Dataset Information

Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

ABSTRACT:

Objectives

To assess the use of the WHO's Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.

Design

A cross-sectional observational health facility assessment.

Setting

This is a secondary analysis of the 'Birth in Brazil' study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).

Participants

Data on 23 894 postnatal women and their newborn babies were analysed.

Main outcome measures

The facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers' sociodemographic characteristics.

Results

The utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (OR_adj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (OR_adj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (OR_adj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (OR_adj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (OR_adj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (OR_adj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (OR_adj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (OR_adj 2.55; 95% CI 2.21 to 2.96).

Conclusions

The coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.

SUBMITTER: Menezes MAS

PROVIDER: S-EPMC6318520 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

Menezes Maria Alexsandra Silva MAS Gurgel Ricardo R Bittencourt Sonia Duarte Azevedo SDA Pacheco Vanessa Eufrazino VE Cipolotti Rosana R Leal Maria do Carmo MDC

BMJ open 20181231 12

<h4>Objectives</h4>To assess the use of the WHO's Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.<h4>Design</h4>A cross-sectional observational health facility assessment.<h4>Setting</h4>This is a secondary analysis of the 'Birth in Brazil' study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (s ...[more]

PMID: 30598483

Similar Datasets

Project description:AimsTo assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya.BackgroundThe vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low-resource settings.DesignCross-sectional survey.MethodsQuestionnaires comprised of clinical vignettes and direct questions and were administered in 2015-2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed.ResultsNurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case-load facilities had lower average knowledge scores compared with better-resourced and busier facilities.ConclusionOverall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6).Relevance to clinical practiceFocus on periodic training, ensuring retention of knowledge and skills among health workers in low-case load setting, and bridging the know-do gap may help to improve the quality of care delivered to mothers and newborns in Kenya.

Project description:BackgroundDespite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.MethodologyThis study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.ResultThe study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.ConclusionThis study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.

Project description:BackgroundEnding preventable newborn deaths is a global health priority, but efforts to improve coverage of maternal and newborn care have not yielded expected gains in infant survival in many settings. One possible explanation is poor quality of clinical care. We assess facility quality and estimate the association of facility quality with neonatal mortality in Malawi.Methods and findingsData on facility infrastructure as well as processes of routine and basic emergency obstetric care for all facilities in the country were obtained from 2013 Malawi Service Provision Assessment. Birth location and mortality for children born in the preceding two years were obtained from the 2013-2014 Millennium Development Goals Endline Survey. Facilities were classified as higher quality if they ranked in the top 25% of delivery facilities based on an index of 25 predefined quality indicators. To address risk selection (sicker mothers choosing or being referred to higher-quality facilities), we employed instrumental variable (IV) analysis to estimate the association of facility quality of care with neonatal mortality. We used the difference between distance to the nearest facility and distance to a higher-quality delivery facility as the instrument. Four hundred sixty-seven of the 540 delivery facilities in Malawi, including 134 rated as higher quality, were linked to births in the population survey. The difference between higher- and lower-quality facilities was most pronounced in indicators of basic emergency obstetric care procedures. Higher-quality facilities were located a median distance of 3.3 km further from women than the nearest delivery facility and were more likely to be in urban areas. Among the 6,686 neonates analyzed, the overall neonatal mortality rate was 17 per 1,000 live births. Delivery in a higher-quality facility (top 25%) was associated with a 2.3 percentage point lower newborn mortality (95% confidence interval [CI] -0.046, 0.000, p-value 0.047). These results imply a newborn mortality rate of 28 per 1,000 births at low-quality facilities and of 5 per 1,000 births at the top 25% of facilities, accounting for maternal and newborn characteristics. This estimate applies to newborns whose mothers would switch from a lower-quality to a higher-quality facility if one were more accessible. Although we did not find an indication of unmeasured associations between the instrument and outcome, this remains a potential limitation of IV analysis.ConclusionsPoor quality of delivery facilities is associated with higher risk of newborn mortality in Malawi. A shift in focus from increasing utilization of delivery facilities to improving their quality is needed if global targets for further reductions in newborn mortality are to be achieved.

Project description:BackgroundAlmost everywhere, neonatal mortality can be decreased with ease if competent obstetricians give the necessary treatment. Unfortunately, observational techniques were not used to examine basic essential newborn care practice among obstetric care providers in Ethiopia. Thus, the purpose of this study was to evaluate factors related to essential newborn care practice using observational techniques among obstetric care providers in public hospitals in the Gamo, Gofa, and Wolayta zones, southern Ethiopia.MethodsAn institutional-based cross-sectional study carried out from May 15 to June 30, 2022. A simple random sampling method was used. Structured self-administered questionnaires with a clinical observational checklist were used to collect data. Data imported into Epidata version 4.6 and analyzed using the SPSS Version 25. Bivariable and multivariable analyses were used to identify factors associated with essential newborn care practices. An odds ratio with a 95% confidence interval was used to assess the direction and strength of the association.ResultsThe overall magnitude of good essential newborn care practice among obstetric care providers was 53.5% (95% CI = 49, 58). Factors positively associated with the practice of essential newborn care were having interest on working in delivery room (AOR = 3.16, 95% CI = 1.71,5.83), having no work load (AOR = 2.96, 95% CI = 1.78,4.49), received in-service training (AOR = 3.09, 95% CI = 1.75,5.45), having supportive supervision (AOR = 3.41, 95% CI = 1.25, 9.24), and having good knowledge on essential newborn care (AOR = 3.04, 95% CI = 1.89,4.90).ConclusionThe observed level of essential newborn care practices among obstetric care providers underscores the necessity for targeted interventions that stimulate interest in delivery room work, effectively manage workloads, and offer comprehensive training along with supportive supervision. By concentrating on these aspects and enhancing providers' knowledge, we can significantly improve essential newborn care practices.

Project description:ObjectiveTo assess readiness and quality of essential newborn care and neonatal resuscitation practices in public health facilities in Afghanistan.DesignCross-sectional assessment.Setting226 public health facilities in Afghanistan, including 77 public health facilities with at least five births per day (high-volume facilities) and 149 of 1736 public health facilities with fewer than five births per day (low-volume facilities).ParticipantsManagers of 226 public health facilities, 734 skilled birth attendants (SBAs) working at these facilities, and 643 women and their newborns observed during childbirth at 77 high-volume health facilities.Outcome measuresAvailability of knowledgeable SBAs, availability of supplies and compliance with global guidelines for essential newborn care and neonatal resuscitation practices.ResultsAt high-volume facilities, 569/636 (87.9%) of babies were dried immediately after birth, 313/636 (49.2%) were placed in skin-to-skin contact with their mother and 581/636 (89.7%) had their umbilical cord cut with a sterile blade or scissors. A total of 87 newborn resuscitation attempts were observed. Twenty-four of the 87 (27.5%) began to breath or cry after simply clearing the airway or on stimulation. In the remaining 63 (72.5%) cases, a healthcare worker began resuscitation with a bag and mask; however, only 54 (62%) used a correct size of mask and three babies died as their resuscitation with bag and mask was unsuccessful.ConclusionsThe study indicates room for improvement of the quality of neonatal resuscitation practices at public health facilities in Afghanistan, requiring only strengthening of the current best practices in newborn care. Certain basic and effective aspects of essential newborn care that can be improved on with little additional resources were also missing, such as skin-to-skin contact of the babies with their mother. Improvement of compliance with the standard newborn care practices must be ensured to reduce preventable newborn mortality and morbidity in Afghanistan.

Project description:Comprehensive assessments of quality of care (QoC) are essential for monitoring progress towards meeting global and national maternal and newborn health (MNH) targets. Liverpool School of Tropical Medicine (LSTM) and the Niger Ministry of Public Health adapted a 2014 WHO QoC tool to cover antenatal care (ANC) and postnatal care (PNC) and include client voices through exit interviews. The objectives of the study were to assess quality of MNH care in Niger and to document lessons learnt from implementing the LSTM QoC tool. Quality of Care (QoC) was assessed using five tools: health facility survey (using register and official record data), partograph reviews, healthcare provider knowledge assessment, exit interviews with clients, and observation of antenatal and postnatal care. A nationally representative sample of 110 public healthcare facilities at three levels (integrated health centres, district hospitals and mother-child hospitals) and 2153 women were included. Descriptive analysis with 95% confidence intervals was presented. The health facility survey showed variable access to electricity (63% [53-72]), water (72% [62-81]), and transportation (40% [31-50]). Tests and treatment for HIV, TB, and malaria were found in more than 90% of relevant facilities. During observation of first ANC visit, 62% [48-74] women were tested for HIV; 13% [5-30] for pre-eclampsia and 22% [12-36] for anaemia. Observation of PNC showed much lower rates of screening (15% [7-27] tested for HIV and 4% [0;11] for malaria). Partographs were used in 86% of deliveries with inconsistent completion. At client interviews, respectful care indicators were variable, with providers not always explaining results to clients (59% [50-67]). Targeted allocation of resources and training could impact on QoC and reduce missed opportunities for prevention, screening and management of diseases among pregnant women and babies. The QoC assessment tool proved capable of offering a comprehensive overview of priorities in MNH, while maintaining feasibility in the Nigerien context.

Project description:BackgroundIncreased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns.MethodsA cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data.ResultsThe use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH.ConclusionsThis is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes.Trial registrationNational Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.

Dataset Information

Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets