A Regionalization Model to Increase Equity of Access to Maternal and Neonatal Care Services in Iran

Abstract

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network

“…These data consist of the demographic characteristics of the newborn's mother including gravidity and parity, medical history including previous miscarriage or abortion, risk factors, consanguinity of parents, gestational age and mode of delivery, date of birth, and pediatric data including baby's geographic location, gender, birth weight, presenting symptoms, diagnosis, neonatal complications, management, clinical outcome, and occurrence of perinatal death. 11,12 Greater than 97% of deliveries in Iran occur in hospitals, making the IMaN database a reliable sample of pregnancy and its complications throughout the country and an important source of epidemiological information for SARS-CoV-2 information in newborns. 11,12 Study patients included liveborn neonates 28 days of age having suspected as well as confirmed SARS-CoV-2 infection that were admitted to the hospital following delivery.…”

“…11,12 Greater than 97% of deliveries in Iran occur in hospitals, making the IMaN database a reliable sample of pregnancy and its complications throughout the country and an important source of epidemiological information for SARS-CoV-2 information in newborns. 11,12 Study patients included liveborn neonates 28 days of age having suspected as well as confirmed SARS-CoV-2 infection that were admitted to the hospital following delivery. Inclusion criteria for suspected cases included having a clinical presentation consistent with neonatal COVID-19 or those neonates having a positive history of contact with SARS-CoV-2-infected persons who required hospital admission.…”

“…10 It is managed through the Iran Ministry of Health and since the start of the COVID-19 pandemic has been a valuable and unique source of real-time data for recording the effects of SARS-CoV-2 infection on pregnant women and their babies. In addition to hospital births, IMaN records almost all births, both liveborn and stillborn, selected demographics, and maternal and neonatal health information electronically from throughout the country [10][11][12] To describe the Iranian national experience with COVID-19 among neonates, we conducted a retrospective analysis of the accumulated data in the IMaN for a 1-year period beginning at the start of the pandemic. This communication describes the epidemiological and clinical spectrum of COVID-19 from 4,015 neonates from throughout Iran who were suspected or confirmed as having SARS-CoV-2 infection following delivery to an infected mother and discusses current concepts of the pathophysiology of vertical infection.…”

Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study

“…3 Meanwhile, every year an estimated 4 million of the 130 million babies born die in the neonatal period. 4 , 5 Most of these deaths occurred in low- and middle-income countries. 6 , 7 Most notably, maternal and neonatal disorders affect a large proportion of women and children in developed countries.…”

“…Inequality and inability to access basic maternal healthcare services have been identified as the main causes of global mortality. 5 , 13 …”