Maternal Health Situation in India: A Case Study

Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India's goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health

Maternal Health in Gujarat, India: A Case Study

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially- increased political will and social awareness

Maternal Health Situation in India: A Case Study

Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India's goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health

Worksite intervention to prevent obesity among hospital employees

Obesity is common, serious and costly. Substantial evidence has linked diet, physical activity, and sedentary behaviors to obesity, and these factors are significantly influenced by the environment. Certain worksites like healthcare settings are linked to higher obesity rates in their employees. Despite the obesity risk that hospital employees face, little is known of the current impact of worksite wellness programs targeting nutrition, physical activity and sedentary behaviors in a healthcare set up. The overall aim of this dissertation was to assess worksite wellness strategies focused on diet and physical activity on the prevention of obesity in hospital employees. The first paper of this dissertation presented the results of a systematic review of the literature between 2000–2016, and identified 30 worksite wellness programs (eight randomized control trials, six cluster randomized control trials, and sixteen quasi-experimental studies) focused on nutrition and physical activity for obesity prevention in health care settings (hospitals, clinics, nursing homes). The findings indicated that a majority of the studies focused on changing diet and physical activity behaviors using behavioral and educational intervention strategies. Multicomponent intervention including behavioral and environmental component fared better than only environmental approaches. Cognitive/behavioral and educational strategies fared better than only educational strategies. While studies included in this review showed evidence that worksite wellness programs have the potential to improve weight outcomes in healthcare employees, there is still a need for well-designed studies with large sample size to demonstrate effectiveness of worksite strategies in preventing obesity in healthcare employees. The second paper of this dissertation evaluated pre-to-post changes of an environmental and social marketing obesity prevention intervention, on the hospital’s nutrition, physical activity environment, and organizational policies and practices using a validated Environment Assessment Tool (EAT) in six hospitals (five intervention, one control) in Houston, Texas. This study also assessed, using key informant interviews, management support, organizational engagement, alignment of the intervention with the organizational objectives and its impact on implementation and sustainability of the intervention in the participating hospitals. A mixed method, sequential explanatory analysis approach was used to analyze secondary data from the Shape Up Houston (SUH) study (EAT survey), and primary data from key informant interviews. Results indicated that only one out of five hospitals demonstrated significant post intervention changes (P=.004) when all subscales were included in the analysis (organizational characteristics, physical activity support, food and nutrition support). Lessons learned included the importance of continued organizational engagement and leadership support, resource allocation (space, budgetary, staff), frequent monitoring and regular follow up of the program components by the program staff, and partnership between wellness staff and departments like vending/cafeteria contractors for the implementation and sustainability of environmental changes for obesity prevention in healthcare settings

Assessing the Regional and District capacity for Operationalizing Emergency Obstetric Care through First Referral Units in Gujarat

Emergency Obstetric Care (EmOC) is crucial for preventing maternal deaths for which the policy has been to establish First Referral Units (FRUs). Twenty seven facilities from 6 districts from each administrative region of Gujarat were studied to understand the management of EmOC at regional, district and below the district levels. In all 7 district hospitals, 8FRUs, 4 community health centers (CHC) and 8 round the clock primary health centers (PHC) were selected. Observation checklists, semi-structured interviews with service providers were used to collect data.Gujarat; Health; Maternal Health; Maternal mortality; First Referral Units; Emergency Obstetric Care; Biomedical Waste; MBBS; Human Resources; Labor Room

Maternal Health in Gujarat, India: A Case Study

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially- increased political will and social awareness

An evidence-based conceptual framework of healthy cooking

Eating out of the home has been positively associated with body weight, obesity, and poor diet quality. While cooking at home has declined steadily over the last several decades, the benefits of home cooking have gained attention in recent years and many healthy cooking projects have emerged around the United States. The purpose of this study was to develop an evidence-based conceptual framework of healthy cooking behavior in relation to chronic disease prevention. A systematic review of the literature was undertaken using broad search terms. Studies analyzing the impact of cooking behaviors across a range of disciplines were included. Experts in the field reviewed the resulting constructs in a small focus group. The model was developed from the extant literature on the subject with 59 studies informing 5 individual constructs (frequency, techniques and methods, minimal usage, flavoring, and ingredient additions/replacements), further defined by a series of individual behaviors. Face validity of these constructs was supported by the focus group. A validated conceptual model is a significant step toward better understanding the relationship between cooking, disease and disease prevention and may serve as a base for future assessment tools and curricula. Keywords: Food preparation, Diet, Nutritio

Pilot evaluation of HEAL – A natural experiment to promote obesity prevention behaviors among low-income pregnant women

Instituting interventions during the prenatal period is optimal for early obesity prevention in the child. Healthy Eating Active Living (HEAL) is a six-week, multi-component program to promote breastfeeding, healthy dietary habits, cooking skills and physical activity among Medicaid-eligible pregnant-women in Texas. HEAL is integrated into the healthcare system and offered as a standard-of-care for eligible patients. Methods: Preliminary evaluation of this natural experiment conducted from March 2015 through October 2016 informs the initial feasibility, acceptability and effects of the program on participant diet, home nutrition environment, physical activity, and breastfeeding self-efficacy and intentions measured using self-report surveys. Analysis of covariance (ANCOVA) was conducted to evaluate pre- and post-intervention changes, controlling for participants' ethnicity, age, and income level. Interaction effects of session attendance on the outcomes were further assessed. Results: Of the 329 women who enrolled in HEAL, 210 women completed the pre-post assessment (64% retention rate). Pre-to-post intervention, there were significant increases in availability and intake of fruits and vegetables, self-efficacy towards consuming more fruits and vegetables, and cooking frequency and skills (p < 0.05), and decreased frequency of eating heat and serve foods (p < 0.05). Significant improvements in physical activity, duration of breastfeeding, perceived benefits and intentions to breastfeed were also observed (p < 0.05). Higher attendance of HEAL sessions was associated with better outcomes. Process evaluation demonstrated 95% fidelity of program implementation. Conclusion: HEAL operationalizes clinic-community linkages and shows promise in improving behaviors during pregnancy. Future research warrants the use of a stringent study design with a control group to determine program efficacy. Keywords: Pregnancy, Obesity prevention, Nutrition, Breastfeeding, Physical activit