Safe Motherhood Programs Research Articles

Examining the combined effect of antenatal care visits and iron-folic acid supplementation on low birth weight: a pooled analysis of two national data sets from Nepal

BackgroundThe prevalence of low birth weight (LBW) has stagnated at approximately 12% for the past 15 years in Nepal, significantly impacting newborn survival. While antenatal care (ANC) visits and iron-folic acid supplementation are recognised as important interventions to reduce LBW, there is a lack of evidence regarding their combined effect. This study aimed to explore the potential synergistic impact of ANC and iron-folic acid supplementation on LBW in Nepal by analyzing data from two national surveys.MethodsThe nationally representative Nepal Demographic and Health Surveys of 2016 and 2022 were used, and the pooled dataset was analysed. Birth weight and the prevalence of LBW (i.e. birthweight < 2500 g) were reported using descriptive statistics. The associations among LBW, ANC visits, and iron-folic acid supplementation were examined using logistic regression analyses.ResultsThe mean birth weight was 3011 g, with an LBW prevalence of 11.2%. Not attending ANC (Adjusted Odds Ratio (AOR): 1.49; 95% Confidence Interval (CI): 1.14, 1.95) and not consuming iron-folic acid supplements (AOR: 1.43; 95% CI: 1.11, 1.84) were independently associated with a higher likelihood of having LBW. Furthermore, when considering both factors together, mothers who attended less than four ANC visits and consumed iron-folic acid for ≤ 90 days had the higher likelihood of having LBW (AOR: 1.99; 95% CI: 1.35, 2.60) compared to those who did not.ConclusionsThis study highlights that the individual and joint influence of ANC visits and iron-folic acid supplementation on having LBW. These findings underscore the significance of ANC attendance and iron-folic acid supplementation in preventing LBW. Traditionally, these two interventions were primarily considered as maternal survival strategies. However, our findings indicate that these existing interventions could be utilised further for both maternal and newborn survival. Given that these services are offered free of cost and are available near people’s homes through the National Safe Motherhood Programme in Nepal, efforts to increase the uptake of these services should be strengthened while emphasising their role in preventing LBW.

A Situational Overview of Prenatal Screening Services in Bhutan

ABSTRACTPrenatal genetic testing is to determine the possibility of the fetus having a genetic aberration or birth defect. Prenatal screening consists of serum analytes screening with or without nuchal translucency (NT) scanning or with cell‐free DNA (CfDNA) screening. Prenatal screening is recommended for all pregnant women regardless of the duration of pregnancy and maternal age or baseline risk. It is not advisable to screen with serum analytes and CfDNA concurrently to avoid discordant results. In developed countries, prenatal testing has been a part of routine antenatal care for a long time with adopting newer methods of screening and testing. In Bhutan, since the integration of the Safe Motherhood Program into primary healthcare in 1994, there has been an unprecedented improvement in obstetric care services. Almost all pregnant women attend antenatal and postnatal care, and 98.5% of deliveries are attended by trained health workers. The maternal mortality has reduced to 53 in 2023 from 770 per 100,000 live births in 1984 and the neonatal dealth has reduced to 15.2 per 1000 live births in 2023. However, despite improvements in the care of pregnant women, many babies are detected with congenital anomalies, syndromes, and birth defects during the postnatal period. Bhutan, being an underdeveloped country, could not initiate any form of prenatal testing program except for the anatomical scanning performed at 18–22 weeks of gestation. Early ultrasound dating scans, limited anomaly scanning, and growth scanning are offered to all pregnant women. There is a need to start centralized prenatal testing services in Bhutan to provide a comprehensive package of obstetric care to pregnant women. In addition, legal rights for parents to terminate severely deformed fetuses or severe genetic diseases before 24 weeks of pregnancy need to be established.

Faktor-Faktor yang Berhubungan dengan Kunjungan Antenatal Care (K4) pada Ibu Hamil di Wilayah Kerja Puskesmas Tarus Kupang

The Maternal Mortality Rate (MMR) is an important measure of a country's health sector progress. Governments aim to lower MMR through initiatives like safe motherhood programs, which include antenatal care (ANC) services. ANC consists of regular pregnancy check-ups to prevent maternal fatalities, with six visits being the minimum recommended number. Although Tarus Community Health Center has reached the K4 service goal, it has not yet met the necessary standards.Based on the data from the Tarus Community Health Center PWS report over the past three years, the National Health Sector SPM target of 100% has not been met. The average K4 coverage was 73.10% in 2020, 70.48% in 2021, and 74.9% in 2022. The underutilization of ANC services by pregnant women at Tarus Health Center is the primary factor contributing to this low performance.This research aims to identify factors related to ANC visits in pregnant women at Tarus Community Health Center in Kupang Regency. The study utilized a quantitative descriptive research method with an analytical survey and cross-sectional approach, analyzing data from 43 individuals using the chi-square test. The findings suggest a correlation between maternal knowledge (p=0.030), parity (p=0.014), culture (p=0.000), and accessibility (p=0.014) with ANC visits. However, the study did not find a significant relationship between mother's attitude (p=0.551) and ANC visits in the research area.The community health center should improve maternal and child health education through electronic and print media. Regular visits and counseling for pregnant women can motivate them to attend antenatal care appointments.

Utilization status of Safe Motherhood Program: a study from Jumla district, Nepal

Utilization status of Safe Motherhood Program: a study from Jumla district, Nepal

Knowledge, Practice Towards Birth Preparedness and Complication Readiness among Pregnant Women Attending Antenatal Clinic at Nyamagana Health Centre in Mwanza Tanzania

Background: Birth preparedness and complication readiness (BPCR) is a key component of globally accepted safe motherhood programs, including those in Tanzania. BPCR helps women deliver safely by ensuring prompt access to skilled care during labor and by facilitating the early recognition of complications. The ultimate goal of the study was to contribute to better maternal and neonatal health outcomes in Mwanza. By improving BPCR, the study hoped to reduce complications during childbirth and increase the number of safe deliveries in the region. Method: This study employed a quantitative cross-sectional design conducted from 23rd June 2021 to 30th September 2021 at an antenatal clinic in Mwanza, Tanzania, to assess birth preparedness among pregnant women. Data analysis was complected and report writing was completed 12th June 2022. A total of 107 participants were randomly selected and interviewed using a structured questionnaire. Descriptive statistics, including numerical summaries, frequencies, proportions, and percentages, were used to analyze the data and assess normality. These statistics were then employed to describe the study population in relation to relevant variables. Result: In this study of 107 pregnant women attending an antenatal clinic in Mwanza, Tanzania, (89.7%) of the women responded. Almost half (60%) of the women had poor knowledge of danger signs and birth preparedness, 26% had fair knowledge, and only 14% had adequate knowledge. The mean percentage of knowledge on obstetric danger signs was 42.7% during pregnancy, 42.8% during labor, and 32.3% during the postpartum period. Conclusion: Pregnant women in Mwanza, Tanzania have low levels of knowledge about danger signs and birth preparedness. This is a concern because it can lead to delays in seeking care for pregnancy complications and childbirth emergencies. To address this problem, we need to strengthen antenatal care services and provide women with access to reliable information about danger signs and birth preparedness, training antenatal care providers to educate women on danger signs and birth preparedness.

Examining birth preparedness and complication readiness: a systematic review and meta-analysis of pregnant and recently delivered women in India

BackgroundBirth preparedness and complication readiness (BPCR) is an essential component of safe motherhood programs. This study aims to systematically identify and synthesize available evidence on birth preparedness and complication readiness among pregnant and recently delivered women in India.MethodsThe study followed PRISMA guidelines and used databases such as PubMed, Cochrane Library, and ProQuest. Joanna Briggs Institute [JBI] Tool was used for critical appraisal of studies. The meta-analysis was conducted using Comprehensive Meta-Analysis [CMA] tool and R studio software. Statistical heterogeneity was evaluated using visual inspection of the forest plot, Cochran’s Q test, and the I2 statistic results. Funnel plot and Egger’s tests were applied to explore the possibility of the publication bias in the studies [PROSPERO: CRD42023396109].ResultThirty-five cross-sectional studies reported knowledge on one or more components of birth preparedness [BP], whilst knowledge on complication readiness [CR] or danger signs was reported in 34 included studies. Utilizing the random effect model, the pooled result showed that only about half of the women [49%; 95% CI: 44%, 53%] were aware on BPCR components. This result ranged between 15% [95% CI: 12%, 19%] to 79% [95% CI: 72%, 84%] in Maharashtra and Karnataka respectively [I2 = 94%, p = < 0.01]. High heterogeneity [> 90%] is observed across all components [p < 0.01]. The result of subgroup analysis indicated no significant difference in the proportion on BPCR among pregnant women [50%; 95% CI: 45%, 55%] and recently delivered women [54%; 95% CI: 46%, 62%]. However, the southern region of India indicates relatively better [56%; 95% CI: 45%, 67%] prevalence.ConclusionOur study highlights the low prevalence of BPCR in India and the factors associated with it. Scaling up cost-effective interventions like BPCR that have a positive overall effect is necessary. Authors strongly suggests that birth preparedness and complication readiness should be given utmost importance to reduce maternal morbidity and mortality to achieve the Sustainable Development Goals. Consideration should be given to fortifying existing resources, such as frontline workers and primary healthcare, as a strategic approach to augmenting the effectiveness of awareness initiatives.

Pengaruh Program GRSSIA (Gerakan Rumah Sakit Sayang Ibu dan Anak) Terhadap Kejadian Stunting Balita di RSUD Sayang Cianjur Tahun 2023

Stunting is a disorder of child growth and development due to chronic malnutrition and recurrent infections, and inadequate psychosocial stimulation which is characterized by the length below based on age the standard (-2SD/Stunted). Stunting occurs with age in the first 1000 days of life (fetus up to 24 months) and children up to 60 month. The GRSSIA (movement of hospital in safe motherhood and childhood) is an innovation programme held by the public hospital in the cianjur area in an effort to reduce maternal mortality, baby and child expecially accelerate the process of preventing and reducing stunting in cianjur district. The purpose of this study was to determine the effect of the GRSSIA (gerakan rumah sakit sayang ibu dan anak /movement in hospital of safe motherhood and childhood) programme on the stunting incidents at the regional public hospital of sayang cianjur in 2023. This type of research is quantitative with a quasy experimental one group pretest-posttest design approach. The sampling technique used is non-random sampling type of total sampling are 55 childrens meet the inclusion and exclusion criteria. The instruments used were the observation sheet, microtoise, and reference of children antropometri. Statistical test using the paired t test. The result showed a p-value of 0.000 &lt; 0.05 which means that there is influence of GRSSIA (Gerakan Rumah Sakit Sayang Ibu dan Anak/Movement of hospital in safe motherhood and childhood) programme on the stunting incidents at the regional general hospital of sayang cianjur in 2023.

Unpacking the Financial Incentives in Health by Revisiting India’s 'Safe Motherhood Program'

Unpacking the Financial Incentives in Health by Revisiting India’s 'Safe Motherhood Program'

Factors influencing the utilization of institutional delivery services by Chepang women in Chitwan district of Nepal

Background: Nepal has not yet achieved less than 70 maternal deaths per 100,000 live births of the SDG. To reduce the maternal death rates, a safe motherhood program has been implemented across Nepal to provide pregnant women with free delivery care in a healthcare facility, as well as transportation incentives promoting institutional delivery. Being a marginalized group of people residing in hilly slope areas, the Chepang population is deprived of significance usage of healthcare services. Objective: This study aimed to assess the incidence of delivery complications, and to investigate the factors associated with the utilization of institutional delivery of the Chepang women in the Chitwan district. Methods: A cross-sectional study was conducted in Rapti, Kalika and Ichchhakamana municipalities with a proportional random sample of 557 mothers. A face-to-face interview using a structured questionnaire was performed to collect the data. Using stepwise logistic regression analysis, the data were analyzed. Results: The results show that the incidence of delivery complications among those who utilized an institutional delivery was lower than the non-institutional delivery respondents. The literate parents were strongly associated with the increased usage of an institutional delivery (OR=12.08, 95%CI=6.32-23.06), and (OR=5.45, 95%CI=2.82-10.51) for literate mothers and literate spouses, respectively. Other significant factors were older ages at delivery of mothers as compared to younger ages mothers (OR= 3.28, 95%CI=1.83-5.90 for ages 20-29 year.; OR=3.75, 95%CI=1.80-7.83 for ages ≥30 year.), and engagement in business and services occupation of mothers (OR=2.01, 95%CI=1.01-4.01). The associations were observed for vehicle transportation to the delivery facility (OR =1.99, 95% CI =1.28-3.11) and travel time ≤30 minutes to the delivery facility (OR=2.80, 95%CI=1.58-4.96). Conclusions: The results revealed a lower incidence of delivery complications among those who utilized the institutional delivery. The analysis also demonstrated that age, education, income, and convenient access to an institutional delivery facility for mothers were associated with the utilization of institutional delivery of Chepang women. The findings could benefit health professionals in developing a health intervention to increase institutional delivery services for marginalized Chepang women.

Unpacking the Financial Incentives in Health by Revisiting India’s “Safe Motherhood Program”

Abstract This paper investigates India’s nationwide health reform to understand its various channels of effect. The reform entitled socio-economically backward mothers with cash transfer if they chose to give birth at public health institutions, and simultaneously employed ASHAs as a direct link between pregnant women and the public healthcare delivery system. Using variations in mothers’ eligibility and differential implementation of ASHAs across states, birth-related outcomes are evaluated in a difference-in-difference framework. Results show that eligible mothers with both cash transfer and ASHA’s guidance outperformed those receiving only cash transfer, in institutional birth rate and timely initiation of breastfeeding. An improved outcome in the ASHA’s presence alongside the conditional cash transfer argues for the vitality of the former’s role in spreading information on the importance of health and the uptake of public healthcare.

A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia

In India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality.&#x0D; The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level.&#x0D; Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia).&#x0D; Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %).&#x0D; Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients.

Level of Autonomy and Antenatal Services Utilization among the Women of Reproductive age Group Residing in an Urban Municipality of Lalitpur

Introduction: Antenatal care is one of the pillars of a safe motherhood programme in improving maternal and child health. Women’s autonomy is seen as an important factor in utilization of maternal health services. Therefore, the objective of study was to find the level of autonomy and utilization of antenatal services among the women of reproductive age group. Methods: A descriptive cross-sectional study design was used. A total of 151 women of reproductive age group having at least one child in the age group of less than one year were selected using non probability purposive sampling technique from four randomly selected wards of Godawari Municipality. A validated and pretested Nepali version interview schedule was used to collect data from the respondents through door-to-door visit. Descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics i.e. Fisher’s exact test was used to analyze data. Results: The study findings revealed that the majority (58.3%) of respondents had a lower level of overall autonomy. The highest autonomy was seen in decision making and lowest in financial related issues. Almost all (96%) of the respondents had fully utilized antenatal services. There was significant association between antenatal services utilization with women’s autonomy (p-value 0.041). Education of women and their husbands (p-value 0.009 and 0.013 respectively) as well as easy access to health facilities and availability of private transportation (p-value 0.005 and 0.039 respectively) were significantly associated with utilization of antenatal services. Conclusions: This study concludes that women’ autonomy tends to influence their antenatal services utilization. Likewise, education of women as well as their husbands tends to facilitate utilization of antenatal services. The study also concludes that easy access to health facilities and availability of private vehicles facilitates utilization of antenatal services.

Delivery site preferences and associated factors among married women of Panauti Municipality, Kavrepalanchok district, Nepal

Introduction: Maternal mortality is a top global developmental agenda. The main cause of being underutilization of available delivery services especially in a developing country like Nepal. Various socio-demographic, socio-cultural and health service-related factors affect the utilization of these services. Thus, the study aims to identify the delivery site preferences and its associated factors among the married women of Panauti municipality of Kavrepalanchok district.&#x0D; Method: A cross-sectional study was conducted among the married women between the ages of 15-49 y residing in Panauti municipality. The face-to-face interviews were conducted using semi-structured questionnaires. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.&#x0D; Result: A total of 106 women of 15-49 y were included in the study. The proportion of institutional delivery among the participants was 68%. 90.6% of total participants would prefer health facility for their future deliveries; 7.5% were not sure about their preferences and very few (1.9%) preferred to deliver at home. The factors like knowledge regarding safe-motherhood program and age at marriage were found to be significantly associated with their delivery site preference (p&lt;0.05).&#x0D; Conclusion: In a country like Nepal, home delivery is still in practice and pregnancy and childbirth are regarded as normal life events. Thus, efforts should be made to change that perception, increasing utilization of available services and improving maternal and child health. This in turn will help to achieve the Sustainable Development Goal target in reducing the Maternal Mortality Rate.

Mothers’ Lives Matter: Reaffirming Commitments from the Past to Strengthen the Future

The death of a woman from pregnancy or childbirth is one death too many. The death of a mother immediately cuts into half her newborn child’s chances of survival.Maternal death is of great concern worldwide, with eight to nine women dying daily, succumbing to various medical and compounding reasons. Approximately 75% of maternal mortalities during or following birth are due to severe bleeding, infections, pre-eclampsia and eclampsia, complications from delivery, and unsafe abortions.1&#x0D; Delays in seeking, reaching, and receiving adequate maternity or obstetric services contribute to maternal mortality.2 The last five decades saw tremendous efforts at the national and international level to improve maternal and neonatal care and mitigate maternal and child mortalities. From the 1978 Alma Ata Declaration on Primary Health Care to the Millennium and Sustainable Development Goals at the turn of the century, global commitment has been continuous.The Department of Health launched the National Safe Motherhood Program (NSMP) which envisions Filipino women having full access to health services for safe pregnancy and delivery by providing technical assistance to and collaborating with Local Government Units (LGUs) in the provision of maternity and newborn services.3&#x0D; The Maternal Newborn and Child Health and Nutrition (MNCHN) strategy framework is a corollary to the NSMP and also aims to reduce the maternal and neonatal mortality rates. MNCHN integrates services and programs for maternal health, family planning, and the prevention of sexually transmitted infections by proposing a continuum of care from pregnancy to delivery and ensures care for children and adolescents.&#x0D; Basic Emergency Obstetric and Newborn Care, or BEmONC, is one of the service packages of the MNCHN strategy that capacitates health care workers at the primary health care level to perform emergency obstetric and newborn resuscitation functions and refer to more equipped facilities for definitive management of obstetric emergencies. Rural health units (RHUs), district hospitals, and private lying-in clinics all over the country were capacitated as BEmONC-provider facilities.4 &#x0D; These facilities were particularly needed in rural areas to reduce the delays in pregnant women reaching and receiving adequate obstetric care. Delays in seeking care may be attributed to women’s beliefs and perceptions of the availability and adequacy of maternityservices in their communities. Articles in this issue give voice to pregnant women, their experiences, and their apprehensions on accessing care in various contexts, including during the COVID-19 pandemic. Also expressed in this issue are the perspectives of health workers on providing much-needed maternal health care.&#x0D; This collection provides but a brief snapshot of the compendium of challenges faced by Filipino women and children, the two great vulnerable groups in our society today. This issue pushes an essential dialogue forward: the importance we give to the lives of women in general, and mothers and children in particular.&#x0D; This is a continuing dialogue that everyone should hear and partake of.&#x0D; Ma. Carmeriza B. Buñing, MD, FPOGS Assistant Professor IADepartment of Anatomy, College of Medicine, UERMMMCI&#x0D; &#x0D; REFERENCES1. World Health Organization. Maternal Mortality [Internet]. 2019 [cited 2022 Aug 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.2. Thaddeus S, Maine D. Too Far to Walk: Maternal Mortality in Context. Soc Sci Med. 1994; 38(8):1091-1110. https://doi.org/10.1016/0277-9536(94)90226-7 3. Department of Health. National Safe Motherhood Program [Internet]. 2018 [cited 2022 Aug 30]. Available from: https://www.doh.gov.ph/national-safe-motherhood-program. 4. Department of Health. Implementing Health Reforms towards Rapid Reduction in Maternal and Neonatal Mortality: Manual of Operations [Internet]. 2009 [cited 2022 Aug 30]. Available from: https://www.doh.gov.ph/sites/default/files/publications/maternalneonatal.compressed.pdf.

Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal

Introduction: Long-acting reversible contraceptives (LARC, Intrauterine contraceptives devices and Implants) stand on 1st regards to safety and effectiveness. It is an easily accessible variety for spacing birth as well as preventing unintended pregnancy soon after childbirth in Nepal due to free supply by the Government under safe motherhood program of Reproductive health policy. Despite free supply, LARC is not routinely implemented in practice among immediate post-partum lady as single approach contraceptives concern to unintended pregnancy due to unmet need. To find out the choice of LARC by antenatal and immediate postpartum women after delivery. Methods: A descriptive cross-sectional study was conducted among 200 women in antenatal clinic and obstetric ward of College of Medical Science and Teaching Hospital using non probability convince sampling technique. Ethical approval was taken form Institutional Review Committee of College of Medical Sciences and Teaching Hospital and data was analyzed using descriptive statistical tools in SPSS. Results: Twenty eight percent of antenatal and 42% of postnatal women had induced abortion for unintended pregnancy in past. All women had knowledge about modern method of contraception but only 47 percent antenatal and 58 percent postnatal women adopted contraception in past. Implant was chosen by 44% antenatal and 46% postnatal women; whereas IUCD was chosen by 45% antenatal and postnatal women as LARC. Jadelle was the choice of LARC in both group due to its convenient duration (5 years) for birth spacing and its safety profile during breastfeeding. Twenty women refuse for LARC in immediate postpartum period. Conclusions: Single approach immediate postpartum LARC in is chosen by women who had induced abortion for unintended pregnancy in past for its long action, convenience during breast feeding and reliability. Maximum antenatal women prefer IUCD compared to Implants among postnatal women. Keywords: Copper T; Immediate post-partum; Jadelle; long-acting reversible contraceptives; Puerperium; Unintended pregnancy.

Realist Evaluation of the "Abiye" Safe Motherhood Initiative in Nigeria: Unveiling the Black-Box of Program Implementation and Health System Strengthening.

Realist evaluation studies have spanned different aspects of medicine, especially in the field of public health. However, very few of these studies explicitly detailed how program implementation triggered outcomes that could strengthen understanding of its effect on Health System Strengthening in specific settings. In low- and middle-income countries, like Nigeria, there is a paucity of realist evaluation studies, despite the implementation of multiple intervention programs and projects in these countries. This article is aimed at unveiling the black-box of program implementation and Health System Strengthening of the "Abiye" Safe Motherhood Program in Ondo State, Nigeria. Specifically, it identified the role of contextual factors in the "Abiye" program in Ondo State, determined the mechanisms that facilitated or constrained outcomes of the "Abiye" program, and developed a Context Mechanism Outcome (CMO) Configuration from which a Middle Range Theory (MRT) can be framed. This was qualitative research structured along with the realist domains (Context, Mechanism, and Outcome). The Initial Program Theory was validated by the qualitative study, after which a new MRT was developed. The study population comprised key stakeholders, secondary stakeholders, and primary stakeholders in the Abiye safe motherhood program. Data was collected through 10 key informant interviews, 28 in-depth interviews, and six focus group discussions sessions. Thematic analysis was used to analyze all the qualitative data collected, and seven themes with 19 subthemes emerged in the study. We identified 13 contextual factors under five principal areas, with most of the factors playing enabling roles, some playing inhibitory roles, while very few played both roles. We elicited eight mechanisms, and some of these facilitated the outcomes, while some constrained the outcomes of the program. Health system strengthening was a key feature of the outcome of the program. We developed a middle-range theory based on the 6 CMO configurations we elicited from the study. Realist evaluation is an iterative process that looks beyond the surface to generate evidence. By applying the realist approach, we generated pieces of evidence that can be adapted for policymaking in public health interventions in LMIC.

Determinants of skilled birth attendants in Nepal: a case of Surkhet district

Background: Safe delivery incentive program was introduced to increase the skilled attendants at births. The program provided childbirth by skilled birth attendants as well as incentives to skilled birth attendants ‘cash’ to women giving birth in a health facility in addition to incentives to health provider for each delivery attended, either at home or the facility. Due to its implementation and administrative delays, the program was reformed and implemented as a ‘safer mother program’ popularly known as “aama-suraksha-karyakram” since January 2009.Methods: The study was conducted in Surkhet district of Nepal. Surkhet is a hilly district and is head-quarter of mid-western development region of Nepal. There is one hospital, 5 PHCCs, 9 HPs and 38 SHPs serving 288,527 people in the district. The delivery by trained health worker (HW) in the district is 31.8% in 2005/06 which has increased about two times for two years. Surkhet is one of the districts monitoring the process indicators for safe motherhood programme in Nepal. Birth preparedness package programme has been implementing in the district from this year. The study population were the mothers within the age group of 15 to 49 years in Surkhet district. The sampling frame of the study was the mothers who had delivered the baby within 12 months preceding the survey.Results: About one third mothers, having 0-5 poverty score, utilised delivery assisted by HWs, while about three fourth of them having more than 5 score utilised HWs as delivery assistant. Higher educated mothers utilised HWs as delivery assistant more than that of higher educated husband. Among higher educated mothers, about 85% utilised delivery assisted by HWs, while it was about 75% for higher educated husband. Occupation of mother was also significantly associated with utilisation of delivery by HWs. Mother having office work utilised about 5 times higher HWs than others as their delivery assistant. The distance to health facility was significantly associated with utilisation of delivery attendant (p value &lt;0.001). The mothers with less travelling time to reach health facility were more likely to utilise HWs as delivery attendant. About three fourth mothers who needed less than half an hour utilised delivery assisted by HWs. There was equal proportion of mothers who needed 30-59 minutes to reach the nearest health facility. In the other hand, about 73% of mothers who needed one hour or more to reach health facility utilised others as delivery assistant. Perceived quality of service to nearby health facility by mothers was also significantly associated with utilisation of HWs as delivery attendant (p value &lt;0.05). About two third of mothers perceiving good quality of service at local health facility utilised HWs as delivery attendant while, it was only 44% among mothers perceiving poor quality of services.Conclusions: There should be adequate planning and preparation at all levels of health facilities; implementing a new program should not adversely affect another existing service delivery system. For the optional implementation, hospital organogram should be revised; and physical facilities and the low-risk birthing-centers with referral linkages should be expanded.

Preparation for birth and complication readiness: rural-urban disparities among pregnant women in communities in Enugu State, Nigeria.

birth preparedness and complication readiness (BPCR) is a key component of safe motherhood programs. The study aimed to determine the rural-urban disparities in BPCR and its predictors among pregnant women. this study was a community-based comparative cross-sectional study carried out among 366 pregnant women living in rural and urban areas in Enugu State, Nigeria. A multistage sampling technique was used to select the participants. Data analysis was carried out using descriptive statistics and inferential statistics at a significant level of p < 0.05. among the respondents, 213 (58.2%) had good knowledge of the components of BPCR. However, a significantly higher proportion of those in urban areas had better knowledge of these components than those in rural areas (p=0.01). Generally, there was a poor practice of BPCR among both groups of respondents. However, between both groups of respondents, good practice of BPCR was statistically significantly higher in respondents from urban areas 69 (37.7%) than those in rural areas 47 (25.7%) (X2=6.108, p=0.013). Several factors were found to be associated with good practice of BPCR among the respondents however, the only predictor of good practice of BPCR among the urban respondents was being aware of free maternal and child health services in the State while for the rural respondents, it was having an assisted delivery in the last stages of pregnancy. there are rural-urban disparities in BPCR. Most pregnant women are knowledgeable about its components but the majority do not practice it appropriately.

Perceived Needs and Barriers to Accessing Sexual Reproductive Health (SRH) Services Among the Ik Community, Kaabong District, Uganda

Background: The Ik are minority group of people in Kaabong district, Uganda. They are the most marginalized. In addition, little is known about their perceived SRH needs and barriers to accessing SRH services.Objective: To determine perceived needs and barriers to accessing SRH services by the Ik community.Material and Methods: A cross-sectional analytical design with analytical was used, both quantitative and qualitative (mixed methods). Data was collected using key informant interviews, focus group discussions and semi-structured questionnaires. Sample of 345 participants selected randomly and purposively. Qualitative analysis was thematic whereas Statistical Package for Social Scientists (SPSS) was for quantitative analysis.Results: Perceived SRH needs of the Ik were; limited access to SRH information, lack of protection from gender-based violence and lack of access to comprehensive safe motherhood programs. Access to SRH services was limited mainly by poverty, limited range of available RH services, long distances to health facilities, poor attitudes of health workers, culture, poor road networks and language barriers. Individual factors; period in marriage (p=0.047), number of sex partners (p=0.041), type of house structure one lived in (p=0.039), economic activity (p=0.009) were significantly associated with access of SRH services.Conclusion: SRH needs of the Ik community is still wanting

Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

ObjectivesTo examine the relationship between complete of providers’ adherence to antenatal care (ANC) guideline during first visit and maternal and neonatal complications during intrapartum and postpartum periods.DesignProspective cohort study.SettingGondar town...