Maternal & Child Health

Unavailability of Essential Obstetric Care Services in a Local Government Area of South-West Nigeria

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area of South-West Nigeria. The objectives were to determine the availability of essential obstetric care services and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. [from abstract]

Did the Strategy of Skilled Attendance at Birth Reach the Poor in Indonesia?

This study assessed whether the strategy of “a midwife in every village” in Indonesia achieved its aim of increasing professional delivery care for the poorest women. [from abstract]

Assessment of Effects of Pre and Post-Training Programme for Healthcare Professionals about Breastfeeding

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. [from abstract]

Expanding the Role of Community Based Workers and Advocates in Safe Motherhood

Under the ENABLE Safe Motherhood Core Initiative, CEDPA/India collaborated with the Community Aid and Sponsorship Program on the Safe Motherhood Initiative to reduce maternal death by showing women, their families and their communities how to prepare for a safe delivery, to identify pregnancy-related complications at their onset, and to seek medical help immediately. [publisher’s description]

Competence of Maternal and Child Health Clinic Workers in Detecting Malnutrition in Somalia

The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. [from abstract]

Contribution of Privately Owned Hospitals in the Provision of Essential Obstetric Care in Nigeria

The objective of the study reported in this article was to highlight the private sector contribution in the provision of essential obstetric care in Abia State, Southeastern Nigeria. [adapted from abstract]

Training of Trainers Module: Women's Nutrition Throughout the Life Cycle and in the Context of HIV and AIDS

This module is intended to equip instructors with basic theory to train health workers in a life cycle approach to women’s nutrition. Women’s nutrition and care in the context of HIV and AIDS is integrated into the module. Health workers will apply the knowledge and skills in negotiation and interpersonal communication to help mothers and caregivers care for their own nutritional needs and feed their infants and young children optimally. [publisher’s description]

Chiranjeevi: Involving Private Obstetricians to Reduce Maternal Mortality in Gujarat (India)

This PowerPoint was presented at the 2007 GHC expert panel “Making it Work: Private Sector Partnerships to Improve Women’s Health.” It discusses the challenges, costs and results of a program to use private practitioners for improving maternal and child survival.

Shortages and Shortcomings: the Maternal Health Workforce Crisis

Providing maternal care requires a viable and effective health workforce. In many countries, and certainly in all countries where maternal mortality is high, the size, skills and infrastructure of the workforce is inadequate… Apart from taking urgent corrective action on salaries and conditions, strategic decisions must be made in three areas: training, deployment, and retention of health workers. [author’s description]

Comparing Maternal Health Services in Four Countries

While the availability and use of trained midwives can shape the quality of care received in pregnancy and childbirth, a number of other underlying health systems structures and processes are important. The management of health workforces, the mix of public and private provision and the impact of reforms affect quality of care across countries…[This study] examined how the structure and operation of a health system influences maternal health care provision and outcomes in Bangladesh, Russia, South Africa and Uganda. [author’s description]

Maternal Health in Sub-Saharan Africa: Tackling the Skills Shortage

Sub-Saharan Africa has the worst rate of maternal ill-health in the world. Maternal deaths occur partly because health systems are inadequately staffed to deal effectively with birth complications. How can maternal health human resources be managed better to ensure that all women, especially in poor, rural areas, can access good quality maternal health care? [author’s description]

Going to Scale with Professional Skilled Care

Because most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. [from summary]

Health Providers' Counselling of Caregivers in the Integrated Mangement of Childhood Illness (IMCI) Programme in Uganda

IMCI was launched in Uganda in June 1995 and has so far been implemented in most districts. However, reports indicate that counselling is poorly performed and that health providers find IMCI counselling the most difficult component to implement. The study was carried out to assess IMCI-trained health providers’ counselling of caregivers and to determine factors that facilitate or constrain counselling. [from abstract]

Achieving Child Survival Goals: Potential Contribution of Community Health Workers

This article discusses the potential contribution of community health workers to child survival rates. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers require focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. This article discusses the need for evaluation of programmes for community health workers. [from summary]

Strengthening Midwife-Hilot Partnership to Improve Maternity and Newborn Care Services in ARMM

This model for strengthening the midwife and hilot partnership was developed to improve the quality and accessibility of maternity and newborn care services (MNCS) in the Autonomous Region in Muslim Mindanao (ARMM). It aims to provide quality MNCS at various service settings like the home, community and health facilities. [introduction]

HIV and Infant Feeding Counselling: Challenges Faced by Nurse-Counsellors in Northern Tanzania

Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. [abstract]

TRACE: a New Way to Measure Quality of Maternal Health Care

To evaluate the quality of maternal clinical care, Immpact, a global research initiative, developed an innovative method, called TRACE, to trace adverse and favourable events in pregnancy care. It is based on the confidential enquiry technique, whereby expert panels of health care professionals assess the quality of health care provided to clients in an
adverse event, such as a maternal death. [author’s description]

Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi

Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]

Health Workers and Vaccination Coverage in Developing Countries: an Econometric Analysis

Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. The author’s aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries. [from summary]

Low Use of Skilled Attendants' Delivery Services in Rural Kenya

The aim of the study was to estimate the use of skilled attendants’ delivery services among users of antenatal care and the coverage of skilled attendants’ delivery services in the general population in Kikoneni location, Kenya. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality. [from abstract]

Postpartum and Newborn Care: a Self-Study Manual for Trainers of Traditional Birth Attendants and Other Community-Level Maternal and Child Health Workers

The purpose of this self-study manual is to provide accurate and accessible information on postpartum and newborn care to trainers of Traditional Birth Attendants (TBAs) and other community-level Maternal and Child Health (MCH) Workers.* The information can be integrated into existing training curricula and materials or it can be adapted into additional units for an ongoing program of instruction for TBAs. [from introduction]

Community-Based Postpartum Care: an Urgent Unmet Need

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.

Effect of Community Nurses and Health Volunteers on Child Mortality: the Navrongo Community Health and Family Planning Project

This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

Documentation and Assessment of the Reproductive and Child Health Alliance (RACHA) Program: an External Assessment

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

Utilizing the Potential of Formal and Informal Private Practitioners in Child Survival: Situation Analysis and Summary of Promising Interventions

This review and discussion paper highlights the important role that private practitioners are already playing in providing health services to children in many countries, and the far greater contribution that they could be called upon to make.

South African Health Review 2006

The 2006 Review seeks to provide a South African perspective on prevailing international public health issues, and in particular provides an opportunity to reflect on progress to achieving the Millennium Development Goals many of which are linked to maternal and child health. It also seeks to stimulate debate and critical discourse, to provide a platform for assessing progress and to identify key gaps and opportunities for future action that is realistic and sustainable. [from foreword]

Packaging Health Services When Resources Are Limited: the Example of a Cervical Cancer Screening Visit

Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services.

Using Quality Assessment to Improve Maternal Care in Nicaragua

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’s description]

Assessing Health Worker Performance of IMCI in Kenya

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

Costing of the Integrated Management of Childhood Illnesses in Bangladesh: a Study Based on Matlab Data

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]