Utilization Of Child Health Services Research Articles

Maternal and child health in Seychelles

Services aimed at improving the health of infants, children and mothers have developed over the years since the initiation of the Seychelles Child Development Study. This paper describes the policies, procedures and facilities and how they have impacted on service provision. The utilisation of antenatal, perinatal and child health services, both in the hospital and community settings, are described. The successes and challenges are illustrated by describing fertility, abortion, teenage pregnancy and infant mortality. This overview of maternal and child services provides a perspective on an important aspect of health care development and the context in which the SCDS is conducted.

Impact of COVID-19 on utilization of maternal, newborn and child health services in Nigeria: protocol for a country-level mixed-methods study

Background: Battling with COVID-19 and providing essential services along the continuum of care could be challenging. This study will evaluate the impact of COVID-19 on utilization of maternal, newborn and child health (MNCH) services in Nigeria and explore the barriers being experienced by women and their families in getting access to MNCH services, as well as other contextual factors that may have shaped the utilization of MNCH services during the COVID-19 pandemic.Methods and analysis: The study will adopt an observational mixed-methods study design involving 18 health care facilities delivering MNCH services in six selected states across six geopolitical zones of Nigeria. We will retrieve longitudinal data on MNCH services from all selected hospitals six months before and after the first recorded case of COVID-19 in Nigeria. Qualitative data will be collected using in-depth interviews conducted via mobile phones or ZOOM meeting platforms among stakeholder participants (users of MNCH services, health workers and policymakers) to ascertain their perceptions on how COVID-19 has shaped the utilization of MNCH services. We will triangulate quantitative and qualitative data to better understand the impact of COVID-19 on the utilization of MNCH services in Nigeria.Ethics and dissemination: Ethics approvals have been obtained from the Health Research Ethics Committee of the tertiary hospitals involved in the study. Our findings will provide the first evidence from an African setting on the impact of COVID-19 on the utilization of MNCH services using a mixed-methods study design for policy formulation towards sustained MNCH service delivery.

Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from "Leaving No One Behind".

BackgroundDespite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia.MethodsThe 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices.ResultsOverall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099–0.173), 0.106 (95% CI=0.035–0.177), 0.348 (95% CI=0.279–0.418), and 0.348 (95% CI=0.279–0.418), respectively. Maternal age and all of the three socio-demographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services.ConclusionThe utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.

Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts.

Background Maternal, Child Health and Nutrition improvement Project is a World Bank-funded project implemented in all then ten regions of Ghana, which aims at improving access and utilization of community-based maternal, child health, and nutrition services in order to accelerate progress. This study is aimed at determining the implementation status of the project in the Eastern region by evaluating the processes involved and identifying implementation barriers from the perspective of implementors. Methods The study was a cross-sectional in design and employed a quantitative data collection approach in ten Community-based Health Planning and Services (CHPS) centres in five districts in the region. The project coordinators and Community Health Officers were interviewed using a structured questionnaire. The project implementation reports at the facility level were reviewed using a checklist. Tertile statistic was used to describe the status of the project implementation. Result The finding from this study indicated “complete implementation status” for maternal, child health, and nutrition activities of the project. However, none of the facilities evaluated had satisfactorily implemented all the governance processes and were therefore rated as “partially complete.” The main implementation barriers emerged from the study were related to restrictions placed on the use of project funds and delays in the fund disbursement to CHPS facilities. Conclusion The evidence gathered from the study showed very good implementation status for community-led maternal and child health service delivery, indicative of a positive response to the guidelines by service providers at the periphery and can have positive impact on the project's objectives and goals. Governance component of the project, however, revealed inadequate alignment with guidelines which might have been influenced by the lack of knowledge as a result of lack of training for implementers. This therefore calls for in-service training and improved supportive supervision at both administrative and service delivery levels.

Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana

BackgroundSustainable Development Goal 3 aims at reducing global neonatal mortality to at least 12 per 1000 livebirths, under-five mortality to at least 25 per 1000 livebirths and maternal mortality ratio to less than 70 per 100,000 livebirths by 2030. Considering the achievement so far, many countries in sub-Saharan Africa, including Ghana are not likely to achieve these targets. Low utilization of maternal, newborn and child health (MNCH) services partly account for this predicament. This study explored the trend and correlates of MNCH services utilization in one administrative district in the Volta Region of Ghana.MethodsThis is an explorative ecological study employing trend analysis of 2015–2017 data from Ghana Health Service District Health Information Management System II. Univariate Poisson regression models were used to determine the factors associated with MNCH services utilization at 95% confidence level.ResultsCumulative record of 17,052 antenatal care (ANC) attendance and 2162 facility-based spontaneous vaginal deliveries (SVDs) was discovered. Compelling evidence of potential unskilled deliveries was observed in 23% of the 26 facilities reported in the DHIMSII data. High cumulative number of midwives in health facilities associated positively with high records of ANC visits (IRR = 1.30, [95% CI:1.29, 1.32]; p = 0.0001), facility-based SVDs (IRR = 1.30 [95% CI:1.25, 1.35]; p = 0.0001) and BCG immunizations (IRR = 1.32 [95% CI:1.29, 1.34]; p = 0.0001). Likewise, high records of ANC visits correlated positively with high facility-based SVDs and child immunizations records (p < 0.0001).ConclusionTargeted health system and community level interventions alongside progressive frontline health staff motivation and retention strategies could further enhance enrollment and retention of mothers in pre-natal and postnatal care services throughout the continuum of care to guarantee better MNCH health outcomes. Investments in universal coverage for quality ANC services has the potential to enhance utilization of supervised deliveries and post-natal care services such as immunizations.

Impact of COVID-19 on utilization of maternal, newborn and child health services in Nigeria: protocol for a country-level mixed-methods study

Background: Battling with COVID-19 and providing essential services along the continuum of care could be challenging. This study will evaluate the impact of COVID-19 on utilization of maternal, newborn and child health (MNCH) services in Nigeria and explore the barriers being experienced by women and their families in getting access to MNCH services, as well as other contextual factors that may have shaped the utilization of MNCH services during the COVID-19 pandemic. Methods and analysis: The study will adopt an observational mixed-methods study design involving 18 health care facilities delivering MNCH services in six selected states across six geopolitical zones of Nigeria. We will retrieve longitudinal data on MNCH services from all selected hospitals three months before and after the first recorded case of COVID-19 in Nigeria. Qualitative data will be collected using in-depth interviews conducted via mobile phones or ZOOM meeting platforms among stakeholder participants (users of MNCH services, health workers and policymakers) to ascertain their perceptions on how COVID-19 has shaped the utilization of MNCH services. We will triangulate quantitative and qualitative data to better understand the impact of COVID-19 on the utilization of MNCH services in Nigeria. Ethics and dissemination: Ethics approvals have been obtained from the Health Research Ethics Committee of the tertiary hospitals involved in the study. Our findings will provide the first evidence from an African setting on the impact of COVID-19 on the utilization of MNCH services using a mixed-methods study design for policy formulation towards sustained MNCH service delivery.

Status of Maternal and Child Health Seeking Behavior among Women Aged 15-45 Years during Earthquake of 2015 in Nepal: A Mixed Method Study

Delivery of the maternal and child health services are generally affected during the time of disaster. This study aims to assess the maternal and child health service utilization in areas in Nepal affected by the 2015 earthquake. A mixed method study was carried in 29 Village Development Committees from nine earthquake-affected districts in Nepal. Quantitative data on maternal, neonatal and child health indicators before and after the earthquake were collected from the Health Management Information System. Focus group discussions and key informant interviews with different stakeholders were conducted to collect qualitative data. Quantitative data was analyzed using Microsoft Excel 2013. Qualitative data was analyzed manually using thematic analysis technique. Most of the indicators were comparable before and after the earthquake. Indicators such as Bacille Calmette-Guerin vs. Measles-Rubella vaccine drop-out rate, 1st antenatal care visit, delivery by skilled birth attendant and 1st postnatal care visit within 24 hours of delivery improved after the earthquake. Though most of the health facilities were damaged, health services resumed under tents or in open spaces. Some of the common problems among pregnant women included stomachache, headache, malnutrition, diarrhea, and mental stress. There was not much effect in the delivery of maternal neonatal and child health services. This reflects the coordinated efforts from government as well as non-government organizations and civil societies during and after the earthquake in Nepal.

Magnitude of Child Food Insecurity, Its Association with Child Immunization and Huosehold wealth Status, and Coping Strategies In Dabat Demographic and Surveillance System North West Ethiopia.

Background The magnitude of food insecurity in Ethiopia ranges from 38.7% to 82.3% among the general population. Children under the age of five years were more prone to food insecurity and its serious consequences like anemia, low bone density, frequent episodes of common cold, stomachache, poor educational performance, and dental carries in developing countries like Ethiopia. However, there is no any research finding that documented the magnitude of child food insecurity, coping strategies, and associated factors in the study area. Therefore, the aim of this study was estimating the magnitude of child food insecurity, major coping strategies, and factors associated with child food insecurity in the study area. Methods A community-based cross-sectional survey has been conducted in Dabat demographic and health surveillance site among 7152 mothers/caretakers of children under the age of five years. Data were collected by experienced data collectors working for the demographic and health surveillance site, and the collected data were entered into EpiData template and then transported to Stata 14 software for data cleaning and analysis. The ordinal logistic regression model was fitted to identify predictors for child food insecurity. Results About 21.42% of children under the age of five years were food insecure in Dabat district of whom 57.8%, 38.6%, and 3.6% had experienced mild, moderate, and severe levels of child food insecurity, respectively. All most all 1391 (92%) of the mothers/caretakers of food insecure children had practiced food insecurity coping strategies. More than half (57%) of mothers/caretakers reduces the size of child meal as insecurity coping strategy. Child food insecurity was associated with household wealth status, parent's education status, and maternal and child health service utilization and child feeding practices. Conclusion A large segment of under-five children had experienced food insecurity in Dabat district, and the major coping strategy for child food insecurity was reducing meal size. Therefore, working on household wealth improvement and expansion of basic health services would improve child food security.

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia.

IntroductionEthiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention’s effectiveness on care utilisation for common childhood illnesses.MethodsWe included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.ResultsThere were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2–59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences −4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services.ConclusionWe found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period.Trial registration numberISRCTN12040912.

The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization.

This study explores possible associations of the Mental Health Parity and Addiction Equity Act (MHPAEA) with child access to behavioral health (BH) services (preimplementation = 2008-2009, transition = 2010, and post = 2011-2013). The study sample included children aged 4-17 years in self-insured "carve-in" plans from large employers. In "carve-ins," BH and medical care are covered through the same insurance plan. The unit of analysis is the person-month (N = 61,823,533). This study employs an interrupted time series model allowing for intercept and slope changes for the transition and postparity periods. Outcomes included total, plan and patient out-of-pocket (OOP) expenditures, and several categories of service utilization. Generalized estimating equations were used to account for clustering. There were significant increases in total and plan expenditures postparity. To illustrate, in July 2012, mean per-member-per-month total expenditures were predicted to be $5.65 without parity but $8.72 with parity. Patient OOP costs did not change significantly. Significant overall increases were seen for utilization of most outpatient services but not intermediate or inpatient services. Our findings suggest that the introduction of MHPAEA was associated with an increase in specialty BH service access for children without a commensurate increase in financial burden for families.

Community-Based Health Insurance Enrollment and Child Health Service Utilization in Northwest Ethiopia: A Cross-Sectional Case Comparison Study.

PurposeUtilization of primary healthcare services in the rural communities of Ethiopia is very low. The Ethiopian government has introduced community-based health insurance (CBHI) to improve the health service utilization of the rural community. Thus, this study was conducted to examine the association between CBHI enrollment and child health service utilization in northwest Ethiopia.Patients and MethodsA cross-sectional case comparison study among CBHI enrolled and unenrolled households was conducted. A total of 226 sick children from 2008 surveyed households were included in the study. Bivariate-probit regression analysis was employed to account the endogenous nature of insurance enrollment and child health services utilization.ResultsThe results showed that the overall sick child healthcare visit in the CBHI enrolled group was about 0.44 (44%) point more compared to those unenrolled households. CBHI enrolled households in the poorest wealth group have a higher probability of visiting healthcare facilities for their sick children (coefficient: 0.13, SD: 0.07, 95% CI: −0.01, 0.27), whereas CBHI enrolled households with older age household head have a lower probability of visiting healthcare facilities for their sick children (coefficient: −0.16, SD: 0.08, 95% CI: −0.32, 0.01).ConclusionA promising positive effect on sick children’s health services utilization among CBHI enrolled was noticed. Moreover, households in the poorest wealth status and older age head affect the use of sick children’s healthcare services among those CBHI enrolled. Therefore, policy measures to expand benefit packages and supply-side interventions are essential to enhance the effects of CBHI on different health service utilization.

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas

BackgroundBy expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. “Optimizing the Health Extension Program” is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities.MethodsBaseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components.DiscussionThis protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond.Trial registrationCurrent Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017.

Association between women’s empowerment and diarrhea in children under two years in Indonesia

Early childhood deaths are caused by disease that can be prevented and treated like diarrhea. Women's empowerment must be deemed as a very critical component because it is commonly related with maternal and child health status, healthcare utilization and uptake of child health services. This study aims to determine the association between women’s empowerment and diarrhea in children under two years in Indonesia. We extracted data from the dataset of the 2017 Indonesian Demographic Health Survey (IDHS) to evaluate the association between women’s empowerment and diarrhea incidents. Data of 5526 mothers of children under two years were analyzed. Child’s factors, maternal and paternal factors, household factors and access to health care factors were the covariates under investigation. We used principal component analysis (PCA) to create four empowerment components (Women’s participation in the labor force, attitude towards wife-beating, decision-making and level of knowledge). Multivariate logistic regression was used to analyze the relationship between women’s empowerment and children’s recent history of diarrhea. Among the children, 17% had experienced diarrhea recently. Children of mothers with a medium attitude towards wife-beating had 29% (AOR = 0.71; 95% CI = 0.55–0.90, p = 0.01) lower odds of experiencing diarrhea recently compared to those of mothers with a poor attitude towards wife-beating. Children of mothers with a good attitude towards wife-beating had 24% (AOR = 0.76; 95% CI = 0.60–0.97, p = 0.03) lower odds of experiencing diarrhea recently compared to those of mothers with a poor attitude towards wife-beating. Children of women with a good knowledge level had 29% (AOR = 0.71; 95% CI = 0.55–0.92, p = 0.01) lower odds of experiencing diarrhea recently compared to those of women with a poor knowledge level. Women’s empowerment is still an important indicator for reducing incident of diarrhea, especially women’s knowledge level and attitude towards wife-beating components. Increasing women’s knowledge level and good attitude toward wife-beating in societies would be a good way to help improve children’s health with regard to experiencing diarrhea. Therefore, improving women’s participation in joint decision making at family level are needed to improve the health of their children.

Utilization of Reproductive and Child Health Services and Client Satisfaction under Different Level of Health Facilities

Background: The utilization of any social services, including health services, has never been equitably distributed throughout society. People with access to the facilities are generally found to make greater use of them than people who have neither knowledge nor access to the facilities. Objective: To study the utilization pattern of RCH services, to identify factors influencing the utilization of RCH services in district Etawah and to describe level of client satisfaction about the various RCH services provided by Health Facility. Methods: This was a cross sectional study conducted in two blocks of Etawah i.e., Basrehar and Jaswant Nagar. Purposive sampling method was used and 260 participants were interviewed during the study period i.e., from May 2018 to April 2019.All the antenatal mothers and mothers with child up to 24 months attending OPD of selected health facility were included in the study. Result: Mean age of participants was found to be 24.9 ± 3.6 years. The proportion of previous delivery that was institutional was found to be 71.7% where as 28.3% had previous home delivery. Most common place for institutional delivery was found to be CHC. Conclusion: Utilization of RCH services were found to be not adequate in the study.

The Utilization of Health Service Packages Among Mothers of Children Less Than 1Year of Age in the Somali Region of Ethiopia.

Health Service Package is the package of services that the government is providing or is aspiring to provide to its citizens in an equitable manner. The Ethiopia Family Health Service Package is part of the health extension program consisting of antenatal care, delivery service, postnatal care, immunization, and family planning. This package facilitates the utilization of maternal, neonatal and child health services and contributes to the reduction of maternal and child mortality. However, there is no data on the utilization of this package in pastoralist societies. This study aimed to assess the utilization of the Family Health Service Package and associated factors among mothers of children less than 1-year-old. From February 18-March 6, 2017 we conducted a community-based cross-sectional study with 421 mothers who gave birth in the last year in the Afdem district of the Somali region in Ethiopia. Mothers who gave birth between January 1/2016 to January 1/2017 in the district were selected by systematic random sampling. The study analysis included descriptive and bivariate statistics and multivariate logistic regression model. The overall utilization of the package was 25.1% (95% CI of 21.1-29.5%). Factors associated significantly with family health service utilization were urban place of residence [(AOR 95% CI) = 3.8 (1.5-9.9)], mother visited by health extension workers [(AOR (95% CI) = 3.1 (1.6-6.3)] and mothers participation in health extension program activities [(AOR (95% CI) = 2.8 (1.5-5.4)]. The utilization of the Family Health Service Package was low. Mothers visited by health extension workers and participated in the health extension program were more likely to utilize family health services. It needs to expand services beyond urban areas and involve rural mothers in health extension program activities.

Access to women physicians and uptake of reproductive, maternal and child health services in India

BackgroundLow availability of women physicians in rural areas can compromise women's health care seeking, where need can be greatest. We examined the associations between availability of women physicians and maternal and child health service utilization in India. MethodsWe analyzed cross-sectional district-level data from all 256 districts in 18 states, from India's District-Level Household and Facility Survey (2012–13) and the National Family Health Survey (2015–16). Assessed measures included lady medical officers (LMOs) availability at Primary Health Centers (PHCs, which are largely rural serving), modern contraceptive use, antenatal care (ANC), skilled birth attendance (SBA), maternal postnatal care (PNC), infant PNC, and child immunization. Multilevel regression models nesting districts in states examined associations between LMO availability and health service utilization, adjusting for district-level socioeconomic status (SES) indicators (e.g., women's education, household water access), urbanicity, health insurance coverage and sampled PHCs (15 on average) within districts. FindingsOnly 72 of 256 districts (28.1%) reported >50% of PHCs with LMOs. In multivariable models, LMO availability in PHCs was associated with higher district prevalence (%) of modern contraceptive use [β=0.04 (95% CI: 0.007, 0.08)], 4+ ANC [β =0.07 (95% CI: 0.008, 0.13)], skilled birth attendance [β=0.09 (0.03, 0.14) and maternal PNC [β=0.08 (95% CI: 0.03, 0.12)], but not infant PNC or child immunization. InterpretationHigher district availability of women physicians is associated with higher maternal health care utilization but not child health care utilization. Improving gender parity in the physician workforce and rural women physician access may improve maternal health care use in India.

No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis.

Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis.

Assessment of Effect of COVID 19 Pandemic on the Utilization of Maternal Newborn Child Health and Nutrition Services in Somali Region of Ethiopia

Background: Somali Region of Ethiopia recorded the first confirmed case of SARS-CoV-2 (COVID 19) pandemic on 26th April 2020. The study aimed to assess the effect of the pandemic on the utilization of maternal new-born and child health services. Subjects and Method: This was a retrospective chart review of monthly DHIS database of health facilities in Farfan zone of Somali Region and test of association using t test was used to compare the mean reduction in utilization of maternal and child health services three months before (January – March 2020) and three months during the pandemic (April 2020 to June 2020) at p value set at significant level of 5%. The outcome measure was the utilization of maternal and child health services. Results: The mean reductions in OPD per capita for children under five, children who received first dose of pentavalent vaccines and pregnant women who received first ANC before and during the pandemic was 14.26%, t=1.07; 95% CI= 283.17 to 725.17; p= 0.325); 12.51%, t=0.74; 95% CI= 1439.33 to 2697.31; p= 0.489) and 14.43%, t=0.49; 95% CI= 2363.33 to 3543.41; p= 0.642) respectively, while the mean reduction in skilled birth deliveries conducted at the health facilities was 21.4%, t= 0.97; 95% CI= 319.26 to 736.16 ; p= 0.371). Conclusion: The study provided early effects of COVID 19 on health and health services and the need for policy development on health system strengthening and resilience to withstand future outbreaks. This study indicated that indirect health service effects are substantial and highlights the importance of maintaining routine essential health and nutrition service delivery and the need to explore innovative ways of delivering both preventive and curative essential service. Keywords: COVID 19, pandemic, maternal newborn and child health, utilization, essential services Correspondence: Olusola Oladeji. UNICEF Somali Field Office, Ethiopia. Email: ooladeji@unicef.org. Journal of Epidemiology and Public Health (2020), 05(04): 458-469 https://doi.org/10.26911/jepublichealth.2020.05.04.08

Effect of systems approach intervention on adherence to antenatal and postnatal appointments: a systematic review

Maternal and child health is one of the most significant aspects of service delivery pillar. With every country focusing on the achievement of sustainable development goal number three (SDG 3), provision and utilization of maternal and child health services continue to attract global attention. Many countries make significant investments to provide these services at no cost to expectant mothers. However, maternal and child health services have not obtained optimal utilization for various reasons. Improving adherence to antenatal care (ANC) is an integral strategy to reduce under-five mortality and to improve maternal and child health. In sub-Saharan Africa, women often initiate antenatal care visit in their first trimester, but do not follow through to the recommended four ANC visits. Failure to attend ANC visits increases fetal, maternal, and neonatal mortality. Therefore, there is need for comprehensive systems to attain SDG 3 by 2030. A systematic approach intervention that cuts across health system has been proven to increase adherence. Interventions such as patient reminders and public relation initiatives such as information sharing, effective communication and education among health workers could prove effective in this course. The aim of this review is to examine the impact of systematic approach intervention on adherence to ANC appointments. The methodology included PRISMA guidelines for systematic reviews. Google Scholar and PubMed databases were searched using the terms such as systems approach intervention, adherence to appointments, missed appointments, ANC visit attendance, Postnatal Care (PNC) visit attendance, ANC adherence, and PNC adherence. Biases were assessed based on geographical area and publication dates. The result of the review showed that all the studies included reported a positive effect of systems approach intervention in increasing appointment adherence, with an average of 42% appointment adherence and 35% reduction in missed appointments in antenatal and postnatal clinics across all the studies. Conclusively, systems approach intervention increases adherence to appointments in antenatal and postnatal clinics. Multiple interventions also produce better outcomes.

In-kind incentives and health worker performance: Experimental evidence from El Salvador

We experimentally evaluated the effects of in-kind team incentives on health worker performance in El Salvador, with 38 out of 75 community health teams randomly assigned to performance incentives over a 12-month period. All teams received monitoring, performance feedback and recognition for their achievements allowing us to isolate the effect of the incentive. While both treatment and control groups exhibit improvements in performance measures over time, the in-kind incentives generated significant improvements in community outreach, quality of care, timeliness of care, and utilization of maternal and child health services after 12 months. Gains were largest for teams at the bottom and top of the baseline performance distribution. We find no evidence of results being driven by changes in reporting or by shifting away effort from non-contracted outcomes. These results suggest that in-kind team incentives may be a viable alternative to monetary or individual incentives in certain contexts.