Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar

Okawa, Sumiyo; Win, Hla Hla; Leslie, Hannah H; Nanishi, Keiko; Shibanuma, Akira; Aye, Phyu Phyu; Jimba, Masamine

doi:10.1136/bmjgh-2018-001078

Cited by 23 publications

(34 citation statements)

References 36 publications

(26 reference statements)

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“…Socioeconomic inequality in ANC contacts exists in Myanmar, as it does in almost all countries around the world. 24 28 39 40 In this study, pregnant women in the lower socioeconomic strata were at a higher risk for not initiating ANC early, not receiving the recommended number of ANC contacts or receiving adequate ANC components. We demonstrated that Myanmar could achieve ~51% coverage of up to seven ANC contacts, if all women were in the highest wealth quintile households.…”

Section: Discussionmentioning

confidence: 78%

“…18 Previous research investigating ANC in Myanmar has identified factors associated with utilisation and access to care during pregnancy, 19–21 birth and postbirth 22 23 and highlighted the need to improve the quality of maternal and newborn care services. 24 However, these studies did not investigate the new WHO recommended ANC guidelines. In 2018, the Myanmar Ministry of Health and Sports issued a national guideline for ANC based on the 2016 WHO guideline for delivery of ANC services.…”

Section: Introductionmentioning

confidence: 99%

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Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

2020

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IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

2020

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“…The reasons behind this might be not enough in understanding or early diagnosis of the severity of the problems, perceived distance of hospital and cost as demonstrated in other study in Nepal. 20 Besides, traditional practices and the status of women can play important roles in the first delay. The main decision makers in household are men in this study.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Besides, there could be a deficiency in high-quality antenatal care and counselling as has been observed in a study in Myanmar. 20 The in-depth understanding of the severity of risk and early communication, especially by the pregnant women herself is important. A study in India reported major cause in first delay was due to caregiver unawareness of severity of problem.…”

Section: Discussionmentioning

confidence: 99%

Who are dying and why? A case series study of maternal deaths in Nepal

et al. 2021

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ObjectivesTo identify delays and associated factors for maternal deaths in Nepal.DesignA cross-sectional case series study of maternal deaths. An integrated verbal and social autopsy tool was used to collect quantitative and qualitative information regarding three delays. We recorded death accounts and conducted social autopsy by means of community Focus Group Discussions for each maternal death; and analysed data by framework analysis.SettingSixty-two maternal deaths in six districts in three provinces of Nepal.ResultsNearly half of the deceased women (45.2%) were primiparous and one-third had no formal education. About 40% were from Terai/Madhesi and 30.6% from lower caste. The most common place of death was private hospitals (41.9%), followed by public hospitals (29.1%). Nearly three-fourth cases were referred to higher health facilities and median time (IQR) of stay at the lower health facility was 120 (60–180) hours. Nearly half of deaths (43.5%) were attributable to more than one delay while first and third delay each contributed equally (25.8%). Lack of perceived need; perceived cost and low status; traditional beliefs and practices; physically inaccessible facilities and lack of service readiness and quality care were important factors in maternal deaths.ConclusionsThe first and third delays were the equal contributors of maternal deaths. Interventions related to birth preparedness, economic support and family planning need to be focused on poor and marginalised communities. Community management of quick transportation, early diagnosis of pregnancy risks, accommodation facilities near the referral hospitals and dedicated skilled manpower with adequate medicines, equipment and blood supplies in referral hospitals are needed for further reduction of maternal deaths in Nepal.

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“…For instance a bottleneck analysis for newborn survival identified wide gaps in almost all aspects of the implementation of intervention packages aimed at in-patient care of the small and sick newborns [7]. In rural populations in Pakistan, despite improved access to primary healthcare services, the quality of care still lags behind best practice [8]. Although the main risk factors [9] and interventions to prevent perinatal mortality have been identified [10], there still exist gaps in our understanding of how these interventions are integrated within community-based maternal and child healthcare services in countries with a high burden of perinatal mortality.…”

Section: Introductionmentioning

confidence: 99%

Exploring women’s experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study

Ahmed

Alam

Khokhar³

et al. 2020

PLoS ONE

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Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan.

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Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar

Cited by 23 publications

References 36 publications

Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

Who are dying and why? A case series study of maternal deaths in Nepal

Exploring women’s experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study

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