Kimberly Peven1,2, Cath Taylor3, Edward Purssell4, Lindsay Mallick5,6, Clara R Burgert-Brucker7, Louise T Day2, Kerry L M Wong8, Christabel Kambala9, Debra Bick10. 1. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, United Kingdom. 2. Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom. 3. School of Health Sciences, University of Surrey, Guildford, United Kingdom. 4. Little Havens Children's Hospice, Benfleet, United Kingdom. 5. University of Maryland, College Park, MD, United States of America. 6. Avenir Health, Glastonbury, CT, United States of America. 7. RTI International, Washington, DC and London School of Hygiene and Tropical Medicine, London, United Kingdom. 8. Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. 9. Environmental Health Department, Malawi University of Business and Applied Sciences, Blantyre, Malawi. 10. Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom.
Abstract
BACKGROUND: Malawi has halved the neonatal mortality rate between 1990-2018, however, is not on track to achieve the Sustainable Development Goal 12 per 1,000 live births. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care. METHODS: Using data We used individual data from the 2015-16 Malawi Demographic and Health Survey and facility data from the 2013-14 Malawi Service Provision Assessment, linking households to all health facilities within specified distances and travel times. We calculated service readiness scores for facilities to measure their capacity to provide birth/newborn care services. We fitted multi-level regression models to evaluate the association between the service readiness and appropriate newborn care (receiving at least five of six interventions). RESULTS: Households with recent births (n = 6010) linked to a median of two birth facilities within 5-10 km and one facility within a two-hour walk. The maximum service environment scores for linked facilities median was 77.5 for facilities within 5-10 km and 75.5 for facilities within a two-hour walk. While linking to one or more facilities within 5-10km or a two-hour walk was not associated with appropriate newborn care, higher levels of service readiness in nearby facilities was associated with an increased risk of appropriate newborn care. CONCLUSIONS: Women's choice of nearby facilities and quality facilities is limited. High quality newborn care is sub-optimal despite high coverage of facility birth and some newborn care interventions. While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care.
BACKGROUND: Malawi has halved the neonatal mortality rate between 1990-2018, however, is not on track to achieve the Sustainable Development Goal 12 per 1,000 live births. Despite a high facility birth rate (91%), mother-newborn dyads may not remain in facilities long enough to receive recommended care and quality of care improvements are needed to reach global targets. Physical access and distance to health facilities remain barriers to quality postnatal care. METHODS: Using data We used individual data from the 2015-16 Malawi Demographic and Health Survey and facility data from the 2013-14 Malawi Service Provision Assessment, linking households to all health facilities within specified distances and travel times. We calculated service readiness scores for facilities to measure their capacity to provide birth/newborn care services. We fitted multi-level regression models to evaluate the association between the service readiness and appropriate newborn care (receiving at least five of six interventions). RESULTS: Households with recent births (n = 6010) linked to a median of two birth facilities within 5-10 km and one facility within a two-hour walk. The maximum service environment scores for linked facilities median was 77.5 for facilities within 5-10 km and 75.5 for facilities within a two-hour walk. While linking to one or more facilities within 5-10km or a two-hour walk was not associated with appropriate newborn care, higher levels of service readiness in nearby facilities was associated with an increased risk of appropriate newborn care. CONCLUSIONS:Women's choice of nearby facilities and quality facilities is limited. High quality newborn care is sub-optimal despite high coverage of facility birth and some newborn care interventions. While we did not find proximity to more facilities was associated with increased risk of appropriate care, high levels of service readiness was, showing facility birth and improved access to well-prepared facilities are important for improving newborn care.
Authors: Nicole E Johns; Ahmad Reza Hosseinpoor; Mike Chisema; M Carolina Danovaro-Holliday; Katherine Kirkby; Anne Schlotheuber; Messeret Shibeshi; Samir V Sodha; Boston Zimba Journal: BMJ Open Date: 2022-07-25 Impact factor: 3.006