Image: A health worker examines a pregnant woman during an antenatal care consultation at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. ©2015 Arturo Sanabria, Courtesy of Photoshare.
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June 2017 | Volume 5 | Number 2
- Can newborn sepsis deaths be reduced practically through active case detection during home visits?
- Why was the WHO Safe Childbirth Checklist along with coaching critical for improving provider practices in Uttar Pradesh?
- How did Marie Stopes use social franchising in public-sector clinics to markedly increase family planning choices in Mali?
- Why is the mental well-being of health professionals dealing with complex emergencies important?
- Why didn’t an mHealth CME intervention lead to knowledge acquisition among community providers in Vietnam?
- What innovations were used in designing new personal protective equipment for use during highly infectious epidemic outbreaks?
Read the June 2017 issue of GHSP to find answers to these questions and more. View a list of all articles by article type below or online.
Visit the GHSP website to read and comment on the articles, and subscribe to receive alerts when new articles and issues are published.
TABLE OF CONTENTS
EDITORIALS
Severe bacterial infection remains one of the major causes of newborn deaths in low-income countries. A key challenge for reducing this burden is making definitive treatment more easily available. Active case detection through early postnatal home visits can work under trial conditions but is difficult to implement at scale under routine conditions. In many settings, making treatment available at peripheral-level primary health care facilities may be more feasible.
Even under optimized trial conditions, antenatal ultrasound was difficult to implement in Equateur Province, DRC. Moreover, the broader study across 5 countries failed to find an impact on pregnancy outcomes. Use of antenatal ultrasound screening appears not ready for wide application in low- and middle-income countries.
Substantial progress has been made toward viable, practical long-acting approaches to deliver HIV treatment and prevention through: (1) continued improvements in long-acting antiretrovirals (ARVs); (2) better innovative delivery systems; and (3) collaboration of willing partners to advance new ARVs. More progress on those 3 fronts is still needed to arrive at the goal of optimized HIV treatment and prevention for all who would benefit—and of finally controlling the HIV epidemic.
COMMENTARIES
We call on humanitarian aid organizations to integrate proven mental health strategies to protect the mental health of their workforce and improve staff capacity to provide care for vulnerable populations. Such strategies could include:
- Pre-deployment training
- Team building
- Narrative Exposure Therapy
- Art therapy
- Physical exercise
- Mindfulness or contemplative techniques
- Mind-body exercises
- Eye movement desensitization and reprocessing
The 2016 WHO guideline on routine antenatal care (ANC) recommends several interventions to improve quality of care and increase use of services including:
- Midwife-led continuity of care throughout the antenatal, intrapartum, and postnatal periods
- Task shifting components of ANC, including promotion of health-related behaviors and distribution of nutrition supplements
- Recruitment and retention of health workers in rural and remote areas
- Community mobilization to improve communication and support to pregnant women
- Women-held case notes
- A model with a minimum of 8 antenatal care contacts
ORIGINAL ARTICLES
Health Extension Workers (HEWs), in general, properly provided antibiotic treatment of possible severe bacterial infections in newborns at the health post level. But only about half of newborns estimated to have infections in the intervention area received treatment by HEWs, and home visits and referrals declined in the final months of the study. Cluster-level analysis suggests a mortality reduction consistent with this level of treatment coverage, although the finding did not reach statistical significance.
Implementation of the WHO Safe Childbirth Checklist with peer coaching resulted in >90% adherence to 35 of 39 essential birth practices among birth attendants after 8 months, but adherence to some practices was lower when the coach was absent.
The BetterBirth Program relied on carefully structured coaching that was multilevel, collaborative, and provider-centered to motivate birth attendants to use the WHO Safe Childbirth Checklist and improve adherence to essential birth practices. It was scaled to 60 sites as part of a randomized controlled trial in Uttar Pradesh, India.
Proximity to a health facility offering delivery services and readiness of the facilities to provide such services were poor in both rural and urban areas outside of Port-au-Prince. Availability of a proximate facility was significantly associated with women in rural and urban areas delivering at a facility, as was the quality of delivery care available at the facilities but only in urban areas.
The original intention was to deliver technical content through brief text messages to stimulate participants to undertake deeper learning. While participants appreciated the convenience and relevance of the text messages, their scores of higher-order knowledge did not improve. The intervention may not have been successful because the messages lacked depth and interactivity, and participants were not explicitly encouraged to seek deeper learning.
A few facilities provided good access to and quality of family planning services, particularly urban, private, and higher-level facilities. Yet only one-third offered family planning services at all, and only 20% of these facilities met a basic measure of quality. Condoms, oral contraceptives, and injectables were most available, whereas long-acting, permanent methods, and emergency contraception were least available. Responding to the DRC’s high unmet need for family planning calls for substantial expansion of services.
While social franchising has been highly successful with private-sector providers, in Mali the approach was expanded to public-sector community health clinics. From 2012 to 2015, these clinics served >120,000 family planning clients, 78% of whom chose long-acting reversible methods. Many clients were young, poor, and had not been using a method during the 3 months prior to their visit.
REVIEWS
The poor lack equitable access to health care in community-based health insurance schemes. Flexible installment payment plans, subsidized premiums, and elimination of co-pays can increase enrollment and use of health services by the poor.
FIELD ACTION REPORTS
In the context of a well-resourced research project on obstetric ultrasound, we encountered major challenges, including security and maintenance of the equipment, electricity requirements, health systems integration, and a variety of other systems issues. We propose future ultrasound interventions have at minimum a functioning health system with skilled and motivated staff, access to a referral hospital capable of providing affordable and higher levels of care, and feasible transportation means.
INNOVATIONS
We redesigned the personal protective equipment ensemble widely used during the 2014 Ebola outbreak into a relatively simpler and more versatile coverall and hood, to improve protection and usability for frontline workers treating patients in infectious disease outbreaks around the world.
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