maternal health care

The WHO’s Rapid Access Expansion (RAcE) program supported the Malawi Ministry of Health to align their Community-Based Maternal and Newborn Care (CBMNC) package with the latest WHO guidelines and to implement and evaluate the feasibility and coverage of home visits in Ntcheu district. A population-based survey of 150 households in Ntcheu district was conducted in July-August 2016 after approximately 10 months of CBMNC implementation. Thirty clusters were selected proportional-to-size using the most recent census. In selected clusters, five households with mothers of children under six months of age were randomly selected for interview. The Health Surveillance Assistants (HSAs) providing community-based services to the same clusters were purposively selected for a structured interview and register review. Less than one third of pregnant women (30.7%) received a home visit during pregnancy and only 20.7% received the recommended two visits. Coverage of postnatal visits was even lower: 11.4% of mothers and newborns received a visit within three days of delivery and 20.7% received a visit within the first eight days. These findings were similar to previous studies, calling into question the feasibility of the current visitation schedule. It is time to re-align the CBMNC package with what the existing platform can deliver and identify strategies to better support HSAs to implement home visits to those who would benefit most.

The neonatal mortality rate (NMR) in Malawi has remained stagnant at around 27 per 1000 live births over the last 15 years, despite an increase in the uptake of targeted health care interventions. We used the nationally representative 2015/16 Demographic Health Survey data set to evaluate the effect of two types of maternal exposures, namely, lack of access to maternal or intra-partum care services and birth history factors, on the risk of neonatal mortality. We included 9553 women and their most recent live birth within 3 years of the survey. The sample's overall neonatal mortality rate was 18.5 per 1000 live births. The adjusted population attributable risk for first pregnancies was 3.9/1000 (P < 0.001), while non-institutional deliveries and the shortest preceding birth interval (8-24 months) each had an attributable risk of 1.3/1000 (Ps = 0.01). Having 2 or more pregnancy outcomes within the last 5 years had an attributable risk of 3/1000 (P = 0.006). Attending less than 4 ANC visits had, a relatively large attributable risk (2.1/1,000), and it was not statistically significant at alpha level 0.05.  

This editorial introduces the Lancet series on maternal health.

This study, conducted in five rural districts in Afghanistan, used qualitative methods to explore traditional practices of women, families and communities related to maternal and newborn care, and sociocultural and health system issues that create access barriers. The traditional practices discussed include delayed bathing of mothers and delayed breastfeeding of infants, seclusion of women after childbirth, restricted maternal diet, and use of traditional home remedies and self-medication instead of care in health facilities to treat maternal and newborn conditions. This study also looked at community support structures, transportation and care-seeking behaviour for maternal and newborn problems which create access barriers. Sociocultural barriers to better maternal-newborn health include shame about utilisation of maternal and neonatal services, women's inability to seek care without being accompanied by a male relative, and care-seeking from mullahs for serious health concerns. This study also found a high level of post-partum depression. Targeted and more effective behaviour-change communication programmes are needed. This study presents a set of behaviour-change messages to reduce maternal and newborn mortality associated with births occurring at home in rural communities. This study recommends using religious leaders, trained health workers, family health action groups and radio to disseminate these messages.

Unpublished
Unpublished

Given the large population at risk, a cross sectional study was conducted in order to better define the burden of malaria in pregnancy in Jharkhand, a malaria-endemic state in central-east India.

A cross-sectional study conducted in two states of India during 2006-08 found a disconnect between routine antenatal practices in India and known strategies to prevent and treat malaria in pregnancy. Prevention strategies, in particular the use of insecticide-treated bednets, are underutilized.

Subscribe to RSS - maternal health care