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Synthesis of recent articles on maternal and child health, global maternal health policies and quality of care

February 25, 2015

Maternal and child health care

Creswell, Assarag and al. (2015): Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012. The objectives of the study are to assess the impact of various health policies on the utilization of facility-based deliveries and the rate of caesarean sections from1987 to 2012 among the poor and to evaluate precisely the effect of three important health policies or programs including the family planning/ Maternal and child health phase V project introduced in 1994, the implementation of a health insurance program between 2005-2006 and the action plan to reduce maternal mortality in 2008. The results showed an increase of the proportion of deliveries in health facilities. The proportion increased from 24,9% in 1987 to 74,1 % in 2010. The deliveries took place in majority in the public sector (89%). Similarly, the rate of caesarean section has also increased from 1,9% in 1987 to 13% in 2010 especially in the private sector. In 2010, 39% of all caesarean section was in the private sector compared to 19% in 1987. The proportion of facility -based deliveries has increased in all socioeconomic groups from 1987 to 2012. Among the lowest socioeconomic group, 20% of households deliver in health facilities at the end of the 1990s. Despite the progress in reducing the equity gap on the use of maternal health services, it is still persisting. The authors explained the increase of facility-based deliveries by a various factors that interact together positively such as the implementation of various health policies addressing both demand and supply side barriers to care. From the supply side, efforts have been made in increasing the number of health providers for delivery and obstetric care, the exemption of user fees, the improvement of quality of care mainly through audit and surveillance. In an economic macro perspective, Morocco faced positive economic and social changes. GPD per capita increased from 1037$US in 1990 to 2902$US in 2012. The fertility has declined from 4.1 births per women in 1990 to 2.7 births per women in 2011.

Taneja and al. Impact on inequities in health indicators (2015): Effect of implementing the integrated management of neonatal and childhood illness programme in Haryana, India. The article documents the results of a secondary analysis to assess the impact of the management of neonatal and childhood illness program on inequities in health indicators (IMNCI). The IMNCI includes post natal home visits for the newborn, the improvement of health workers skills on case management of neonatal and childhood illness and the supervision of community health workers, the improvement of the drug supplies and the community awareness. The trial is a cluster- randomized trial in 18 primary health care centres. The results showed a positive effect of IMNCI on newborn and infant care practices and survival among all groups (wealth, casts, education). Improvement in newborn and infant care was observed especially on the starting of breastfeeding within the first hour of birth (41% vs. 11.2%). The infant mortality rate was low in the intervention group compared to the control group. No effect has been observed on inequities in neonatal mortality. The intervention has an effect on gender inequity in care seeking for serious neonatal illness. In the control group, 19,3% of girls severely ill were taken to a health facility compared to 36,3% of boys. In the intervention group, 41,1% of girls and 50,7% of boys are brought to a health facility. Mortality outcome was more important among the most vulnerable groups especially in terms of access to health care. The absence of effect on inequities in neonatal mortality is explained by the fact that there is an important proportion of neonatal deaths that took place in the first days of life and might be linked to maternal healthcare which is not part of the IMNCI program.

Global maternal health policies

Maurice (2015): PMNCH gains traction and a new leader. On the First of February, Robin Gorna became the new executive director of the Partnership for Maternal, Newborn & Child Health (PMNCH). PMNCH has been introduced in 2005 to accelerate the progress to reach the MDG 4 and 5 that focus on the reduction of child and maternal mortality by two-thirds from 1990 and 2015. PMNCH includes four major existing partnerships: the maternal and child health, the safe motherhood and newborn health, the child survival, and the healthy newborn. The aim of PMNCH is to enhance the concept of ‘continuum of care’ taking into consideration the health of women, children from pregnancy to childbirth, to childhood to adolescence. PMNCH is acting from the bottom level of the system (community) to the high level of the health system. The financial resources have also increased from US$5.9 million per year in 2009 to $14.7 million in 2013.The new executive director will face several challenges. According to her, she will help to “steer the partnership through the final stages of the MDG era and through the ongoing discussions over the post-2015 SDGs”. Two of the partnerships: the global strategy on women’s and children’s health, need to be updated. Roadmaps will be implemented to follow the progress post MDG 2015. And a new global financing facility for women’s, children’s, and adolescents’ health will be introduced this year to support the Global Strategy.

Quality of care

Patabendige and al. (2015): Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience. The objective of the paper is to analyse the use of the World Health Organization safe childbirth checklist (SCC) in a tertiary hospital in Sri Lanka. The checklist is composed of 29 items that addressed the major causes of maternal and neonatal morbidity. This checklist aims to improve quality of maternal and neonatal care. The checklist was used for a total of 824 births. Among the health providers working in the hospital (n=170), 98 answered to the questionnaire. Among the 29 items included in the checklist, health providers checked for 21 items. Educating the mother to seek help during labour, after delivery and after discharge from hospital, seeking assistance during labour, early breastfeeding, maternal HIV infection and discussions on contraception methods were items neglected often by health providers. The authors explained the lack of attention to discussion on family planning by the fact that staff might considered this issue to be dealt either during pregnancy or postnatal care. The lack of discussion on HIV is explained by the low prevalence of HIV in Sri Lanka. HIV affected none of the cases selected in the study. The mean level of knowledge on the checklist among health workers was 60,1%. The acceptability of using the checklist among health providers is considered as satisfactory. 69,4% agreed with the statement that the checklist stimulates the interpersonal communication and team’s work. The workload, poor motivation of health providers and the level of user friendliness were identified as barriers to its use.

Scheerhagen and al. (2015): Measuring Client Experiences in Maternity Care under Change: Development of a Questionnaire Based on the WHO Responsiveness Model. The objective of the paper is to test a questionnaire on maternity care based on client’s experience and more specifically on the WHO responsiveness model. This model is defined as: “the professional and the environment in which the client is treated”. The study took place in the Netherlands. A questionnaire called ReproQ was built based on WHO responsiveness model. The questionnaire is divided into five sections: (1) information about current care, process, location of care and health providers, (2) clinical outcomes for bother mother and baby by clients in non medical terms, (3) client experience based the eight domains of responsiveness model, (4) information about previous pregnancies (5) socio demographic characteristics of the client. Among 605 pregnant women invited to fill out the questionnaire, 483 of them responded. Among 801 women who had recently give birth, 483 responded. In the interview with the stakeholders to identify the content validity of the questionnaire, the domain of dignity and communication were identified as the most important. The stakeholders have highlighted some issues with the following terms: “personal attention”, “home situation”. The domain-wise, autonomy, respect, confidentiality were experienced better with pregnant women compared to women who had recently give birth (p between 0,021 <0,001). Women who had given birth recently have rated better experience with prompt attention and social consideration choice and continuity (p between 0,033<0,0001). In delivery and post partum period, women who received care in an integrated facilities had higher score compared to less integrated facilities (Md=3,78 IQR=3,53-3,90 vs. Md= 3,63, IQR= 3,34-3,84; p <0,001). According to the perspective of the stakeholders, more attention should be paid to sensitivity for the cultural background and the experienced professional expertise.