Setting priorities for safe motherhood interventions in resource-scarce settings

Prata, Ndola; Sreenivas, Amita; Greig, Fiona; Walsh, Julia; Potts, Malcolm

doi:10.1016/j.healthpol.2009.08.012

Cited by 34 publications

(27 citation statements)

References 22 publications

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“…Timeliness is an important dimension of quality of care [24]. This study found that delays in the initiation of care occurred in all stages of care, including triage response time, obstetric resident response time, and ICU waiting time.…”

Section: Discussionmentioning

confidence: 99%

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Mawarti

Hakimi

2017

BMC Pregnancy Childbirth

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BackgroundReducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon.MethodsA retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta, and maternal near misses were used as controls. Data were obtained from medical records from February 1, 2011 to September 30, 2012. Three groups of variables were measured: (1) timeliness of care, (2) adherence to a standard of process indicators, and (3) associated extraneous variables. Variables were analysed using logistic regression to explore their effects on maternal mortality.ResultsThe mean of triage response time and obstetric resident response time were longer in maternal deaths (8 ± 3.59 and 36.17 ± 23.48 min respectively) compared to near misses (1.29 ± 0.24 and 18.78 ± 4.85 min respectively). Near misses more frequently received oxytocin treatment than the maternal deaths (OR 0.13; 95%CI 0.02–0.77). Magnesium sulfate treatment in severe-preeclampsia or eclampsia was less given in maternal deaths although insignificant statistically (OR 0.19; 95% CI 0.03–1.47). Prophylactic antibiotic was also more frequently given in near misses than in maternal deaths though insignificant statistically (OR 0.3; 95% CI 0.06–1.56). Extraneous variables, such as caesarean sections were less performed in maternal deaths (OR 0.15; 95% CI 0.04–0.51), vaginal deliveries were more frequent in maternal deaths (OR 3.47; 95% CI 1.05–11.54), and more women in near misses were referred from other health care facilities (OR 0.09; 95% CI 0.01–0.91).ConclusionsThe near misses had relatively received better quality of care compared to the maternal deaths. The near misses had received faster response time and better treatments. Timely referral systems enabled benefits to prevent maternal death.

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Section: Discussionmentioning

confidence: 99%

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Mawarti

Hakimi

2017

BMC Pregnancy Childbirth

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“…Researchers have also consistently emphasized the need for trained medical personnel to attend women during labor and delivery Mobeen et al 2011;Sibley, Sipe, and Barry 2012). Because a large proportion of maternal deaths occur within the first few days after delivery, safe motherhood programs have recently increased their emphasis on the importance of postnatal care (Prata et al 2010). Timely ANC, delivery by skilled attendants, obstetric care, active management of third stage labor, and community management of post-partum Adequate Maternal Health Care Services in Kenya 205 bleeding improve access to and quality of ANC to reduce maternal mortality and morbidity (Ghi et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Individual and Contextual Determinants of Adequate Maternal Health Care Services in Kenya

Achia

Mageto

2015

Women & Health

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This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008-09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care.

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“…OBA programs subsidize specific health care packages based on provision of care with pre-defined quality standards [6,10,11]. Most OBA programs have the following goals: to improve service quality, to stimulate client use of selected services, to target services among high-priority populations where service uptake is low in the absence of the subsidy, and to contain costs [12-16]. Most OBA programs have a supervisory or regulatory body that meets periodically to oversee their operations including contracts with providers.…”

Section: Introductionmentioning

confidence: 99%

Community experiences and perceptions of reproductive health vouchers in Kenya

et al. 2013

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BackgroundResearch on demand-side health care financing approaches such as output-based aid (OBA) programs have focused on evaluating the role of the programs improving such outcomes as utilization of services and quality of services with limited focus on the experiences and perceptions of the target communities. This paper examines community members’ views of the output-based aid voucher program in Kenya.MethodsA household survey was conducted in 2010 among 1,336 women aged 15-49 years living in the catchment areas of contracted health facilities in three districts participating in the voucher program (Kisumu, Kiambu and Kitui). Twenty seven focus group discussions were conducted with voucher users, non-users, opinion leaders and voucher distributors in the three districts as well as in Nairobi. Analysis of the quantitative data involved frequency distributions and cross-tabulations. Qualitative data were transcribed and analyzed by adopting framework analysis and further triangulation of themes across respondents.ResultsMajority (84%) of survey respondents had heard about the safe motherhood voucher compared to 24% and 1% that had heard about the family planning and gender-based violence recovery services (GBVRS) vouchers respectively. Similarly, 20% of the respondents had used the safe motherhood voucher compared to 2% for family planning and none for the GBVRS vouchers. From the community members’ perspectives, the voucher program is associated with improvements in access to health services for poor women, improved quality of care, and empowerment of women to make health care decisions. However, community members cited difficulties in accessing some accredited health facilities, limitations with the system of selling vouchers, lack of male involvement in women’s reproductive health issues, and poor understanding of the benefits associated with purchasing the voucher.ConclusionThe findings of this paper showed that the voucher program in Kenya is viewed by the community members as a feasible system for increasing service utilization, improving quality of care, and reducing financial barriers to accessing reproductive health services. However, the techniques of program execution such as proper information and availability of the distributors as well as local attitudes influence whether vouchers are purchased and used.

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Setting priorities for safe motherhood interventions in resource-scarce settings

Cited by 34 publications

References 22 publications

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study

Individual and Contextual Determinants of Adequate Maternal Health Care Services in Kenya

Community experiences and perceptions of reproductive health vouchers in Kenya

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