in months (β = 0.04, p = 0.001) were all positively associated with DDS. Furthermore, receiving IYCF information via mass media (β = 0.04, p = 0.001) and during antenatal (β = 0.91, p = 0.022) and postnatal checkups (β = 0.21, p = 0.043) were positive predictors of DDS. Conclusions Promoting the socioeconomic status of the community, strengthening of home gardening, involving husbands in IYCF, and enhancing maternal knowledge of IYCF may advance DD.

An assessment of utilization of postnatal care services in urban area Jabalpur district

Background: Postnatal period is a vulnerable time, because most maternal and new born deaths occur during this period, especially immediately after childbirth. Postnatal care in the first hours and days after childbirth could prevent the great majority of these deaths. The objective of study was to assess the utilization of post-natal care and associated factors for low utilization in urban area of Jabalpur district.Methods: A community based cross-sectional study was carried 360 mothers who delivered in last one year in urban area of Jabalpur district. Sampling method was multistage sampling method. A total 36 wards with 10 mothers from each ward was selected. The questionnaire included information related to mode of delivery, post-natal checkups and visits of health care providers.Results: Among 360 mothers, 93.9% mothers received first postnatal check-up within 24 hrs. 1.11% of mothers between 2-3 days and 1.67% of mothers received first postnatal check-up between 4-7 days while 3.33% of mothers didn’t receive any postnatal check-up. Regarding number of post-natal visits, 58.33% mothers received 3 or more postnatal visits, 35% of mother received 2 PNC visits, while 3.3% did not receive a single postnatal visit. The education of mothers, joint type of family, high socioeconomic status, early registration of pregnancy, minimum 4 ANC visits and institutional deliveries were found significantly associated with utilization of postnatal check-up.Conclusions: Utilization of postnatal services is still poor in the urban areas even though the physical accessibility was adequate. In the present study, it was concluded that the role of education, especially of female education, is important contributing factor associated with utilization of postnatal care.

A study protocol for an mHealth, multi-centre randomized control trial to promote use of postpartum contraception amongst rural women in Punjab, Pakistan

BackgroundProvision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling.MethodsA three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15–44 years who are in their first or second trimester and have a mobile phone for their own use will be eligible to participate in this study. The participants will be randomly allocated to one of three study arms: a) voice and text messages; b) interactive telephone-based counselling; or c) control arm (no additional phone-based support). The intervention counselling module will be developed based on the Integrated Behaviour Model which was recently adapted, and tested for the family planning context in Pakistan. It will broadly cover birth-preparedness, importance of birth spacing, and postnatal care. The phone-based intervention aims to improve women’s ability to use contraception by providing them with information about a range of methods, access to family planning methods through outlets such as Suraj SF providers, connecting them with MSS field health educators to help them reach the centres, motivation by re-enforcing the benefits of contraceptive use on women’s quality of life, and dispelling myths and misconceptions about modern contraceptive methods. Risk differences will be used as the measure of effect of the intervention on the outcomes.DiscussionThe study findings will highlight effectiveness of mobile phone in raising awareness of maternal health and contraception, which in turn, is expected to be translated into increased proportion of: at least four antenatal visits, skilled birth or institutional delivery, postpartum contraceptive use, postnatal check-up, child immunization, and breastfeeding. Moreover, if the text and voice messages approach is proven to be non-inferior to interactive calls, it will provide evidence to making promotion of healthcare less resource intensive, and thereby contribute in improving the efficiency of the healthcare system.Trial registrationThis trial was prospectively registered with the Clinical Trials registry (NCT03612518) on August 2nd, 2018.

More than credit: Exploring associations between microcredit programs and maternal and reproductive health service utilization in India.

Microcredit programs are increasingly popular interventions aimed at enabling women's economic empowerment in low- and middle-income countries. Resultant improved income, and social support from co-members of microcredit programs, may lead to increased utilization of health services. But existing research is inconclusive. This study investigates the association of microcredit program awareness and participation, with maternal and postpartum reproductive health service utilization in India. We use data from a nationally representative survey, the National Family Health Survey (2015–16), and assess three indicators of maternal health service utilization: receipt of four or more antenatal check-ups, institutional delivery, and postnatal check-up among women who had a child less than 5 years of age (N = 32,880). Reproductive health service utilization is assessed via postpartum contraceptive use within 12 months of childbirth, among women who had a live birth in the 12–59 months preceding the survey (N = 24,258). We use binomial and multinomial logistic regression models to examine associations. Additionally, we use propensity score matching to account for self-selection bias. One-third of women are aware of microcredit programs in their community/village, but only 6% have ever taken a loan from these programs. Both microcredit program awareness and participation are associated with higher odds of antenatal care, postnatal check-ups, as well as use of a modern method of contraceptive within 12 months of childbirth, even after accounting for self-selection bias. Stratified analysis by household wealth show that significant associations seen in our primary analyses are significant only for the poorest women. Findings highlight the potential value of microcredit programs in improving health service utilization during and after pregnancy, particularly among poor women. Microcredit program benefits extend beyond their participants. Non-participants living close to the programs also have greater odds of maternal and reproductive health service utilization, suggesting a spillover effect of these programs at the community level.

Modern contraceptive use and intention to use: implication for under-five mortality in Ethiopia

ObjectiveHigh under-five mortality has been identified as a major problem in many developing countries including Ethiopia. The main purpose of this study is to examine the effect of modern contraceptive use on under-five mortality in Ethiopia. MethodsThe study draws on data from the 2011 and 2016 Ethiopia Demographic and Health Surveys. The Kaplan-Meier survival function was used to demonstrate the survival probabilities of children while a multivariate analysis using the Cox proportional hazards model was used to estimate the under-five mortality risks for various predictors. ResultsThe results show consistently higher survival probabilities for children of mothers who use modern contraceptives for all survival periods. Significant predictors of under-five mortality include modern contraceptive use, tetanus vaccinations, mother's age, child's sex, parity, postnatal checkup, marital status, and source of drinking water. ConclusionModern contraceptive use has a notable implication for the chances of under-five survival in Ethiopia. This underscores the importance of modern contraceptive use in the pursuit of a substantial reduction in under-five mortality in the country.

Mothers´ experiences in relation to a new Swedish postnatal home-based model of midwifery care–A cross-sectional study

BackgroundThe goal of postnatal care is to provide the highest possible quality of care and medical safety with the least possible intervention in order to optimize health and wellbeing of the new family. The aim of the study was to describe mothers´ experiences in relation to a new postnatal home-based model of midwifery care. MethodsThe current study uses a cross-sectional mixed method design to assess a new postnatal home-based model of midwifery care in Sweden. Healthy women with an uncomplicated pregnancy and childbirth, and with a healthy baby answered an online questionnaire one week after birth. Data were collected during one year (2017–2018) and analyzed using descriptive and inferential statistics for quantitative data, and manifest content analysis for qualitative data. FindingsIn total, 180 mothers with one to six children were included. They were most likely to have been discharged between six and 12 h after childbirth (56%) and 90% reported that the time for their discharge was good. The postnatal check-ups included were telephone contact (100%), home visit(s) (94%) and hospital visit(s) (98%). Most mothers had a positive postnatal care experience from using the new postnatal model of midwifery care (mean VAS 8.74, Std. Deviation 1.438). For 75%, of the participants, home-based postnatal care would be preferred for their next childbirth. ConclusionHome-based postnatal care is well accepted by mothers who were discharged early after childbirth. Mothers with a positive experience of the new postnatal model of midwifery care would prefer home-based postnatal care for their next childbirth. Midwifery care should include home-based postnatal care.

Pantawid Pamilyang Pilipino Programı Nakit Teşvik Uygulamasının Kent Merkezinde Yaşayan Ailelerin Sağlık Hizmetlerine, Okul Ve Aile Gelişimi Temelli Yapılan Görüşmelere Ulaşabilmesinin Etkileri

Aim: The study determined the effects of the cash incentive implementation of Pantawid Pamilyang Pilipino Program in terms of family attendance to health consultations, school and family development sessions in an urban community. Methods: A cross-sectional study was conducted among Pantawid Pamilyang Pilipino Program Filipino families with a total sample size of 124. An assisted interview was done and the data were analyzed using Stata 14. Results: Among 124 respondents, seventy percent were housewives, 35 finished secondary education with median income of 400 pesos ($7) daily. Out of 381 pregnancies, there were 342 and 39 pregnancies before and after implementation. All pre and post-natal check-ups attended by a physician. Childbirth were in secondary and tertiary health care facilities. Preventive health check-ups for children were reported only in 45 children aged zero to five years old. Deworming were received twice a year by 261/264 children 6-14 years old. There were 96% enrolled in school for the academic year 2018-2019 and 92% receive elementary education. Family development sessions included topics of wide variety. Conclusion: Overall, the Pantawid Pamilyang Pilipino Program beneficiaries were compliant with conditionalities of the cash transfers. Mothers were seen and giving birth in health care facilities while children are receiving preventive medical care and education. Keywords: preventive health services, health promotion, cash incentive plans, Pantawid Pamilyang Pilipino Program, Philippines

A DESCRIPTIVE CROSS-SECTIONAL STUDY OF BREAST FEEDING PRACTICE

Background: Breastfeeding practices play an important role in reducing child mortality and morbidity.&#x0D; Methods: The cross sectional study was conducted on mothers with infants less than 1 year who came to immunization center for vaccination was included in the study. Total 500 mothers include in this study.&#x0D; RESULTS: Only 36% of the mothers did the exclusive breastfeeding until 6 months and started weaning after 6 months. A total 59%of mothers in our study prematurely started weaning.&#x0D; Conclusions: The study emphasizes the need for breastfeeding intervention programs especially for the mothers during antenatal and postnatal check-ups. The information regarding the advantage and duration of breastfeeding need to be provided for the community as a whole.&#x0D; Keywords: Immunization, Infants, Mothers.

Factors Associated with Delayed Initiation of Breastfeeding Among Hospital Deliveries: Secondary Analysis of Bangladesh Demographic and Health Survey 2014 (P18-107-19)

ObjectivesThis study investigates the factors associated with delayed initiation of breastfeeding among hospital deliveries in Bangladesh, where only 50% women initiate breastfeeding within the 1st hour of birth and the rate is lower among deliveries at a health facility (38%). Early initiation of breastfeeding is crucial in improving maternal and newborn health outcomes. MethodsWe used data from the 2014 Bangladesh demographic and health survey. A total of 1277 last-born children born at a health facility in the 2 years preceding the survey were included in this analysis. ‘Early’ breastfeeding was defined using WHO recommendations as initiating within 1st hour of birth. Univariate and multivariable logistic regression were performed to determine factors associated with delayed initiation. ResultsAbout three-fifth (n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond the first hour. After adjusting for potential confounders, delayed initiation was found to be more common among caesarean deliveries (aOR 3.31; 95%CI 2.38–4.61), delivery by medically un-trained personnel (aOR 1.57; 95%CI 1.02–2.42), delay in first postnatal check-up after birth (aOR 1.61; 95%CI 1.17–2.21), and women exposed to media less than once a week (aOR 1.57; 95%CI 1.09–2.26). Women with higher body mass index had an increased likelihood of delaying initiation (aOR 1.05; 95%CI 1.01–1.10). Multiparous women were less likely to delay initiation (aOR 0.72; 95%CI 0.53–0.98). ConclusionsDelayed initiation following caesarean deliveries continues to be a challenge but several other health facility factors and maternal characteristics also contributed to delayed initiation of BF. Interventions to promote early breastfeeding initiation should include strengthening the capacity of healthcare providers to encourage early initiation especially for caesarean deliveries. Funding SourcesEndeavour Postgraduate Scholarship. Supporting Tables, Images and/or Graphs▪

Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: results from a qualitative study

BackgroundRecently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS.MethodsA qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software.ResultsA total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants’ acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS.ConclusionsThis qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS.

Breastfeeding performance in Afar regional state, northeastern Ethiopia: a cross sectional study

BackgroundIn Ethiopia fewer than 20% of infants aged less than six months are appropriately fed. This study aimed to identify predictors of poor breastfeeding performance among mother-infant pairs in Samara-Logia city administration, Afar Regional State, Ethiopia.MethodsFive hundred and seventy six mothers of infants aged less than six months were recruited to participate in face-to-face structured interviews at their home. Infant feeding practices were measured by breastfeeding performance index (BPI). Infants who scored 0–3 BPI were classified as achieving ‘Low BPI’, 4–5 as ‘Medium BPI’, and 6–7 scores as ‘High BPI’. A pre-tested instrument was used to assess demographic characteristics of mothers and their experiences of infant feeding. EpiData version 3.02 was used to enter, clean and code the data. Then, data were analyzed using SPSS version 20.ResultsFive hundred thirty six (93.1%) of the study mothers had ever breastfed their infants. About 83% [95% CI: 80.0, 86.0%] of infants had achieved low or medium BPI scores. Being older than 34 years [AOR: 4.55; 95% CI (1.33, 15.73)], having an infant aged 4–5 months [AOR: 2.49; 95% CI (1.08, 5.76)], giving birth at home [AOR: 4.25; 95% CI (1.37, 13.23)] or by caesarean section [AOR: 8.00; 95% CI (2.78, 23.09)] and receiving advice on proper infant feeding practices at postnatal checkup [AOR:0.28; 95% CI (0.13,0.59)] were independent predictors of low/medium BPI scores.ConclusionThis study revealed that nearly eight in ten infants aged less than six months achieved low/medium BPI scores. Being older than 34 years, having an infant aged 4–5 months, giving birth at home or by caesarean section and lack of advice on proper infant feeding practices were associated with higher odds of low/medium BPI scores.

Public health nurse services for maternal-child immigrant healthcare: a literature review

Aim: To examine the impact of the complexity of regulations and restrictive policies on the accessibility of healthcare services for immigrants, particularly maternal and child healthcare. Public health nurses can facilitate management of healthcare services for immigrants in the community by preventing mortality and morbidity among the immigrant population. This literature review was used to identify the challenges faced by public health nurses in providing maternal-child immigrant healthcare. Design: A literature review. Methods: Relevant healthcare databases including PubMed, CINAHL, Scopus, and Google Scholar were searched using the following combination of search terms: public health nurses, maternal care, child care, and immigrants. Results: Six articles were included in the review. Immigrants (undocumented immigrant families in particular) have limited access to public healthcare services, due to factors such as: socio-demographics; language barriers; cultural differences; the status of unregistered families; psychological distress; and problems with health insurance. Public health nurses deliver health education, maternal and postnatal check-ups, and vaccination through community and/or home-based service programs. The role of immigrant health volunteers is facilitated by the partnership between public health nurses and the immigrant population in providing comprehensive maternal and child healthcare in the community. Conclusion: There are barriers that currently impact on the development of public health nurses' provision of maternal and child healthcare services to immigrants. Strategies that can be implemented to improve public health nurse competencies in maternal and child healthcare of immigrants include bicultural or bilingual training, and cultural competencies in visit programs.

Mobile Phone Messaging to Husbands to Improve Maternal and Child Health Behavior in India

Over 90% of households in rural Uttar Pradesh, the most populous state of India, have at least one mobile phone. However, ownership of mobile phone among women is quite low. Implementation research was conducted in Uttar Pradesh to examine (a) whether providing information on selected maternal and child health (MCH) behaviors to a husband’s mobile phone would enhance the man’s knowledge and lead to discussions in their family, and (b) whether such discussions would help in the adoption of healthy practices. The m-Health intervention included biweekly voice messages in local language (Hindi) on MCH topics to the mobile phone of pregnant women’s husbands. Using a quasi-experimental design, after four months of the m-Health intervention, in 2014, 881 husbands and 956 women from the study area were interviewed. Husbands’ knowledge, controlling for their socio-demographic characteristics, were significantly higher among the listeners of the messages than the non-listeners. Multivariate logistic regression analysis showed that if husbands discussed the messages with family members, the odds of wives’ practicing health behaviors improved significantly for three behaviors. These include one antenatal checkup in last trimester of pregnancy (odds ratio 1.72, p < 0.05), receiving a postnatal checkup within 7 days of delivery (odds ratio 3.02, p < 0.05), and delayed bathing of newborn (odds ratio 1.93, p < 0.05). Thus, communicating messages using m-Health was found to be an effective intervention for behavior change. The study demonstrated that mobile phones can be used effectively to reach men with MCH information and encourage them to promote healthy behavior in their family.

A Study to Assess the Program Management Factors, Services and Level of Performance of Reproductive Maternal Newborn Child Health and Adolescent plus Program (RMNCH+A) in Selected Block Primary Health Centers and Rural Hospitals of 24 Parganas (North), West Bengal

Introduction: A descriptive survey was done on assessment of the program management factors, services and level of performance of Reproductive Maternal Newborn Child Health and Adolescent Plus Program (RMNCH+A) at selected block primary health centers and rural hospitals in North 24 Parganas, West Bengal. The conceptual framework was based on the Chen’ Program Theory for program evaluation. Methods: The sample under the study consisted of eleven block primary health centers and rural hospitals of North 24 Parganas, West Bengal. A validated and reliable tool was used to collect data, e.g., the background data and data on the program management factor in terms of adequacy of human resources and their training status was collected by an interview schedule through interviewing health service providers, data on the program management factor in terms of infrastructural facilities, equipment, drugs, record maintenance and services of RMNCH+A Program was collected by observation checklist through observation by the investigator, and data on performance of services and referrals by block primary health centers and rural hospitals was collected by means of record analysis by Record Analysis Proforma. Results: The result showed that most of the community health centers are block primary health centers (64%). There are shortfalls in human resources like general duty medical officers (24.68%), obstetricians and pediatricians (90.90%), surgeons (100%), staff nurses (29.13%), laboratory technicians (42.86%), pharmacists AYUSH (47.82%), drivers (66.67%), GDA (51.25%). Lowest training of medical officers is found in CEmOC, F-IMNCI, LSAS (2.70%) and of nurses in RBSK (2.58%). Major non-availability of infrastructural facilities is separate ANC ward (45.45%), observation room and eclampsia room (100%), laboratory facility (63.63%), NRC (100%), etc. Non-availability of IEC displays found like SBA protocol on APH (18.18%); adult resuscitation kit (90.90%), pulse oximetry (81.81%), wall suction machine (100%), etc. were not available. Inj. Insulin (100%), Tab. Mifepristone (36.36%), Tab. Nevirapine (72.72%), Inj. Gentamycin (27.27%) drugs were not available. E mOC (90.90%), CAC service (36.36%), SNSU (63.63%) were not provided by the selected facilities. 81.81% of the facilities had referral transport and 18.18% facilities did not have any referral transport. There was significant difference between the number of medical officers and number of OPD attendance (‘t’=6.07; df (9), p<0.05), The number of trained medical officers on RTI/STI and number of RTI/STI case management of adolescent (‘t’=2.45; df (9), p<0.05), the number of trained doctors on NSV and the number of NSV cases. (‘t’=2.27; df (9), p<0.05), the number of SBA-trained nurses and the number of institutional delivery cases (‘t’=2.35; df (9), p<0.05). There is highly positive correlation among number of nurses, number of medical officers and postnatal checkup score of the facilities, which is statistically significant (‘r’=0.732; df (9), p<0.05).

Spatio-temporal analysis of reproductive health indicators in Nigeria

Reproductive health is a state of complete physical, mental and social well being instead of absence of reproductive disease. It is a matter of universal concern and an important aspect of social development goals. Poor reproductive health outcomes are manifested in the rate of maternal mortality. Medical and socio economic factors that cause maternal deaths are preventable if there is access to adequate reproductive health services. However, access to health services itself is influenced by certain socio economic factors. Nigeria at present has one of the highest rates of maternal mortality in the developing world. The present study attempts to analyze few indicators that directly and indirectly influence the state of reproductive health in Nigeria. Reproductive health index have been computed with the help of relevant indicators (median age at first birth, antenatal care for most recent birth, antenatal care from a skilled provider, tetanus toxoid injection, percentage of delivery in a health facility, delivery by a skilled provider, postnatal checkup, current use of contraception and problems in accessing health care facility) to show state wise differential in reproductive health in Nigeria. Secondary data sources from Nigeria’s Demographic and Health Survey (2008 and 2013) have been used to compute the index. The study reveals the change in reproductive health in the country.Keywords: Reproductive health, maternal mortality, reproductive health index, antenatal care and postnatal checkup

Status of New HIV Infections among Infants Born of HIV Positive Mothers on Prevention of Mother to Child Transmission at Kisii Teaching and Referral Hospital, Kenya

Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that contribute to 65% of new HIV (Human Immunodeficiency Virus) in infections in Kenya. The study was to determine the prevalence of new HIV infections among infants (3 - 18 months) born of HIV positive mothers on PMTCT follow up at Kisii Teaching and Referral Hospital (KTRH). Method: This was a descriptive cross sectional study involving 96 infants born of HIV positive mothers on PMTCT programme at Kisii Teaching and Referral Hospital (KTRH) was conducted. The infants were between 3 to 18 months of age. The infants were investigated for their HIV status and factors associated with prevalence. The data collection was done during postnatal checkups, antiretroviral treatment follow up and immunization schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 13.5% (95% C.I = 10.1% to 16.9%) were found to be positive despite their mothers being on PMTCT program. There was no significant difference between gender and status of the infant (χ2 = 0.758, df = 1, p-value = 0.0384). Conclusion: The study confirms that there are still new HIV infections despite being followed up in the PMTCT program. The new HIV infections were associated with mixed feeding. Recommendation: Counseling on Infant feeding, use of ant-retroviral treatment and support from partners should be strengthen in the PMTCT program to ensure reduction of new HIV infections.

Socially accountable medical education strengthens community health services.

Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes. This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates. Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p<0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p=0.003); receive their first postnatal check-up <7days of birth (p<0.001); and have a youngest child with normal (>2500g) birthweight (p=0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6months of age (p=0.045); received a vitamin K injection soon after birth (p=0.026); and was fully immunised against polio (p<0.001), hepatitis B (p< 0.001), measles (p=0.008) and diphtheria/pertussis/tetanus (p<0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20000Php) were less likely (p<0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets. The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.

Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995-2030: a Bayesian analysis of population-based household data.

Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014. We used a Bayesian regression model to estimate the trend and to predict the coverage of UHC indicators along with the probabilities of achieving UHC targets of 80% coverage of health services and 100% coverage of financial risk protection from catastrophic and impoverishing health payments by 2030. We used the concentration index and relative index of inequality to assess wealth-based inequality in UHC indicators. If the current trends remain unchanged, we estimated that coverage of childhood vaccinations, improved water, oral rehydration treatment, satisfaction with family planning, and non-use of tobacco will achieve the 80% target by 2030. However, coverage of four antenatal care visits, facility-based delivery, skilled birth attendance, postnatal checkups, care seeking for pneumonia, exclusive breastfeeding, non-overweight, and adequate sanitation were not projected to achieve the target. Quintile-specific projections showed wide wealth-based inequality in access to antenatal care, postnatal care, delivery care, adequate sanitation, and care seeking for pneumonia, and this inequality was projected to continue for all indicators. The incidence of catastrophic health expenditure and impoverishment were projected to increase from 17% and 4%, respectively, in 2015, to 20% and 9%, respectively, by 2030. Inequality analysis suggested that wealthiest households would disproportionately face more financial catastrophe than the most disadvantaged households. Despite progress, Bangladesh will not achieve the 2030 UHC targets unless the country scales up interventions related to maternal and child health services, and reforms health financing systems to avoid high dependency on out-of-pocket payments. The introduction of a national health insurance system, increased public funding for health care, and expansion of community-based clinics in rural areas could help to move the country towards UHC. Japan Ministry of Health, Labour, and Welfare.

Gender inequities in curative and preventive health care use among infants in Bihar, India.

BackgroundIndia has the highest rate of excess female infant deaths in the world. Studies with decade-old data suggest gender inequities in infant health care seeking, but little new large-scale research has examined this issue. We assessed differences in health care utilization by sex of the child, using 2014 data for Bihar, India.MethodsThis was a cross-sectional analysis of statewide representative survey data collected for a non-blinded maternal and child health evaluation study. Participants included mothers of living singleton infants (n = 11 570). Sex was the main exposure. Outcomes included neonatal illness, care seeking for neonatal illness, hospitalization, facility-based postnatal visits, immunizations, and postnatal home visits by frontline workers. Analyses were conducted via multiple logistic regression with survey weights.FindingsThe estimated infant sex ratio was 863 females per 1000 males. Females had lower rates of reported neonatal illness (odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.6–0.9) and hospitalization during infancy (OR = 0.4, 95% CI = 0.3–0.6). Girl neonates had a significantly lower odds of receiving care if ill (80.6% vs 89.1%; OR = 0.5; 95% CI = 0.3–0.8) and lower odds of having a postnatal checkup visit within one month of birth (5.4% vs 7.3%; OR = 0.7, 95% CI = 0.6–0.9). The gender inequity in care seeking was more profound at lower wealth and higher numbers of siblings. Gender differences in immunization and frontline worker visits were not seen.InterpretationGirls in Bihar have lower odds than boys of receiving facility–based curative and preventive care, and this inequity may partially explain the persistent sex ratio imbalance and excess female mortality. Frontline worker home visits may offer a means of helping better support care for girls.