Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive ...Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.展开更多
Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges,global funding continues to flow disproportionately to HIV and maternal,newbo...Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges,global funding continues to flow disproportionately to HIV and maternal,newborn and child health(MNCH).Using the experience of MNCH,this short article argues that successful human rights fram-ing and the development of robust and regular reporting mechanisms in the international development architec-ture has contributed to these areas receiving attention.Taking non-communicable diseases(NCDs)as an example of a relatively neglected health area,we propose mechanisms that would improve integrated reporting of health issues in a way that aligns with the move toward cross-cutting themes and matching political and financial commit-ments with impact.As new frameworks are being developed to support multi-agency approaches to achieving SDG 3—including reporting and accountability—there are opportunities to ensure MNCH and NCDs jointly seek data col-lection measures that can support specific targets and indicators that link NCDs with early childhood development.展开更多
Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG)...Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG) targets. In Kenya, as the 2030 SDG deadline approaches, the gap in maternal, neonatal, and child health services remains significant. Addressing these challenges is critical to improving Maternal, Neonatal, and Child Health (MNCH) outcomes. Objective: This study explores how integration of digital health innovations into the MNCH chain of service delivery affects the quality of MNCH care within the selected PHC settings in Kajiado, Kisii and Migori Counties in Kenya. Methodology: This Quasi-experimental study was conducted 1-year post-intervention targeting a total of 482 pregnant women from intervention and control sites in Kisii, Kajiado and Migori Counties, Kenya. Data was analysed using Chi-Square test comparing frequencies between intervention and control groups when both variables are categorical. Results: Pre-intervention data revealed an increase in first ANC coverage within first trimester, from 167 to 278 post-intervention (p Linda mama social health insurance registrations increased from 1008 to 1135. At the intervention sites, 938 pregnant women got screened by midwives using portable mobile Obstetric Point-of-Care Ultrasound (OPOCUS) technology compared to the 27 cases that accessed ultrasound services in the noncontiguous control sites. The pilot sites midwives earned themselves an incentive income totaling Ksh 400,000 while the Community Health Promoters (CHPs) who created demand for OPOCUS earned an incentive income totaling Ksh 327,195 from their IGAs that were project supported. There was a significant increase in mobile health application usage and e-resources access for health information in the intervention group (p services and improved adherence to referrals. Conclusion: The success of digital health interventions in improving health-seeking behaviour, knowledge, and service uptake highlights the potential of such innovations to strengthen health systems and achieve universal health coverage. We recommend the intervention for a scale-up in other PHC settings in Kenya.展开更多
The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Ke...The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Kenya, under the Tekeleza project1. It aimed to assess how these interventions influenced MNCH service uptake, outcomes, and referral systems, using a mixed-methods approach with data from healthcare providers, community health promoters, and mothers. Findings showed that digital tools like the LUCY App improved coordination and maternal care but highlighted the need for better app features and wider access. Task sharing in areas like sonography enhanced service delivery but required stronger stakeholder engagement. Capacity-building through training was crucial for skill development, though additional training on emerging health issues was needed. Financial interventions, such as the Linda Mama program, boosted service uptake, but reimbursement processes needed improvement. Strengthening referral systems between lower- and higher-level facilities was identified as essential for timely access to care. The study concludes that integrating digital tools, expanding task sharing, enhancing training, and reinforcing health financing and referral systems are critical for strengthening MNCH services in rural Kenya, with broader implications for similar low-resource settings.展开更多
Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tio...Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.展开更多
BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both...BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both mother and baby.AIM To investigate the relationships between FI and pregnancy outcomes,particularly GDM and PIH,while also examining the mediating role of the dietary diversity score(DDS).METHODS A cross-sectional study was undertaken to examine this relationship,involving 600 pregnant women.Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes.The FI was measured via the Household Food Security Survey Module,with GDM defined as fasting plasma glucose levels of≥5.1 mmol/L or a 2-hour oral glucose tolerance test value of≥8.5 mmol/L.The DDS is determined by evaluating one's food consumption based on nine distinct food groups.A logistic regression model was used to explore the relationship between FI and PIH,and GDM.RESULTS Seventeen percent of participants reported experiencing FI during pregnancy.The study found a significant association between FI and an elevated risk of GDM[odds ratio(OR)=3.32,95%CI:1.2-5.4].Once more,food-insecure pregnant women had higher rates of PIH(OR=0.10,95%CI:0.02-0.45)and they also faced a higher likelihood of neonatal complications,such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight.The FI wasfurther linked to metabolic disruptions,such as elevated fasting blood sugar(FBS),low-density lipoprotein cholesterol,and triglyceride levels.Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM.In particular,the mediation analysis showed that approximately 65%of the effect was mediated through DDS(P=0.002).CONCLUSION These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health.Additionally,the study explored how DDS mediates the relationship between FI and the incidence of GDM.展开更多
ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hos...ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).展开更多
Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderso...Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.展开更多
<strong>Introduction</strong>: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on fac...<strong>Introduction</strong>: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. <strong>Design</strong>: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. <strong>Result</strong>: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). <strong>Conclusion</strong>: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.展开更多
Introduction:The novel coronavirus disease 2019(COVID-19)continues to disrupt the availability and utilization of routine and emergency health care services,with differing impacts in jurisdictions across the world.In ...Introduction:The novel coronavirus disease 2019(COVID-19)continues to disrupt the availability and utilization of routine and emergency health care services,with differing impacts in jurisdictions across the world.In this scoping review,we set out to synthesize documentation of the direct and indirect effect of the pandemic,and national responses to it,on maternal,newborn and child health(MNCH)in Africa.Methods:A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15,2022.We searched MEDLINE,Embase,HealthSTAR,Web of Science,PubMed,and Scopus electronic databases.We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic,published from January 2020 to March 2022,and written in English.Papers that did not focus on the African region or an African country were excluded.A data-charting form was developed by the two reviewers to determine which themes to extract,and narrative descriptions were written about the extracted thematic areas.Results:Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis.We identified three overarching themes:delayed or decreased care,disruption in service provision and utilization and mitigation strategies or recommendations.Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children,especially in historically underserved areas in Africa.Conclusions:Reviewed literature illuminates the need for continued prioritization of maternity services,immunization,and reproductive health services.This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.展开更多
There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in fo...There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.展开更多
Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted i...Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.展开更多
Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa...Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.展开更多
High maternal and child deaths in developing countries are frequently linked to poor health services provided to pregnant women and children. To improve the quality of maternal, neonatal and child health (MNCH) servic...High maternal and child deaths in developing countries are frequently linked to poor health services provided to pregnant women and children. To improve the quality of maternal, neonatal and child health (MNCH) services, the government and other stakeholders in MNCH emphasize the importance of quality assessment. However, effective quality assessment approaches are mostly lacking in most developing countries, particularly in Tanzania. This study, therefore, aimed at developing a quality assessment approach that can effectively assess and report on the quality of MNCH services. Due to the need for a good quality assessment approach that suits a resource-constrained environment, machine learning-based approach was proposed and developed. K-means algorithm was used to develop a clustering model that groups MNCH data and performs cluster summarization to discover the knowledge portrayed in each group on the quality of MNCH services. Results confirmed the clustering model’s ability to assign the data points into appropriate clusters;cluster analysis with the collaboration of MNCH experts successfully discovered insights on the quality of services portrayed by each group.展开更多
Introduction:Result-Based Financing(RBF)is an umbrella term for financial mechanisms that link incentives to outputs or outcomes.International development agencies are promoting RBF as a viable financing approach for ...Introduction:Result-Based Financing(RBF)is an umbrella term for financial mechanisms that link incentives to outputs or outcomes.International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage,with numerous pilot trials,particularly in low-and middle-income countries(LMICs).There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization.This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level,focusing on maternal,newborn,and child health(MNCH)programming in LMICs.Methods:A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019.Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix.The matrix headers included country of application;program setting;coverage and duration;evaluation design and methods;outcome measures;and key findings.A content thematic analysis approach was used to synthesize the evidence and emerging issues.Results:The review identified 13 reports from 11 countries,predominantly from Sub-Saharan Africa.Performancebased financing was the most common form of RBF initiatives.The majority of evaluation designs were randomized trials.The evaluations focused on outputs,such as coverage and service utilization,rather than outcomes.RBF schemes in all 11 countries expanded their scope,either geographically or accordingly in terms of performance indicators.Furthermore,only three studies conducted a cost-effectiveness analysis,and only two included a discussion on RBF’s sustainability.Only three countries have institutionalized RBF into their national policy.On the basis of the experience of these three countries,the common enabling factors for institutionalization seem to be political will,domestic fund mobilization,and the incorporation of demand-side RBF tools.Conclusion:RBF evidence is still growing,partial,and inconclusive.This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF.Additional research is needed,particularly regarding costeffectiveness,affordability,and sustainability of RBF programs.展开更多
Background:Reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)data is an indispensable tool for program and policy decisions in low-and middle-income countries.However,being equipped with evidence do...Background:Reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)data is an indispensable tool for program and policy decisions in low-and middle-income countries.However,being equipped with evidence doesn’t necessarily translate to program and policy changes.This study aimed to characterize data visualization interpretation capacity and preferences among RMNCH&N Tanzanian program implementers and policymakers(“decision-makers”)to design more effective approaches towards promoting evidence-based RMNCH&N decisions in Tanzania.Methods:We conducted 25 semi-structured interviews in Kiswahili with junior,mid-level,and senior RMNCH&N decision-makers working in Tanzanian government institutions.We used snowball sampling to recruit participants with different rank and roles in RMNCH&N decision-making.Using semi-structured interviews,we probed participants on their statistical skills and data use,and asked participants to identify key messages and rank prepared RMNCH&N visualizations.We used a grounded theory approach to organize themes and identify findings.Results:The findings suggest that data literacy and statistical skills among RMNCH&N decision-makers in Tanzania varies.Most participants demonstrated awareness of many critical factors that should influence a visualization choice—audience,key message,simplicity—but assessments of data interpretation and preferences suggest that there may be weak knowledge of basic statistics.A majority of decision-makers have not had any statistical training since attending university.There appeared to be some discomfort with interpreting and using visualizations that are not bar charts,pie charts,and maps.Conclusions:Decision-makers must be able to understand and interpret RMNCH&N data they receive to be empowered to act.Addressing inadequate data literacy and presentation skills among decision-makers is vital to bridging gaps between evidence and policymaking.It would be beneficial to host basic data literacy and visualization training for RMNCH&N decision-makers at all levels in Tanzania,and to expand skills on developing key messages from visualizations.展开更多
In the 21st century,the rapid growth of the Internet has presented a significant avenue for China to respond actively to the aging population and promote the“Healthy China”strategy in an orderly manner.This study use...In the 21st century,the rapid growth of the Internet has presented a significant avenue for China to respond actively to the aging population and promote the“Healthy China”strategy in an orderly manner.This study uses panel data from the China Health and Retirement Longitudinal Study(CHARLS)to empirically investigate the influence of Internet use on the mental health of older adults,particularly those who lack intergenerational emotional support and suffer from chronic diseases.This study employs a multi-period difference-in-differences(DID)method and a two-stage instrumental variable approach to address the endogenous problem.Results show that Internet use has improved the mental health of older adults in China significantly.Moreover,Older adults who lack intergenerational emotional support benefit more from Internet use.The beneficial effect is stronger for women and the elderly.Older adults with chronic diseases get greater benefits from using the Internet.Additionally,there is gender and age heterogeneity.Given this,governments should strengthen the Internet infrastructure and create a favorable online environment for older adults to maximize the positive impact of the Internet.Simultaneously,governments should make practical efforts to increase older adults’Internet usage,particularly those who lack intergenerational emotional support and those suffering from chronic diseases.展开更多
Birth of preterm infants is a stressful event for their parents, particularly for mothers. The mothers of preterm infants often feel hard to relate their infants because they have separated since their first days afte...Birth of preterm infants is a stressful event for their parents, particularly for mothers. The mothers of preterm infants often feel hard to relate their infants because they have separated since their first days after delivery. Long term separation and less attractive, less responsive appearance of preterm infants also make it difficult to build mother-child relationships. In addition, the mothers of preterm infants are likely to have mood disorders such as depression, anxiety, and stress-related disorders. The mothers’ psychiatric illnesses affect the psychosocial development of preterm infants and are often regarded as a risk factor for child abuse and maltreatment in later life. Child abuse and maltreatment are also prevalent among preterm infants than the full term infants. Intervention from the early period of preterm birth is an important issue for both preterm infants and their mothers. Medical and co-medical professionals should pay attention to developmental outcome of preterm as well as psychosocial conditions of their mothers for the improvement of their mental health.展开更多
文摘Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.
基金This article was fully funded by the WHO NCD Global Coordination Platform.
文摘Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges,global funding continues to flow disproportionately to HIV and maternal,newborn and child health(MNCH).Using the experience of MNCH,this short article argues that successful human rights fram-ing and the development of robust and regular reporting mechanisms in the international development architec-ture has contributed to these areas receiving attention.Taking non-communicable diseases(NCDs)as an example of a relatively neglected health area,we propose mechanisms that would improve integrated reporting of health issues in a way that aligns with the move toward cross-cutting themes and matching political and financial commit-ments with impact.As new frameworks are being developed to support multi-agency approaches to achieving SDG 3—including reporting and accountability—there are opportunities to ensure MNCH and NCDs jointly seek data col-lection measures that can support specific targets and indicators that link NCDs with early childhood development.
文摘Background: While global efforts have led to a decline in maternal and neonatal mortality, Sub-Saharan Africa continues to face disproportionately high rates, remaining far above the Sustainable Development Goal (SDG) targets. In Kenya, as the 2030 SDG deadline approaches, the gap in maternal, neonatal, and child health services remains significant. Addressing these challenges is critical to improving Maternal, Neonatal, and Child Health (MNCH) outcomes. Objective: This study explores how integration of digital health innovations into the MNCH chain of service delivery affects the quality of MNCH care within the selected PHC settings in Kajiado, Kisii and Migori Counties in Kenya. Methodology: This Quasi-experimental study was conducted 1-year post-intervention targeting a total of 482 pregnant women from intervention and control sites in Kisii, Kajiado and Migori Counties, Kenya. Data was analysed using Chi-Square test comparing frequencies between intervention and control groups when both variables are categorical. Results: Pre-intervention data revealed an increase in first ANC coverage within first trimester, from 167 to 278 post-intervention (p Linda mama social health insurance registrations increased from 1008 to 1135. At the intervention sites, 938 pregnant women got screened by midwives using portable mobile Obstetric Point-of-Care Ultrasound (OPOCUS) technology compared to the 27 cases that accessed ultrasound services in the noncontiguous control sites. The pilot sites midwives earned themselves an incentive income totaling Ksh 400,000 while the Community Health Promoters (CHPs) who created demand for OPOCUS earned an incentive income totaling Ksh 327,195 from their IGAs that were project supported. There was a significant increase in mobile health application usage and e-resources access for health information in the intervention group (p services and improved adherence to referrals. Conclusion: The success of digital health interventions in improving health-seeking behaviour, knowledge, and service uptake highlights the potential of such innovations to strengthen health systems and achieve universal health coverage. We recommend the intervention for a scale-up in other PHC settings in Kenya.
文摘The study evaluated the impact of digital health tools, task sharing, capacity building, and maternal health financing on Maternal, Newborn, and Child Health (MNCH) systems in Kisii, Kajiado, and Migori counties in Kenya, under the Tekeleza project1. It aimed to assess how these interventions influenced MNCH service uptake, outcomes, and referral systems, using a mixed-methods approach with data from healthcare providers, community health promoters, and mothers. Findings showed that digital tools like the LUCY App improved coordination and maternal care but highlighted the need for better app features and wider access. Task sharing in areas like sonography enhanced service delivery but required stronger stakeholder engagement. Capacity-building through training was crucial for skill development, though additional training on emerging health issues was needed. Financial interventions, such as the Linda Mama program, boosted service uptake, but reimbursement processes needed improvement. Strengthening referral systems between lower- and higher-level facilities was identified as essential for timely access to care. The study concludes that integrating digital tools, expanding task sharing, enhancing training, and reinforcing health financing and referral systems are critical for strengthening MNCH services in rural Kenya, with broader implications for similar low-resource settings.
基金The San Juan Bautista School of Medicine’s Institutional Review Board approved the study(EMSJBIRB-7-2021).
文摘Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.
基金The research received approval from Children’s Hospital of Shanxi Committee (Approval Number:KLT6230511).
文摘BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both mother and baby.AIM To investigate the relationships between FI and pregnancy outcomes,particularly GDM and PIH,while also examining the mediating role of the dietary diversity score(DDS).METHODS A cross-sectional study was undertaken to examine this relationship,involving 600 pregnant women.Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes.The FI was measured via the Household Food Security Survey Module,with GDM defined as fasting plasma glucose levels of≥5.1 mmol/L or a 2-hour oral glucose tolerance test value of≥8.5 mmol/L.The DDS is determined by evaluating one's food consumption based on nine distinct food groups.A logistic regression model was used to explore the relationship between FI and PIH,and GDM.RESULTS Seventeen percent of participants reported experiencing FI during pregnancy.The study found a significant association between FI and an elevated risk of GDM[odds ratio(OR)=3.32,95%CI:1.2-5.4].Once more,food-insecure pregnant women had higher rates of PIH(OR=0.10,95%CI:0.02-0.45)and they also faced a higher likelihood of neonatal complications,such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight.The FI wasfurther linked to metabolic disruptions,such as elevated fasting blood sugar(FBS),low-density lipoprotein cholesterol,and triglyceride levels.Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM.In particular,the mediation analysis showed that approximately 65%of the effect was mediated through DDS(P=0.002).CONCLUSION These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health.Additionally,the study explored how DDS mediates the relationship between FI and the incidence of GDM.
基金supported by the Natural Science Foundation of Hubei Province(No.2021CFB348).
文摘ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).
文摘Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.
文摘<strong>Introduction</strong>: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. <strong>Design</strong>: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. <strong>Result</strong>: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). <strong>Conclusion</strong>: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.
文摘Introduction:The novel coronavirus disease 2019(COVID-19)continues to disrupt the availability and utilization of routine and emergency health care services,with differing impacts in jurisdictions across the world.In this scoping review,we set out to synthesize documentation of the direct and indirect effect of the pandemic,and national responses to it,on maternal,newborn and child health(MNCH)in Africa.Methods:A scoping review was conducted to provide an overview of the most significant impacts identified up to March 15,2022.We searched MEDLINE,Embase,HealthSTAR,Web of Science,PubMed,and Scopus electronic databases.We included peer reviewed literature that discussed maternal and child health in Africa during the COVID-19 pandemic,published from January 2020 to March 2022,and written in English.Papers that did not focus on the African region or an African country were excluded.A data-charting form was developed by the two reviewers to determine which themes to extract,and narrative descriptions were written about the extracted thematic areas.Results:Four-hundred and seventy-eight articles were identified through our literature search and 27 were deemed appropriate for analysis.We identified three overarching themes:delayed or decreased care,disruption in service provision and utilization and mitigation strategies or recommendations.Our results show that minor consideration was given to preserving and promoting health service access and utilization for mothers and children,especially in historically underserved areas in Africa.Conclusions:Reviewed literature illuminates the need for continued prioritization of maternity services,immunization,and reproductive health services.This prioritization was not given the much-needed attention during the COVID-19 pandemic yet is necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.
文摘There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.
基金funded as part of Chinese Government Scholarship(CSC 2016GXYX07).
文摘Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.
文摘Background: Adequate and quality Maternal and Child Health (MNCH) care is considered essential in reduction of maternal and child mortality. More than half of the global maternal deaths (66%) are in sub-Saharan Africa with infant mortality of 51/1000 live births in the WHO Africa region [1]. There is potential to improve access and utilization of health services through investing in Primary Health Care (PHC) digital innovations [2] especially in underserved settings [3]. In the last quarter of the year 2021 after lifting of the COVID-19 restrictions, Tekeleza project, aims to integrate digital health innovations into MNCH care within PHC settings in Kenya. The project team undertook a baseline survey in three rural counties (Kisii, Kajiado and Migori) characterized with low social-economic status to identify opportunities to leverage on the use of evidence-based digital innovations to reverse the adverse trends in Maternal and Child Health. Methods: A cross-sectional and descriptive study was conducted in 15 Community Health Units (CHUs) in Kenya that were linked to selected Primary Health Care (PHC) facilities from three rural counties. Mixed methods were used to collect data from 404 Households (HHs) selected across the sampled CHUs on Probability Proportionate to Size (PPS). The selected households were assigned unique household or respondent identifiers. The sampling frame for household surveys consisted of all women 18 - 49 years of age, who were either pregnant or in their 18 months post-delivery. From the constructed sampling frame, a simple random sampling procedure was used to select the study sample. An audit was also carried out at the selected PHC facilities and sixty-two (62) Primary Health Workers (PHCWs) including facility managers were interviewed to establish challenges affecting ICT infrastructure and sustainable financing of MNCH services. Findings: The majority of the sampled women (64.9%) were lactating at the time of the study, with 34.4% being pregnant and 0.7% both pregnant and lactating. Despite the high proportions of mothers who received Skilled Birth Attendance, discontinuity in seeking antenatal and postnatal care services was observed in all three counties. The proportion of mothers (n = 404) who reported to have attended at least one ANC was 46.8%. This was attributed to limited access to health facilities, poor staff attitude, and negative cultural practices that got exacerbated by the COVID-19 pandemic. An average of 53.2% of the respondents started attending ANC clinics much later after 12 weeks of gestation to minimize the costs and time they will spend on attending ANC clinics. It also emerged that 68.7% of the respondents had low knowledge levels of selected perinatal and infant care practices. On the making of Sexual and Reproductive Health (SRH) health-seeking decisions, 54.7% of the respondents said, it is their husbands who decide. The PHCWs expressed limited access to Continuing Professional Development (CPDs), a situation that worsened with the COVID-19 Pandemic. Notably, only 54.9% of the PHCWs reported having access to either a Smartphone or desktop at the point of service delivery. Nearly the same proportion (54.8%) has access to the internet at their workstations. Facilities reported delayed reimbursement of National Hospital Insurance Fund (NHIF) and only 54% of the women interviewed had registered in Linda mama NHIF package meant to enable them to access free maternity care. Only one county (Migori) had significant utilization of CHVs. Conclusion: There is increasing access to Skilled Birth Attendance (SBA) in rural Kenya but discontinuous pregnancy care is still a problem and it got worse during the COVID-19 pandemic. Rural PHC facilities have poor ICT infrastructure and despite the 98% rural access to a phone by women, there is limited bankable usage of handheld technology to improve health information literacy on self and infant care among women of reproductive age. Recommendations: Feasibility studies to be conducted on how to sustainably deploy Primary Health Care digital solutions to improve the quality of, access to, and Utilization of Maternal and Child Health (MNCH) services.
文摘High maternal and child deaths in developing countries are frequently linked to poor health services provided to pregnant women and children. To improve the quality of maternal, neonatal and child health (MNCH) services, the government and other stakeholders in MNCH emphasize the importance of quality assessment. However, effective quality assessment approaches are mostly lacking in most developing countries, particularly in Tanzania. This study, therefore, aimed at developing a quality assessment approach that can effectively assess and report on the quality of MNCH services. Due to the need for a good quality assessment approach that suits a resource-constrained environment, machine learning-based approach was proposed and developed. K-means algorithm was used to develop a clustering model that groups MNCH data and performs cluster summarization to discover the knowledge portrayed in each group on the quality of MNCH services. Results confirmed the clustering model’s ability to assign the data points into appropriate clusters;cluster analysis with the collaboration of MNCH experts successfully discovered insights on the quality of services portrayed by each group.
文摘Introduction:Result-Based Financing(RBF)is an umbrella term for financial mechanisms that link incentives to outputs or outcomes.International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage,with numerous pilot trials,particularly in low-and middle-income countries(LMICs).There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization.This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level,focusing on maternal,newborn,and child health(MNCH)programming in LMICs.Methods:A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019.Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix.The matrix headers included country of application;program setting;coverage and duration;evaluation design and methods;outcome measures;and key findings.A content thematic analysis approach was used to synthesize the evidence and emerging issues.Results:The review identified 13 reports from 11 countries,predominantly from Sub-Saharan Africa.Performancebased financing was the most common form of RBF initiatives.The majority of evaluation designs were randomized trials.The evaluations focused on outputs,such as coverage and service utilization,rather than outcomes.RBF schemes in all 11 countries expanded their scope,either geographically or accordingly in terms of performance indicators.Furthermore,only three studies conducted a cost-effectiveness analysis,and only two included a discussion on RBF’s sustainability.Only three countries have institutionalized RBF into their national policy.On the basis of the experience of these three countries,the common enabling factors for institutionalization seem to be political will,domestic fund mobilization,and the incorporation of demand-side RBF tools.Conclusion:RBF evidence is still growing,partial,and inconclusive.This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF.Additional research is needed,particularly regarding costeffectiveness,affordability,and sustainability of RBF programs.
基金Grant Number 7059904 on the“National Evaluation Platform Approach for Accountability in Women’s and Children’s Health”from the Department of Global Affairs Canada to the Institute for International Programs at the Johns Hopkins Bloomberg School of Public Health.
文摘Background:Reproductive,maternal,newborn,child health,and nutrition(RMNCH&N)data is an indispensable tool for program and policy decisions in low-and middle-income countries.However,being equipped with evidence doesn’t necessarily translate to program and policy changes.This study aimed to characterize data visualization interpretation capacity and preferences among RMNCH&N Tanzanian program implementers and policymakers(“decision-makers”)to design more effective approaches towards promoting evidence-based RMNCH&N decisions in Tanzania.Methods:We conducted 25 semi-structured interviews in Kiswahili with junior,mid-level,and senior RMNCH&N decision-makers working in Tanzanian government institutions.We used snowball sampling to recruit participants with different rank and roles in RMNCH&N decision-making.Using semi-structured interviews,we probed participants on their statistical skills and data use,and asked participants to identify key messages and rank prepared RMNCH&N visualizations.We used a grounded theory approach to organize themes and identify findings.Results:The findings suggest that data literacy and statistical skills among RMNCH&N decision-makers in Tanzania varies.Most participants demonstrated awareness of many critical factors that should influence a visualization choice—audience,key message,simplicity—but assessments of data interpretation and preferences suggest that there may be weak knowledge of basic statistics.A majority of decision-makers have not had any statistical training since attending university.There appeared to be some discomfort with interpreting and using visualizations that are not bar charts,pie charts,and maps.Conclusions:Decision-makers must be able to understand and interpret RMNCH&N data they receive to be empowered to act.Addressing inadequate data literacy and presentation skills among decision-makers is vital to bridging gaps between evidence and policymaking.It would be beneficial to host basic data literacy and visualization training for RMNCH&N decision-makers at all levels in Tanzania,and to expand skills on developing key messages from visualizations.
基金supported by the Major projects of the National Social Science Fund of China under Grant(No.18ZDA064)the National Natural Science Foundation of China under Grant(No.11901149).
文摘In the 21st century,the rapid growth of the Internet has presented a significant avenue for China to respond actively to the aging population and promote the“Healthy China”strategy in an orderly manner.This study uses panel data from the China Health and Retirement Longitudinal Study(CHARLS)to empirically investigate the influence of Internet use on the mental health of older adults,particularly those who lack intergenerational emotional support and suffer from chronic diseases.This study employs a multi-period difference-in-differences(DID)method and a two-stage instrumental variable approach to address the endogenous problem.Results show that Internet use has improved the mental health of older adults in China significantly.Moreover,Older adults who lack intergenerational emotional support benefit more from Internet use.The beneficial effect is stronger for women and the elderly.Older adults with chronic diseases get greater benefits from using the Internet.Additionally,there is gender and age heterogeneity.Given this,governments should strengthen the Internet infrastructure and create a favorable online environment for older adults to maximize the positive impact of the Internet.Simultaneously,governments should make practical efforts to increase older adults’Internet usage,particularly those who lack intergenerational emotional support and those suffering from chronic diseases.
文摘Birth of preterm infants is a stressful event for their parents, particularly for mothers. The mothers of preterm infants often feel hard to relate their infants because they have separated since their first days after delivery. Long term separation and less attractive, less responsive appearance of preterm infants also make it difficult to build mother-child relationships. In addition, the mothers of preterm infants are likely to have mood disorders such as depression, anxiety, and stress-related disorders. The mothers’ psychiatric illnesses affect the psychosocial development of preterm infants and are often regarded as a risk factor for child abuse and maltreatment in later life. Child abuse and maltreatment are also prevalent among preterm infants than the full term infants. Intervention from the early period of preterm birth is an important issue for both preterm infants and their mothers. Medical and co-medical professionals should pay attention to developmental outcome of preterm as well as psychosocial conditions of their mothers for the improvement of their mental health.
