Health system and community level interventions for improving antenatal care coverage and health outcomes

Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea; Richardson, Marty; Garga, Kesso Habiba; Ongolo‐Zogo, Pierre

doi:10.1002/14651858.cd010994.pub2

Cited by 117 publications

(115 citation statements)

References 161 publications

(370 reference statements)

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“…For the woman, prenatal care promotes health, helps prepare for birth, and prevents and detects complications including anemia, hypertensive diseases of pregnancy and infection. 1–4 For the neonate, regular prenatal care is associated with decreased incidence of low birth weight and neonatal deaths. 1,3,5 …”

Section: Introductionmentioning

confidence: 99%

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Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

Swartz

Hainmueller

Lawrence

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To measure the result of access to prenatal care on unauthorized and low-income, new legal permanent resident immigrant women and their offspring. Methods We used a difference-in-difference design that leverages the staggered rollout of Emergency Medicaid Plus by county from 2008 to 2013 as a natural experiment to estimate the effect on health service utilization for women and health outcomes for their infants. Regular Medicaid pregnancies were used as an additional control in a triple difference design. Results Our sample included pregnancies covered by Emergency Medicaid (34,319), Emergency Medicaid Plus (12,344), and Medicaid (163,537). After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.46 to 7.98), receipt of adequate prenatal care (28% increased rate, CI 26 to 31), rates of diabetes screening (61% increased rate, CI 56 to 65) and fetal ultrasounds (74% increased rate, CI 72 to 77). Maternal access to prenatal care was also associated with an increased number of well-child visits (0.24 more visits, CI 0.07 to 0.41), increased rates of recommended screenings and vaccines (0.04 increased probability, CI 0.002 to 0.074), and reduced infant mortality (-1.04 per 1000, CI -1.45 to -0.62) and rates of extremely low birth weight (<1000g) (-1.5 per 1000, CI -2.58 to -0.53). Conclusion Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are United States citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.

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Section: Introductionmentioning

confidence: 99%

“…1–4 For the neonate, regular prenatal care is associated with decreased incidence of low birth weight and neonatal deaths. 1,3,5 …”

Section: Introductionmentioning

confidence: 99%

Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

Swartz

Hainmueller

Lawrence

et al. 2017

Obstetrics &Amp; Gynecology

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“…In addition, strengthening community systems and infrastructure will drive the demand of RMNCH services. Evidence from recent reviews shows that interpersonal and community-based interventions are effective in increasing the demand and uptake of RMNCH services [46], for example through site and home visits [46,47].…”

Section: Increasing Demand and Utilization Of Integrated Rmnch Intervmentioning

confidence: 99%

“…Mobilizing and training them to seek, demand and utilise RMNCH services will be an important second step. Interpersonal education and information strategies are effective in increasing uptake of maternal and neonatal outcomes [47], and these could work well within outreach programs. In addition, there is a need to leverage on women's agency and desire to improve their own reproductive health.…”

Section: Increasing Demand and Utilization Of Integrated Rmnch Intervmentioning

confidence: 99%

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Ndimbii

Ayón

Abdulrahman³

et al. 2018

Sexual & Reproductive Healthcare

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Highlights Globally there is limited research concerning women who inject drugs. This paper reports important insights related to the experiences, needs and barriers preventing the utilisation of reproductive maternal, neonatal and child health services among women who inject drugs in coastal Kenya. Findings from this study will inform the development of equitable, comprehensive, and family-centered RMNCH interventions targeting women who inject drugs, including the integration of RMNCH services within harm reduction programs. ABSTRACT Introduction:The Kenyan government has committed to increasing access to comprehensive reproductive, maternal, neonatal and child health (RMNCH) services. However, inequalities still exist.Women who inject drugs are an important sub-population for public health interventions, yet their RMNCH needs have largely been overlooked. Additionally, there is a lack of research to inform RMNCH interventions for this sub-population. Methods:In 2015, we undertook interviews and focus group discussions with 45 women who inject drugs and five key stakeholders to understand these women's RMNCH experiences and needs. Results:Women' access to essential services across the RMNCH continuum was low. Two thirds of the women were not using contraception. Many discovered they were pregnant late, due to amenorrhea of drug use, and thus were unable to enroll for antenatal care early. Facilitybased deliveries were limited with many choosing to deliver at home. Following delivery, women's attendance to immunization services was sub-optimal. Stigma from healthcare workers was a major factor impeding women's use of existing RMNCH services. The prospect of experiencing withdrawals at health facilities where waiting times were long, deterred utilization of these services. Additionally, women faced competing priorities, having to choose between purchasing heroin or spending their money on health-related costs. Conclusions:Several barriers disrupted women's access to services across the RMNCH continuum.Consequently, there is a need to develop equitable, comprehensive, and family-centered RMNCH interventions tailored to women who inject drugs, through a combination of supplyand demand-side interventions. For optimal impact, RMNCH services should be integrated into harm reduction programs.

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“…Antenatal care introduces the woman and her family with the formal health system (WHO, 2016a), which can then also increase the chance of using a skilled attendant at birth and contribute to good health throughout the life cycle. Empowering women and engaging them more in antenatal care has proven as a success story to improve health outcomes in many countries (Mbuagbaw et al, 2016;Phillippi, 2009;Shortall et al, 2013). The WHO recommends that all pregnant women receive at least four antenatal care visits evenly spaced from the first trimester, which include getting an essential package of health services such as infection screening, nutrition advice, education on pregnancy and birth warning signs, among others (Mbuagbaw et al, 2016).…”

Section: Improving Pregnant Women's Access To Antenatal Carementioning

confidence: 99%

Health systems strengthening in global and national contexts

Macarayan¹

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Despite advances in medical research, the burden of disease in most countries remains high.Further, health inequalities continue to grow and emerging infectious diseases are still wreaking havoc across countries. To respond to contemporary public health challenges, a new systems thinking paradigm has emerged that highlighted a holistic approach towards health systems, resulting to an emerging field -health policy and systems research (HPSR). HPSR seeks to understand and enhance how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes. However, research gaps remain particularly in applying this paradigm to strengthen health systems performance across countries. This thesis contributes to HPSR by: a. examining the underlying concepts of health systems strengthening; b. determining how health systems contribute to better health outcomes, particularly on reducing infant mortality rates and improving life expectancies at birth, and c. understanding mechanisms to use findings from health systems strengthening assessments to inform global and national-level health policymaking processes.In 2015, 40% of the Global Fund investments go toward health systems strengthening (HSS). The global health threats posed by recent viral epidemics such as Ebola and Zika even further increased calls to invest in and develop better health systems. These health systems investments were also in most cases subjected to performance-based funding, but contrary to other monitoring and evaluation methods used for other health programs, health systems monitoring and evaluation demand a new analytical frame due to its complexity, along with the very different country capacities, uneven data sources and data availability and quality, including the varied contexts that drive priority areas for health systems. As such, monitoring these initiatives remain to be highly contentious despite its importance to inform health resource allocation. In particular, studies often highlighted different conceptual and methodological challenges associated with health systems assessments worldwide.To address these issues, I first introduced a new HSS framework based on existing monitoring and evaluation frameworks collected from my field experience, systematic reviews, and thematic analyses of existing HSS documents and database. Based on the developed HSS framework, existing HSS indicators were also examined to guide further analysis. Further, I quantitatively assessed health systems performance using a new composite indicator based on previous efforts for a global health systems performance index. To do this index, I used data collected from the Demographic Health Surveys, the World Bank Indicators, and the World Health Organisation ii (WHO) Global Health Surveys. In particular, I used fixed-effects and random-effects regression analyses to determine how each health system characteristic affects health outcomes, particularly infant mortality rates and life expectan...

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Health system and community level interventions for improving antenatal care coverage and health outcomes

Cited by 117 publications

References 161 publications

Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Health systems strengthening in global and national contexts

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