Browsing by Author "Kerber, Katherine J"

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    The continuum of care of maternal, newborn and child health : coverage, co-coverage and equity analysis from demographic and health surveys
    (2007) Kerber, Katherine J; Thiede, Michael; Lawn, Joy
    The continuum of care for maternal, newborn and child health (MNCH) has recently been highlighted as a systematic approach to integrating health service provision throughout the life-cycle and across levels of service delivery. The continuum provides a framework for delivering high-impact interventions organised in health service packages to deliver high quality reproductive, maternal, newborn and child care services, ensuring appropriate linkages between family and community care, outreach and outpatient services and clinical and the first level facility and the hospital. This study, using data from Demographic and Health Surveys from eight African countries, provides an analysis of the coverage and co-coverage of four essential MNCH packages along the continuum of care, with a particular focus on inequalities in the distribution of services. The analysis of coverage of antenatal care, skilled attendance at childbirth, postnatal care and immunisation packages reveals key gaps, especially during childbirth and the postnatal period. Coverage is especially low for women and children from the poorest households in these countries, with coverage among the richest quintile up to 6 times higher than the poorest quintile. Nigeria emerges as the country with the lowest coverage overall and the largest gap between rich and poor while Malawi has the highest coverage and the most equitable coverage of services Continuity of care between these important packages increases health system efficiency as well as user and provider satisfaction. Co-coverage along the continuum of care was analysed to determine which mothers, newborns and children received all four care packages. While at least three quarters in Nigeria and up to 99% of mothers, newborns and children in Malawi and Tanzania receive at least one package of care, less than half received all four packages. There is greater variation in co-coverage between countries and within countries among the richest and poorest households compared to coverage of single packages alone. The richest quintile in Malawi is twice as likely to receive all four packages compared to the poorest quintile whereas in Nigeria the difference between richest and poorest is 13 fold. The purpose of applying these measures should be seen not as an end in itself but as a tool to describe current patterns and distribution of services and to advance improvements in the continuum of care. This research highlights the importance of integrating MNCH packages in different contexts as well as further improvements in data collection in order to effectively guide and monitor progress towards universal coverage of packages along the continuum of care to save the lives of women and children. Addressing issues of exclusion among families from the poorest households and establishing effective links between these packages is crucial to improving overall coverage. The postnatal period in particular is a notable gap that lacks a systematic package in all these countries. In the meantime, available information can be used to improve MNCH integration and service delivery along the continuum of care in order to reach the highest number of women, newborns and children with effective care.
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    Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby
    (BioMed Central Ltd, 2015) Kerber, Katherine J; Mathai, Matthews; Lewis, Gwyneth; Flenady, Vicki; Erwich, Jan Jaap; Segun, Tunde; Aliganyira, Patrick; Abdelmegeid, Ali; Allanson, Emma; Roos, Nathalie; Rhoda, Natasha; Lawn, Joy; Pattinson, Robert
    BACKGROUND: While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. METHODS: We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. RESULTS: Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. CONCLUSIONS: Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.