Utilization Of Child Health Services Research Articles

Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia

Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia

Impact of COVID-19 on the Utilization of Maternal and Child Health Services at a Regional Referral Hospital in Kenya

Background and Objective Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. Methods In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. Results The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. Conclusion and Global Health Implications This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.

Sociodemographic Correlates of Integrated Maternal, Newborn, and Child Health Services Utilization Among Childbearing Mothers in Nigeria.

Background Some social and demographic factors might limit the ability of childbearing mothers (CBMs) to use healthcare services for themselves and their children, thereby exposing them to maternal, infant, and child morbidity and mortality. This study aimed to investigate the sociodemographic correlates of the utilization of integrated maternal, newborn, and child health (IMNCH) services by CBMs in Benue State, Nigeria. Methodology A community-based, correlational survey study was conducted among a random sample of 1,200 CBMs. Face-to-face interviews were conducted using a pretested, structured questionnaire, the Integrated Maternal, Newborn, and Child Health Services Utilization Questionnaire (IMNCHSUQ), and study participants were chosen using a multistage sampling procedure. Of the IMNCHSUQ issued, only 896 copies had complete data, which were used for the analysis. The data collected were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). The data were evaluated using the mean, standard deviation, and point-biserial correlation, and the null hypotheses were tested using linear regression at the 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (x= 3.30, SD = 0.94). The sociodemographic factors studied had little or no influence on the utilization of IMNCH services among CBMs. The most significant demographic predictor was the place of residence. Marital status, educational level, parity, and age were also found to be significant predictors in a few services. Conclusions Uneven distribution of IMNCH centers may be a major cause of the failure of CBM's lack of utilization of IMNCH services, especially in rural settlements with sparse distribution of facilities.

Accessibility andutilization of maternal and child health services among mothers in rural and urban communities of Oyo State

Background: Utilization of maternal and child health services has been linked to the characteristics of the health delivery system like the geographical and economic accessibility (cost) of these services. Low utilization of these services has been implicated in the explanation of high maternal and child mortality worldwide. Early and prompt utilization of maternal and child health care services would have averted most of these deaths. This study assessed the accessibility and utilization of maternal and child health services among mothers in rural and urban communities of Oyo state.Methods: This is a comparative cross-sectional study using a mixed method (quantitative and qualitative) of data collection. A pre-tested interviewer-administered questionnaire was used to collect data from 300 respondents that were recruited using a multistage sampling technique. The qualitative data was obtained through focus group discussions (FGD) with four groups selected using purposive sampling. Data was analyzed using IBM SPSS version 22 at 95% significance level with a p<0.05.Results: This study showed that significant differences existed between the respondents' utilization of maternal and child health services among women of child bearing age in the rural and urban communities (p= 0.013). Few respondents in rural communities (72, 48.0%) have good utilization of maternal and child health services compared to the urban communities where more respondents (119,79.3%) have good utilization of maternal and child health services. Proximity of health facility and affordability of maternal and child health service were found to be statistically significant for respondents in the rural community. This finding is also similar to the FGD findings from the rural discussants.Conclusion: Overall good accessibility and good utilization of maternal and child health services were found to be more for respondents in the urban areas compared their counterparts in the rural communities. It is important for the government to initiate policies on health insurance to favour maternal and child health services especially in the rural communities.

Perceived Impact of COVID-19 and Strategies for effective Implementation of Maternal and Child Health Care Services in Ethiopia: A Qualitative Study

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Impact of the COVID-19 pandemic and policy response on access to and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda and Zambia.

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18-49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18-49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.

To leave no one behind: Assessing utilization of maternal newborn and child health services by all the 13 particularly vulnerable tribal groups (PVTGs) of Odisha, India.

Indigenous tribal people experience lower coverage of maternal, newborn and child healthcare (MNCH) services worldwide, including in India. Meanwhile, Indian tribal people comprise a special sub-population who are even more isolated, marginalized and underserved, designated as particularly vulnerable tribal groups (PVTGs). However, there is an extreme paucity of evidence on how this most vulnerable sub-population utilizes health services. Therefore, we aimed to estimate MNCH service utilization by all the 13 PVTGs of the eastern Indian state of Odisha and compare that with state and national rates. A total of 1186 eligible mothers who gave birth to a live child in last 5years, were interviewed using a validated questionnaire. The weighted MNCH service utilization rates were estimated for antenatal care (ANC), intranatal care (INC), postnatal care (PNC) and immunization (for 12-23-month-old children). The same rates were estimated for state (n = 7144) and nationally representative samples (n = 176843) from National Family Health Survey-5. The ANC service utilization among PVTGs were considerably higher than national average except for early pregnancy registration (PVTGs 67% versus national 79.9%), and 5 ANC components (80.8% versus 82.3%). However, their institutional delivery rates (77.9%) were lower than averages for Odisha (93.1%) and India (90.1%). The PNC and immunization rates were substantially higher than the national averages. Furthermore, the main reasons behind greater home delivery in the PVTGs were accessibility issues (29.9%) and cultural barriers (23.1%). Ours was the first study of MNCH service utilization by PVTGs of an Indian state. It is very pleasantly surprising to note that the most vulnerable subpopulation of India, the PVTGs, have achieved comparable or often greater utilization rates than the national average, which may be attributable to overall significantly better performance by the Odisha state. However, PVTGs have underperformed in terms of timely pregnancy registration and institutional delivery, which should be urgently addressed.

Factors Affecting the Utilization of Maternal and Child Health Services in Urban Primary Health Care Centers in Enugu State (Abakpa and Uwani)'

10.18103/mra.v12i1.5064 Background/Aim: Poor Maternal and Child Health service indicators have been a recurring Public Health challenge in Nigeria since the documentation of National Maternal, Newborn, and Child Health (NMNCH) statistics began in the early 1990s. This study was aimed at identifying the factors that affect the utilization of Maternal and Child Health services among women of childbearing age attending urban Primary Health Care centers in Enugu State (Abakpa and Uwani). Methodology: This was a retrospective and descriptive cross-sectional study and data was collected through a self-administered questionnaire. 296 respondents participated and analysis of data was done using Statistical Package for Social Sciences (SPSS) version 20.0. The findings revealed that the number of deliveries in the health centers was highest in 2018 with a total of 378 deliveries compared to 2016 & 2017 with 280 and 254 deliveries respectively. The total number of under 5 children receiving yellow fever/ measles vaccine in the health center increased throughout the years with a total of 1493 vaccinations in 2016, 1510 in 2017, and 2083 in 2018. Results: It was also observed that the main factors that enhanced Maternal and Child Health (MCH) services in the health centers were decreased maternal age, maternal educational status, affordability of services rendered, good attitude of health workers, and the proximity of both health centers to the homes of the respondents. On the other hand, increased maternal age, poor maternal education, high parity, and long waiting hours experienced by the patients were the major factors hindering the utilization of services rendered in the health centers. Conclusion: To improve utilization of MCH services as identified by the women include; advocacy and sensitization campaigns, community dialogue, and upgrading of the existing health care centers.

The impact of urban family physician program on health service access and utilization in Iranian children and adolescents: Results of the national health services utilization survey in 2015

Background. The Urban Family Physician Program (UFPP) has been implemented in Fars and Mazandaran provinces of Iran since 2013 with the aim of improving access and utilization of health services, with a particular focus on children and adolescents. In order to evaluate the effectiveness of the program in achieving this goal, this study aimed to compare the access and utilization of health services among children living in areas covered by the UFPP with those living in other regions of Iran. Methods. A secondary analysis was performed using data from the 2015 National Health Utilization Survey. The data of people aged under 18 were extracted and indicators on the use of health services based on three main models of health service provisions were compared: (1) cities in Fars and Mazandaran provinces (UFPP implemented); (2) cities in other Iranian provinces (excluding Fars and Mazandaran); and (3) villages and cities with a population under 20,000. Results. The study included 20,689 children. The outpatient and inpatient visits in children living in Fars and Mazandaran provinces were higher than in children from other provinces and smaller towns (11.89 vs. 7.92 and 7.21 for outpatient and 4.74 vs. 3.51 and 4.27 for inpatient, respectively). Furthermore, UFPP was found to be associated with a higher utilization of health services in children residing in cities (odds ratio=1.50 (1.98-1.15)). Additionally, the cost of outpatient and inpatient health services in areas where the UFPP was implemented was lower compared to other parts of the country. Conclusion. The urban family physician program has been successful in increasing the access to health services and reducing health costs in children. Practical Implications. The findings suggest that the urban family physician program can be an effective strategy for improving healthcare access and reducing costs, especially in areas with high population density. Policymakers and healthcare providers can use the results of this study to inform the development and implementation of similar programs in other countries, with the aim of improving healthcare access and reducing healthcare costs in children and adolescents.

Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data

IntroductionDespite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life.MethodsMothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened.ResultsTotal mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization.DiscussionFindings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.

Mapping Evidence on the Determinants of Postnatal Care Knowledge among Postpartum Women in sub-Saharan Africa: A Literature Review

Maternal and neonatal deaths continue to pose significant public health challenges globally. In 2020, low-to-middle-income countries accounted for over 95% of all maternal deaths. Sub-Saharan Africa (SSA) is the region most severely impacted, accounting for 70% of global maternal deaths in 2020. Most of the maternal deaths and about a third of child deaths occur in the postnatal period. These unnecessary deaths can be avoided if postpartum women have adequate knowledge about postnatal care (PNC). This literature review’s aim was to determine the factors that influence PNC knowledge among postpartum women in SSA. The methodology of this literature review was loosely guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement. Peer-reviewed articles describing determinants of PNC knowledge among postpartum women in SSA published in English between 2013 and 2023 were searched using several search engines. All the twenty-five articles used in this literature review reported on quantitative cross-sectional studies. Some of the individual-level determinants of PNC knowledge identified in this review include place of residence, age of the mother, marital status, educational status of the mother, and the socio-economic status of the woman while the health system-level determinants include distance to a healthcare facility, source of PNC information, place of delivery, and previous maternal healthcare service experience. To improve PNC knowledge of postpartum women, we recommend developing rural areas through improving transport networks, improving the socio-economic status of women, and devising strategies to increase maternal and child health services utilization.

Child health services and armed conflict in Tigray, North Ethiopia: a community-based study

BackgroundAccess to basic health services, notably child health services, is severely hampered by the armed conflict in Tigray, North Ethiopia. Little is known regarding the impacts of the armed conflict during the war in Tigray on access to child health services. The current study investigates the impact of the armed conflict on the utilization of child health services in Tigray.Methods4,381 caregivers from randomly recruited households (HHs) with at least one child younger than 1 year old participated in a community-based cross-sectional survey. We collected data on childhood immunizations and illness-related treatment seeking from August 4 to 20, 2021. We describe data using frequency and percentage and carry out an internal comparison among the study participants using chi-square tests.Results4,381 children under the age of one included in the study. In total, 39% of infants received no basic vaccines, 61.3% of the children under the age of one received at least one vaccine, and 20% received all the vaccinations recommended for their age. About 61% of children were affected by at least one childhood ailments where majority of them were from rural areas. Mothers who did not seek postnatal care (PNC) were responsible for more than 75% of reported childhood illnesses.ConclusionsA sizable portion of children were unvaccinated and had at least one childhood sickness while the war was in progress. Particularly, people who live in rural areas reported a higher percentage of children’s illnesses but a lower use of child health services. To lower childhood morbidity and mortality in the besieged area, such as Tigray, local to global actors need to get coordinated and warrying parties should stop weaponization of vaccination healthcare services.

Accessibility and Utilisation Of Maternal and Child Health Services Among BPL Households: A Case Study of Guntur District

Mothers and children make up over 2/3 of the whole population. Women in reproductive age (15-49) constitute 21%, pregnant women, 4.5%, children under15, 47%, children under 5, 18%, under 3: 12% and infants: 4%. Maternal mortality is an adverse outcome of many pregnancies. About 80 percent of maternal deaths in are directed obstetric deaths. They result from obstetric complications of the pregnant state (pregnancy, labour, and puerperium), from intervention, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

A Cross-sectional study to evaluate maternal health care services utilization among women residing in an urban slum area, Ahmedabad

Background: Reducing the global Maternal Mortality Ratio to less than 70 per 1,00,000 live births is the first target of Sustainable Development Goal-3. Adequate utilization of Maternal and Child Health (MCH) services is essential for improved maternal and neonatal health outcomes. The utilization of MCH services is a complicated phenomenon, and several factors have an impact on it. This study aims to assess the current status of utilization of antenatal, intranatal, and postnatal maternal health services and determinants of utilization. Methods: This cross-sectional study was conducted in an urban slum during 1st January and February 2020 using a pre-tested, semi-structured questionnaire. A total of 126 women who delivered after 1st January 2018 were included as study subjects after getting informed oral consent. Data entry and analysis were done in Microsoft Excel. P-value<0.05 was considered statistically significant. Result: In all, 64% of study subjects had adequate Antenatal care (ANC) services utilization. The majority (94.5%) had institutional delivery. In all, 62% of women breastfed their child within four hours after birth. The reason for inadequate utilization was mainly due to lack of unawareness of MCH services. Conclusion: Overall, MCH services are good in this area. Efforts should be made to improve the quality of services for ANC registration within first trimester, Iron and Folic Acid tablet consumption, initiation of early breastfeeding, and postnatal care services, and the major determinants that influence utilization of MCH services including mother's education and parity

The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania.

Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.

Risk Factors for Low Birth Weight Babies in Women Delivered in a Tertiarry Referral Hospital

Background: Low birth weight is an important indicator of reproductive health and general health status of population. LBW is considered as the single most important predictor of infant mortality, especially of deaths within the first month of life. It is also a significant determinant of infant and childhood morbidity, particularly of neurodevelopmental impairments such as mental retardation and learning disabilities. This study aimed to determine the risk factors associated with low birth weight. Material & Methods: It was a prospective cross sectional observational study carried out in the Department of Obstetrics & Gynaecology, Dhaka Medical College, Dhaka, during the period of January 2012 to June 2012. Total 308 samples were included in this study. All women ≥28 weeks of pregnancy who delivered a LBW baby during six months of study period were selected. The database was processed by the application of statistical package SPSS for windows version 24. Results: This study shows most frequent maternal age group was 20-25 years. The mean maternal age was 23.86±4.82 years. Fifty three percent (53%)were female and 46.76% were male babies. Low birth weight was associated with inadequate Antental care, pre-delivery weight <55 kg, height <145 cm, low socio-economic status, and anemia. ln LBW babies’ mother having regular antenatal care (23.8%\. The incidence of mild anemia was 10.71 o/o, moderate anemia 32.79% and there were 2.60% cases of severe anemia. Maternal factors including maternal height (27.92%), maternal weight (36.36%), anaemia (43.50%), placenta praevia (12.18%), eclampsia (20.29%), PROM (24.35%), preterm labour (15.42%), severe PET (8.12%), twin pregnancy (17.86%), heart disease (2.44%) and DM (1.620/o) were associated with low birth weight. 62.01% mothers had average food intake, 37.99o/o had poor food intake. Conclusion: The incidence of low birth weight is 19.05%. Maternal height, maternal weight, ANC, anemia, eclampsia, preeclampsia, PROM, preterm labor, sever PET, twin pregnancy and heart disease were associated with low birth weight. There is a need for national prospective research project to study the low birth weight problem at the national level. There is also a need to discourage teenage pregnancies and to encourage utilization of mother and child health services, and treat concomitant illnesses during pregnancy. Maternal malnutrition, inadequate antenatal care and poor weight gain during pregnancy are significant predictors for delivery of a low birth weight neonate.

Association between the continuum of care and postpartum depression among Angolan mothers

BackgroundThis study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). MethodsThis study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. ResultsThe data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00–2.10; AOR = 1.57, 95 % CI = 1.24–1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12–2.28) had significantly higher odds of PPD. LimitationsThe onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. ConclusionPPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.

Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis

BackgroundEvidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy (‘SONU’: Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso.MethodsWe conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test.ResultsGratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01–0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13–2.47, p < 0.001), new consultations in children 1–4 years (Coeff 0.81; 95% CI 0.50–1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44–0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant.ConclusionsOur study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.

Utilization of Reproductive and Child Health Services and Client Satisfaction from Urban Primary Health Centers by Recently Delivered Women Living in Urban Slums of Lucknow, India

Background: Due to rapid urbanization, there is an increase in population in slums often lacking access to basic health services. Objective: The purpose of this study was to assess the utilization of reproductive and child health services by recently delivered women and their children residing in catchment areas of urban PHCs, to evaluate their level of satisfaction and to determine the factors associated with utilization of these services by recently delivered women. Settings and Design: The study was conducted in the catchment areas of urban primary health centre of Lucknow. Methods and Material: A cross-sectional study was conducted among 320 women having children less than 24 months in the slums covered under selected U-PHCs, sampled through a multi-stage random sampling technique using a semi-structured questionnaire. Statistical analysis used: SPSS-26 and MedCalc software were used for data analysis. Results: Utilization of RCH services by recently delivered women from UPHC was 39%. About 24% of recently delivered women availed ANC services from UPHC and 56.7% utilized family planning services and 95.8% immunization services for children. Child care services for diarrhea and ARI were availed by 9.9 and 3.1% of women, respectively. Satisfaction regarding maternal care and immunization services was seen in 84 and 95.8% of women. Poor satisfaction regarding child care was seen in 56.5% of women. Conclusions: The utilization of RCH services was found to be poor in the study population. Most recently delivered women were satisfied with all services except child care.