Every Newborn: progress, priorities, and potential beyond survival

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00837-5.pdf

Stillbirths: rates, risk factors, and acceleration towards 2030

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60792-3.pdf

Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

Global hearing health care: new findings and perspectives

Stillbirths : ending preventable deaths by 2030

The Ethiopian Federal Ministry of Health and partners have scaled up integrated community case management (iCCM) and community-based newborn care (CBNC), allowing health extension workers (HEWs) to manage the major causes of child and newborn death at the community level. However, low service uptake remains a key challenge. We conducted a scoping review of peer-reviewed and grey literature to assess barriers to the utilization of HEW services and to explore potential solutions. The review, which was conducted to inform the Optimizing the Health Extension Program project, which aimed to increase the utilization of iCCM and CBNC services, included 24 peer-reviewed articles and 18 grey literature documents. Demand-side barriers to utilization included lack of knowledge about the signs and symptoms of childhood illnesses and danger signs; low awareness of curative services offered by HEWs; preference for home-based care, traditional care, or religious intervention; distance, lack of transportation and cost of care seeking; the need to obtain husband’s permission to seek care and opposition of traditional or religious leaders. Supply-side barriers included health post closures, drug stockouts, disrespectful care and limited skill and confidence of HEWs, particularly with regard to the management of newborn illnesses. Potential solutions included community education and demand generation activities, finding ways to facilitate and subsidize transportation to health facilities, engaging family members and traditional and religious leaders, ensuring consistent availability of services at health posts and strengthening supervision and supply chain management. Both demand generation and improvement of service delivery are necessary to achieve the expected impact of iCCM and CBNC. Key steps for improving utilization would be carrying out multifaceted demand generation activities, ensuring availability of HEWs in health posts and ensuring consistent supplies of essential commodities. The Women’s Development Army has the potential to improving linkages between HEWs and communities, but this strategy needs to be strengthened to be effective.

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Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review.

Introduction: Newborn deaths account for 43% of under-five mortality in Ethiopia, and newborn infection contributes to one third of these deaths. The provision of community-based newborn care services through the Health Extension Program platform is a key strategy to increase the utilization of newborn care services by increasing access near the community. In March 2013, the Ethiopian government launched community based newborn care, through which community health workers are trained, supplied with essential commodities, and supervised on the provision of community based newborn care, including the management of severe newborn infections.
Objective: To assess the effect of CBNC intervention on improving health care-seeking behavior for community newborn and child health services.
Results: The number of sick young infants seen at HPs increased 21-fold after the initiation of community-based newborn care. Managed cases of very severe disease and cases of local bacterial infection increased six-fold and four-fold, respectively. Managed cases of pneumonia and diarrhea showed only slight increases.
Conclusions: Overall, community-based newborn care has improved the health care-seeking behavior of mothers of sick young infants in Ethiopia. However, care-seeking is still low when compared with the numbers of expected cases.
Key words: Sick young infants; sick children; community-based newborn care; care-seeking behavior; pre- and post- community-based newborn care

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The Effect of Community-Based Newborn Care Intervention on Service Utilization for Sick Newborn and Children

BACKGROUND Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. METHODS Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. RESULTS Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs' confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. CONCLUSION This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.

/pdf/barriers-to-the-uptake-of-community-based-curative-child-4pz81b581j.pdf

Barriers to the uptake of community-based curative child health services in Ethiopia.

Introduction: Neonatal mortality declined by 41% in the past 15 years but remains unacceptability high in Ethiopia (29/100 live births).  Further reductions in neonatal mortality are a major priority and will require improvements in care for mothers and newborns during pregnancy, postnatally, and especially around the time of delivery. These improvements rely on the readiness of facilities to provide high quality services to those who need them. 
Objective: To assess the facility readiness for newborn care in Ethiopia.
Methods: The study data is drawn from a cross-sectional national health facility assessment of 175 health centers and 120 hospitals conducted between December 2016 and February 2017. The study focused on the availability and functionality of newborn care corner and related services and newborn intensive care units in the nine regions and two city administrations of Ethiopia.
Results: The study found that 91% of health centers had newborn corners established within labor rooms although wide variations existed between regions. Radiant warmers were assembled in nearly all HCs (82%), however oxygen was used in only 29% of HCs.  Most of the hospitals had received radiant warmers with oxygen cylinders, phototherapy, incubators, and continuous positive airway pressure sets.  Radiant warmers with oxygen cylinders and phototherapy arrived ready to use. However, only 77% of hospitals had assembled and used incubators and only 11% of hospitals had assembled and used continuous positive airway pressure sets.

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Mariame Sylla

Papers

Barriers to the utilization of community-based child and newborn health services in Ethiopia: a scoping review.

The Effect of Community-Based Newborn Care Intervention on Service Utilization for Sick Newborn and Children

Barriers to the uptake of community-based curative child health services in Ethiopia.

Readiness of Primary Health Care Units in Addressing Facility-Based Newborn Care in Ethiopia