Scaling the Maternal and Newborn Survival Initiative (MANSI)

2019 ◽  
Vol 8 (1) ◽  
pp. 94-111
Author(s):  
Deepa Fernandes Prabhu ◽  
Richard C. Larson
Keyword(s):  
System Analysis ◽  
Maternal Mortality Ratio ◽  
Infant Mortality Rate ◽  
Dynamics Model ◽  
Public And Private ◽  
System Analysis Approach ◽  
Mortality Ratio ◽  
Hospital Births ◽  
The Village ◽  
Maternal And Newborn

The infant mortality rate (IMR) and maternal mortality ratio (MMR) are unacceptably high in many parts of rural India. This article focuses on a system analysis approach to the best practices for scaling and replicating of maternal and newborn survival initiative (MANSI), a field-tested pilot program for addressing high IMRs and MMRs. A system dynamics model of the village birthing system is used to understand the resources needed for the viability of scaling or replication, is constructed and incorporated in the analysis. The MANSI program is a public and private partnership between a few key players. Implemented in the Seraikela area of India's Jharkhand state, the program has achieved a 32.7% reduction in neonatal mortality, a 26.5% reduction in IMR, and a 50% increase in hospital births, which tend to have better health outcomes for women and newborns. The authors conclude with a discussion of the prospects for and difficulties of replicating MANSI in other resource-constrained areas, not only in India but in other developing countries as well.

Scaling the Maternal and Newborn Survival Initiative (MANSI)

2020 ◽  
pp. 224-246
Author(s):  
Deepa Fernandes Prabhu ◽  
Richard C. Larson
Keyword(s):  
System Analysis ◽  
Maternal Mortality Ratio ◽  
Infant Mortality Rate ◽  
Rural India ◽  
Public And Private ◽  
System Analysis Approach ◽  
Mortality Ratio ◽  
Hospital Births ◽  
The Village ◽  
Maternal And Newborn

The infant mortality rate (IMR) and maternal mortality ratio (MMR) are unacceptably high in many parts of rural India. This article focuses on a system analysis approach to the best practices for scaling and replicating of maternal and newborn survival initiative (MANSI), a field-tested pilot program for addressing high IMRs and MMRs. A system dynamics model of the village birthing system is used to understand the resources needed for the viability of scaling or replication, is constructed and incorporated in the analysis. The MANSI program is a public and private partnership between a few key players. Implemented in the Seraikela area of India's Jharkhand state, the program has achieved a 32.7% reduction in neonatal mortality, a 26.5% reduction in IMR, and a 50% increase in hospital births, which tend to have better health outcomes for women and newborns. The authors conclude with a discussion of the prospects for and difficulties of replicating MANSI in other resource-constrained areas, not only in India but in other developing countries as well.

scholarly journals Impact Evaluation Design for Community Midwife Technicians in Malawi

2016 ◽  
Vol 12 (27) ◽  
pp. 349
Author(s):  
Nathan B.W. Chimbatata ◽  
Chikondi M. Chimbatata
Keyword(s):  
Rural Areas ◽  
Human Resources For Health ◽  
Maternal Mortality Ratio ◽  
Health Sector ◽  
Health Staff ◽  
Community Midwives ◽  
Mortality Ratio ◽  
Training Institutions ◽  
Training Community ◽  
Maternal And Newborn

Maternal Mortality Ratio and neonatal mortality rate are alarmingly high in Malawi. The shortage and poor retention of midwives coupled with poor working conditions have been a major challenge affecting the provision of high-quality maternity care for women. Many women are giving birth without skilled attendants, increasing the risk of maternal and neonatal illness and death. The major driving factor in the shortage of health staff is the limited number of existing training slots and hence the minimum output from the training institutions into service delivery units. Midwifery is a key component of sexual, reproductive, maternal, and newborn healthcare. Responding to the crisis, the Malawi Government has made a commitment in strengthening human resources for health, including accelerating training and recruitment of health professionals to fill all the shortage gaps in the health sector. One mechanism implemented by Malawi Government to increase skilled attendance at birth in rural areas is the introduction of Community midwifery assistants (CMA) training. This program of training community midwives is being piloted and targets the general population of pregnant women and their new born babies in rural areas where the CMAs are deployed. However, there is a great need to have this initiative evaluated and gauge its impact in attaining the desired outcomes.

scholarly journals Performance of Ashas in ANC and Birth Planning in Uttar Pradesh, India

2018 ◽  
Vol 5 (7) ◽  
pp. 4896-4899
Author(s):  
Dr. Tridibesh Tripathy ◽  
Mrs. Anjali Tripathy
Keyword(s):  
Pregnant Women ◽  
Child Survival ◽  
Maternal Mortality Ratio ◽  
Uttar Pradesh ◽  
Structured Interview ◽  
The State ◽  
Infant Mortality Rate ◽  
Mortality Ratio ◽  
Birth Planning ◽  
Targeted Messages

ASHAs were introduced in UP through NRHM in 2005, the first major task of ASHAs was to focus on maternal and child health to reduce Maternal Mortality Ratio and Infant Mortality Rate in the state of UP. Their primary activity was to visit homes of pregnant women. The first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all pregnancies to decipher messages on ANC and birth planning is an integral part of the work of ASHAs across the state of UP.  The current study explores variables like the average visits of each of the ASHAs to pregnant women in absolute numbers in four districts of UP. Further, the study sees the percentage of the ASHAs that give messages on ANC like TT injections, BP and abdominal examination, IFA tablets and provision of 3 ANCs to pregnant women. In addition to that, the percentage of ASHAs giving messages on birth planning like identification of place of delivery, birth attendant, arranging money, arranging transport and identification of blood donor.  Information on JSY was also a part of the message.  These activities were done by the ASHAs in the last 3 months prior to the survey.      The relevance of the study assumes significance as data on the details of targeted messages done by ASHAs through home visits are never discussed in detail and further there is no comparison to their performance visa vis the inputs they received through capacity building.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study.  The numbers of pregnant women visited by each of the ASHAs in the 4 districts in their catchment area in the 3 months were in the range of 4-6. Among the messages on ANC, IFA tablets consumption and TT injections were given by most of the ASHAs in the 4 districts.  Among the birth planning messages, identification of place and birth attendant were given by most of the ASHAs in the 4 districts. This reflected that the focus of messages were neither prioritized nor covered by all the ASHAs.   

scholarly journals Reducing maternal mortality in China in the era of the two-child policy

2020 ◽  
Vol 5 (2) ◽  
pp. e002157
Author(s):  
Jue Liu ◽  
Li Song ◽  
Jie Qiu ◽  
Wenzhan Jing ◽  
Liang Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Maternal Mortality Ratio ◽  
Pregnancy Risk ◽  
Risk Screening ◽  
Live Births ◽  
Child Policy ◽  
Mortality Ratio ◽  
Maternal And Newborn

Reducing maternal mortality ratio (MMR) is of great concern worldwide. After the implementation of the two-child policy in 2013, the number of live births and the proportion of high-risk pregnancies both increased, and these bring new challenges to the reduction of MMR. China implemented a package of nationwide strategies in April 2016, the Five Strategies for Maternal and Newborn Safety (FSMNS). The FSMNS consists of five components: (1) pregnancy risk screening and assessment strategy, (2) case-by-case management strategy for high-risk pregnancies, (3) referral and treatment strategy for critically ill pregnant women and newborns, (4) reporting strategy for maternal deaths (and 5) accountability strategy. To better implement the FSMNS, China formulated a unified pregnancy risk screening form. After risk assessment and classification, medical records of all the pregnant women are labelled with green (low risk), yellow (moderate risk), orange (high risk), red (highest risk) or purple (infectious disease) for tailored management. By the implementation of FSMNS, China has already kept the MMR stable and cause it to enter a controlled decline. MMR in China has declined by 21.1%, from 23.2 per 100 000 live births in 2013 to 18.3 per 100 000 live births in 2018. The country’s challenges and experience in reducing the MMR could provide useful lessons for other countries.

WHAT IS THE CAUSE OF THE DECLINE IN MATERNAL MORTALITY IN INDIA? EVIDENCE FROM TIME SERIES AND CROSS-SECTIONAL ANALYSES

2013 ◽  
Vol 46 (3) ◽  
pp. 351-365 ◽  
Author(s):  
SRINIVAS GOLI ◽  
ABDUL C. P. JALEEL
Keyword(s):  
Time Series ◽  
Maternal Mortality ◽  
Health Facility ◽  
Maternal Mortality Ratio ◽  
Demographic Factors ◽  
Infant Mortality Rate ◽  
Cross Sectional ◽  
Institutional Deliveries ◽  
Mortality Ratio ◽  
Socioeconomic And Demographic Factors

SummaryStudies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (−1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (−0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=−0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between ‘increase in institutional deliveries' and ‘decline in maternal mortality ratio’ suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

A system analysis approach to Kinetic School Drawings (KSD)

2010 ◽  
Vol 65 (3) ◽  
pp. 495-527 ◽  
Author(s):  
Zoltán Vass
Keyword(s):  
System Analysis ◽  
Analysis Approach ◽  
System Analysis Approach

A tanulmány a kinetikus iskolarajz (Kinetic School Drawings, KSD) értelmezését mutatja be a rendszerszemléletű konfigurációelemzés (SSCA) módszerével. A bevezetőben kifejezéspszichológiai szemléleti keretet vázol fel, amelyben a rajzot a kifejező viselkedés részének tekinti, elhelyezi a tesztet a rajzvizsgálatok rendszerében és röviden kitér a teszt előzményeire. A tesztfelvétel módszere után részletesen ismerteti a kinetikus iskolarajzok rendszerszemléletű konfigurációelemzési módszerét. Célja, hogy olyan értelmezési módszert adjon a gyakorló pszichológusok kezébe, amely szótárszerű jelentésadás nélkül vezet el a kinetikus iskolarajz megértéséhez és olyan összefüggések hálózatát eredményezi, amelyek mindig egyedi módon szólnak a gyermekről. A tanulmány befejező része a kinetikus iskolarajzokkal végzett, hazai kutatási eredményekről ad összefoglalót.

Impact of National Health Mission of India on Infant and Maternal Mortality: A Logical Framework Analysis

2021 ◽  
pp. 097206342199498
Author(s):  
Rajesh Kumar
Keyword(s):  
Maternal Mortality ◽  
Health System ◽  
National Health ◽  
Maternal Mortality Ratio ◽  
Evaluation Framework ◽  
Infant Mortality Rate ◽  
Series Data ◽  
Health Management Information System ◽  
Live Births ◽  
Fund Allocation

Background: Since independence, life expectancy has increased substantially in India, but the goal of health-for-all has not been achieved yet. Hence, National Rural Health Mission was launched in 2005, and several strategies were implemented to strengthen the health system. Impact evaluation of the mission was done to learn lessons for future health planning. Materials and Methods: Logical evaluation framework was used to examine input, output and impact indicators systematically using time series data from Health Management Information System, National Family Health Surveys, National Sample Surveys and Sample Registration Scheme. Findings: After launch of the mission, fund allocation has increased nearly five times. The number of auxiliary nurse midwives has doubled, and the number of nurses has trebled. The number of accredited social health activists has increased to about one million. Institutional deliveries have increased from 38.7% in 2005–2006 to 78.9% in 2015–2016. Full immunisation coverage has increased from 43.5% to 62%. Oral rehydration solution (ORS) use in childhood diarrhoea has increased from 26% to 51%. Infant mortality rate has declined from 58 in 2005 to 33 per 1,000 live births in 2017 and maternal mortality ratio has also registered a decline from 254 in 2004–2006 to 122/100000 live births in 2015–2017. However, out-of-pocket health expenditure continues to be fairly high (69.3% of the total expenditure on health). Conclusions: Though National Health Mission has made a significant impact, the goal of universal care coverage is not yet fully achieved. Hence, capacity of health system needs to be trebled by a substantial increase in fund allocation.

scholarly journals The Role of Place of Delivery in Preventing Neonatal and Infant Mortality Rate in India

Geographies ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 47-62
Author(s):  
Ujjwal Das ◽  
Barkha Chaplot ◽  
Hazi Mohammad Azamathulla
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Neonatal Mortality ◽  
Public Hospitals ◽  
Infant Mortality Rate ◽  
Private Institutions ◽  
Public And Private ◽  
Place Of Delivery ◽  
At Home

Skilled birth attendance and institutional delivery have been advocated for reducing maternal, neonatal mortality and infant mortality (NMR and IMR). This paper examines the role of place of delivery with respect to neo-natal and infant mortality in India using four rounds of the Indian National Family Health Survey conducted in 2015–2016. The place of birth has been categorized as “at home” or “public and private institution.” The role of place of delivery on neo-natal and infant mortality was examined by using multivariate hazard regression models adjusted for clus-tering and relevant maternal, socio-economic, pregnancy and new-born characteristics. There were 141,028 deliveries recorded in public institutions and 54,338 in private institutions. The esti-mated neonatal mortality rate in public and private institutions during this period was 27 and 26 per 1000 live births respectively. The study shows that when the mother delivers child at home, the chances of neonatal mortality risks are higher than the mortality among children born at the health facility centers. Regression analysis also indicates that a professionally qualified provider′s antenatal treatment and assistance greatly decreases the risks of neonatal mortality. The results of the study illustrate the importance of the provision of institutional facilities and proper pregnancy in the prevention of neonatal and infant deaths. To improve the quality of care during and imme-diately after delivery in health facilities, particularly in public hospitals and in rural areas, accel-erated strengthening is required.

scholarly journals Global epidemiology and socio-economic development correlates of the reproductive ratio of COVID-19

2021 ◽  
Author(s):  
Lutz P Breitling
Keyword(s):  
Economic Development ◽  
Empirical Evidence ◽  
Maternal Mortality Ratio ◽  
Developed Countries ◽  
Linear Regression Models ◽  
Extreme Poverty ◽  
Development Indicators ◽  
Global Epidemiology ◽  
Socio Economic Development ◽  
Mortality Ratio

Abstract Background The most commonly cited argument for imposing or lifting various restrictions in the context of the coronavirus disease 2019 (COVID-19) pandemic is an assumed impact on the reproductive ratio of the pathogen. It has furthermore been suggested that less-developed countries are particularly affected by this pandemic. Empirical evidence for this is lacking. Methods Based on a dataset covering 170 countries, patterns of empirical 7-d reproductive ratios during the first months of the COVID-19 pandemic were analysed. Time trends and associations with socio-economic development indicators, such as gross domestic product per capita, physicians per population, extreme poverty prevalence and maternal mortality ratio, were analysed in mixed linear regression models using log-transformed reproductive ratios as the dependent variable. Results Reproductive ratios during the early phase of a pandemic exhibited high fluctuations and overall strong declines. Stable estimates were observed only several weeks into the pandemic, with a median reproductive ratio of 0.96 (interquartile range 0.72–1.34) 6 weeks into the analysis period. Unfavourable socio-economic indicators showed consistent associations with higher reproductive ratios, which were elevated by a factor of 1.29 (95% confidence interval 1.15 to 1.46), for example, in the countries in the highest compared with the lowest tertile of extreme poverty prevalence. Conclusions The COVID-19 pandemic has allowed for the first time description of the global patterns of reproductive ratios of a novel pathogen during pandemic spread. The present study reports the first quantitative empirical evidence that COVID-19 net transmissibility remains less controlled in socio-economically disadvantaged countries, even months into the pandemic. This needs to be addressed by the global scientific community as well as international politics.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

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