UNASSIGNED: The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa.
UNASSIGNED: The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists.
UNASSIGNED: The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities.
UNASSIGNED: This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.

The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries.
The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: \"impact\' AND \'COVID-19\' AND \'maternal and child health services\' AND \'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results.
Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4).
The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic\'s impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond.
PROSPERO (CRD42021285178).

OBJECTIVE: Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited.
BACKGROUND: Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures.
OBJECTIVE: To identify and synthesise available literature addressing the experiences of healthcare professionals enacting whistleblowing in maternal and newborn care settings.
METHODS: This scoping review followed Arksey and O\'Malley\'s framework. Five academic databases were systematically searched for documents published between January 2013 and October 2023 with additional searches of Google Scholar and related reference lists.
RESULTS: Whilst 35 papers from international sources were identified, the majority originated from the United Kingdom, where recent high-profile incidents have occurred. Thematic analysis identified three main themes: \'Structural Power\', \'Perfectionism\' and \'Bravery, Hope and Disappointment\', each with sub-themes.
CONCLUSIONS: Whistleblowing is frequently an altruistic act in a hierarchical system. It exposes poor practices and disrupts power dynamics, especially in challenging workplace cultures. Open disclosure, however, requires psychological safety. Obstacles persist, emphasising the need for a culture of trust and transparency led by individuals who embody the desired values.
CONCLUSIONS: Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.

Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming.
Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in low- and middle-income countries (2010-2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter\'s PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized.
More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, training-focused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors.
A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider\'s behavior (beyond knowledge-enhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.

Men have conventionally been excluded from Maternal and Child Health (MCH) services, thereby reinforcing the erroneous notion that pregnancy and the processes leading to childbirth and child-rearing are the preserve of women. Participation of men in MCH is crucial for the reduction of infant and maternal mortality. This scoping review focuses on the contribution of male involvement to MCH care and explores the feasible strategies to improve it. Studies on male involvement in the crucial timelines of the MCH and strategies for implementing and improving male involvement in MCH care in India and other developing countries were obtained through a review of literature in PubMed databases using the medical subject headings (MeSH) terms and unpublished, grey literature during the year 1990-2020. Nearly 50 of the eligible articles were included and synthesized into a scoping review report. Findings revealed that the men\'s participation had a beneficial impact on all crucial timelines of MCH care. Yet, women perceived low male participation in most of the studies. Several different factors that influence have been identified, including education, socioeconomic status, traditional practices, negative stereotyping among males, and lack of male friendly health-care system. Utilization of community volunteers, male peer educators, workplace-based or mass media education, and men-friendly policy changes or health-care provider initiatives could be crucial in improving male involvement in MCH care. Despite worldwide acceptance as an essential contributor to enhancing MCH care, the scoping review revealed low male involvement levels in developing countries and identified strategies to address this lacuna.

Breastfeeding up to two years and beyond supports the health and neurobiological development of a child. Nevertheless, mothers experience criticism from health professionals towards breastfeeding beyond 12 months. Competence related to breastfeeding counselling is defined as minimum knowledge, skills and attitudes that all health professionals should have to protect, promote and support breastfeeding. Professionals\' education related to breastfeeding beyond 12 months is insufficient worldwide which challenges the competent and evidence-based support mothers wish for.
This systematic review aimed to synthesize the existing literature on health professionals\' competencies regarding breastfeeding beyond 12 months. The search was limited to peer-reviewed scientific papers published between 2000 and 2022 that focused on the competencies of health professionals regarding breastfeeding beyond 12 months. Seven databases were searched, and of the 884 studies retrieved, seven were included in the review. The studies were subjected to the Joanna Briggs Institute (JBI) critical appraisal checklists. The data were analyzed using deductive thematic analysis, driven by the concept of competence.
All the dimensions of competence could be found in the data. Health professionals\' knowledge or skills related to breastfeeding beyond 12 months were explored in all seven studies, and attitudes towards breastfeeding beyond 12 months were explored in four studies. The main themes identified were Knowledge Combined with Skills, and Attitudes. The main theme, Knowledge Combined with Skills, was formed out of eight themes: perceptions regarding nutritional value, perceptions regarding economic value, perceptions regarding family interaction, perceptions regarding impacts on the mother\'s wellbeing, perceptions regarding impacts on the child\'s wellbeing, perceptions regarding suitable duration, perceptions regarding recommendations, and counseling skills. The attitudes varied and therefore the Attitudes main theme consisted of three themes: promotive attitudes, hostile attitudes, and passive attitudes towards breastfeeding beyond 12 months.
Health professionals\' knowledge and skills include several dimensions and vary substantially. Health professionals\' attitudes vary between hostile and supportive and influence professionals\' advice regarding breastfeeding beyond 12 months. The results suggested that there is considerable variation in health professionals\' competencies, which emphasizes the importance of education regarding breastfeeding beyond 12 months.

Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, this review aims to provide a comprehensive overview of the empirical literature on peer support interventions across various MCH services in sub-Saharan Africa. Specifically, we aim to understand how, why, for whom, and in what circumstances different forms of MCH peer support interventions contribute to improving healthcare outcomes in sub-Saharan Africa.
This review follows five iterative steps for undertaking realist reviews (1) defining the review scope; (2) developing initial programme theories; (3) searching for evidence; (4) selecting and appraising evidence; and (5) extracting, analysing and synthesising evidence. Four databases-Cochrane Library, PubMed, CINAHL, and EMBASE-were repeatedly searched between March and June 2021. From a large volume of records retrieved from the database and citation search, 61 papers have been selected for review. We will conduct a second search of the same database covering June 2021 to the present before the final extraction and synthesis. The final list of selected papers will be imported into NVivo 12 software and organised, extracted, analysed and synthesised iteratively to examine and illustrate the causal links between contexts, mechanisms and outcomes of MCH peer support interventions in SSA. We have drawn on the existing literature on peer support in healthcare generally to develop initial programme theories. We will then use the empirical literature on MCH peer support interventions in SSA, inputs from a stakeholders\' workshop in Ghana and a conference presentation to refine the initial programme theory.
The review will develop an explicit theory of peer support intervention in healthcare delivery and provide insights for developing evidence-informed policy on the intervention. Drawing lessons from the different national contexts and diverse areas of MCH in SSA, the review will provide an analytically generalizable programme theory that can guide intervention design and implementation. While focusing on MCH peer support interventions in SSA, the review contributes to evolving conversations on the use of theory for health policy planning and complex intervention design and implementation globally.
PROSPERO registration ID: CRD42023427751 .

UNASSIGNED: Globally, approximately 800 women and 6400 newborns die around the time of childbirth each day. Many of these deaths could be prevented with high-quality emergency obstetric and newborn care (EmONC). The Monitoring Emergency Obstetric Care: A handbook guides strengthening EmONC services. However, the handbook contains limited quality of care measures. Our study identified and prioritised quality of care indicators for potential inclusion in the handbook, which is undergoing revision.
UNASSIGNED: We conducted a consultative scoping review, mapping, and prioritisation exercise to select a short list of indicators on facility-based maternal and newborn quality of care. Indicators were identified from literature searches and expert suggestions and organised by the categories of structure, process, and outcomes as defined in the World Health Organization\'s Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. We focused on process indicators, encompassing the provision of care and experience of care during the intrapartum period, and developed a priority list of indicators using the selection criteria of relevance and feasibility. Experience of care indicators were also mapped against the Person-Centered Maternity Care (PCMC) scale.
UNASSIGNED: We extracted a total of 3023 quality of care indicators. After removing out-of-scope and duplicate indicators and applying our selection criteria, we identified 20 provision of care indicators for possible inclusion in the revised EmONC handbook. We recommend including a score for experience of care that could be measured with the 30-item or the 13-item PCMC scale. We also identified 29 experience of care items not covered by the PCMC scale that could be used. Provider experience, patient safety, and quality of abortion care were identified as areas for which no or few indicators were found through our scoping review.
UNASSIGNED: Through a rigorous, consultative, and multi-step process, we selected a short list of process-related, facility-based quality of care indicators for emergency obstetric and newborn care. This list could be included in the EmONC handbook or used for other monitoring purposes. Country consultations to assess the utility and feasibility of the proposed indicators and their adaptation to local contexts will support their refinement and uptake.
UNASSIGNED: https://osf.io/msxbd (Open Science Framework).

In approximately 15% of all pregnancies, a potentially fatal complication that necessitates medical attention arises, requiring a significant obstetrical intervention for the pregnant women to survive. Between 70% and 80% of maternal life-threating complication have been treated through emergency obstetric and newborn services. This study investigates women\'s satisfaction with emergency obstetric and newborn care services in Ethiopia and factors associated with their satisfaction.
In this systematic review and meta-analysis, we searched electronic databases, such as PubMed, Google Scholar, HINARI, Scopus, and Web of Sciences for primary studies. A standardized data collection measurement tool was used to extract the data. STATA 11 statistical software was used to analyze the data, and I2 tests were used to evaluate heterogeneity. The pooled prevalence of maternal satisfaction was predicted using a random-effects model.
Eight studies were included. The pooled prevalence of maternal satisfaction with emergency obstetric and neonatal care services was 63.15% (95% confidence interval: 49.48-76.82). Age (odds ratio = 2.88, 95% confidence interval: 1.62-5.12), presence of birth companion (odds ratio = 2.66, 95% confidence interval: 1.34-5.29), satisfaction with health workers\' attitudes (odds ratio = 4.02, 95% confidence interval: 2.91-5.55), educational status (odds ratio = 3.59, 95% confidence interval: 1.42-9.08), length of stay at health facility (odds ratio = 3.71, 95% confidence interval: 2.79-4.94), and antenatal care visits (odds ratio = 2.22, 95% confidence interval: 1.52-3.24) were associated with maternal satisfaction with emergency obstetric and neonatal care service.
This study found a low level of overall maternal satisfaction with emergency obstetric and neonatal care services. To increase maternal satisfaction and utilization, the government should focus on improving the standards of emergency maternal, obstetric, and newborn care by identifying gaps in maternal satisfaction regarding the services provided by healthcare professionals.

UNASSIGNED: Ineffective organisation of care leads to increased morbidity and mortality in neonates and their mothers. We aimed to identify and describe strategies used in low- and middle-income countries that attempt to deliver coherent, coordinated, and continuous services (i.e., integrated care) and how the various strategies affect the organisation of care.
UNASSIGNED: We conducted a systematic literature review to identify, appraise, and synthesise relevant evidence about strategies for integrating maternal care in low- and middle-income countries, searching multiple electronic databases.
UNASSIGNED: Fourteen studies met our inclusion criteria. We identified five types of integration strategies: 1) organisational, 2) service/professional, 3) functional, 4) organisational combined with normative strategies, and 5) clinical combined with functional integration strategies. The most frequent types of strategies were organisational, and service/professional integration strategies. We did not identify any publications describing systemic integration strategies implemented in low- and middle-income countries.
UNASSIGNED: Most types of strategies described in theory have been implemented and studied in low- and middle-income countries. Our findings suggest that different types of strategies may lead to comparable organisational outcomes. For example, organisational integration strategies and professional or service integration strategies may similarly influence inter-organisational collaboration. Inter-organisational collaboration may play a particularly important role in the context of maternal care integration.