This document summarizes a presentation about inequalities in access to maternal health care and the role of transport interventions. It discusses the high rates of maternal mortality globally, with most deaths occurring in developing regions. Three main delays that contribute to mortality are identified: delay in deciding to seek care, reaching care, and receiving care. Coverage of maternal health services is unequal, with those in rural and poorer populations receiving less care. Interventions like the Mom's Van program in Bangladesh and Burkina Faso aim to address transport barriers by providing motorized transportation to medical facilities for obstetric emergencies. The program aims to reduce delays and maternal deaths through improved access.
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Safe motherhood services basically a topic of commutiny medicine...
All of the services are described well in the slides
Hope so all of uu will find it and it 'll be helpfull for all of you
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
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Millennium Development Goal 5: Maternal Health InterventionsSolveij Praxis
Presentation in Governance and Poverty seminar class. Explanation of MDG 5 and update on progress status in 2013. Overview of 3 High-Impact Intervention areas and a MOMS (Midwives and Others with Midwifery Skills) with Misoprostol program which addresses #2 and #3 to prevent maternal mortality.
Maternal, Newborn and Child Health: A Global PerspectiveMichelle Avelino
Presentation of Jacqueline F. Kitong, M.D., MPH, technical officer for Maternal and Child Health and Nutrition, World Health Organization at the PhilHealth Maternal, Newborn and Child Health Summit
Safe motherhood services basically a topic of commutiny medicine...
All of the services are described well in the slides
Hope so all of uu will find it and it 'll be helpfull for all of you
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
RMNCH + A MCH Program Dr Girish .B Associate Professor, CIMS, ChamarajanagarDr Girish B
RMNCH + A MCH Program Dr Girish .B Associate Professor, Department of Community Medicine, Chamarajanagar Institute of Medical Sciences (CIMS), Chamarajanagar
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RESEARCH ARTICLE Open AccessQuality of antenatal care pred.docxrgladys1
RESEARCH ARTICLE Open Access
Quality of antenatal care predicts retention
in skilled birth attendance: a multilevel
analysis of 28 African countries
Adanna Chukwuma1,2* , Adaeze C. Wosu3, Chinyere Mbachu4 and Kelechi Weze1
Abstract
Background: An effective continuum of maternal care ensures that mothers receive essential health packages from
pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of
skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the
continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care
clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care
received.
Methods: We pooled nationally representative data from Demographic and Health Surveys conducted in 28 African
countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of
retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).
Results: Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and
country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure
checked, received information about pregnancy complications, had blood tests conducted, received at least one
tetanus injection, and had urine tests conducted.
Conclusions: Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received
prenatally may increase client retention during delivery, reducing maternal mortality.
Keywords: Antenatal, Continuum, Delivery, Birth, Quality, Determinants, Maternal health
Background
Sub-Saharan Africa has the highest regional maternal
mortality ratio in the world with 546 maternal deaths
per 10,000 live births [1]. The risk of maternal death
peaks around the time of birth, when coverage of care is
at its lowest [2]. An effective continuum of skilled ma-
ternal care ensures that mothers receive essential health
packages from pre-pregnancy to delivery, and postna-
tally, reducing the risk of maternal death [2]. However,
across Africa, the proportion of mothers that receive
skilled birth attendance (51%) is lower than the propor-
tion that receives any skilled antenatal care (78%) [3].
Where this difference is due to dropouts from skilled
delivery care represents missed opportunities to reduce
maternal mortality in Africa.
Understanding predictors of retention in the con-
tinuum of care can inform policy and programs to re-
duce maternal mortality. To date, few studies have
characterized the determinants of retention along the
continuum of care in Africa. These include a recent
study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal,
Tanzania, and Uganda) [4] and another study that fo-
cused on Nigeria [5]. These studies focused exclus.
Improve quality and increase access to family planning and maternal health care services
Educate couples to ensure they have the best chance for a wanted and safe pregnancy
Safe motherhood is one of the important components of Reproductive Health. It means ensuring that all women receive the care they need, to be safe and healthy throughout pregnancy and childbirth. It is the ability of a mother to have safe & healthy pregnancy & child birth.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
1. Inequalities in Access to Maternal Health
Care and Role of Transport Intervention:
Mom’s Van as an Example.
Nazmul Alam, MPH, DrPH
Université de Montréal
November 22, 2014
Ryerson University
Quebec, Canada
2. Outline of the Presentation
• Maternal mortality: causes and consequences
• Maternal care services: persistent inequality
• Interventions to address inequality
• Role of transport intervention: The walk
• Mom’s van intervention
3. Maternal Mortality: A Global Tragedy
• In 2013, 289 000
women died from
complications of
pregnancy or
childbirth.
– 99% in developing
world
– >50% of them in
Africa
• http://gamapserver.who.int/gho/interactive_charts/mdg5_mm/atlas.html
5. 5
Progress towards Millennium
Development Goal 5
Countdown of 75 countries, account for 95% of all deaths.
Nine countries are on track; 25 made insufficient or no progress.
Count down to 2015: briefing note
6. Causes of Maternal Mortality
*Malaria, HIV, accident etc..
**Obstructed labor, ambolism etc..
Source: Countdown to 2015, 2010.
7. Three Delays Model
• 1st delay: delay in decision to seek care
• Lack of understanding of complications
• Acceptance of maternal death
• Low status of women
• Socio-cultural barriers to seeking care
• 2nd delay: delay in reaching care
• Mountains, islands, rivers
• Distance to health centres and hospitals
• Availability of and cost of transportation
• 3rd delay: delay in receiving care
• Supplies, personnel
• Poorly trained personnel with punitive attitude
* 3 delay model, Thaddeus 1994
8. 8
Maternal Health Care
Prenatal care
Antenatal care
Skilled attendent
at Birth
Emergency
obstetric care
Postnatal care
9. EmOC is fundamental
Screening
TBA
Training
Antenatal
Care
Skilled
Attendant Referral
Risk
Social
Mobilization
Waiting
Homes
Emergency Obstetric Care
10. Coverage of care
• Good quality maternal health
services are not universally
available and accessible
– > 35% receive no antenatal
care
– ~ 50% of deliveries
unattended by skilled
provider
– ~ 70% receive no
postpartum care during 1st 6
weeks following delivery
11. Maternal care services and MMR
R2 = 0.74
2000
1800
1600
1400
1200
1000
800
600
400
200
0
Y Log. (Y)
0 10 20 30 40 50 60 70 80 90 100
% skilled attendant at delivery
Maternal deaths per 1000000 live births
12. Prenatal care, skilled birth attendance and MMR
in India.
Praveen et. al., PLoS One. 2010 Oct 27;5(10):e13593.
18. 18
Mothers education and SBA
Trends in the percentage of skilled birth attendance by (A) woman’s education, (B) partner’s
education, (C) wealth index, 1993–2008. BMJ Open 2013 3:
19. Interventions to reduce maternal
mortality
Health systems improvements
• Antenatal care
• Skilled attendant at delivery
• Functional EmOC
• Referral
Structural interventions
- Girls education
- Infrastructure
- Health care financing
23. 23
Health Voucher scheme
Demand side financing: maternal health voucher scheme in Bangladesh, Ahmed, Soc. Sci & Med, 2011
24. In Burkina Faso, household costs related to maternal care has been
progressively reduced: i. abolition of ANC user fees, 2002; ii. subsidy for
C-sections, 2006; iii. subsidy for all deliveries, 2007. (De Allegri, Valerie, 2012)
24
User fee abolitions
25. Referral and transport intervention
Poor transport specially in rural areas in LMIC is one
of the avoidable factors.
• scarcity of transportation
• distance
• cost of transport
• poor road conditions
26. Referral and transport intervention
The Walk video:
Every Mother Counts
http://youtu.be/8HZuMmU778I
27. Three wheeler motor van (Mom’s van)
for transportation of women with
obstetric emergency
28. Existing transport intervention:
Mostly in Africa, where it needs more….
- RESCUER project in Uganda
- Yellow flag initiative in Nigeria
- Safe motherhood transport plan- Malawi
But existing transport intervention are either inadequate,
urban focused, facing management or sustainability
problem
29. Goal: Contribute in reduction of maternal mortality to
achieve MDG targets
Objectives
• to understand availability transportation and
referral network during obstetric emergencies in
rural areas
• to assess acceptability, feasibility and utilization
of ‘Mom’s van’ intervention
31. 31
Study Area
Bangladesh, Mymensingh District, Nandail Upazila: approximately
328,847 population
Kaya district in Burkina Faso: approximately 66,851 population
32. Formative research
Qualitative and quantitative methods have
been used:
Those methods included:
• Literature review,
• Survey with a semi structured
questionnaire,
• In-depth interviews with key informants,
• Focus group discussions (FGDs),
32
35. 35
Place of delivery and experience to travel
Burkina Faso Bangladesh
36. 36
Care seeking during pregnancy and delivery,
Bangladesh
Characteristics Number, N=300 %
Complications during last
pregnancy/delivery
137 45.7
Sought care for complications 128 42.7
Mode of transportation to go health
centres
Ambulance/micro-bus
CNG/Auto
Rickshaw/ Rickshaw van
Boat
On foot
(n=187)
26
80
71
3
7
13.9
42.8
38.0
1.6
3.7
Time needed to go a health facility
(range) 1h24m (30m-3h30m)
Cost for one visit (range) 752.7 (1500-3500)
37. Care seeking during pregnancy and delivery, Burkina
Faso
37
Characteristics Number (N=340) %
Complications during last
preg./delivery
247 73.2
Sought care for complications 229/247 92.7
Available transportation
Motor cycle
On foot
Moto ambulance
208
69
2
75.0
20.3
0.6
Ave. time to reach health facility (range) 1h:30m (10m-10h)
Cost (FCFA*) for each visit (range) 750 (0-3750)
38. Van modeling
38
Allwells Marketing company and Rasendic
motors Inc..
39. Key features/innovations:
• A three wheeler, suitable for rural roads, safer than two
wheeler.
• Cell phone connectivity to help rapid communication
with families and service providers.
• Manage by community support group to promote sense
of ownership, included women in committee
• Adopted a business model for limited income generation
for sustainability.
• Will carry women from poor families for free to promote
equity.
40. How it helps:
•Availability of Mom’s van in the community will help
reduce 1st delay (decision making)
•Women with complications can reach facilities in
less 60 minutes (2nd delay).
• Mobile connectivity will help reduce delay at the
facility (3rd delay).
41. Major outcomes:
• Acceptability: acceptability will be assessed by
interviewing women who received services and their
family head .
• Feasibility: feasibility will be assessed by measuring cost,
management and administrative issues
• Effectiveness: measuring distal outcome like met need,
travel time, referral rate, etc..
46. Major challenges:
- Sustainability vs. affordability
- Creating demand
- Risk of accident
- Monitoring and supervision
47. Singh A, Mavalankar DV, Bhat R, Desai A, Patel SR, et al. (2009) Providing skilled birth attendants and emergency obstetric
care to the poor through partnership with private sector obstetricians in Gujarat, India. Bulletin of World
Health Organization 87: 960–964.
Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE (2007) Huge poorrich inequalities in maternity and child care in
developing countries. Bulletin of the World Health Organization 85(10): 745–754.
Freedman LP, Graham WJ, Brazier E, Smith JM, Ensor T, et al. (2007) Practical lessons from global safe motherhood
initiatives: time for a new focus on implementation. Lancet 370: 1383–91.
Pathak PK, Singh A, Subramanian SV. Economic inequalities in maternal health care: prenatal care and skilled birth
attendance in India, 1992-2006.PLoS One. 2010 Oct 27;5(10):e13593.
McIntyre D, Thiede M, Birch S: Access as a policy-relevant concept in low- and middle-income countries. Health Economics,
Policy and Law 2009, 4:179–193.
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The World Health Organization, Department of Reproductive Health and Research (2007) Maternal mortality in 2005:
estimates developed by WHO, UNICEF and UNFPA. Geneva: World Health Organization.
United Nations. 2012b. The Millennium Development Goals Report. New York.
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47
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