<strong>Introduction:</strong> Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to d...<strong>Introduction:</strong> Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. <strong>Methods:</strong> This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. <strong>Results:</strong> Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. <strong>Conclusions:</strong> Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data.展开更多
Background:In an effort to improve access to proven maternal and newborn health interventions,Rwanda implemented a mobile phone(mHealth)monitoring system called RapidSMS.RapidSMS was scaled up across Rwanda in 2013.Th...Background:In an effort to improve access to proven maternal and newborn health interventions,Rwanda implemented a mobile phone(mHealth)monitoring system called RapidSMS.RapidSMS was scaled up across Rwanda in 2013.The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.Methods:Using data from the 2014/15 Rwanda demographic and health survey,we identified a cohort of women aged 15-49 years who had a live birth that occurred between 2010 and 2014.Using interrupted time series design,we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care(ANC),health facility delivery and vaccination coverage.Results:Overall,the coverage rate at baseline for ANC(at least one visit),health facility delivery and vaccination was very high(>90%).The baseline rate was 50.30%for first ANC visit during the first trimester and 40.57%for at least four ANC visits.We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC(level change:-1.00%(95%CI:-2.30 to 0.29)for ANC visit at least once,-1.69%(95%CI:-9.94 to 6.55)for ANC(at least 4 visits),-3.80%(95%CI:-13.66 to 6.05)for first ANC visit during the first trimester),health facility delivery(level change:-1.79,95%CI:-6.16 to 2.58),and vaccination coverage(level change:0.58%(95%CI:-0.38 to 1.55)for BCG,-0.75%(95%CI:-6.18 to 4.67)for polio 0).Moreover,there was no significant trend change across the outcomes studied.Conclusion:Based on survey data,the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda.In most instances,this was because the existing level of the indicators we studied was very high(ceiling effect),leaving little room for potential improvement.RapidSMS may work in contexts where improvement remains to be made,but not for indicators that are already very high.As such,further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.展开更多
Introduction: The health cheque system is a prepayment mechanism aimed at reducing neonatal and maternal mortality through improving the management of pregnant women. The pregnant woman with the health cheque system t...Introduction: The health cheque system is a prepayment mechanism aimed at reducing neonatal and maternal mortality through improving the management of pregnant women. The pregnant woman with the health cheque system that she pays at six thousand francs XAF (African financial community) is covered free of charge for all the care provided by the cheque system in the health facilities accredited to the health cheque project. We did a study, with objective to determine the hospital outcome of newborns with a health cheque system (HCS) compared to those without health cheque system. Method: A descriptive cross-sectional study with retrospective data collection was carried out at the Ngaoundere Regional Hospital from January 2018 to September 2021. Results: During our study period, 2985 newborns were received. We saw an increase in admissions over the years, particularly in the group of newborns with the health cheque system. Comparatively, the percentage of newborns cured in the health cheque system group was 76.73% (n = 1643) versus 77.72% (n = 656) those in the non-health cheque system group. Those who died were 8.96% (n = 192) in the health cheque system group compared to 6.27% (n = 53) in the non-health cheque system group. Conclusions and Recommendations: Most patients admitted to our service have the health cheque system. We notice an increase in hospital attendance with the health cheque project. The outcome of the newborn under the health cheque system is not different from that without health cheque system. The health cheque system was successful in getting the larger number of newborns into care. The next step is to put strategies in place to keep these patients in care for the duration of hospitalization.展开更多
Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form th...Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local com...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. <b></b></span><b><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. <b></b></span><b><b><span style="font-family:Verdana;">Results</span><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">-7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare.</span> <b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7<sup>th</sup> Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.</span>展开更多
After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are ...After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are a unique and valuable resource for the development of new newborn screening tests, quality assurance and biomedical research. Recent changes to the 2014 Newborn Screening Reauthorization Saves Lives Act require explicit parental consent for the retention and use of dried bloodspots in federally funded research. This has raised several ethical and regulatory issues and highlighted the challenges of respecting individual autonomy and public health goals. This article provides an overview of these issues and discusses methods for obtaining parental consent. These issues may be applicable to consent for the storage and use of biospecimens among other settings according to proposed changes to the Common Rule.展开更多
文摘<strong>Introduction:</strong> Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. <strong>Methods:</strong> This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. <strong>Results:</strong> Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. <strong>Conclusions:</strong> Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data.
文摘Background:In an effort to improve access to proven maternal and newborn health interventions,Rwanda implemented a mobile phone(mHealth)monitoring system called RapidSMS.RapidSMS was scaled up across Rwanda in 2013.The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.Methods:Using data from the 2014/15 Rwanda demographic and health survey,we identified a cohort of women aged 15-49 years who had a live birth that occurred between 2010 and 2014.Using interrupted time series design,we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care(ANC),health facility delivery and vaccination coverage.Results:Overall,the coverage rate at baseline for ANC(at least one visit),health facility delivery and vaccination was very high(>90%).The baseline rate was 50.30%for first ANC visit during the first trimester and 40.57%for at least four ANC visits.We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC(level change:-1.00%(95%CI:-2.30 to 0.29)for ANC visit at least once,-1.69%(95%CI:-9.94 to 6.55)for ANC(at least 4 visits),-3.80%(95%CI:-13.66 to 6.05)for first ANC visit during the first trimester),health facility delivery(level change:-1.79,95%CI:-6.16 to 2.58),and vaccination coverage(level change:0.58%(95%CI:-0.38 to 1.55)for BCG,-0.75%(95%CI:-6.18 to 4.67)for polio 0).Moreover,there was no significant trend change across the outcomes studied.Conclusion:Based on survey data,the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda.In most instances,this was because the existing level of the indicators we studied was very high(ceiling effect),leaving little room for potential improvement.RapidSMS may work in contexts where improvement remains to be made,but not for indicators that are already very high.As such,further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.
文摘Introduction: The health cheque system is a prepayment mechanism aimed at reducing neonatal and maternal mortality through improving the management of pregnant women. The pregnant woman with the health cheque system that she pays at six thousand francs XAF (African financial community) is covered free of charge for all the care provided by the cheque system in the health facilities accredited to the health cheque project. We did a study, with objective to determine the hospital outcome of newborns with a health cheque system (HCS) compared to those without health cheque system. Method: A descriptive cross-sectional study with retrospective data collection was carried out at the Ngaoundere Regional Hospital from January 2018 to September 2021. Results: During our study period, 2985 newborns were received. We saw an increase in admissions over the years, particularly in the group of newborns with the health cheque system. Comparatively, the percentage of newborns cured in the health cheque system group was 76.73% (n = 1643) versus 77.72% (n = 656) those in the non-health cheque system group. Those who died were 8.96% (n = 192) in the health cheque system group compared to 6.27% (n = 53) in the non-health cheque system group. Conclusions and Recommendations: Most patients admitted to our service have the health cheque system. We notice an increase in hospital attendance with the health cheque project. The outcome of the newborn under the health cheque system is not different from that without health cheque system. The health cheque system was successful in getting the larger number of newborns into care. The next step is to put strategies in place to keep these patients in care for the duration of hospitalization.
文摘Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. <b></b></span><b><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. <b></b></span><b><b><span style="font-family:Verdana;">Results</span><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">-7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare.</span> <b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7<sup>th</sup> Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.</span>
文摘After newborn screening is completed, most states retain leftover dried bloodspots. These dried bloodspots are stored for varying lengths of time among different state newborn screening programs. Dried bloodspots are a unique and valuable resource for the development of new newborn screening tests, quality assurance and biomedical research. Recent changes to the 2014 Newborn Screening Reauthorization Saves Lives Act require explicit parental consent for the retention and use of dried bloodspots in federally funded research. This has raised several ethical and regulatory issues and highlighted the challenges of respecting individual autonomy and public health goals. This article provides an overview of these issues and discusses methods for obtaining parental consent. These issues may be applicable to consent for the storage and use of biospecimens among other settings according to proposed changes to the Common Rule.
