Health insurance for the poor decreases access to HIV testing in antenatal care: evidence of an unintended effect of health insurance reform in Colombia

Prevention of mother-to-child transmission of HIV was added to standard antenatal care (ANC) in 2000 for Colombians enrolled in the two national health insurance schemes, the ‘subsidized regime’ (covering poor citizens) and the ‘contributory regime’ (covering salaried citizens with incomes above the poverty threshold), which jointly covered 80% of the total Colombian population as of 2007. This article examines integration of HIV testing in ANC through the relationship between ordering an HIV test with the type of health insurance, including lack of health insurance, using data from the nationally representative 2005 Colombia Demographic and Health Survey. Overall, health-care providers ordered an HIV test for only 35% of the women attending ANC. We regressed the order of an HIV test during ANC on health systems characteristics (type of insurance and type of ANC provider), women’s characteristics (age, wealth, educational attainment, month of pregnancy at first antenatal visit, HIV knowledge, urban vs. rural residence and sub-region of residence) and children’s characteristics (birth order and birth year). Women enrolled in the subsidized regime were significantly less likely to be offered and receive an HIV test in ANC than women without any health insurance (adjusted odds ratio = 0.820, P < 0.001), when controlling for the other independent variables. Wealth, urban residence, birth year of the child and the type of health-care provider seen during the ANC visit were significantly associated with providers ordering an HIV test for a woman (all P < 0.05). Our findings suggest that enrolment in the subsidized regime reduced access to HIV testing in ANC. Additional research is needed to elucidate the mechanisms through which the potential effect of health insurance coverage on HIV testing in ANC occurs and to examine whether enrolment in the subsidized regime has affected access to other essential health services

Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya

Background: Since the 2009 WHO and UNICEF recommendation that women receive home-based postnatal care within the first three days after birth, a growing number of low-income countries have explored integrating postnatal home visit interventions into their maternal and newborn health strategies. This randomized trial evaluates a pilot program in which community health workers (CHWs) visit or call new mothers three days after delivery in peri-urban Kiambu County, Kenya. Methods: Participants were individually randomized to one of three groups: 1) early postnatal care three days after delivery provided in-person with a CHW using a simple checklist, 2) care provided by phone with a CHW using the same checklist, or 3) a standard of care group. Surveys were conducted ten days and nine weeks postnatal to measure outcomes related to compliance with referrals, self-reported health problems for mother and baby, care-seeking behaviors, and postnatal knowledge and practices around the recognition of danger signs, feeding, nutrition, infant care and family planning. Results: The home visit administration of the checklist increased the likelihood that women recognized postnatal problems for themselves and their babies and increased the likelihood that they sought care to address those problems identified for the child. In both the home visit and mobile phone implementation of the checklist, actions taken for postnatal problems happened earlier, particularly for infants. Knowledge was found to be high across all groups, with limited evidence that the checklist impacted knowledge and postnatal practices around the recognition of danger signs, feeding, nutrition, infant care and family planning. Conclusion: We find evidence that CHW-administered postnatal checklists can lead to better recognition of postnatal problems and more timely care-seeking. Furthermore, our results suggest that CHWs can affordably deliver many of the benefits of postnatal checklists. Trial Registration: ClinicalTrials.gov NCT02104635; registered April 2, 2014

Additional file 2: of Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya

Postpartum care-seeking behaviors, health problems and responses, and postpartum knowledge and health behaviors, among subsample of participants reached by the day 3 postpartum interventions. (DOCX 110 kb

Trends in cannabis polysubstance use during early pregnancy among patients in a large health care system in Northern California.

Question: Is prenatal cannabis use increasing more rapidly over time among pregnant patients without vs those with co-occurring prenatal substance use? Findings: In this cross-sectional time-series study using data from 367 138 pregnancies among 281 590 unique pregnant patients screened for prenatal substance use during early pregnancy as part of routine prenatal care in Kaiser Permanente Northern California, rates of prenatal use of only cannabis increased faster than rates of use of cannabis and 1 other substance, while rates of use of cannabis and 2 or more substances decreased. Meaning: This study suggests that increases in prenatal cannabis use may be associated in part with pregnant individuals who use only cannabis and no other substances, which could reflect growing acceptability of cannabis use and decreasin