Maternal, Newborn, and Child Health (MNCH) / la santé de la mère, du nouveau-né, et de l’enfant

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Application of a qualitative rapid assessment approach to inform community-responsive information, education and communication activities
(2018-02) Bergen, Nicole; Shifera, Asfaw
The study examined the application of a qualitative rapid assessment approach to explore community perceptions and experiences related to health and health inequality, focusing on maternal and child health (MCH). Participants identified health inequalities within communities and attributed them to lack of knowledge, exclusion from social groups, and poverty. Health Extension Workers (HEWs), religious leaders and “development army” members are well-positioned to disseminate knowledge and influence health behaviours. The study generated a context-specific situational analysis to inform the design and delivery of information, education and communication (IEC) activities in Jimma Zone (Ethiopia).
The costs and benefits of CRVS as a tool for women's empowerment
(2019-01) Espey, Jessica
This paper complements the others’ contextual analysis by focusing on some of the practical barriers to the expansion of CRVS systems, namely costs, current levels of investment, and shortfall, while also highlighting the immense investment opportunity. The two other papers are : "Leave no one behind : CRVS, Gender and the SDGS" and "Harnessing CRVS data for the gender-related SDGs; opportunities and challenges".
Cultural influences on the assessment of children’s pain
(2009) Finley, G A; Kristjánsdóttir, Ó; Forgeron, P A
Culture is commonly regarded as a factor in pain behaviour and experience, but the meaning of the term is often unclear. There is little evidence that pain perception is modified by cultural or ethnic factors, but pain expression by children and interpretation by caregivers may be affected by the culture of the patient or the caregiver. The present paper examines some of the research regarding cultural influences on children’s pain assessment, and addresses directions for future research. A focus on cultural influences should not distract clinicians from the need to be sensitive to individual beliefs and attitudes.
Determinants of parents' reticence toward vaccination in urban areas in Benin (West Africa)
(BioMed Central, London, GB, 2009) Fourn, Léonard; Haddad, Slim; Fournier, Pierre; Gansey, Roméo
Analysis of the data reveals those who are vaccination-reticent say it goes against the will of God, that it is a poison from the “white witch doctor,” and a sin. Members of the control group argued against this, but without conviction. They adhere to the principle of obedience to authority, a biblical precept invoked when the vaccinators oblige them to vaccinate their children. To limit the spread of this phenomenon among the religious population of the cities like Parakou and Cotonou in Benin, more detailed information and negotiation between health authorities and pastors of the churches are essential.
Equity and vaccine uptake : a cross-sectional study of measles vaccination in Lasbela District, Pakistan
(BioMed Central, London, GB, 2009) Mitchell, Steven; Andersson, Neil; Ansari, Noor Mohammad; Omer, Khalid; Legorreta Soberanis, José; Cockcroft, Anne
Vaccination coverage is lower in most developing countries, particularly in the poorest segments of these countries. Although vaccination is theoretically free, this does not account for costs of travel to the facilities and time away from work or home. In both urban and rural areas, access to a government facility providing vaccinations, a key equity factor, was a determining factor for uptake. This cross-sectional study of communities in the Lasbela district of south Pakistan, explores knowledge, attitudes and discussion around measles vaccination. Findings illustrate the role of equity in determining vaccination uptake.
Evidence-based discussion increases childhood vaccination uptake : a randomised cluster controlled trial of knowledge translation in Pakistan
(BioMed Central, London, GB, 2009) Andersson, Neil; Cockcroft, Anne; Ansari, Noor M.; Omer, Khalid; Baloch, Manzoor
The relatively low-cost knowledge translation intervention applied in this study significantly increased vaccine uptake, without relying on improved services, in a poor district (Lasbela, Pakistan) with limited access to services. The study results prove relevant towards better vaccination coverage in developing countries. The intervention comprised three structured discussions separately with male and female groups in each cluster. Adjusting for baseline differences between intervention and control clusters with generalized estimating equations, the intervention doubled the odds of measles vaccination in the intervention communities (OR 2.20, 95% CI 1.24-3.88). It trebled the odds of full DPT vaccination (OR 3.36, 95% CI 2.03-5.56).
Exploring inequalities in access to and use of maternal health services in South Africa
(2012-05) Silal, Sheetal P; Penn-Kekana, Loveday; Harris, Bronwyn; Birch, Stephen; McIntyre, Diane
While health system barriers to obstetric care have been well documented, “patient-oriented” barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in South Africa. Rural women face the greatest barriers, including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability. Negative provider-patient interactions include: staff inattentiveness, turning away women in early-labour, shouting at patients, and insensitivity towards those who had experienced stillbirths. To achieve its MDGs, South Africa must systematically address the access constraints as well as altering the attitudes and actions of health care providers.
Fallacy of coverage : uncovering disparities to improve immunization rates through evidence; results from the Canadian International Immunization Initiative, Phase 2 - Operational Research Grants
(BioMed Central, London, GB, 2009) Mhatre, Sharmila L.; Schryer-Roy, Anne-Marie
The evidence points to a “fallacy of coverage,” and provides reasons for lack of effective immunization coverage. Five themes are: timeliness of immunization; social and gender inequities; vaccine efficacy; understanding demand side issues to tailor interventions; and national data sets that mask actual district level coverage rates. The research results demonstrate how locally generated evidence can inform immunization strategies to ensure that children who need to get vaccinated will get vaccinated, and vaccinated on time. Funding for improving immunization should focus not only on increasing coverage, but also on future diseases and vaccines.
Gift of Agency: Sexual Exchange Scripts among Nigerian Youth
(2010) Barnett, J P; Maticka-Tyndale, E; HP4RY Team
This article examines the practice of directly exchanging goods for sexual intercourse using data from 36 focus-group discussions with youth living in rural southern Nigeria. Conceptualizing this practice as a sexual script, the authors conduct a deductive thematic analysis framed by the broader context in which sexual exchange occurs. Combining scripting theory with an analysis of the form of the payment, it was found that the cultural script of exchange supports girls’ agency. However, at the interpersonal level of practice, this script often loses out in conflict with the cultural scripting of male control. The shape of this practice is influenced by intrapsychic scripts (e.g., sexual violence is an option), interpersonal resources (e.g., family money), and cultural scripts (e.g., stuff and status bring friends). In the final analysis, sexual exchange is found to be a script that both enables and restricts agency. It is a power niche for those with limited social and economic power, enabling them to seek and access material goods, social status, and sexual experience. It is also a means of coercing unwanted sex via peer and parental pressure, poverty, and a context of gender inequality. Implications for HIV prevention are discussed.
Global immunization : status, progress, challenges and future
(BioMed Central, London, GB, 2009) Duclos, Philippe; Okwo-Bele, Jean-Marie; Gacic-Dobo, Marta; Cherian, Thomas
This paper briefly reviews global progress and challenges with respect to public vaccination programmes. New vaccine introduction should be viewed as an opportunity to strengthen immunization systems, increase vaccine coverage and reduce inequities of access to immunization services. Global vaccination coverage trends continued to be positive. The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes by expanding the reach of immunization, including new vaccines, to every eligible person.
Governance, Equity and Health : evaluation report 2006-2011
(IDRC, Ottawa, ON, CA, 2010) IDRC. Governance, Equity and Health Program
During the first four years of Phase II (2006 – 2010), the GEH program managed 97 projects, with recipient institutions in 34 countries. GEH supports Southern researchers and institutions committed to democracy, health equity and social justice by enabling knowledge-generation and exchange, and by influencing how research on health systems is conducted and applied, especially in the context of health reforms. This evaluation report presents some of GEH key research findings, summarizes GEH’s three most significant interlinked program outcomes, provides brief reflections on challenges faced in relation to each of these three outcome categories, and summarizes lessons learned.
Harnessing CRVS systems for the gender-related SDGs - opportunities and challenges
(Knowledge Brief Series on Gender, 2019-02) Badiee, Shaida; Appel, Deirdre
This paper describes how CRVS data is not only critical for reporting on the SDGs, but for guiding and implementing policies necessary to achieve them. Doing so is contingent on the usability, openness and interoperability of data, which CRVS systems help produce. It is this symbiotic relationship between data and gender-related SDGs that underscores how well-functioning CRVS systems are needed for the international development community to achieve the SDGs by 2030.
Household cost-benefit equations and sustainable universal childhood immunization : a randomised cluster controlled trial in South Pakistan
(BioMed Central, London, GB, 2005) Andersson, Neil; Cockcroft, Anne; Ansari, Noor; Omer, Khalid; Losos, Joe
Background: Household decision-makers decide about service use based largely on the costs and perceived benefits of health interventions. Very often this leads to different decisions than those imagined by health planners, resulting in under-utilisation of public services like immunisation. In the case of Lasbela district in the south of Pakistan, only one in every ten children is immunised despite free immunisation offers by government health services. // Methods/design: In 32 communities representative of Lasbela district, 3344 households participated in a baseline survey on early child health. In the 18 randomly selected intervention communities, we will stimulate discussions on the household cost-benefit equation, as measured in the baseline. The reference (control) communities will also participate in the three annual follow-up surveys, feedback of the general survey results and the usual health promotion activities relating to immunisation, but without focussed discussion on the household cost-benefit equations. // Discussion: This project proposes knowledge translation as a two-way communication that can be augmented by local and international evidence. We will document cultural and contextual barriers to immunisation in the context of household cost-benefit equations. The project makes this information accessible to health managers, and reciprocally, makes information on immunisation effects and side effects available to communities. We will measure the impact of this two-way knowledge translation on immunisation uptake.
How culture shapes the sexual and reproductive health practices among adolescent girls in Eastern Equatoria, South Sudan
(South Sudan medical journal (SSMJ), 2018-08) Chowdhury, Reajul; McKague, Kevin
BRAC (Building Resources Across Communities) studied attitudes and practices relating to adolescent sexual reproductive health and related topics. This paper reports the findings from this qualitative study. South Sudan has one of the world’s youngest populations with 72 percent below 30 years of age; 26 percent of adolescent girls (15 to 19 years) are mothers. One participant stated, “If a girl does not get pregnant at early age, people think she is barren.” When asked how many children a woman should have, a majority of participants said that a woman should give birth to eight to twelve children and, therefore, should start giving birth early. The article starts on page 56.
Human resource management in the Georgian National Immunization Program: a baseline assessment
(2007-07) Esmail, Laura C; Cohen-Kohler, Jillian Clare; Djibuti, Mamuka
Background: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole.
Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature
(2009-02) Dogba, Maman; Fournier, Pierre
Background: This paper reports on a systematic literature review exploring the importance of human resources in the quality of emergency obstetric care and thus in the reduction of maternal deaths. Methods: A systematic search of two electronic databases (ISI Web of Science and MEDLINE) was conducted, based on the following key words "quality obstetric* care" OR "pregnancy complications OR emergency obstetric* care OR maternal mortality" AND "quality health care OR quality care" AND "developing countries. Relevant papers were analysed according to three customary components of emergency obstetric care: structure, process and results. Results: This review leads to three main conclusions: (1) staff shortages are a major obstacle to providing good quality EmOC; (2) women are often dissatisfied with the care they receive during childbirth; and (3) the technical quality of EmOC has not been adequately studied. The first two conclusions provide lessons to consider when formulating EmOC policies, while the third point is an area where more knowledge is needed.
Human resources for health challenges of public health system reform in Georgia
(2008-05) Djibuti, Mamuka; Gotsadze, George; Mataradze, George; Menabde, George
Background: Human resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia. Methods: We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level. Results: There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government. Conclusion: After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of conducive policy environment with sufficient resources to address these problems and assure adequate functionality of public health programs.
The impact of universal home visits with pregnant women and their spouses on maternal outcomes: a cluster randomised controlled trial in Bauchi State, Nigeria
(BMJ Global Health, 2019-01-04) Cockcroft, Anne; Omer, Khalid; Gidado, Yagana; Chadi Baba, Muhammad; Aziz, Amar; Ansari, Umaira; Ibrahim Gamawa, Adamu; Yarima, Yahaya; Andersson, Neil
In Bauchi State (Nigeria) maternal morbidity is associated with domestic violence, heavy work in pregnancy, ignorance of danger signs, and lack of spousal communication. This cluster randomized controlled trial tested the impact of universal home visits where risk factors were discussed with pregnant women and their spouses, to precipitate household actions that protect pregnant women. Universal home visits which share evidence and provoke discussion between pregnant women and their husbands can reduce maternal morbidity without an increased load on facilities for antenatal and delivery care.
Increasing the demand for childhood vaccination in developing countries : a systematic review
(BioMed Central, London, GB, 2009) Shea, Beverley; Andersson, Neil; Henry, David
This article provides a systematic review of 60 studies of evidence for improving routine vaccination programs in developing countries. Mass media campaigns may be effective, but the impact depends on access to media and may be costly if run at a local level. Interventions to increase demand for routine childhood vaccination have not been adequately investigated. Collateral-free credit to poor women may improve their autonomy and capacity to care for their families, including vaccination. However, attempts to maintain or increase deteriorating vaccination coverage almost all focus on supply side interventions: improving availability and delivery of vaccines.
Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda
(2011-10) Kabakyenga, Jerome K; Östergren, Per-Olof; Turyakira, Eleanor; Mukasa, Peter K; Pettersson, Karen Odberg
The study investigated the role of individual and health facility factors on the risk of obstructed labour and its adverse outcomes in south-western Uganda. A review was performed on 12,463 obstetric records (2006) from six hospitals. It was found that the risk of obstructed labour was statistically significantly associated with residence in a particular district. Individual socio-demographic and health system factors are strongly associated with obstructed labour and its adverse outcomes. The study provides baseline information for policy makers and implementers to improve safe motherhood programmes.

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