BMC Health Services Research最新文献

Background: Care during the immediate postpartum period is critical for women and newborn's health. Following facility-based birth, it is recommended to monitor the health of women and newborns in the facility. In Tanzania, a third of women who give birth in a health facility report not receiving a health check during their stay. Duration of stay and factors influencing them are not well documented in Tanzania. We describe postpartum length-of-stay at two time-points, 2015/2016 and 2022 in Tanzania, and explore factors associated with early discharge.

Methods: We analysed secondary data from two Demographic and Health Surveys: n = 3,582 women from 2015 to 16 and n = 4,618 from 2022 who had a livebirth in a health facility during the three years preceding the survey. Early discharge was defined as discharge < 24 h after vaginal birth and < 72 h after a caesarean birth. We describe the percentage of early discharge at both DHS time-points and explore factors associated with it using 2022 data with multivariable logistic regression, separately by mode of birth.

Results: Almost half of women who had a vaginal birth were discharged early in 2015-16, compared to 30.3% in 2022. Early discharge increased among women who had a caesarean section from 17.2% in 2015-16 to 25.2% in 2022. The odds of early discharge were higher in Zanzibar compared to Eastern zone, and factors associated with early discharge included level of facility, frequency of antenatal care visits, maternal education and newborn underweight status.

Conclusions: Despite progress in reducing early postpartum discharge after vaginal births, it continued to affect a third of women giving birth in Tanzania in 2022. Disparities between regions and facility levels suggest potential inconsistencies in the application of postpartum guidelines, warranting the need to determine and address the underlying causes, standardise practice and ensure equitable access to quality postpartum care.

Background: Reducing maternal, newborn and child mortality remains one of the top global public health priorities. Each year, approximately 303,000 mothers, globally, die during delivery. Stillbirths and neonatal deaths within the first 28 days of life are estimated at 2.6 million and 2.7 million, respectively. Rural residents face challenges in accessing health care due to difficulties in transportation. Given the voucher-based transport's potential to address inaccessibility to health services, this study explored the health stakeholders' perspectives on the benefits and challenges of this intervention.

Methods: Using an exploratory qualitative design, this study was conducted in Kitui County located in the lower Eastern part of Kenya. The study was conducted from July to August 2023, with data collection occurring over a two-week period in August 2023. Participants were purposively drawn from the six wards in Kitui South Sub County. The interview guide included questions on views, experiences, challenges, and perspectives on voucher-based transport system for skilled birth attendance. Data triangulation was ensured through audio-recorded Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). All audio recordings were transcribed verbatim, coded and thematically analyzed, using a holistic approach.

Results: Perceived benefits of Skilled Birth Attendance (SBA) champions model included improved access to delivery services, improved health outcomes and socioeconomic and awareness benefits. The perceived challenges and concerns of the SBA model included economic and sustainability challenges, infrastructure and connectivity challenges, as well as administrative and logistical challenges.

Conclusions: Overall, the SBA Champions model has proven effective in improving access to maternal services within the community, but prevailing challenges and sustainability issues need to be addressed. Additionally, the study provided strategic information to inform policy makers about the model and strengthen MCH policy.

Background: People with long-term neurological conditions such as Alzheimer's dementia and Parkinson's disease live with these increasingly debilitating conditions for years. However, palliative care is provided only towards the end of life. To address the gap between patient needs and services provided, we piloted an early neuro-palliative model of care - Neurosupport. In this study, we explored pre-implementation barriers and enablers for the adoption, scale-up, and sustainability of Neurosupport.

Methods: We conducted semi-structured interviews using an interview guide based on the Theoretical Domains Framework. Participants were neurologists and healthcare professionals involved in the care of patients with long-term neurological conditions. Interviews were conducted between May and December 2021. We used deductive and inductive coding followed by code-mapping to arrive at themes.

Results: Twenty-one participants were interviewed, comprising 12 neurologists, four neurology nurses, and five allied healthcare professionals (two speech therapists, one physiotherapist, one medical social worker, and one psychologist). Five themes were generated: (I) build rapport and support patients and families/caregivers; (II) current challenges, foreseeable barriers, and mitigation strategies; (III) unclear value-add of Neurosupport; (IV) integration of health and social services; and (V) implementing and sustaining Neurosupport.

Conclusion: This study elicited critical gaps and issues regarding the value proposition, workflows, and resources relevant to the implementation of Neurosupport. Future scale-up and sustainability of Neurosupport depend on these short-comings being addressed.

Clinical trial number: Not applicable.