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Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries.

ABSTRACT: The objective of this paper is three-fold: (i) to analyse the coverage and equity of access to selected maternal and child healthcare interventions, particularly those delivered in Primary Healthcare (PHC) setting; (ii) to analyse the main drivers of inequitable access to selected interventions; and (iii) to synthesise and compare the results across the Middle East and North Africa (MENA) region as well as over time. We analysed data for five key maternal and child healthcare interventions from 29 national surveys (DHS and MICS) covering 13 MENA countries and spanning a period of almost 20 years (2000-2018). We calculated coverage indicators, concentration indices (CI) and decomposition of CIs according to standard definitions. We synthetized the results by country groups based on their human development index (HDI). Over time and among countries that started from a lower base, there has been an improvement in coverage and equity of selected interventions (four ante-natal care visits and skilled birth assistance). When considering the place of skilled delivery, there is a clear rich-poor divide, with women from richer wealth quintiles gravitating toward private healthcare facilities and those from poorer wealth quintiles toward public ones. While most of the care-seeking for common child illnesses occurs in PHC facilities, a fraction (20-30 percent) of care-seeking takes place in secondary healthcare facilities. PHC has played a role in improving coverage and equity of access in key maternal and child health interventions in the wider MENA region. Better integration of care, strengthening and improving the PHC network could increase the use of cost-effective interventions, which are key to improving maternal and child health.

SUBMITTER: Nikoloski Z

PROVIDER: S-EPMC7823042 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries.

Nikoloski Zlatko Z Wannis Hrayr H Menchini Leonardo L Chatterjee Anirban A

SSM - population health 20210112

The objective of this paper is three-fold: (i) to analyse the coverage and equity of access to selected maternal and child healthcare interventions, particularly those delivered in Primary Healthcare (PHC) setting; (ii) to analyse the main drivers of inequitable access to selected interventions; and (iii) to synthesise and compare the results across the Middle East and North Africa (MENA) region as well as over time. We analysed data for five key maternal and child healthcare interventions from ...[more]

PMID: 33532537

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Project description:IntroductionConflict, fragility and political violence, that are taking place in many countries in the Middle East and North Africa (MENA) region have devastating effects on health. Digital health technologies can contribute to enhancing the quality, accessibility and availability of health care services in fragile and conflict-affected states of the MENA region. To inform future research, investments and policy processes, this scoping review aims to map out the evidence on digital health in fragile states in the MENA region.MethodWe conducted a scoping review following the Joanna Briggs Institute (JBI) guidelines. We conducted descriptive analysis of the general characteristics of the included papers and thematic analysis of the key findings of included studies categorized by targeted primary users of different digital health intervention.ResultsOut of the 10,724 articles identified, we included 93 studies. The included studies mainly focused on digital health interventions targeting healthcare providers, clients and data services, while few studies focused on health systems or organizations managers. Most of the included studies were observational studies (49%). We identified no systematic reviews. Most of the studies were conducted in Lebanon (32%) followed by Afghanistan (13%) and Palestine (12%). The first authors were mainly affiliated with institutions from countries outside the MENA region (57%), mainly United Kingdom and United States. Digital health interventions provided a platform for training, supervision, and consultation for health care providers, continuing education for medical students, and disease self-management. The review also highlighted some implementation considerations for the adoption of digital health such as computer literacy, weak technological infrastructure, and privacy concerns.ConclusionThis review showed that digital health technologies can provide promising solutions in addressing health needs in fragile and conflict-affected states. However, rigorous evaluation of digital technologies in fragile settings and humanitarian crises are needed to inform their design and deployment.

Project description:PurposeThe Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region.MethodsThis review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012-2017 for observational studies, and 2015-2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm.ResultsWe identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12-96% in children and adolescents, and 54-90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude.We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000-2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies.The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country.ConclusionHypovitaminosis D is prevalent in the MENA region, and doses of 1000-2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed.

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Dataset Information

Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries.

Publications

Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries.

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