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The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

ABSTRACT: Background:Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. Methods:This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Results:Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Conclusion:Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition.

SUBMITTER: Lipira L

PROVIDER: S-EPMC6454494 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

Lipira Lauren L Kemp Christopher C Domercant Jean Wysler JW Honoré Jean Guy JG Francois Kesner K Puttkammer Nancy N

International health 20180101 1

<h4>Background</h4>Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti.<h4>Methods</h4>This analysis used longitudinal data from 2012 to 2014 from the iSanté ...[more]

PMID: 29329386

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Project description:BackgroundUnderstanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care.MethodsData came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors.ResultsOverall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas availability of delivery services was significantly associated with women's greater likelihood of using facility-based delivery care after controlling for other covariates, while facilities' readiness to provide delivery services was also important in nonmetropolitan urban areas.ConclusionIncreasing physical access to delivery care should become a high priority in rural Haiti. In urban areas, where delivery services are more available than in rural areas, improving quality of care at facilities could potentially lead to increased coverage of facility delivery.

Project description:BackgroundAccess to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+.ObjectiveTo assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti.MethodsLongitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan-Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition.ResultsAmong 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9-37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6-52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001).ConclusionsART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.

Project description:BACKGROUND:Early initiation of breastfeeding (within an hour of birth) has benefits for newborn health and survival. Optimal breastfeeding supports growth, health, and development. Health facilities provide essential pregnancy, maternal, and newborn care and offer support for early breastfeeding. We examined the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. METHODS:Using data from recent Service Provision Assessment (SPA) surveys in Haiti and Malawi, we defined three indicators of the health service environment: availability of facilities with ANC services reporting routine breastfeeding counseling; provider training on breastfeeding; and breastfeeding counseling during ANC. We linked SPA data geographically to Demographic and Health Surveys (DHS) data from Haiti and Malawi. Multilevel, multivariable logistic regressions examined associations between the health service environment and early initiation of breastfeeding, controlling for women's background characteristics, with separate analyses for urban and rural residence. RESULTS:Over 95% of facilities in Haiti and Malawi reported routinely providing breastfeeding counseling during ANC. Only 40% of both urban and rural providers in Malawi and 29 and 26% of providers at urban and rural facilities in Haiti (respectively) received recent training in counseling on breastfeeding. Further, only 4-10% of clients received counseling. Breastfeeding counseling was generally more common among clients who attended ANC with a provider who had received recent training. After linking SPA and DHS data, our analysis showed that having more providers recently trained on breastfeeding was significantly associated with increased odds of early breastfeeding among women in urban areas of Haiti and Malawi. Additionally, women in urban areas of Malawi lived near facilities with more counseling during ANC were more likely to begin breastfeeding within an hour of birth compared with women in areas with less counseling. CONCLUSIONS:Our study identified gaps in the health system's capacity to implement the recommended global guidelines in support of optimal breastfeeding practices. While breastfeeding counseling during ANC can promote early breastfeeding, counseling was not common. The study provides evidence that provider training could help improve counseling and support for early initiation of breastfeeding.

Project description:The provision of quality obstetric care in health facilities is central to reducing maternal mortality, but simply increasing childbirth in facilities not enough, with evidence that many facilities in sub-Saharan Africa do not fulfil even basic requirements for safe childbirth care. There is ongoing debate on whether to recommend a policy of birth in hospitals, where staffing and capacity may be better, over lower level facilities, which are closer to women's homes and more accessible. Little is known about the quality of childbirth care in Liberia, where facility births have increased in recent decades, but maternal mortality remains among the highest in the world. We will analyse quality in terms of readiness for emergency care and referral, staffing, and volume of births. We assessed the readiness of the Liberian health system to provide safe care during childbirth use using three data sources: Demographic and Health Surveys (DHS), Service Availability and Readiness Assessments (SARA), and the Health Management Information System (HMIS). We estimated trends in the percentage of births by location and population caesarean-section coverage from 3 DHS surveys (2007, 2013 and 2019-20). We examined readiness for safe childbirth care among all Liberian health facilities by analysing reported emergency obstetric and neonatal care signal functions (EmONC) and staffing from SARA 2018, and linking with volume of births reported in HMIS 2019. The percentage of births in facilities increased from 37 to 80% between 2004 and 2017, while the caesarean section rate increased from 3.3 to 5.0%. 18% of facilities could carry out basic EmONC signal functions, and 8% could provide blood transfusion and caesarean section. Overall, 63% of facility births were in places without full basic emergency readiness. 60% of facilities could not make emergency referrals, and 54% had fewer than one birth every two days. The increase in proportions of facility births over time occurred because women gave birth in lower-level facilities. However, most facilities are very low volume, and cannot provide safe EmONC, even at the basic level. This presents the health system with a serious challenge for assuring safe, good-quality childbirth services.

Project description:IntroductionPostpartum intrauterine contraceptive devices (PP-IUCD) are one type of post-partum family planning method, which can be provided to a post-partum woman starting from the placental delivery time (within 10 minutes), or within the first 48 hours of postpartum period. In most developing countries, delivery time is the primary opportunity for women to access post-partum family planning methods, especially for those living in remote areas. Hence, this study assesses providers' knowledge on postpartum intrauterine contraceptive device service provision.MethodsA facility-based cross-sectional study was conducted in Amhara region health center and hospitals. Health providers surveyed included obstetricians, gynecologists, general practitioners, emergency surgical officers, health officers, midwives and nurses from September 18, 2015 to December18, 2016. Simple random sampling was used to select 864 subjects. Data were collected by using a structured self-administered questionnaire and observing the facility. Multilevel analysis was done to see factors associated with outcome.ResultsA total of 197 health facilities and 864 providers are included in the final analysis. Of the total providers 524 (60.6%) were from a health center. The mean age (±SD) of participants was 27.8 years (±5.4). The number of providers with good knowledge accounted for 253 of those surveyed (29.3%). The proportion of good knowledge among trained PP-IUCD providers was 35.7% (those who scored above average), and 27.9% was untrained about PP-IUCD. A considerable heterogeneity was observed between health facilities for each indicator of provider's knowledge. Gender differences were observed as the mean knowledge score deference on PP-IUCD by 0.4 points (β = -0.41; -0.72, -0.10) when the participant was female. Having experience of regular counseling of pregnant women increases PP-IUCD knowledge score by 0.97. (β = 0.97; 95% CI: 0.48, 1.47). Where the health facility requested clients to purchase the IUCD themselves, the mean knowledge score decreased by 0.47 points compared with free of charge at the facility level (β = -0.47; 95%CI: -0.87, -0.07).ConclusionOur findings showed that providers' knowledge about postpartum IUCD was low in the Amhara region public health facility. The lowest knowledge score was noted among nurses, health Officers, midwives, and general practice professionals. Factors associated with providers' knowledge on PP-IUCD are the status of health facility, female sex, training on PP-IUCD, regular counseling of pregnant women, and unavailability of IUCD service.

Project description:This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of skilled health workers.

Project description:BackgroundPrimary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial.ObjectiveThe aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India.MethodsWe conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care.ResultsA total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic.ConclusionsExisting PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.

Project description:BackgroundAchieving maternal and newborn related Sustainable Development Goals targets is challenging for Nepal, mainly due to poor quality of maternity services. In this context, we aim to assess the Basic Emergency Obstetric and Newborn Care (BEmONC) service availability and readiness in health facilities in Nepal by analyzing data from Nepal Health Facility Survey (NHFS), 2015.MethodsWe utilized cross-sectional data from the nationally representative NHFS, 2015. Service availability was measured by seven signal functions of BEmONC, and service readiness by the availability and functioning of supportive items categorized into three domains: staff and guidelines, diagnostic equipment, and basic medicine and commodities. We used the World Health Organization's service availability and readiness indicators to estimate the readiness scores. We performed a multiple linear regression to identify important factors in the readiness of the health facilities to provide BEmONC services.ResultsThe BEmONC service readiness score was significantly higher in public hospitals compared with private hospitals and peripheral public health facilities. Significant factors associated with service readiness score were the facility type (14.69 points higher in public hospitals, P<0.001), number of service delivery staff (2.49 points increase per each additional delivery staff, P<0.001), the service hours (4.89 points higher in facilities offering 24-hour services, P = 0.01) and status of periodic review of maternal and newborn deaths (4.88 points higher in facilities that conducted periodic review, P = 0.043).ConclusionsThese findings suggest that BEmONC services in Nepal could be improved by increasing the number of service delivery staff, expanding service hours to 24-hours a day, and conducting periodic review of maternal and newborn deaths at health facilities, mainly in the peripheral public health facilities. The private hospitals need to be encouraged for BEmONC service readiness.

Dataset Information

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

Publications

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

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