Facilitators of co-leadership for quality care.

Olive Cocoman and colleagues argue that national leadership for quality of care requires working in a co-leadership model such that quality and programme units have equal standing and clearly defined individual roles and responsibilitie

Strengthening the policy, implementation, and accountability environment for quality care: experiences from quality of care network countries

Despite global commitment to universal health coverage with quality, poor quality of care (QOC) continues to impact health outcomes for mothers and newborns, especially in low-and-middle income countries. Although there is much experience from small-scale projects, without a long-term perspective it is unclear how to implement quality of care effectively and consistently for impact. In 2017, ten countries together with the WHO and a coalition of partners established the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network). The Network agreed to pursue four strategic objectives—Leadership, Action, Learning and Accountability (LALA) for QOC. This paper describes, analyses and reflects on what has worked and some of the challenges faced in implementation of the LALA framework. The implementation of the LALA framework has served as a catalyst to develop an enabling environment for QOC in the Network countries through strengthening the policy, implementation, accountability and community engagement for quality care. Developing an enabling health system environment takes time, but it is possible and shows results. The implementation shows that health systems continue to face persistent challenges such as capacities to quickly scale up changes across subnational levels, limited workforce capability to implement quality improvement consistently and gaps in quality of relevant data. The implementation has also highlighted the need to develop new mechanisms for community engagement and learning systems that inform scaling up of good QOC practices across programmes and levels of care. Moving forward, the Network countries will build on the experiences and lessons learned and continue to strengthen the implementation of LALA strategic objectives for impact. We hope the Network experience will encourage other countries and partners to adopt the Network implementation model to enable delivery of quality care for everyone, everywhere, and actively collaborate and contribute to the QOC global learning network

Exploring and prioritising strategies for improving uptake of postnatal care services in Thyolo, Malawi: A qualitative study.

Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of these services has remained low worldwide. This study explored and prioritised the strategies for optimising the uptake of postnatal care (PNC) services in Malawi. A qualitative descriptive study followed by nominal group techniques was conducted at three health facilities in Malawi from July to December 2020 and in October 2021. We conducted focus group discussions among postnatal mothers, fathers, healthcare workers, elderly women, and grandmothers. We conducted in-depth interviews with midwives and key health managers. Nominal group techniques were used to prioritise the main strategies for the provision of PNC. The demand strategies include appointment date reminders, provision of free health passport books, community awareness campaigns, and involvement of men in the services. The supply strategies included training health providers, improving clinic operations: task-shifting and hours of operation, having infrastructure for the services, and linkage to other services. Having services delivered near end-user residences was a crosscutting strategy. Refresher training and improvement in the clinic operations especially on hours of operation, appointment date reminders, and linkage to care were the prioritised strategies. There is a need to use acceptable and contextualised strategies to optimise the uptake and delivery of postnatal care services. Educating the healthcare workers and the community on postnatal services is key to increasing the demand and supply of the services

Histamine Derived from Probiotic Lactobacillus reuteri Suppresses TNF via Modulation of PKA and ERK Signaling

Beneficial microbes and probiotic species, such as Lactobacillus reuteri, produce biologically active compounds that can modulate host mucosal immunity. Previously, immunomodulatory factors secreted by L. reuteri ATCC PTA 6475 were unknown. A combined metabolomics and bacterial genetics strategy was utilized to identify small compound(s) produced by L. reuteri that were TNF-inhibitory. Hydrophilic interaction liquid chromatography-high performance liquid chromatography (HILIC-HPLC) separation isolated TNF-inhibitory compounds, and HILIC-HPLC fraction composition was determined by NMR and mass spectrometry analyses. Histamine was identified and quantified in TNF-inhibitory HILIC-HPLC fractions. Histamine is produced from L-histidine via histidine decarboxylase by some fermentative bacteria including lactobacilli. Targeted mutagenesis of each gene present in the histidine decarboxylase gene cluster in L. reuteri 6475 demonstrated the involvement of histidine decarboxylase pyruvoyl type A (hdcA), histidine/histamine antiporter (hdcP), and hdcB in production of the TNF-inhibitory factor. The mechanism of TNF inhibition by L. reuteri-derived histamine was investigated using Toll-like receptor 2 (TLR2)-activated human monocytoid cells. Bacterial histamine suppressed TNF production via activation of the H2 receptor. Histamine from L. reuteri 6475 stimulated increased levels of cAMP, which inhibited downstream MEK/ERK MAPK signaling via protein kinase A (PKA) and resulted in suppression of TNF production by transcriptional regulation. In summary, a component of the gut microbiome, L. reuteri, is able to convert a dietary component, L-histidine, into an immunoregulatory signal, histamine, which suppresses pro-inflammatory TNF production. The identification of bacterial bioactive metabolites and their corresponding mechanisms of action with respect to immunomodulation may lead to improved anti-inflammatory strategies for chronic immune-mediated diseases

Hinder för prenatal mödravård i Rwanda - En litteraturstudie om hinder för tillgång till mödravård hos gravida kvinnor i Rwanda.

Introduction: Antenatal care (ANC) can be seen as a key factor in predicting the outcome of childbirth and can help to detect early risk factors and begin treatment for pregnant women who suffers from complications during pregnancy. In many low-income countries, and especially in sub-Saharan Africa, numerous obstacles exist in order to allow women to attend ANC-clinics during pregnancy. Aim: The purpose of this paper was to identify barriers for pregnant women to attend ANC and analyse it in the Rwandan context. Method: A literature-based study design was used and the material consisted of quality-reviewed articles. In order to analyse the selected articles the results were categorized. Results: Five main categories were identified as barrier to ANC: Limited access to healthcare, lack of male involvement, lack in knowledge, cultural barriers and financial barriers. Four strategies for a better ANC coverage in Rwanda were also identified: Better access to ANC clinics, more education about the importance of ANC, increased male involvement during pregnancy and better insurance coverage. Conclusion: In order to create a better ANC coverage among pregnant women in Rwanda these barriers need to be overcome. In order to overcome these barriers, this study suggested four different strategies. By implementing these strategies into national policies and programs more women can have a better chance of attending ANC and giving birth at a health facility in Rwanda.Introduktion: Prenatal mödravård kan ses som en nyckelfaktor för att förutsäga utfallet av en förlossning och kan även hjälpa till att upptäcka tidiga riskfaktorer och påbörja behandling för gravida kvinnor som lider av komplikationer under graviditeten. I många låginkomstländer, och framför allt i Afrika söder om Sahara, existerar många hinder för kvinnor att få tillgång till prenatal mödravård under graviditeten. Syfte: Syftet med denna uppsats var att identifiera hinder för gravida kvinnor att få tillgång till prenatal mödravård och analysera det i en rwandisk kontext. Metod: En litteraturbaserad studie design användes för denna uppsats och materialet bestod av kvalitetsgranskadeartiklar. För att analysera de utvalda artiklarna tematiserades resultaten. Resultat: Fem olika teman identifierades som hinder för prenatal mödravård: Begränsad tillgång till hälso-och sjukvård, brist på manligt engagemang under graviditeten, brist på kunskap, kulturella barriärer och finansiella hinder. Fyra strategier för en bättre prenatal mödravårdstillgång i Rwanda identifierades även: Bättre tillgång till prenatala mödravårdskliniker, mer utbildning om vikten av prenatal mödravård, ökat manligt engagemang under graviditet och bättre försäkringsskydd. Slutsats: För att skapa en bättre tillgång till prenatal mödravårds bland gravida kvinnor i Rwanda måste dessa hinder övervinnas. För att övervinna dessa hinder, föreslår denna studie fyra olika strategier. Genom att införa dessa strategier till nationella strategier och program kan fler gravida kvinnor få en bättre tillgång till prenatal mödravård i Rwanda

Mödradödlighet i Afrika söder om Sahara: En kvantitativ studie om den nationella utvecklingens påverkan på mödradödlighet.

About 1000 women in the so called developing countries die every day associated with pregnancy and childbirth. Sub-Saharan Africa is the worst affected region. This study aims to explore the different key factors in national development that can interact with a reduced maternal mortality. The study compares 15 countries in sub-Sahara where the greatest reduction in maternal mortality occurred with 15 countries in sub-Sahara where maternal mortality reduction has been at its lowest, between the years 2000 to 2010. This study also analyzes the link between reduced maternal mortality and various key factors for national development. The essay is based on the understanding that health is a broad phenomenon, where an improved state of health globally requires a multidisciplinary work that focuses on more factors than the medical. The results of the study are based on two different statistical analyzes. One of the analyzes have been done by comparing the mean value in the improvement of various development factors between the countries in sub-Sahara where the greatest reduction in maternal mortality occurred with the 15 countries of sub-Sahara where maternal mortality reduction was lowest, between the years 2000-2010. The second analysis was done by a correlation analysis between maternal mortality and various development factors. All data provided in the study were taken from the World Bank's open database. The results show that six different development factors correlate with reduced maternal mortality. These are; an increase in GDP per capita, increased education, increased life expectancy, a greater focus on health care, better access to clean water and better access to sanitation. Increased education was the only factor that showed a statistically significant difference between countries in sub-Sahara where the greatest reduction in maternal mortality occurred between the years 2000-2010 , with countries of sub-Sahara where maternal mortality reduction was lowest. By bringing together the results of the two analyzes shows that a higher level of education is a very important factor in achieving reduced maternal mortality in the sub-Saharan countries surveyed in the study

Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi

Abstract Background Postnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 h of birth, 48–72 h, 7–14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies. Methods A concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study was conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 h of birth, at 48–72 h, 7–14 days, and six weeks after birth were conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach. Results The uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 h of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded the utilisation of PNC services. The enablers included the mother’s level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities. Conclusion Optimisation of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, time points, and services that need to be delivered to create demand for the services. There is a need to assess the contextual factors for a better response in improving the uptake of PNC services and in turn inform the development of strategies for optimizing the uptake of PNC services

Focus group discussion guide.

Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of these services has remained low worldwide. This study explored and prioritised the strategies for optimising the uptake of postnatal care (PNC) services in Malawi. A qualitative descriptive study followed by nominal group techniques was conducted at three health facilities in Malawi from July to December 2020 and in October 2021. We conducted focus group discussions among postnatal mothers, fathers, healthcare workers, elderly women, and grandmothers. We conducted in-depth interviews with midwives and key health managers. Nominal group techniques were used to prioritise the main strategies for the provision of PNC. The demand strategies include appointment date reminders, provision of free health passport books, community awareness campaigns, and involvement of men in the services. The supply strategies included training health providers, improving clinic operations: task-shifting and hours of operation, having infrastructure for the services, and linkage to other services. Having services delivered near end-user residences was a crosscutting strategy. Refresher training and improvement in the clinic operations especially on hours of operation, appointment date reminders, and linkage to care were the prioritised strategies. There is a need to use acceptable and contextualised strategies to optimise the uptake and delivery of postnatal care services. Educating the healthcare workers and the community on postnatal services is key to increasing the demand and supply of the services.</div

Sample size and sampling technique for qualitative component.

Sample size and sampling technique for qualitative component.</p