Improving women’s health in low-income and middle-income countries. Part I

Mariani, Giuliano; Kasznia-Brown, Joanna; Páez, Diana; Mikhail, Miriam N.; Salama, Dina H.; Bhatla, Neerja; Erba, Paola Anna; Kashyap, Ravi

doi:10.1097/mnm.0000000000000751

Cited by 28 publications

(16 citation statements)

References 10 publications

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“…Current statistics suggest that in high-income countries very few women die from childbirth, and the key maternal health care services, for example, antenatal and professional child birth services are nearly universal. 10,11 In contrast, LMICs account for ∼99% of global maternal mortality 12 with the coverage of SBA being as low as 50% (in sub-Saharan Africa). 13 The main challenges for promoting maternal health care utilization in resource-limited settings are surrounding those of accessibility and affordability barriers stemming from various infrastructural, 14 skilled human resource, 15 technological 16 and financial 17 issues at health systems level and poor health literacy, 18 self-efficacy, 19 and behavioral 20 factors at the individual level.…”

Section: Introductionmentioning

confidence: 99%

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

Yaya

Bishwajit

2019

Health Equity

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Purpose: Globally, low-middle-income countries continue to account for almost all of the pregnancy-related mortalities that are largely preventable through adequate utilization of essential maternal health care services such as antenatal care (ANC) and skilled birth assistance (SBA). Promoting the use of ANC and SBA services are hindered by numerous policy- and capacity-related barriers along with widespread inequality in utilization of the existing services that further exacerbates the scenario. In an attempt to better understand the geography of inequality in service utilization, we conducted this brief descriptive study by using World Health Organization (WHO) data on ANC and SBA utilization among the member states. Methods: This was a descriptive study based on open access data on ANC and SBA use between 2012 and 2015 available through the Global Health Observatory of WHO. Country-level data were collected for Asia (41 countries), Africa (35 countries), Europe (35 countries), North America (10 countries), Latin America and the Caribbean (25 countries), and Oceania (16 countries). Cross-country and continent comparisons were made using dot and bar charts. Results: The overall prevalence of ANC and SBA use were, respectively, 78.17% and 88.33%. Considerable disparities were found in terms of ANC and SBA use across the continents, especially in Asia and Africa. Globally, the poorest performing countries included Afghanistan, Somalia, and South Sudan where more than three-quarters of the women remain deprived of ANC and SBA services during the period of 2012 and 2015. The greatest inequality in ANC use was observed in Africa (9.4% in Somalia and 99.9% in Libya), whereas that of SBA use was observed in Asia (17.8% in Afghanistan vs. 100% in Bahrain). Europe was the most equal of all regions in terms of both ANC (66.8% in Albania vs. 99.7% in Belarus) and SBA (94.4% in Denmark vs. 100% in Lithuania) use. Conclusion: Although in the majority of countries more than three-quarters of the women receive ANC and SBA services, the extent of intraregional inequality remains overwhelming especially for Asia and Africa. Progress toward maternal health-related targets should be interpreted in terms of the disparities to ensure a more even and sustainable outcome at both national and global level.

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Section: Introductionmentioning

confidence: 99%

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

Yaya

Bishwajit

2019

Health Equity

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“…Breast ultrasound represents an essential step in the pathway to diagnosis. Due to radiologist shortages, the majority of breast ultrasound in LMICs is task‐shifted to sonographers with variable breast‐specific training 18,19 . This necessitates a thoughtful approach to gradually introduce an optimal system, such as BI‐RADS, as breast imaging experience and knowledge increases.…”

Section: Discussionmentioning

confidence: 99%

A phased approach to implementing the Breast Imaging Reporting and Data System (BI‐RADS) in low‐income and middle‐income countries

Lam

Entezari

Duggan

et al. 2020

Cancer

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BACKGROUND: Successful breast cancer detection programs rely on standardized reporting and interpreting systems, such as the Breast Imaging Reporting and Data System (BI-RADS), to improve system performance. In low-income and middle-income countries, evolving diagnostic programs have insufficient resources to either fully implement BI-RADS or to periodically evaluate the program's performance, which is a necessary component of BI-RADS. This leads to inconsistent breast ultrasound interpretation and a failure to improve performance. METHODS: The authors applied the Breast Health Global Initiative's phased implementation strategy to implement diagnostic ultrasound and BI-RADS within the context of a limited-resource setting. RESULTS: The authors recommended starting with triage ultrasound to distinguish suspicious masses from normal breast tissue and benign masses such as cysts because the majority of health workers performing ultrasounds at this level have minimal breast imaging experience. Transitioning to full diagnostic ultrasound with condensed or full BI-RADS should occur after performance and quality metrics have been met. CONCLUSIONS: Transitioning through these phases across facilities likely will occur at different times, particularly in rural versus urban settings. Cancer 2020;126:2424-2430.

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“…However, these phases may not represent the woman’s experience and may not exist as the discrete periods of ANC, birth, and PNC for postpartum women. This concept of the life continuum must be considered in the measurement, evaluation, and improvement in maternal health and the health of the family as a whole ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…This concept of the life continuum must be considered in the measurement, evaluation, and improvement in maternal health and the health of the family as a whole. 27…”

mentioning

confidence: 99%

Postnatal care in Rwanda: facilitators and barriers to postnatal care attendance and recommendations to improve participation

Williams

Murindahabi

Butrick

et al. 2019

Journal of Global Health Reports

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Back Background ground Sub-Saharan Africa has the highest rates of neonatal mortality in the world with an estimated 1.2 million deaths within the first 28 days of life. Postnatal care (PNC) can contribute to reductions in morbidity and mortality in mothers and newborns through vital support that identifies danger signs and establishes valuable practices and referral processes. Methods Methods This qualitative data was collected as a part the East Africa Preterm Birth Initiative (PTBi-EA) to guide development of a group antenatal (ANC) and PNC model in Rwanda. Key-informant in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in four districts. Sixteen FGDs with 180 participants and 22 IDIs were completed at the time of thematic saturation. R Results esults Four themes highlighted facilitators and barriers to PNC attendance and recommendations to improve participation: 1) There is little awareness in the community of what the PNC package is; PNC 4 in particular is not well understood; 2) PNC visits by community health workers (CHWs) are well accepted and valued; 3) Providers perceive PNC 4 as an added burden to an already high workload; 4) Community structures exist to better disseminate key messages about PNC, but have not yet been effectively utilized. C Conclusions onclusions This qualitative work provides evidence that the PNC package was not initially well understood. Regardless, PNC service delivery performed by CHWs in Rwanda is well accepted and appreciated by the population, providing assurance that the full package has potential to be well utilized and valued by the population.

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Improving women’s health in low-income and middle-income countries. Part I

Cited by 28 publications

References 10 publications

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

A phased approach to implementing the Breast Imaging Reporting and Data System (BI‐RADS) in low‐income and middle‐income countries

Postnatal care in Rwanda: facilitators and barriers to postnatal care attendance and recommendations to improve participation

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