Trends in health facility births in sub-Saharan Africa: an analysis of lessons learned under the Millennium Development Goal framework

Sub-Saharan Africa (SSA) has the highest maternal and under-5 mortality rates as well as low facility births, with a high percentage of births occurring in the absence of skilled personnel. We examine trends in health facility births in SSA by geographic areas (urban-rural) and regions; and also the correlation between health facility birth and neonatal mortality rate (NMR). Data come from Demographic and Health Surveys (27 countries), conducted between 1990 and 2014. Median health facility births, urban-rural gaps, and regional variations in health facility births between initial (1990) and latest (2014) surveys were calculated. The median health facility birth increased from 44% at initial survey to 57% at the latest survey. Rural areas had a higher percentage increase in health facility births between initial and latest surveys (16%) than urban areas (6%) with a 2% overall gap reduction between initial and latest surveys. Health facility births were inversely associated with NMR at initial (R2=0.20, p=0.019) and latest (R2=0.26, p=0.007) surveys. To achieve the Sustainable Development Goal target of reducing neonatal mortality, policies should particularly focus on bringing rural areas on par with urban areas.Keywords: Skilled birth attendants, maternal mortality, infant mortality, neonatal mortality, health facility birt

Intimate partner violence and uptake of HIV testing and STI treatment among married women in Nigeria

Context/Background: Nigeria has a high prevalence of Intimate Partner Violence (IPV) and STIs including HIV/AIDS - which constitute a major public health problem.Data Sources and Methods: This study examines the association between IPV, uptake of HIV testing and STI treatment and their correlates among married women of reproductive age, with recent STI, using the 2013 Nigeria DHS Data.Results: We observed high prevalence of any IPV (60%), lower prevalence of HIV testing uptake (20%) and higher prevalence of STI treatment (74%). There was reduced odds of HIV testing uptake and increased odds of STI treatment among women who experienced IPV, but these were not statistically significant. Education and health facility visit were associated with HIV testing uptake while wealth quintile and autonomy were associated with STI treatment.Conclusion: There is need to improve early identification of women at risk of experiencing IPV, understand the barriers to HIV testing uptake and STI treatment and intervene early.

Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: A 10-minute brochurebased IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs\u27 federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. Pediatrics 2013;132:S134-S139. © 2013 by the American Academy of Pediatrics

Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: A 10-minute brochurebased IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs\u27 federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. Pediatrics 2013;132:S134-S139. © 2013 by the American Academy of Pediatrics