Quality Of Maternal Health Services Research Articles

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Artificial Neural Network Prediction Model for Maternal Health Services Quality in Nigeria

This study presents an innovative approach in predicting the quality of maternal health services in Nigeria using artificial neural networks (ANNs). It focuses on a binary classification task in categorizing maternal health services facilities into "High_Quality" and "Low_Quality" classes. Dataset was collected from diverse healthcare facilities in Nigeria through a WHO Health Resources and Services Availability Monitoring System (HeRAMS) cross sectional-survey report. The collected data was preprocessed; the ANN architecture was developed and trained using back-propagation method. The network was modeled using feed-forward modeling approach with 16 variables at the input layer, 2 hidden layers of 65 and 55 neurons each, and an output of 2 neurons. Hence, 87.17% accuracy with only 2.48% deviation at the 50 epoch was achieved. The model's performance was evaluated using standard metrics of accuracy (87%), precision (88%), recall (89%), and F1-score (88%) to assess its ability to accurately classify maternal health services facilities. The findings of the study can have significant implications to policymakers, healthcare providers, and maternal health advocates to optimize healthcare resources and achieve better maternal health outcomes in Nigeria. Data availability, potential biases in the data, and the subjective nature of some quality-related indicators were acknowledged as limitations. However, despite these challenges, the ANN classification model remains a valuable tool for supporting decision-making in maternal healthcare facility delivery service in Nigeria. Artificial neural network, Binary classification, Health services, Maternal health, Predictive modeling

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

IntroductionAchieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative...

Receipt of core antenatal care components and associated factors in Ethiopia: a multilevel analysis.

Despite recent promising progress, maternal morbidity and mortality are still unacceptably high in Ethiopia. This is partly attributed to the lack of quality health services. Pregnant women may not receive adequate services that are essential to protect the health of women and their unborn children. This study aimed to examine the extent of receiving prenatal care components and associated factors in Ethiopia. It also assessed prenatal service use inequality between urban and rural residents. The analysis was carried out using the 2016 Ethiopian Demographic and Health Survey (EDHS), which is nationally representative survey data. A weighted sample of 4,772 women nested within 595 communities who had live births five years preceding the survey was included in the study. Necessary adjustments were made to account for the design of the survey, and sampling weights were used to adjust for nonproportional allocation of the sample to strata. Bivariate and multivariable multilevel ordered logit models were used to analyze factors associated with receiving comprehensive ANC contents. Statistically significant predictors were identified at p value ≤ 0.05. Among those women who had at least one ANC visit, only 15% (95% CI: 13, 16) received six core elements of antenatal care. The proportion of mothers who had essential prenatal components in rural areas was less than 13 percentage points. Approximately 43% of women did not receive at least two doses of tetanus toxoid vaccines to protect them and newborn infants against this life-threatening disease. Moreover, the majority of them, particularly those in rural Ethiopia, were not informed about pregnancy danger signs. Mothers who had at least four ANC visits received more types of prenatal components compared to those who had fewer ANC visits. The multilevel regression analysis revealed that receiving adequate ANC content is positively associated with having more frequent ANC visits, attaining a higher education level, being a member of a household in the highest wealth quintile and residing in urban areas. The evidence implies that the quality of maternal health services needs to be improved. Health programs and interventions should also give priority to rural areas where the majority of Ethiopian women reside.

Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis

BackgroundPotentially life-threatening maternal conditions (PLTCs) is an important proxy indicator of maternal mortality and the quality of maternal health services. It is helpful to monitor the rates of severe maternal morbidity to evaluate the quality of maternal care, particularly in low- and lower-middle-income countries. This study aims to systematically identify and synthesize available evidence on PLTCs.MethodsWe searched studies in English from 2009‒2023 in PubMed, the National Library of Medicine (NLM) Gateway, the POPLINE database, and the Science Direct website. The study team independently reviewed the illegibility criteria of the articles. Two reviewers independently appraised the included articles using the Joanna Briggs Instrument for observational studies. Disputes between the reviewers were resolved by consensus with a third reviewer. Meta-analysis was conducted in Stata version 16. The pooled proportion of PLTCs was calculated using the random effects model. The heterogeneity test was performed using the Cochrane Q test, and its level was determined using the I2 statistical result. Using Egger's test, the publication bias was assessed.ResultThirty-two cross-sectional, five case–control, and seven cohort studies published from 2009 to 2023 were included in the meta-analysis. The highest proportion of PLTC was 17.55% (95% CI: 15.51, 19.79) in Ethiopia, and the lowest was 0.83% (95% CI: 0.73, 0.95) in Iraq. The pooled proportion of PLTC was 6.98% (95% CI: 5.98–7.98). In the subgroup analysis, the pooled prevalence varied based on country income level: in low-income 13.44% (95% CI: 11.88–15.00) I2 = 89.90%, low-middle income 7.42% (95% CI: 5.99–8.86) I2 = 99.71%, upper-middle income 6.35% (95% CI: 4.21–8.50) I2 = 99.92%, and high-income 2.67% (95% CI: 2.34–2.99) I2 = 99.57%. Similarly, it varied based on the diagnosis criteria; WHO diagnosis criteria used 7.77% (95% CI: 6.10–9.44) I2 = 99.96% at P = 0.00, while the Centers for Disease Controls (CDC) diagnosis criteria used 2.19% (95% CI: 1.89–2.50) I2 = 99.41% at P = 0.00.ConclusionThe pooled prevalence of PLTC is high globally, predominantly in low-income countries. The large disparity of potentially life-threatening conditions among different areas needs targeted intervention, particularly for women residing in low-income countries. The WHO diagnosis criteria minimize the underreporting of severe maternal morbidity.Trial registrationCRD42023409229.

Determining the Relationship between Political Decentralization and the Quality of Maternal Health Services in Uganda, Sheema Municipality, Sheema District.

The study investigated the relationship between political decentralization and the quality of maternal health services in Uganda, Sheema Municipality Sheema District. cross-sectional and correlational research designs were adopted on a sample of 235 respondents. Quantitatively data was analyzed by use of descriptive statistics, frequencies and percentage tables and qualitatively, by thematic content analysis. Inferential analysis results indicated that political decentralization had a strong positive significant relationship with quality of maternal health services. Therefore, it was concluded that political decentralization as a component of decentralization policy implementation is essential for quality of maternal health services. The study recommended that the Government of Uganda should implement political decentralization policy in the health sector by granting local government powers and authority to manage and run the health facilities in order to improve the quality of maternal health services.

Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts’ maternal death surveillance and response data

IntroductionSierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care...

Finding out the Relationship Between Financial Decentralization and Quality of Maternal Health Services in Uganda. Sheema Municipality, Sheema District.

Finding out the Relationship Between Financial Decentralization and Quality of Maternal Health Services in Uganda. Sheema Municipality, Sheema District.

Analysis of Caesarean Delivery in General Hospitals in Sokoto State Using Robson’s Ten Classification: A Cross-Sectional Study

Maternal mortality is relatively higher in the northern part of Nigeria. The level of caesarean section (CS) performed in a facility in a locality is an important indicator of access to, and quality of maternal health services in that locality. The Robson classification has been recommended by the World Health Organization as a gold standard for assessing, monitoring, and comparing CS rates at all levels. This was a cross-sectional study across six primary health facilities (General hospitals (GHs) spread across six local government areas in Sokoto state, Northwest Nigeria. Data were collected from medical charts of all women who attended antenatal care/delivered from August - November 2022. The overall CS was calculated, and the women categorized into one of the ten Robson groups. The data showed that the women with the highest frequency of delivery were aged less than 20 (44.98%) followed by those aged 20-34. The CS rate in Sokoto State GHs was 13.56%, a rate relatively higher than the average in sub-Saharan Africa. The data showed that the commonest forms of CS were those in Robson’s Group 1-4, which are categorized as low risk forms of CS, where Group 4 had the highest CS cases (26.62%). Our findings can guide the State Ministry of Health in policy formulation and implementation to improve the maternal and child health in the State. Keywords: Caesarean section, delivery, Robson Classification, Obstetrics, Sokoto Nigeria, primary healthcare.

Non-Medical Determinants of Access and Quality of Maternal Health Services in India-Protocol for a Scoping Review.

The Maternal Mortality Rate (MMR) is one of the most important health indicators of a country. In India, MMR has decline from 130 to 113 per 100,000 live births between 2014 and 2018, however, there are wide disparities in utilization of maternal health services (MHS) among different states and across different socioeconomic groups within the states. Although the government is providing MHS through various health programs in India, there are several non medical factors leading to the underutilization of MHS services. To map and summarise the non-medical determinants of access and quality of MHS in India. We are conducting a scoping review of the published literature from 2000 till date in databases such as PubMed, Cochrane, Science Direct and CINAHL by including eligible qualitative as well as quantitative studies conducted in India. Data extraction and analysis will be conducted through a narrative integrative synthesis approach to summarize the non-medical determinants of access and quality of MHS in India and understand their mechanisms of influence.At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. We will summarise the non-medical determinants that influence the access and quality of MHS. This scoping review would help to understand and summarise the existing non-medical determinants of access and quality of MHS, highlight the research gaps and suggest potential modalities for improvement of access and quality of MHS.

A STUDY OF MATERNAL HEALTH SERVICES BY PRIVATE MIDWIVES IN SURABAYA CITY, INDONESIA

Maternal mortality in Indonesia increased but the coverage of antenatal care and birth attendants by health workers is high. The majority of antenatal care was by private midwives and the majority of birth attendants was by midwives. The study aims to determine the maternal health services by private midwives in maternal health services. It was a mixed study, carried out in Surabaya City because of the highest maternal deaths in East Java Province in 2016. The secondary data of maternal health services were collected from Surabaya City Health Office and Indonesian Midwives Association of Branch Surabaya City. The qualitative data were domain on internal and external problems of private practice midwives. There were 10 informants whom selected purposively. The data were collected by round table discussion. The secondary data were analyzed univariately and the qualitative data were analyzed descriptively. From about 250 private midwives in Surabaya City, 133 were ‘Delima’ midwives in which a program of the Indonesia Midwives Association. Maternal health services by private midwives enhance access. The ‘Delima’ midwives have requirements of knowledge, enhancing skill, reporting, infrastructure standards, and development. So, the quality of maternal health services by ‘Delima’ midwives was relatively better. However, private midwives’ services, including the ‘Delima’ midwives in Surabaya city had not analyzed ANC results, pregnant women visiting private midwives should visit health centers for integrated ANC, midwives’ duties beyond educational competencies, and lack of mentoring for apprentice midwives because of many midwives’ duties. It suggests improving the knowledge and skill of private midwives.

THE CORRELATION OF QUALITY OF ANTENATAL CARE, MATERNAL COVID, AND MATERNAL MORTALITY DURING THE PANDEMIC PERIOD IN EAST JAVA, INDONESIA

Introduction: Indonesia's maternal mortality rate is still above the target of the Sustainable Development Goals (SDGs). Meanwhile, the trend of maternal mortality in Indonesia during the COVID- 19 pandemic in 2021 increased sharply from 4,627 to 6,865 cases in 2021. Aims: This study was conducted to analyze the relationship between the quality of maternal health services on the incidence of maternal COVID and maternal mortality during the COVID pandemic in East Java, Indonesia. Methods: The research was conducted in East Java Province in 2021. The sample was randomly selected as many as 35 samples from a total of 38 samples of Regencies / Cities. The data used secondary data sourced from data from the East Java Health Office. Data analysis used Person Correlation analysis with Chi-Square analysis method. Results: The first hypothesis did not find a relationship between quality of Antenatal Care services and Maternal COVID cases (p- value: 0.195, r: -0.087). The second hypothesis has a significant relationship between the Maternal COVID and the Maternal Mortality (p- value: 0.040, r: 0.548). Also, the third hypothesis showed a substantial correlation between Maternal Mortality and quality of Antenatal Care (p- value: 0.001, r: -0.555). Conclusion: There is a strong relationship between the high Maternal COVID cases and the quality of access to antenatal care services to the high Maternal COVID cases during the pandemic. There needs to be a strategy to improve the quality and access of antenatal care services in reducing the high maternal mortality rate.

Experiences of mothers and health workers with MomCare and SafeCare bundles in Kenya and Tanzania: A qualitative evaluation.

Between 2019 and 2022, the digital dividend project (DDP), a technology-based intervention that combined care (MomCare) and quality improvement (SafeCare) bundles to empower mothers to access quality care during pregnancy, labor, and delivery, and postnatally, was implemented in Kenya and Tanzania aiming to improve maternal and newborn health outcomes. We describe the experiences of the mothers in accessing and utilizing health services under the bundles, and the experiences of the health workers in providing the services. Between November and December 2022, we conducted a qualitative evaluation across health facilities in Kenya and Tanzania. We held Interviews with mothers (pregnant and postpartum women who had benefited from the care bundles) and health workers (physicians, nurses, and midwives who provided the care bundles, including health facility In-Charges) at the antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) service delivery points. We performed content analysis. Findings are reported using themes and quotes from the participants. We included 127 mothers (Kenya = 76, Tanzania = 51) and 119 health workers. Findings revealed that among mothers, the care bundles eased access to health services, ensured easy access and optimal ANC use, provision of respectful care, removed financial constraints, and led to the receipt of sufficient health education. Health workers reported that the care bundles offered them a new opportunity to provide quality maternal and newborn care and to adhere to the standard of care besides experiencing a positive and fulfilling practice. Health systems improvements included prompt emergency response and continual care, infrastructural developments, medical supplies and logistics, staffing, and increased documentation. Overall, the care bundles led to the strengthening of the healthcare system (staffing, service delivery, financing, supplies/logistics, and information management) in order to deliver quality maternal and child health services. The bundles should be replicated in settings with similar maternal and child health challenges.

Effects of COVID-19 pandemic on provision and use of maternal health services in Allada, southern Benin: a local health system perspective.

To assess the effects of the COVID-19 pandemic on the provision and use of maternal health services in southern Benin from a local health system perspective. We conducted a qualitative study from April to December 2021 in a health district in southern Benin. We interviewed health workers involved in antenatal, delivery, postnatal and family planning care provision, alternative and spiritual care providers, administrative staff of the district hospital, community health workers, adolescents and women who had given birth in the past six weeks in public health centers were interviewed. The World Health Organization health systems building blocks framework was used to guide the thematic analysis from a local health system perspective. The COVID-19 pandemic changed the lines of command and the institutional arrangements in the local health systems leadership; it put the interpersonal relationships in the health care provision team under stress and reduced the overall revenues of the district hospital. The motivation of allopathic health workers was undermined. Communities underutilized maternal health services in the COVID-19 period. Plausible causes included negative patient perceptions of COVID-19 measures taken at the public health facility level as well as well as fear of being forcibly vaccinated against COVID-19 in the health facilities. In times of health crises, appropriate local health system governance that integrates providers' concerns into effective guidelines is critical to reach and maintain a sufficient level of work motivation to ensure quality maternal health services.

THE CONTINUITY OF CARE FROM PREGNANCY TO NEWBORN FOR MRS. FR AT PUBLIC HEALTH WELAHAN I JEPARA

Background: The acceleration of MMR reduction is carried out by ensuring that every mother is able to access quality maternal health services, such as pregnant women's health services, childbirth.
 Method : Type of descriptive research case study method, place conducted at Puskesmas Welahan I.
 Result : Results Pregnancy care is carried out according to 10 T care standards, physiological pregnancy. The labor process applies normal labor care, proceeds normally.
 Conclution : The results of COC midwifery care are able to deliver mothers and babies in healthy conditions.

Strategies to Reduce Maternal Death Rate and Improve the Provision of Quality Healthcare Services in Selected Hospitals of Vhembe District Limpopo Province.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

IMPLEMENTASI KLASIFIKASI KEHAMILAN BERESIKO DENGAN METODE NAIVE BAYES PADA PUSKESMAS KELURAHAN MALAKA JAYA

Pregnancy risk is classified into three categories: Low Risk Pregnancy (KRR), High Risk Pregnancy (KRT), and Very High Risk Pregnancy (KRST). Examination data recorded in the Maternal and Child Health (MCH) book at Puskesmas is used to categorize pregnancy risk. Although the maternal mortality rate has decreased, recent surveys show a significant increase. The causes include lack of counseling on obstetric and gynecological health, lack of emergency obstetric and neonatal care, and the use of ineffective traditional medicine. To overcome this problem, it is necessary to improve quality maternal health services. Efforts to accelerate the reduction of maternal mortality rate (MMR) include access to appropriate health services, postpartum care, and family planning services. Data processing uses data mining techniques with the Naïve Bayes classification method, which has high accuracy and short execution time. This study aims to develop a Naïve Bayes classification model in early detection of pregnancy risk, so that it can help diagnose pregnant women with low or high risk.

Evaluation of Quality of Maternal Health Services in Selected Primary Health Centers in Rivers State

The quality of care a woman experience during the prenatal, intrapartum and postpartum period has a direct impact on her health and the health of her child, and it might also affect her decision to seek care in the future. This study evaluated the quality of maternal health services in selected primary health centers in Rivers State. The study design was cross-sectional study design. Multistage sampling was used to select seven Primary health centers (PHCs) while simple random sampling was used to select 384 post-natal mothers across the selected PHCs. Self-administered questionnaire and checklist were used to assess the postnatal mothers and primary health centers respectively. The questionnaire collected data on socio-demographic variables, levels of satisfaction and factors influencing the quality of maternal health services while the checklist collected data on the extent to which the facilities have the capacity to support quality maternal health services. Three hundred and forty-one questionnaires and the entire checklist used for the survey were retrieved. SPSS V22 was used in the analytical process and data was analyzed using descriptive statistics. Results revealed that 40.2% of the postnatal mothers were within age 26-33 years, 54.8% had secondary school as their highest educational level and 85% were married. Majority of the mothers were satisfied with the maternal healthcare services in PHCs in Rivers State, mean was 102.24±11.68; the perceived factors influencing the quality of maternal health services in PHCs in Rivers State include, healthcare delivery (96.2%), adequate human and material resources (94.1%), staff conduct and practice (86.2%) and physical facilities (84.5%); although PHCs with facilities that are available and in good condition were 85.7% they are not fully equipped to support quality basic obstetric emergency care.

The relationship between financial decentralization and quality of maternal health services

This study aimed at investigating Decentralisation policy implementation and quality of maternal health services in Kihiihi Town Council and Nyanga Sub county-Kanungu District. It was guided by three objectives namely. The objectives were; to determine the relationship between Political decentralization and the quality of maternal health services in Kihiihi town council and Nyanga Sub County - Kanungu district, to find out the relationship between financial decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County - Kanungu district and to assess the relationship between administrative decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County -Kanungu district. The study adopted descriptive crosssectional research and correlational designs on a sample of 235 respondents. Data was collected using a questionnaire and an interview guide. Quantitative data were analyzed using frequencies, percentages mean, correlation and regression. Qualitative data were analyzed using thematic analysis. Inferential analysis results indicated that financial decentralisation had a strong positive significant relationship with quality of maternal health services. Therefore, it was concluded that financial decentralisation as components of decentralization policy implementation is essential for quality of maternal health services. Keywords: financial decentralization, maternal health services, women.

Health facilities preparedness to deliver maternal and newborn health care in Kilifi and Kisii Counties, Kenya

IntroductionHealth facility preparedness is essential for delivering quality maternal and newborn care, minimizing morbidity and mortality by addressing delays in seeking skilled care, reaching appropriate facilities, and receiving emergency care. A rapid assessment of 23 government health facilities in Kilifi and Kisii counties identified poor maternal and newborn indicators in 16 facilities. The Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project supported these facilities with training, equipment, and referral linkages. This study focuses on facility preparedness of the 16 facilities to deliver maternal and newborn health services, specifically delays two and three at the end of the project implementation.MethodsA descriptive cross-sectional study was carried-out on behalf of AQCESS project team by respective county ministry of health in-charge of reproductive maternal newborn and child health programs and trained nurses and medical doctors from Aga Khan health services in December 2019. The study evaluated the accessibility and reliability of drugs, commodities, equipment, personnel, basic necessities (such as water and electricity), and guidelines using validated World Health Organization service availability and readiness assessment tool. The findings of the assessment are presented through frequency and percentage analysis, along with a comparative analysis between the two counties.ResultsAll the 16 facilities assessed offered routine antenatal care (ANC) and normal delivery, but only two provided comprehensive emergency obstetric and newborn care (CEmONC). Most essential medicines, commodities, and required equipment were available. BEmONC and CEmONC guidelines were present in Kilifi, not in Kisii. One staff member was available 24/7 for cesarean section (CS) in each county, with one anesthetist in Kilifi. Electricity was accessible in all facilities, but only half had secondary power supply. Facilities offering CS had backup generators.ConclusionThe Facilities assessed had necessary drugs, commodities, equipment, and requirements, but staffing and guidelines were limited. Kilifi outperformed Kisii in most indicators. Additional support is needed for infrastructure and human resources to deliver quality maternal and newborn health services. Continuous monitoring will facilitate resource allocation based on facility needs.