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OBJECTIVE: The Indonesian Healthcare Program starting in 2014 enabled access to healthcare delivery for large population groups. Guidance of usage, infrastructure and healthcare process development were the most challenging tasks during the implementation period. Due to the high social impact obstetric care and related quality assurance require evidence-based developmental strategies. This study aims for analysis of outcome and maternal health care utilization, as well as differences related to demographic and economic subgroups.
METHODS: For univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants.
RESULTS: Specialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; p<0.001) and rural setting (R2 = 0.288; p = 0.001) are correlated with reduced insufficient referral. Their presence within provinces was related to lower occurrence of complicated cases (R2 = 0.294; p = 0.001). However, higher SPOG rates within provinces were also related to high C-section rates (p<0.001). MMR and stillbirth rates can be predicted by availability of human resources and C-section rates explaining 49.0% of variance.
CONCLUSIONS: Improvement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.

BACKGROUND: In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of \"Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model\".
METHODS: The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants\' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants\' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.
CONCLUSIONS: This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.
UNASSIGNED: IR.MUMS.NURSE.REC. 1403. 014.
In recent decades, medical management of the labor and delivery process has extended beyond its limitations to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. The global midwifery situation indicates that one in every five women worldwide gives birth without the support of a skilled attendant. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. In industrialized countries, maternal and infant mortality rates have decreased over the past 60 years due to medical or social reasons. So far, the policies and programs of the Ministry of Health to diminish medical interventions and cesarean section rates have not been successful. Midwifery models in hospital care contain midwives who support women’s choices and diverse ideas about childbirth on the one hand, and on the other hand, they must adhere to organizational guidelines as employees, primarily based on a medical and pathological approach rather than a health-oriented and midwifery perspective. Therefore, the current study aims to be conducted with the purpose of “Designing a midwifery-led birth centered maternity program based on the MAP-IT model”. It is a Model for Implementing Healthy People 2030, (Mobilize, Assess, Plan, Implement, Track), a step-by-step method for creating healthy communities. Using MAP-IT can help public health professionals and community changemakers implement a plan that is tailored to a community’s needs and assets.

Digital health interventions can overcome geographical barriers and prepare health-care providers for better health outcomes in rural and remote tribal areas, however, it has not been explored among traditional birth attendants (TBAs). A mobile application, \"maternal and infant care\" (MAI) for capacity building of tribal birth attendants was developed and its quality was evaluated using the Mobile Application Rating Scale for user\'s interest in and satisfaction with the esthetics, information, and functionality. Thirteen Android user TBAs with the MAI application were piloted with the MARS checklist. Engagement, functionality, esthetics, and information quality; and one subjective quality scale having 29 items were used. The application was found to be entertaining excellent rating (mean score ± standard deviation) (4.00 ± 0.58), and scored high on performance (3.77 ± 0.93); layout design (3.85 ± 0.90); subjective quality (4.23 ± 0.93), however, scored minimum on interest; gestural design; visual appeal, etc. MAI is a user-friendly, culturally acceptable Android app that can be used for the capacity building of frontline workers.

UNASSIGNED: Ongoing military conflict in Sudan has had significant repercussions on the health and well-being of the population, particularly among women of reproductive age. This study aimed to investigate the impact of conflict on maternal health by employing a mixed qualitative and quantitative research approach.
UNASSIGNED: Through in-depth interviews and survey questionnaires (388 women), this study examined the experiences and challenges faced by pregnant women and new mothers and the availability and accessibility of maternal healthcare services in conflict-affected areas. Using a qualitative approach, in-depth interviews were conducted with 35 women who had recently given birth or were pregnant in regions affected by the Khartoum State-Sudan conflict. Thematic analysis was used to analyze the data collected from the interviews.
UNASSIGNED: Most women did not have access to healthcare services (86.6%), and out of the total sample, 93 (24%) experienced adverse outcomes. The factors associated with adverse effects were parity (OR 1.78, CI [1.15-2.75], p-value 0.010), gestational age (OR 2.10, CI [1.36-3.25], p-value 0.002), access to healthcare (OR 2.35, CI [1.48-3.72], p-value 0.001), and delivery mode (OR 1.68, CI [1.05-2.69], p = 0.030). Factors significantly associated with accessibility to maternal healthcare services included age (OR, 1.28; = 0.042) and higher conflict levels (1.52 times higher odds, p = 0.021). The narratives and experiences shared by women exposed the multifaceted ways in which the conflict-affected maternal health outcomes.
UNASSIGNED: The significance of this study lies in its potential to contribute to the existing literature on maternal health in conflict-affected areas, especially in Sudan, and to help us understand how women can receive maternal health services.

While behavioural change interventions are utilized in low- and lower-middle-income countries and may be essential in reducing maternal and child mortality, evidence on the effectiveness of such interventions is lacking. This review provides evidence on the effectiveness of behavioural change interventions designed to improve maternal and child healthcare-seeking behaviour in low- and lower-middle-income countries. We searched three electronic databases (PUBMED, EMBASE, and PsycINFO) for articles published in English and French between January 2013 and December 2022. Studies that evaluated interventions to increase maternal and child healthcare utilization, including antenatal care, skilled birth care, postnatal care, immunization uptake, and medication or referral compliance, were included. We identified and included 17 articles in the review. Overall, 11 studies found significant effects of the behavioural change interventions on the desired healthcare outcomes, 3 found partially significant effects, and 3 did not observe any significant impact. A major gap identified in the literature was the lack of studies reporting the effect of behavioural change interventions on women\'s non-cognitive and personality characteristics, as recent evidence suggests the importance of these factors in maternal and child healthcare-seeking behaviour in low-resource settings. This review highlights some intervention areas that show encouraging trends in maternal and child healthcare-seeking behaviours, including social influence, health education, and nudging through text message reminders.
Bien que les interventions visant à modifier les comportements soient utilisées dans les pays à faibles et moyens revenus et qu\'elles pourraient être essentielles pour réduire la mortalité maternelle et infantile, les preuves de l\'efficacité de telles interventions font défaut. Cette revue synthétise les preuves de l\'efficacité des interventions de changement de comportement conçues pour améliorer le recours aux soins maternels et infantiles dans les pays à faibles et moyens revenus. Nous avons identifiés dans trois bases de données électroniques (PUBMED, EMBASE et PsycINFO) les articles publiés en anglais et en français entre janvier 2013 et décembre 2022. Les études qui évaluaient les interventions visant à accroître l\'utilisation des soins de santé maternelle et infantile, y compris les soins prénatals, les soins d\'accouchement par du personnel qualifié, les soins postnatals, la vaccination et l\'observance des traitements médicamenteux ou de référence, ont été incluses. Nous avons identifié et inclus 17 articles dans la revue. Dans l\'ensemble, 11 études mettent en évidence des effets significatifs des interventions visant à modifier les comportements en matière de soins de santé, 3 mettent en évidence des effets partiellement significatifs et 3 n\'observent pas d\'impact significatif. Une lacune majeure dans la littérature est le manque d\'études rapportant l\'effet des interventions de changement de comportement sur les caractéristiques non cognitives et de personnalité des femmes, alors que des travaux récents suggèrent l\'importance de ces facteurs pour le recours aux soins de santé pour la mère et l\'enfant dans les environnements à faibles ressources. Cette étude met en lumière certains domaines d\'interventions qui encourageraient les comportements de recours aux soins des mères et des enfants, notamment l\'influence sociale, l\'éducation à la santé et l\'incitation par le biais de rappels par SMS.

BACKGROUND: The Continuum of care for reproductive, maternal, newborn, and child health includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. In Ethiopia, the magnitude of antenatal care, skilled delivery, postnatal care, and immunization for children have shown improvement. Despite this, there was limited research on the percentage of mothers who have completed maternal and child continuum care.
OBJECTIVE: To assess the Completion of Maternal and Child Health Continuum of Care and Associated Factors among women in Gode District, Shebele Zone, Eastern Ethiopia ,2022.
METHODS: A community-based cross-sectional study design applied from November 1-15, 2022. A stratified sampling method was applied. A woman who had two 14-24 months child preceding the data collection period were included in the study. An interviewer-administered semi-structured questioner had been used for data collection. Data collected by using kobo collect and analyzed using STATA version 17. Both Bivariable and multivariable logistic regression analyses were done. In multivariable analysis, variables having P-values ≤ 0.05 were taken as factors associated with the completion of the maternal and child health continuum of care.
RESULTS: The Completion of maternal and child continuum of care was 13.5% (10.7-17.0%) in Gode district,2022. Accordingly, Husband occupation (Government employee) [AOR = 2.3, 95%CI 1.2-4.7] and perceived time to reach health facility (less than 30 min) [AOR = 2.96, 95%CI 1.2-7.5] were factors showing significant association with maternal and child health continuum of care among mothers in Gode district, Somali regional State;2022 at P-value ≤ 0.05.
CONCLUSIONS: Only 13.5% of mothers in Gode district received all of the recommended maternal and child health services during their pregnancy, childbirth, and postpartum period. The study found that two factors were associated with a higher likelihood of receiving Maternal and child continuum of care: Government employed husband and perceived time to reach a health facility. Governments can play a key role in increasing the maternal and child health continuum of care by investing by making health care facility accessible.

Efforts have been made to improve maternal and child health care globally, with a focus on promoting postnatal home visitation care. Despite the known significance of postnatal home visits, concerns still exist regarding mothers\' satisfaction with home visitation care. This study examined maternal satisfaction with postnatal home visitation care in the Ashanti Region. A cross sectional correlational study design was used to gather data from the study participants using the Jipi\'s questionnaire to assess maternal satisfaction with healthcare. Ten (10) district hospitals were randomly selected from 27 district hospitals in the region. A sample size of 170 postnatal mothers were then selected randomly from the 10 districts hospitals according to proportion of mothers at each facility. SPSS version 25 was used to analyse the data using descriptive statistics and Chi-square at a p-value = 0.05. The results indicated that the mothers were satisfied with the overall home visitation services, yet, showed dissatisfaction towards some specific postnatal care, including the quality of information on maternal care and support rendered by the CHNs regarding the care of the newborn during their visit. The satisfaction levels of mothers with these services are high, yet there are still opportunities for improving them by addressing specific challenges and tailoring these services to the diverse needs of postnatal mothers. In conclusion, CHNs\' work during postnatal period is essential in promoting the health of both the baby and the mother.
Des efforts ont été déployés pour améliorer les soins de santé maternelle et infantile à l’échelle mondiale, en mettant l’accent sur la promotion des soins postnatals à domicile. Malgré l’importance connue des visites postnatales à domicile, des inquiétudes subsistent quant à la satisfaction des mères à l’égard des soins de visite à domicile. Cette étude a examiné la satisfaction des mères à l\'égard des soins postnatals à domicile dans la région d\'Ashanti. Un plan d’étude corrélationnelle transversale a été utilisé pour recueillir des données auprès des participantes à l’étude à l’aide du questionnaire Jipi afin d’évaluer la satisfaction des mères à l’égard des soins de santé. Dix (10) hôpitaux de district ont été sélectionnés au hasard parmi 27 hôpitaux de district de la région. Un échantillon de 170 mères postnatales a ensuite été sélectionné au hasard dans les 10 hôpitaux de district en fonction de la proportion de mères dans chaque établissement. SPSS version 25 a été utilisé pour analyser les données à l\'aide de statistiques descriptives et du chi carré à une valeur p = 0,05. Les résultats ont indiqué que les mères étaient satisfaites de l\'ensemble des services de visites à domicile, mais qu\'elles montraient une insatisfaction à l\'égard de certains soins postnatals spécifiques, notamment de la qualité des informations sur les soins maternels et du soutien apporté par les CHN concernant les soins du nouveau-né lors de leur visite. Les niveaux de satisfaction des mères à l\'égard de ces services sont élevés, mais il existe encore des possibilités de les améliorer en relevant des défis spécifiques et en adaptant ces services aux divers besoins des mères postnatales. En conclusion, le travail des RCS pendant la période postnatale est essentiel pour promouvoir la santé du bébé et de la mère.

BACKGROUND: Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation.
METHODS: The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen\'s analytical approach.
RESULTS: Eight nurses participated, and from the data three themes, each with several subthemes, emerged: \'being-in-the-world of the rural and remote nurse\' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; \'scope of practice - unprepared or underprepared\' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; \'moral distress\' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery.
CONCLUSIONS: The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed.
CONCLUSIONS: This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

BACKGROUND: Ethiopia has one of the highest maternal mortality ratios in Africa. Few have examined the quality of labour and delivery (L&D) care in the country. This study evaluated the quality of routine L&D care and identified patient-level and hospital-level factors associated with the quality of care in a subset of government hospitals.
METHODS: This was a facility-based, cross-sectional study using direct non-participant observation carried out in 2016. All mothers who received routine L&D care services at government hospitals (n = 20) in one of the populous regions of Ethiopia, Southern Nations Nationalities and People\'s Region (SNNPR), were included. Mixed effects multilevel linear regression modeling was employed in two stages using hospital as a random effect, with quality of L&D care as the outcome and selected patient and hospital characteristics as independent variables. Patient characteristics included woman\'s age, number of previous births, number of skilled attendants involved in care process, and presence of any danger sign in current pregnancy. Hospital characteristics included teaching hospital status, mean number of attended births in the previous year, number of fulltime skilled attendants in the L&D ward, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent to which the hospital met the 2014 Ethiopian Ministry of Health standards regarding to resources available for providing quality of L&D care (measured on a 0-100% scale). These standards pertain to availability of human resource by category and training status, availability of essential drugs, supplies and equipment in L&D ward, availability of laboratory services and safe blood, and availability of essential guidelines for key L&D care processes.
RESULTS: On average, the hospitals met two-thirds of the standards for L&D care quality, with substantial variation between hospitals (standard deviation 10.9 percentage points). While the highest performing hospital met 91.3% of standards, the lowest performing hospital met only 35.8% of the standards. Hospitals had the highest adherence to standards in the domain of immediate and essential newborn care practices (86.8%), followed by the domain of care during the second and third stages of labour (77.9%). Hospitals scored substantially lower in the domains of active management of third stage of labour (AMTSL) (42.2%), interpersonal communication (47.2%), and initial assessment of the woman in labour (59.6%). We found the quality of L&D care score was significantly higher for women who had a history of any danger sign (β = 5.66; p-value = 0.001) and for women who were cared for at a teaching hospital (β = 12.10; p-value = 0.005). Additionally, hospitals with lower volume and more resources available for L&D care (P-values < 0.01) had higher L&D quality scores.
CONCLUSIONS: Overall, the quality of L&D care provided to labouring mothers at government hospitals in SNNPR was limited. Lack of adherence to standards in the areas of the critical tasks of initial assessment, AMTSL, interpersonal communication during L&D, and respect for women\'s preferences are especially concerning. Without greater attention to the quality of L&D care, regardless of how accessible hospital L&D care becomes, maternal and neonatal mortality rates are unlikely to decrease substantially.