What Works? Strategies to Increase Reproductive, Maternal and Child Health in Difficult to Access Mountainous Locations: A Systematic Literature Review

Byrne, Abbey; Hodge, Andrew; Jimenez-Soto, Eliana; Morgan, Alison

doi:10.1371/journal.pone.0087683

Cited by 46 publications

(48 citation statements)

References 42 publications

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“…9 Many of the studies demonstrating the positive effects of PFM exercise on POP required the participants to have multiple follow-up sessions with a health professional, which may not be feasible for many women who have accessibility issues. 5,10 In remote regions of Nepal, health education is delivered predominantly through radio programs or female community health volunteers (FCHV). 11 The FCHVs have basic health training and facilitate mother's groups using verbal instruction to deliver information on various maternal and child health topics.…”

Section: ≥11mentioning

confidence: 99%

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Caagbay

Black

Dangal

et al. 2017

J Nepal Health Res Council

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INTRODUCTIONPelvic organ prolapse (POP) is a common condition for women globally and is one of the most widespread reproductive health problems in Nepal.1,2 POP occurs when the pelvic floor muscles (PFM) and supporting tissues are stretched, weakened or damaged allowing the bladder, uterus or bowel to descend into the vagina. 3Women who have weak or damaged PFMs have 4-11 times the risk of developing a POP when compared to women with good PFM function. 4 Strengthening the PFMs is the first line conservative treatment option for POP and can improve symptoms, quality of life (QOL) and severity.5 However, teaching women to correctly exercise their PFMs is challenging and up to 50% may still do it incorrectly even after verbal instruction. 6 The aim of this pilot study was to investigate whether brief verbal instruction in conjunction with an illustrated leaflet resulted in Nepali women being able to correctly contract their PFMs. METHODSIn February 2016, a pilot study of parous women aged 18 years and above was conducted. The women were attending two gynecology outpatient clinics run by the Public Health Concern Trust: Kathmandu Model Hospital and Kirtipur Hospital, Nepal.Women attending the hospital outpatient clinics were invited to participate in the study by their doctor. Initially, the doctor performed the Pelvic Organ Prolapse Quantification scale (POP-Q) to assess for POP. Following their clinical examination, a demographic questionnaire containing questions about their age, educational Background: Pelvic organ prolapse is a common disorder for women in Nepal causing symptoms and reduced quality of life. Pelvic floor muscle exercise is a conservative treatment option for pelvic organ prolapse but the effective way to teach women in Nepal is not known. The objective of this pilot study was to determine if an illustrative leaflet with brief verbal instruction could teach Nepali women to correctly contract their pelvic floor muscles. Methods:Fifteen parous women attending two outpatient gynecology clinics in Kathmandu Valley were interviewed to assess their knowledge of pelvic organ prolapse and pelvic floor muscles exercise. Following verbal instruction and an illustrative leaflet on how to contract their pelvic floor muscles, the transabdominal real time ultrasound was applied to assess the muscle contraction. Results:The median age of 15 participants was 45 years (range 18-75 years) and 10 women had pelvic organ prolapse. Some of the participants (9/15) knew about pelvic organ prolapse but none were aware of the pelvic floor muscles. After being taught how to contract their pelvic floor muscle, only 4 of 14 correctly contracted the pelvic floor muscle. Conclusions:This study highlighted the low knowledge of the pelvic floor muscle, and brief verbal instruction with an illustrative leaflet is also not sufficient in teaching Nepali women how to correctly contract their pelvic floor muscle. Further research is needed to determine how to teach a correct pelvic floor muscle contraction for women with low...

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Section: ≥11mentioning

confidence: 99%

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Caagbay

Black

Dangal

et al. 2017

J Nepal Health Res Council

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“…Perhaps most common is the impact of geographical remoteness on access to such services (Singh [61], on the Tibetan Autonomous Region; Gyaltsen et al [23], on Qinghai Province, China; literature review on access to and use of health services in mountainous regions by Byrne et al [9]. In contrast, one study from Ethiopia describes greater remoteness and worse health outcomes in the lowlands compared to the highlands [55].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, one study from Ethiopia describes greater remoteness and worse health outcomes in the lowlands compared to the highlands [55]. Remoteness is not the only factor leading to poor access to services: political priorities and individuals’ decisions over the use of services are also relevant (Singh [61] and Morris [44], on uptake of health services in Honduras; Van Vo et al [66], on the use of maternal health care services in Vietnam; Rheinländer et al [52], on care-seeking practices in Vietnam; Oxfam [47], on provision of healthcare services in Nepal; Byrne et al [9]).…”

Section: Discussionmentioning

confidence: 99%

“…Many studies also consider intersecting vulnerabilities based on caste, class, gender and—of particular relevance here—generation, creating conditions of particular disadvantage for the most vulnerable members within mountain communities [20, 22, 49, 67]. Consequently, many advocate a child rights based approach [47, 48, 61, 67] and investment in improved accessibility, quality, and cultural appropriateness of services [1, 9, 50, 52, 66, 69]. …”

Section: Themesmentioning

confidence: 99%

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Mountain Child: Systematic Literature Review

Audsley¹,

Wallace

Price

2016

Matern Child Health J

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Objectives This systematic review identifies and reviews both peer-reviewed and ‘grey’ literature, across a range of disciplines and from diverse sources, relating to the condition of children living in mountain communities in low- and middle-income countries. Findings The literature on poverty in these communities does not generally focus on the particular vulnerabilities of children or the impact of intersecting vulnerabilities on the most marginalised members of communities. However, this literature does contribute analyses of the broader context and variety of factors impacting on human development in mountainous areas. The literature on other areas of children’s lives—health, nutrition, child mortality, education, and child labour—focuses more specifically on children’s particular vulnerabilities or experiences. However, it sometimes lacks the broader analysis of the many interrelated characteristics of a mountainous environment which impact on children’s situations. Themes Nevertheless, certain themes recur across many disciplines and types of literature, and point to some general conclusions: mountain poverty is influenced by the very local specificities of the physical environment; mountain communities are often politically and economically marginalised, particularly for the most vulnerable within these communities, including children; and mountain communities themselves are an important locus for challenging and interrupting cycles of increasing inequality and disadvantage. While this broad-scale review represents a modest first step, its findings provide the basis for further investigation.

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“…Review identified many reasons behind the lack of accessibility, such as poor communication system, land slide or flash flood during rainy season, etc. In total 20 papers reported the telemedicine features of addressing challenges of geographic remoteness [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 11 papers reported time saving [29][30][31][32][33]40,41,[47][48][49][50] character. 4 papers reported communication and transportation 30,32,46,49 related issues.…”

Section: Theme 1: Geographic Difficulties and Emergency Contextmentioning

confidence: 99%

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

Siddiquee¹,

Poudyal²,

Pandey³

et al. 2020

SHTT

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The traditional model of health services imposes limitations, especially in resourcelimited countries like Nepal. Introduction to information technology can mitigate various challenges like geographic complexity, urban-rural disparity, poor accessibility, shortage of healthcare professionals, inadequate health facilities, higher cost, and time. Nepal is a resourcelimited country with diverse geographic features making it hard to have proper access to healthcare facilities. Telemedicine service has the potential to improve service quality and accessibility of the disadvantaged and underserved population by overcoming the existing challenges. The objective of this review was to explore the roles of telemedicine in vanquishing existing challenges. Seven data sources (namely CINAHL, PubMed, POPLINE, Web of Science, Scopus, DOAJ and Summon) were consulted using five keywords (telemedicine, telehealth, eHealth, mHealth and Nepal to find the literature using the Boolean operator AND) to obtain the relevant materials. The narrative synthesis method was used to review papers and to analyze the findings. This review selected 27 papers for further analysis by scrutinizing 1161 initial search results. The most common features of telemedicine services so far, implemented or piloted in Nepal, were addressing geographic remoteness (21%), a shortage of in healthcare service providers (11%), saving time (11%), addressing challenges of extreme conditions (10%), cost saving (9%), service quality (9%) and real-time services (8%). Some other features of telemedicine were communication, transportation, referral, collaboration, addressing challenges in proper diagnosis and the shortage of health professionals. In a nutshell, the review findings suggested improved service quality, increased collaboration and accessibility and decreased the disparity in comparison with traditional health service models. Although it cannot be said that telemedicine in Nepal has been mainstreamed, yet the appeal is increasing due to its positive impact, especially in rural and hard-to-reach areas where with a lack of healthcare set-up and professionals.

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What Works? Strategies to Increase Reproductive, Maternal and Child Health in Difficult to Access Mountainous Locations: A Systematic Literature Review

Cited by 46 publications

References 42 publications

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Can a Leaflet with Brief Verbal Instruction Teach Nepali Women How to Correctly Contract Their Pelvic Floor Muscles?

Mountain Child: Systematic Literature Review

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

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