https://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf

Why invest, and what it will take to improve breastfeeding practices?

Title. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

Aim.  This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.

Background.  Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.

Data sources.  A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched.

Review methods.  A systematic review was carried out and both quantitative and qualitative studies were included.

Results.  Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband’s education, marital status, availability, cost, household income, women’s employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women’s age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.

Conclusion.  More qualitative research is required to explore the effect of women’s satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women’s overall (social, political and economic) status needs to be considered.

/pdf/factors-affecting-the-utilization-of-antenatal-care-in-vcy78qq0wv.pdf

Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature

Aim:A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction.Method:This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer rev...

Determinants of patient satisfaction: a systematic review:

Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women’s satisfaction with maternity care in developing countries. The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach. Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women. Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction.

https://link.springer.com/content/pdf/10.1186%2Fs12884-015-0525-0.pdf

Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries

Globally, there is increasing interest in community health worker’s (CHW) performance; however, there are gaps in the evidence with respect to CHWs’ role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India’s CHW programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur. We undertook qualitative research to explore stakeholders’ perceptions and experiences of the ASHA scheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed using the thematic framework approach. Findings suggested that ASHAs are mostly understood as link workers. ASHA’s ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care. However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate ASHAs. Finally, ASHAs had limited knowledge about their role as an ‘activist’ and how to realise this. ASHAs are valued for their contribution towards maternal health education and for their ability to provide basic biomedical care, but their role as social activists is much less visible as envisioned in the ASHA operational guideline. Access by ASHAs to fair monetary incentives commensurate with effort coupled with the poor functionality of the health system are critical elements limiting the role of ASHAs both within the health system and within communities in rural Manipur.

/pdf/community-health-workers-in-rural-india-analysing-the-2xmv28atat.pdf

Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles

Dietary data were collected on 496 households and anthropometric measurements were carried out on 248 children under 5 years of age in rural Bangladesh. The effect of socioeconomic determinants on infant feeding and malnutrition was analyzed using univariate and logistic regression models. Of the children aged under 5 52% were stunted and 57% were of low weight-for-age. Malnutrition was significantly influenced (p < 0.05) by income size of cropland the education of both parents and some infant-feeding practices but the mothers education emerged as the primary predictor of the nutritional status of children. Breast feeding was the norm and 95% of the mothers perceived breast milk to be superior to milk substitutes but rejection of colostrum preference for prelacteal feeds early supplementation and inadequate timing and type of weaning diet were widespread. Often there was a discrepancy between the expressed infant-feeding preferences and actual practices. (authors)

https://journals.sagepub.com/doi/pdf/10.1177/156482659902000402

Feeding Practices and Malnutrition in Children in Rural Bangladesh

The prevalence of infection and disease due to Onchocerca volvulus in regions at different altitudes and distances from the nearest breeding site for the Simulium vectors were studied in a forested area of Cameroon. A total of 1,785 subjects in 14 villages underwent clinical and parasitological evaluation. According to WHO endemicity criteria, villages 267 and 720 m above the sea level (asl) were hyperendemic, whereas lower villages, at 55 n asl, were meso-endemic. Altitude was positively correlated and distance from vector breeding site negatively correlated with several clinical indicators of onchocerciasis: prevalence of infection, microfilarial density, onchocercomata, and blindness. Location and altitude of his or her village and the subject's duration of residence in the village, age and sex were all found to be independent predictors of infection by logistic regression. The observed pattern of forest onchocerciasis reflects an interplay of multiple factors rather than a simple relationship between endemicity and distance from the nearest river. In order to select communities most affected by onchocerciasis for control programmes, two indicators, the prevalence of blindness and the prevalence of onchocercomata, might be used.

Forest onchocerciasis in Cameroon: its distribution and implications for selection of communities for control programmes.

En 1990 une étude sur l’état nutritionnel des enfants de moins de cinq ans a été menée (2). La comparaison des résultats de cette étude et de ceux d’une étude nationale exécutée en 1978 (3) montrait que le taux de malnutrition aiguë chez les enfants de 3 à 59 mois avait augmenté de 0,7% en 1978 à 9,1% en 1990 et qu’il était plus élevé en milieu rural qu’en ville. Ceci a conduit à la mise au point d’un programme de surveillance nutritionnelle par les hôpitaux au niveau des Départements et des Arrondissements. Le programme s’est limité à deux aspects d’intervention nutritionnelle : le monitoring de la croissance des enfants de moins de cinq ans et la promotion de l’allaitement maternel fournissant tous les éléments nutritionnels nécessaires pendant les cinq premiers mois de la vie ((4,5).

Les enfants de poids insuffisant a la naissance : les exigences d'un programme de surveillance nutritionnelle exemple : la zone rurale de la province du littoral (cameroun)

Objectif Evaluer les attentes des usagers et leur degre de satisfaction ainsi que la qualite des soins dispenses dans des zones rurales du Bangladesh. Methodes Un total de 1913 personnes, choisies par echantillonnage aleatoire systematique ont ete interrogees avec succes immediatement apres avoir recu des soins dans des formations sanitaires du secteur public. Resultats Le meilleur facteur predictif du degre de satisfaction des patients quant aux soins assures par le secteur public etait le comportement des soignants, notamment le respect et la politesse ; cet aspect revetait aux yeux des malades beaucoup plus d’importance que la competence technique. Une reduction du temps d’attente (30 minutes en moyenne) etait en outre plus importante pour les patients qu’un allongement de la duree, assez breve (du point de vue medical), des consultations (2 min 22s en moyenne), 75 % des patients se declarant satisfaits. L’attente, environ deux fois plus longue dans les formations peripheriques que dans les formations fixes, etait le seul sujet de mecontentement chez les usagers des formations peripheriques. Conclusion L’etude confirme que la satisfaction des patients est fonction du contexte culturel. Idealement, les soins devraient repondre a la fois aux besoins medicaux et psychologiques, mais l’etude montre qu’en realite des soins qui satisfont tous les besoins medicaux ne repondent pas forcement aux besoins affectifs ou sociaux des patients, et que l’on se trouve donc devant un dilemme. A l’inverse, des soins qui repondent aux besoins psychologiques des patients peuvent les laisser medicalement ne danger. Il apparait important que les pays en developpement qui privilegient les services de sante axes sur les malades entreprennent des recherches plus approfondies sur les determinants de la satisfaction des patients dans leurs cultures respectives.

Satisfaction des patients et qualitedes soins dans des zones rurales du Bangladesh

Evaluation du progrès du programme national de lutte contre les maladies diarrhéiques dans la province du littoral (Cameroun)

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