Background The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB’s implementation. Thus, this study aimed to evaluate the MCH-HB’s implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies. Methods A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities’ overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis. Results A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data’s analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB’s content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier. Conclusions Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities.
Although the maternal and child health (MCH) Handbook is widely used in many countries, its development and implementation process has not been sufficiently documented in scientific publications. This is a report of how the Angola MCH Handbook was developed, what challenges we encountered during its implementation and how they were solved. Leading the process was the MCH Handbook Committee set up to develop the MCH Handbook and implement the programme in liaison with various stakeholders. We developed the MCH Handbook through participatory workshops with the objective of producing user-responsive content and designs, foster healthy interaction and build common understanding among stakeholders. After pilot use in select health facilities, the MCH Handbook programme, which included training, monitoring and supervision, mothers’ class and community awareness raising activities, was gradually implemented in three model provinces. Core members of the committee closely observed each step of the programme to identify challenges in each field, and revised the tool and programme throughout the process. As nationwide implementation of the MCH Handbook Programme progresses, it is important to continually identify challenges specific to different localities while taking measures to address them. In our experience, stakeholder involvement from the early planning and preparation stages was critical to ensure their continued commitment at later stages and for programme continuity. Our approach of tool development involving various stakeholders and flexible implementation strategies were key elements for user acceptance and programme sustainability that may be applicable for introduction of similar interventions in other settings.
To reach the ambitious target of the UN Sustainable Development Goal (SDG), with countries aiming to end preventable death of newborn and under five children and reduce the mortality rate among children under 5 years to at least 25 per 1000 live birth, we need to understand the principles preventable causes and risk factors leading to child mortality. Among these preventable diseases, meningitis has one of the highest fatality rates and the potential to cause long term disability and devastating epidemics. This study is the first one in trying to identify the risk factors associated in mortality with meningitis in children admitted at luabango pediatric hospital. We conducted a retrospective cross-sectional study to identify the sociodemographic and clinical risk factors associated with mortality in children admitted with the diagnosis of meningitis at lubango pediatric hospital, Angola. Following approval of the ethics committee at Lubango Pediatric Hospital, records of patients diagnosed with acute meningitis between 2020 and 2021 was extracted from infectious ward file record. Data was analyzed using SPSS 23. 20 (26.7%) of children admitted at lubango Pediatric hospital with the diagnosis of meningitis during the period of the study died. Mother’s level of education ((P: 0.000), Vaccination status of the children (P:0.018) and vomiting (P: 0.007) were associated with mortality in a Bivariate analysis. Lethality rate of children with the diagnosis of meningitis admitted at lubango Pediatric hospital during the period of the study was 26.7%. mother’s level of education, Vaccination status of the children and vomiting were strongly associated with mortality.
Background The maternal and child health (MCH) handbook is promoted as a tool for strengthening continuum of care. We assessed the effect of a MCH handbook intervention package on continuum of maternal and child health care and health outcomes for mother and child. Methods We conducted an open-label, parallel two-arm cluster randomized controlled trial in Angola. We randomly assigned municipalities in Benguela province through block randomization to a group using a package of enhanced maternity care service (which included the MCH handbook distribution and its supplementary intervention) and another using usual care (two stand-alone home-based records). We included women who were pregnant at the beginning of the trial period and attended a public health care facility for maternity care services. Neither health care providers, study participants nor data assessors were masked, but the statistician was. The primary outcome was a measure of service utilization assessed via achievement of maternal behavior-based continuum of care at three months postpartum. We conducted an intention-to-treat analysis in women with available data. Results We randomized 10 municipalities to either the intervention (five clusters) or control (five clusters) group. Of the 11 530 women approached between June 8, 2019, and September 30, 2020, 11 006 were recruited and 9039 included in the final analysis (82%; 3774 in the intervention group and 5265 in the control group). The odds for achievement of maternal behavior-based continuum of care in the intervention group was not significantly different from that in the control group (adjusted odds ratio (aOR) = 1.18, 95% confidence interval (CI) = 0.46-2.93) at three months postpartum. However, the odds of initiating antenatal care clinic use were significantly higher in the intervention group (odds ratio (OR) = 5.16, 95% CI = 2.50-10.67). No harms associated with the intervention were reported. Conclusions Distribution of the MCH handbook and its supplementary interventions promoted initiation of antenatal care service use, but did not increase service utilization sufficiently enough for attainment of study defined maternal behavior-based continuum of care. Registration ISRCTN20510127.
According to WHO (2018), almost 15 million babies are born every year before 37 weeks of pregnancy, the majority taking place in Sub Saharan Africa and in south Asia. Preterm birth is a common complication of pregnancy and usually bore heavy short- and long-term medical, socio-economic and financial burden to the affected children, the family, the heath system and the community as all. Angola with one of the highest fertility rates in the world, 6.2 according to the DHS 2015-2016, coupled with the fact that preterm birth is regarded as a traumatic social even for the parent and a quite expensive condition to the health system will need to stablish the main risk factors for preterm birth in order to inform strategies to prevent its occurrence. We conducted an hospital based cross sectional study to determine the prevalence and the risk factors of preterm birth at Irene Neto Maternity Hospital- Lubango-Angola. Three trained research assistants were recruited from the post labour wards and the new born unit and trained to collect data. Gestational age was calculated using a standard obstetric wheel based on menstrual dates or first trimester ultrasound (when available). A Newborn clinical assessment using the Finnstrom Score aided by a printed pictorial scoring chart was then conducted within 24 hours of birth, by a trained medical Doctor for confirmation. 17.7% of women giving birth at Lubango maternity hospital had a preterm new-born. Among the socio- demographics factors, only maternal age (p :0.021), family income(p:0.032), use of alcohol (p: 0.013) and lack ANC (p: <0.001) were associated with premature birth. Clinical factors found to increase the risk of premature birth included Antecedent of hypertension (p: 0.021), Preeclampsia (p: 0.026), Malaria (p:0.001) and multiple gestation (p: 0.01). Only antecedent of premature birth (p:0.0049), lack of antenatal care (p<0.001), malaria (p:0.009) and multiple gestation (p: 0.001) remained significant after controlling for confounders. Premature birth is still a public health problem in Angola, principally among pregnant women who do not attend ANC clinic and those with multiple gestation. Malaria infection during pregnancy as well as preeclampsia are also serious predictors of premature birth. With a prevalence of 17.7%, premature birth is a still a serious problem at lubangopediatric hospital and deserve a multisectoral well-coordinated action. ANC clinic should be actively promoted, improved and expended. Pregnant women with antecedent of premature birth should be closely monitored Preeclampsia and malaria should be prevented, searched and serious treated when present during pregnancy. We the recommend a Multicentre and large sample size, longitudinal observational analytic study for better understanding of the principal predictors at a country level.
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