Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018

Objectives. This study is aimed at investigating the time trends and disparities in access to maternal healthcare in Pakistan using Bayesian models. Study Design. A longitudinal study from 2006 to 2018. Methods. The detailed analysis is based on the data from Pakistan Demographic and Health Survey (PDHS) conducted during 2006-2018. We have proposed Bayesian logistic regression models (BLRM) to investigate the trends of maternal healthcare in the country. Based on different goodness-of-fit criteria, the performance of proposed models has also been compared with repeatedly used classical logistic regression models (CLRM). Results. The results from the analysis suggested that BLRM perform better than CLRM. The access to antenatal healthcare increased from 61% to 86% during years 2006-18. The utilization of medication also improved from 44% in 2006 to 60% in 2018. Despite the improvements from 2006 to 2018, every three out of ten women were not protected against neonatal tetanus, neither delivered in the health facility place nor availed with the skilled health provider at the time of delivery during 2018. Similarly, two-fifth mothers did not received any skilled postnatal checkup within two days after delivery. Additionally, the likelihood of MHS provided to mothers is in favor of mothers with lower ages, lower birth orders, urban residences, higher education, higher wealth quintiles, and residents of Sindh and Punjab. Conclusions. The gaps in utilization of MHS in different socioeconomic groups of the society have not decreased significantly during 2006-2018. Any future maternal health initiative in the country should focus to reduce the observed disparities among different socioeconomic sectors of the society.

Are Return of Service Bursaries an Effective Investment to Build Health Workforce Capacity? A Qualitative Study of Key South African Policymakers

Background: Return-of-service schemes or bursaries are used in South Africa and other nations to publicly fund the training of skilled health professionals in return for the beneficiary agreeing to return to serve in their local provinces on a year-for-year basis. This study aimed to understand how these policies operate across different provinces in South Africa to examine whether they achieved their objectives and identify strengths and areas for improvement in the schemes to inform policymakers in South Africa and internationally. Methods: This research draws on the insights of 15 key South African policymakers from eight of its nine provinces through semi-structured, qualitative interviews. The respondents were interviewed through Microsoft Teams virtual platform, either in pairs (4) or as individuals (7). Data were analysed using inductive, thematic content analysis in NVIVO. Results: Respondents reported that the schemes had resulted in an increase in the number of skilled health professionals and had provided opportunities for study and employment for previously marginalised groups. Formal evaluations of the impact of the schemes were not reported, however, a number of shortcomings with current schemes were identified that were likely limiting their effectiveness. Respondents reported a lack of foresight in the scheme implementation including a bias in the selection of beneficiaries towards medical professionals at the expense of other health workers. Furthermore, failure to plan for practice location when beneficiaries finished training limited the capacity of the schemes to meet the needs of local populations. Monitoring of recipients was limited by loopholes in contract design, decision-making and, poor coordination between departments. Between 5 and 30% of beneficiaries were reported to default their contracts with some not completing their studies, some not returning after completing their internship and others terminating their services before concluding their contracts. Conclusions: Return-of-service schemes have helped in overcoming health professional shortages. However, they haven’t been formally evaluated. Several planning and implementation shortcomings were identified which can be improved to enhance access to healthcare in South Africa.

Challenges to Health and Safety Compliance for Construction Projects in South East, Nigeria

The aim of this research is to establish the challenges to health and safety compliance for construction projects in South East Nigeria. This study which is essentially survey based and empirical collected quantitative and qualitative data through questionnaire survey and field observations. The questionnaires were administered to indigenous construction firms and professionals in the construction projects in Abia, Anambra, Imo, Enugu and Ebonyi States of the South East area of Nigeria which are the study population. The tools used for data analysis were Regression using Friedman Q Test Ranking and crosstab. The findings revealed that the challenges to health and safety compliance in South East Nigeria are bribery and corruption, ignorance of the benefits of compliance, lack of health and safety culture, perception of stakeholders, neglect of human rights and moral values, non-commitment of the major construction players, inadequate training of staff and lack of skilled health and safety personnel, non-inclusion of health and safety in contract document and tendering process and inadequate funding. This study concludes that the lack of awareness and understanding of health and safety significantly hinders compliance to health and safety. The study therefore recommends that using enforcement in form of incentives based approach will equally take care of the identified different challenges to Health and Safety Compliance in South East, Nigeria. Furthermore, the health and safety regulations should not be enforced only through inspections and sanctions, rather there should be economic incentives to encourage and motivate self- compliance.

‘it Is Beyond Our Reach’: Policies and Infrastructure Influencing Postpartum Care in Rural Kenya

BackgroundMaternal mortality in low middle-income countries is still high. Like most countries in Sub-Saharan Africa, the progress towards reducing maternal mortalities in Kenya is slow. Approximately 488 women out of every 100,000 live births die during the childbearing process. Kenya has put in place several strategies to mitigate maternal mortalities. For instance, Kenya introduced free maternity services in 2013 to remove financial barriers to skilled health services for mothers and children under five years old. Hence, it is necessary to explore how the policies and infrastructure intersect with other socioeconomic factors to influence postpartum care in rural Kenya to mitigate maternal and infant deaths.MethodsThis qualitative research conducted in-depth focused ethnographic (FE) interviews with 23 nurses and midwives working in nine health centres and the County Hospital in Nandi County, Kenya, between July 2017 and February 2018. We used thematic analysis approach as described by Braun and Clarke to analyze the data. Lincoln and Guba criteria for establishing the trustworthiness of data was used. ResultsThe analysis of data generated six themes. The findings from the theme, Policies and Infrastructure Influencing Postpartum Care will be discussed in this paper. The findings will be discussed under three sub-themes 1) Free maternity services, 2) Adherence to perinatal care guidelines, and 3) Recruitment and retention of nurses and midwives. Facilities lacked the essential equipment and supplies required to provide these services, recruitment and retention of staff, demotivation of healthcare providers, lack of regular training and supervision of staff, and lack of adherence to postpartum guidelines. These issues intersected to determine the quality of skilled postpartum services provided to childbearing women and their families as well as women and infants’ overall perinatal health outcomes. ConclusionThe findings have underscored the importance of having a functional healthcare system that supports both the clinical and emotional aspects of the women and healthcare providers. Efforts should be directed into addressing the negative factors influencing care provision at the facility level. Suboptimal care could cause women not to attend skilled health care and sabotage the global goals of eliminating maternal and infant mortalities. This can be achieved by creating policies that considers the diverse causes and power-relations withing the healthcare organization.

DETERMINAN KULTURAL DAN STRUKTURAL DALAM KEMITRAAN BIDAN DENGAN DUKUN BAYI (BHISA/SANDO) DI KABUPATEN WAKATOBI, SULAWESI TENGGARA

Background: Births assisted by skilled health personnel in health facilities is the prevention of maternal mortality. Wakatobi District has a low coverage of birth attendance by skilled health personnel, and the community has a powerful culture in all aspects of life, including visiting traditional birth attendants known as Bhisa/Sando in caring for women from pregnant to childbirth. Objective: To identify the cultural and structural determinants that affect the partnership between Bhisa/Shando and midwives in maternal and child health services (MCH). Methods: This study used an operational research design with a qualitative approach. A total of 68 informants were involved in focus group discussions, in-depth interviews, and participatory observations. Thematic analysis was used in processing all information. Results: Cultural determinants that affect the partnership between Bhisa/Shando and midwives were hereditary traditions and a powerful belief in Bhisa/Shando's ability to take care for pregnant women, labor women, postpartum women, and newborns. Meanwhile, structural determinants included inadequate facilities and health personnel for MCH services and suboptimal supports from related parties. These results may cause the partnership between Bhisa/Shando and midwives will not be optimal. Conclusion: Cultural and structural factors have a strong influence in realizing the partnership between Bhisa/Sando and midwives. The involvement of Bhisa/Sando in MCH services conducted by midwives, adequate MCH service infrastructure, and support from community leaders, cadres, and related agencies is essential to be carried out to improve Bhisa/Sando's partnership with midwives in improving MCH services. Keywords: Bhisa/Shando, partnership of midwives and traditional birth attendants, maternal and child health Abstrak Latar belakang: Persalinan yang ditolong oleh tenaga kesehatan di fasilitas kesehatan merupakan upaya untuk mencegah kematian ibu. Kabupaten Wakatobi memiliki cakupan penolong persalinan oleh tenaga kesehatan yang rendah, dan masyarakatnya memiliki budaya yang sangat kuat dalam segala aspek kehidupan, termasuk mendatangi dukun bayi yang disebut sebagai Bhisa/Sando dalam menangani ibu hamil hingga bersalin. Tujuan: Mengidentifikasi determinan kultural dan struktural yang memengaruhi kemitraan antara Bhisa/Shando dengan bidan dalam pelayanan kesehatan ibu dan anak (KIA). Metode: Studi ini menggunakan desain riset operasional dengan pendekatan kualitatif. Total 68 informan terlibat dalam diskusi grup terarah, wawancara mendalam, dan observasi partisipasi. Analisis tematik digunakan dalam mengolah seluruh informasi. Hasil: Determinan kultural yang memengaruhi kemitraan antara Bhisa/Shando dengan bidan yaitu tradisi turun temurun dan kepercayaan yang kuat terhadap kemampuan Bhisa/Shando dalam menangani ibu hamil, ibu bersalin, ibu nifas, dan bayi baru lahir. Sedangkan determinan struktural meliputi fasilitas dan tenaga kesehatan untuk pelayanan KIA yang belum memadai serta dukungan dari pihak terkait yang belum optimal. Hal ini menyebabkan kemitraan antara Bhisa/Shando dengan bidan belum optimal. Kesimpulan: faktor kulturan dan struktural berpengaruh kuat dalam mewujudkan kemitraan antara Bhisa/Sando dengan bidan. Keterlibatan Bhisa/Sando dalam pelayanan KIA yang dilakukan bidan, infrastruktur pelayanan KIA yang memadai, dan dukungan dari tokoh masyarakat, kader, dan instansi terkait perlu dilakukan untuk meningkatkan kemitraan Bhisa/Sando dengan bidan dalam meningkatkan pelayanan KIA. Kesimpulan: Kualitas hidup ibu hamil dan ibu nifas relatif sama dengan kecenderungan lebih rendah pada kualitas hidup ibu nifas Kata kunci: Bhisa/Shando, kemitraan bidan dan dukun bayi, kesehatan ibu dan anak

Equity and access to maternal and child health services in Ghana a cross-sectional study

Background Inequities in the distribution of and access to maternal and child health care services is pervasive in Ghana. Understanding the drivers of inequity in maternal and child health (MCH) is important to achieving the universal health coverage component of the Sustainable Development Goals (SDGs) and poverty reduction in developing countries. However, there is increasing disparities in MCH services, especially in rural -urban, and income quintiles. The study aimed to examine the disparities in maternal and child health care services in Ghana for policy intervention. Methods Data for this study was extracted from the nationally representative Ghana Statistical Service (GSS) Multiple Indicator Cluster Survey (MICS) round 4, 2011. Respondents of this survey were women of reproductive age 15–49 years with a sample size of 10,627 households. The models were estimated using multivariate regression analysis together with concentration index (CI) and risk ratio (RR) to assess the distribution of MCH indicator groups across the household wealth index. Results The results show that women with secondary school level and above were more likely to receive family planning, prenatal care, and delivery by a skilled health professional than those without formal education. Mothers with low level of educational attainment were 87% more likely to have their first pregnancy before the age of 20 years, and 78% were more likely to have children with under-five mortality, and 45% more likely to have children who had diarrhoea. teenage pregnancy (CI = − 0.133, RR =0.679), prenatal care by skilled health worker (CI = − 0.124, RR =0.713) under five mortality, child underweight, reported diarrhoea, and suspected pneumonia, though not statistically significant, were more concentrated in the poorer than in the richer households, The RR between the top and bottom quintiles ranged from 0.77 for child underweight to 0.82 for child wasting. Conclusion Geographic location, income status and formal education are key drivers of maternal and child health inequities in Ghana. Government can partner the private sector to implement health policies to address inequalities in MCH services through primary health care, and resource allocation skewed towards rural areas and the lower wealth quintile to bridge the inequality gaps and improve MCH outcomes. The government and the private sectors should prioritize female education, as that can improve maternal and child health.

A Twitter analysis of World Pharmacists Day 2020 images: Sending the wrong messages

Background: Pharmacists are often depicted as dispensers of medication as opposed to health professionals who provide patient care. Our objective was to identify how pharmacists’ roles were portrayed in images on Twitter for World Pharmacists Day (WPD) 2020. Methods: A qualitative content analysis was undertaken to evaluate the images of pharmacists on WPD. Tweets were included that had a photo or image, used 1 of 5 WPD hashtags and were posted between September 24 and 26, 2020. Thematic analysis was performed independently by 2 investigators. Tweets were categorized into 5 groups: 1) drug distribution roles, 2) patient care roles, 3) no described roles, 4) not professional/unprofessional roles and 5) not relevant. Subgroup analysis was performed for the users who posted the tweets. Results: Of the 970 tweets analyzed, only 11% of the overall tweets portrayed the patient care roles of pharmacists, whereas 51% portrayed drug distribution roles and 29% did not describe any particular roles of pharmacists. These proportions were similar between subgroups of tweeters. Discussion: WPD is intended to promote and advocate for the pharmacy profession. The results of our study show poor messaging of pharmacists’ roles and reflect a missed opportunity to showcase the full scope of pharmacy practice. Conclusion: Based on the images tweeted on WPD 2020, the diversity of pharmacists’ practice as skilled health care practitioners was lost in a sea of tweets portraying pharmacists’ roles in drug distribution. We hope that pharmacists and pharmacy organizations will awaken to this self-induced problem for WPD 2021. Can Pharm J (Ott) 2021;154(5):xx-xx.

The knowledge and use of misoprostol among women in a Nigerian population

Background: Increasing the availability and accessibility of misoprostol in low resource settings has been advocated to reduce maternal deaths from primary postpartum haemorrhage (PPH). WHO recommends a strategy of antenatal distribution of misoprostol to pregnant women, for self-administration for the prevention of PPH, in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel. The success of such strategies depends on the current knowledge and acceptability of misoprostol among women in such population. The aim of this study was that we assessed the knowledge and use of misoprostol among Nigerian women.Methods: It was a prospective cross-sectional population based survey in which 16445 consenting women, from randomly selected households and communities across the 20 local government areas (LGA) of Lagos state, had in-depth interview with the aid of an interviewer administered structured questionnaire to assess their knowledge and use of misoprostol. Data obtained were presented in frequency and proportions.Results: Thirteen per cent and 6.5% of the respondents were aware of drugs that could be used to terminate pregnancy and stop bleeding following childbirth, respectively. Only 5.2% of the women were aware of misoprostol, two-third (67%) of which knew it could be used to terminate pregnancy and 5% of women aware of misoprostol knew it could be used to reduce or stop bleeding following childbirth. Only 2.3% of the entire study population admitted to personal use of misoprostol.Conclusions: Knowledge about the safe, life-saving and effective use of misoprostol among Nigerian women is low. There is need to disseminate information about misoprostol especially in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel.

Social work and public health – Logical collaborators

This last year, our lives have been turned upside down by Covid-19 and the public health responses needed to keep our communities safe. Most of us probablyhad little awareness of public health before this. At the height of lockdown, and almost overnight, public health had become a topic of daily conversation; suddenly, everyone was talking about epidemiology, and disease modelling. The pandemic turned public health from obscurity into a focusof intense and life-saving relevance, taking public health professionals a bit by surprise; everyone from chief medical officers to epidemiologists were getting crash courses in media interviews and press conferences. Skilled health communicators such as Siouxie Wiles in Aotearoa New Zealand and Norman Swan in Australia became crucial interpreters for the wider community inthe face of complex information about the pandemic. While many social workers may not know a lot about public health, either as a discipline or specialisation of medical practice, there are substantial points of connection with our profession—enough to consider that social work and public health are logical collaborators.