Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia

The study examines the association of unwanted pregnancy and the utilization of maternal-child health services, and the adverse health outcomes in urban and rural settings. The study employed data from the 2017 Indonesia Demographic Health Survey that included 13,806 live births; the mothers were not pregnant at the interview and were married participants. The multiple logistic regression analysis concerning residential areas was conducted separately to compare outcomes related to unwanted pregnancy. Non-standard antenatal care visits (adjusted odds ratio [AOR]=1.7; 95% confidence interval [CI]=1.2–2.4), prolonged labor (AOR=1.6; 95% CI=1.2–2.1), the absence of child’s birth documentation (AOR=1.3; 95% CI=1.0–1.6), and smaller baby size (AOR=1.2; 95% CI=1.0–1.4) are associated with unwanted pregnancy in urban areas. In rural settings, on the other hand, unwanted pregnancy is associated with non-standard antenatal care (AOR=1.6; 95% CI=1.2–2.2). Therefore, in Indonesia, urban areas lack maternal-child healthcare services utilization and higher adverse events due to unwanted pregnancy than rural areas. An adjustment approach is required in maternal-child health-related programs in both areas, particularly for women living in urban.

Preterm birth among Pacific Islander women and related perinatal outcomes: a scoping review protocol

IntroductionInfants born alive <37 weeks are classified as premature. The global estimate of preterm birth in 2014 was 10.6%, and it is the leading cause of death of children under the age of 5 years. Preterm birth disproportionately affects women of minority populations, yet knowledge about the incidence and associated outcomes among Pacific Islanders is limited. The objectives of this scoping review are to identify studies that describe risk factors, maternal-child health outcomes and existing interventions to prevent preterm birth among Pacific Islanders, and to summarise the barriers and facilitators to decrease the burden.Methods and analysisWe will follow the Joanna Briggs Institute Manual for Evidence Synthesis for scoping reviews and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) to conduct this scoping review. The Covidence web application will be used for data management and consensus review. We will search on MEDLINE ALL (Ovid), EMBASE (Ovid), Web of Science Core Collection (as licensed at Yale), the Cochrane Library, CINAHL (EBSCOhost) and two non-indexed regional journals (Pacific Journal of Reproductive Health and Pacific Health Dialog). Title-abstract and full-text screening of eligible studies will be performed by two authors, and data will be extracted by the first author. Outcomes extracted will be presented using evidence mapping.Ethics and disseminationFindings will drive suggestions for new data collection needed to fill knowledge gaps and improve future study designs to decrease the burden of preterm birth among Pacific Islanders. There are no ethical concerns. This protocol will be disseminated in related peer-reviewed journals.

Food Insecurity, Nutritional Inequality, and Maternal–Child Health: A Role for Biocultural Scholarship in Filling Knowledge Gaps

Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security's four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children's nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.

THE DIFFERENCES OF PREGNANT WOMEN KNOWLEDGE LEVEL IN THE OWNERSHIP OF MCH HANDBOOK

Background: The MCH (Maternal Child Health) Handbook is a mandatory handbook for mother and children that has function as information especially for pregnant women until childbirth and also newborn to toddlers. One of the utilization of MCH Handbook is by an active reading role is considered to be able to achieve the goal so that mothers can carry out health care independently so that pregnant women can detect complications as early as possible. Method : The research method is analytic Observational with cross-sectional design. The total sample is 114 pregnant women, using purposive sampling technique. The independent variable is the ownership of MCH Handbook which is categorized in 3 groups of reading activities and the dependent variable is the level of knowledge. Data analysis using Kruskal Wallis test. Result : The result showed that pregnant women who read entire contents of the MCH Handbook had a good level of knowledge is 47 respondents and none had sufficient or insufficient knowledge, while pregnant women who read some of the contents of the MCH Handbook had a good level of knowledge is 55 people and 2 others had enough knowledge.For the group of pregnant women who did not read the contents of MCH Handbook, there were 10 people and all of them had a good level of knowledge. The result of Kruskal Wallis test is p values = 0,365 ( p>0,05). Conclusion : There is no different of the knowledge level on 3 reading group.

IMPLICATIONS OF LONG-LASTING INSECTICIDE-TREATED BED NETS (LLINs) FOR MALARIA CONTROL AND PREVENTION IN SOMALIA

In Sub-Saharan Africa, bed nets are mainly aimed at the prevention of the nuisance of mosquito biting rather than against malaria. The species that are involved in malaria infection are all present in Somalia with the leading one being Plasmodium falciparum that causes about 98% of all infections in the country. This alarming spread of malaria underscores the need to develop interventions that can effectively curb the malaria menace. This study sought to examine the implications of the utilization of long-lasting insecticide-treated bed nets (LLINs) for malaria control and prevention. The population constituted 1,100 pregnant women attending MCH clinics and the two thousand two hundred heads of households, totalling three thousand three hundred. A simple random sampling technique was used to obtain a representative sample of households. In surveying 110 pregnant women attending Maternal Child Health (MCH) clinics and 220 heads of households in the Belet Hawo district in Somalia in 2019, the study found that the majority of households knew the effect of LLINs on preventing malaria. They were also knowledgeable about how to control malaria while facing limited access to LLINs. Furthermore, LLIN usage helped households to raise awareness and knowledge about the effect of LLINs on preventing malaria. This study provided the Somalian government with a better understanding of the causes, control, and prevention of malaria.

Assessment of Factors Contributing to Medicine Expiry in Rwanda: Case of the Medical Procurement and Production Division

BackgroundRegardless of the significant efforts used and put in place to enhance supply chain performance in Rwanda, there is still poor inventory management and big loss due to expiry of medicines at Medical Procurement and Production Division (MPPD).ObjectiveTo assess the factors that contributes to expiry of medicines at MPPD and formulate recommendations for the improvement of the current situation.MethodsThis is a descriptive cross-sectional study used for 25 respondents. A questionnaire containing closed-ended questions was used focusing on factors contributing to expiries of medicines for each product category managed by MPPD from 2014-2018. Additionally, the researcher reviewed all inventory reports, including expiries for the same period under study. The study focused on targeting respondents working at MPPD as pharmacists both technical and administrative, also other non-pharmacist working in the warehouse were considered as respondents. The hard copy of questionnaire was handed over to 26 respondents and requested to provide filled questionnaire within seven days. Twenty-five respondents were able to return the filled questionnaire on time, giving 96% response rate.ResultsThe study found that in MPPD, medicines are still expiring. During five years (from 2014 up to 2018) the total expired products were valued at RWF 6,046,778,655 for all program categories: HIV commodities had the largest share 53.3%, Essential Medicines 22.5%, Malaria 13%, Maternal Child Health commodities 5.7%, Products used for Community health workers 4.5%, TB products 1% and 0.1% for Family Planning products. The study found that major contributing factors for expiry of health commodities at MPPD, are ranked as follows: Supply chain management 90%, other factors 73%, Poor storage management 68% and Excessive drug supply 67%. ConclusionConsidering the study results, it looks like no significant effect of excessive drug supply and inventory management on the expiration of medicines at MPPD. However, the Supply Chain Management components are the most vulnerable to contribute to the expiration of medicines at MPPD. There are many changes to be done inside the institution to remedy the issue of expiration like working according to the standard operating procedures, improving the Skills of personnel in supply chain management, empowering the procurement unit with skilled personnel and improving the communication with stakeholders to facilitate the smooth and quick replenishment and distribution of the stock. Rwanda J Med Health Sci 2021;4(2): 281-291

Costs of Implementing an Integrated Package of Maternal and Pediatric Interventions Including SQ-LNS in Rural Niger

Background: In January 2015, the Alliance for International Medical Action and Bien Être de la Femme et de l’Enfant au Niger launched the 1000 Days Program in Mirriah District, Niger, to provide an integrated package of maternal and pediatric preventive and curative interventions. A new component of the package was the provision of small-quantity lipid-based nutritional supplements (SQ-LNS) for children 6 to 23 months. Objective: The objective of this study was to estimate the costs associated with providing the 1000 days package. Methods: Activity-based costing was used to estimate the total costs of the 10 activities included in the 1000 days package and also the incremental costs of new interventions, those beyond the standard of care. Results: The total cost of the 1000 Days Program was US$2.31 million for 9000 mother–child pairs. The average cost per pair was US$257 or US$103 per year. Incremental costs for new interventions accounted for 56% of program costs. Small-quantity lipid-based nutritional supplement represented 30% of incremental costs. A combination of efficiency measures could lower program costs by 15%. Conclusions: This study is the first to estimate the costs of an integrated, preventative–curative package of maternal–child health interventions with SQ-LNS. Implementing the 1000 days package across Niger will be challenging with only the country’s domestic health resources. Efficiency measures and creative financing arrangements, including support from external partners, should be explored. The approach and results described can inform future resource mobilization, financing, and budgeting efforts to scale the 1000 days or similar programs.