“Whatsapping” the continuity of postpartum care in Switzerland: A socio-anthropological study

BackgroundDigital media such as Apps, Internet and social networks have become integral parts of the maternity experience for more than a decade. These media can support or undermine women’s experiences as has been shown in digital sociology research. Using Immediate Messaging Applications to provide information and support to women during the perinatal period is an emerging practice.AimThis article analyses how health and social care professionals – with a focus on community midwives – and women communicate between postpartum home visits through Immediate Message Applications in Switzerland.MethodsA socio-anthropological study that relied on qualitative methods including semi-directed interviews with midwives and health and social care professionals (n = 30) and immigrant women (n = 20).FindingsSince the introduction of Immediate Messaging Applications, women and their carer converse more regularly between post-partum home visits. Women send questions, pictures and videos to them, often allowing swift responses to their concerns. Midwives encounter difficulties answering women’s questions when they cannot be solved through quick communication (e.g. infant crying). To them, texting frequency forms a clinical clue to women’s mental health. Not all women contact their carer through digital messages; immigrant women are less likely to know and use this service.Discussion and conclusionImmediate Messaging Applications form a promising communication tool, complementary to home visits, and contribute to woman-centered care and continuity of care. As an emergent practice, it has not been framed by a guideline yet. Policy makers and practitioners should ensure that its use does not contribute to unequal access to care.     

Systematic review on the cost and cost-effectiveness of mHealth interventions supporting women during pregnancy

ObjectivesThe increased integration of digital health into maternity care—alongside growing use of, and access to, personal digital technology among pregnant women—warrants an investigation of the cost-effectiveness of mHealth interventions used by women during pregnancy and the methodological quality of the cost-effectiveness studies.MethodsA systematic search was conducted to identify peer-reviewed studies published in the last ten years (2011–2021) reporting on the costs or cost-effectiveness of mHealth interventions used by women during pregnancy. Available data related to program costs, total incremental costs and incremental cost-effectiveness ratios (ICERs) were reported in 2020 United States Dollars. The quality of cost-effectiveness studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).FindingsNine articles reporting on eight studies met the inclusion criteria. Direct intervention costs ranged from $7.04 to $86 per woman, total program costs ranged from $241,341 to $331,136 and total incremental costs ranged from -$21.16 to $1.12 million per woman. The following ICERs were reported: $2168 per DALY averted, $203.44 per woman ceasing smoking, and $3475 per QALY gained. The full economic evaluation studies (n = 4) were moderate to high in quality and all reported the mHealth intervention as cost-effective. Other studies (n = 4) were low to moderate in quality and reported low costs or cost savings associated with the implementation of the mHealth intervention.Conclusions for practicePreliminary evidence suggests mHealth interventions may be cost-effective and “low-cost” but more evidence is needed to ascertain the cost-effectiveness of mHealth interventions regarding positive maternal and child health outcomes and longer-term health service utilisation.     

The cost of vaginal birth at home,in a birth centre or in a hospital setting in New South Wales: A micro-costing study

BackgroundWomen want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings.AimThe aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales.MethodsA micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy.FindingsThe median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings.ConclusionIn this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.     

Fathers and infant health and survival in Ende,a rural district of Eastern Indonesia

Studies have shown that child survival can be greater when fathers are more highly involved in infant care than when they are less involved. This paper investigates fathers’ and paternal grandmothers’ knowledge and experiences relating to infants’ survival in a rural district of Eastern Indonesia, a context for which such information is lacking. Twenty fathers or replacement relatives participated in in-depth interviews. Most had very limited knowledge of the danger signs of childhood illness. None of participants had received child health-related information from local health personnel. Male-dominated forms of decision-making in relation to infant health care are the norm. Inadequacies in the child health services, such as difficulties in accessing health facilities, health personnel unavailability and discomfort during delivery, remain as challenges. Fathers appear to rely largely on their wives for their infant health and survival knowledge and have little involvement with their infants. They see their roles in terms of providing economic support and basic care for their infants. Grandmothers are seen as a major source of health information by fathers, but have limited knowledge of infant survival. The findings demonstrate a need for child health promotion programs and campaigns, including the safe motherhood program, to include fathers as well as mothers, in order to increase their awareness of infant survival and involvement in infant raising, and to persuade them to allow mothers greater scope to make child health-seeking decisions, especially when children require emergency treatment.     

Simultaneity in the use of maternal-child health care and contraceptives: evidence from developing countries

This study examined the relationship between the use of maternal-child health (MCH) care and the use of contraceptives. The high correlation between the two may be due to the independent effect of one on the other or to an association of both with the same or similar background factors. We used structural equation models to examine the relationship between these two interventions. The data were derived from six Demographic and Health Surveys: Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. The results show that in all six countries, the use of contraceptives and MCH care are significantly associated, independent of intervening factors; this finding suggests that families develop a joint demand for better-quality health and limited family size and translate these demands into action by using health services for mothers and for children and by voluntarily regulating fertility.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.     

Type of Health Facility and Utilization of Antenatal Care Services Among Ghanaian Women

This study examined if differences exist in the number and timing of antenatal care (ANC) visits for users of public and private health care facilities in Ghana. Also, the study explored if such variations could be attributed to health-provider factors or the selective socioeconomic characteristics of the users. Data were drawn from the recently collected Ghana Demographic and Health Survey and from a representative sample of t 2135 women who attended antenatal care in a health facility 6 months preceding the survey. Random-effects Poisson and logit models were employed for analysis. Results showed statistically significant differences between users of private and public health facilities for number of ANC visits, but not for the timing of such visits. Although some health-provider factors were significantly associated with ANC visits, these factors did not explain why users of private health facilities had significantly higher number of ANC visits than users of public health facilities. Differences in ANC visits for both private and public health facilities were rather explained by the selective socioeconomic characteristics of the users, especially as wealthy and educated women patronized private health care than poorer and uneducated women. The study concludes that Ghanaian women attending private health facilities may not have improved access to antenatal care compared to those attending public health facilities, and adds to the emerging body of literature that questions private health care in sub-Saharan Africa as more effective than public health care.     

Determinants of prenatal health care utilisation by low-risk women: A prospective cohort study

BackgroundPrenatal health care is pivotal in providing adequate prevention and care to pregnant women.AimWe examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.MethodsWe used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.FindingsWe collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.ConclusionInadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services.     

The potential impact of comparative effectiveness research on U.S. Health Care expenditures

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or—if none of these are pursued—active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is $7,300, while other alternatives are more expensive—$19,000 for brachytherapy and $46,900 for IMRT. However, a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated $1.7 to $3.0 billion (2009 present value) could be saved each year.     

Health Benefits and Health Cost Savings Due to Pets: Preliminary Estimates from an Australian National Survey

American, Australian and British studies have shown that pet dogs and cats confer health benefits on their owners. This paper reports results from the first national survey (N = 1011) estimating the magnitude of these benefits. The survey showed that dog and cat owners make fewer annual doctor visits and are less likely to be on medication for heart problems and sleeping difficulties than non-owners. An important public policy implication is that pet ownership probably reduces national health expenditure. By linking sample survey results to data on health expenditure, the paper proposes a method of estimating savings. A preliminary estimate of savings of $988 million is given for Australia for financial year 1994--95.     

Health Service Utilization Among Immigrants to the United States

This study uses data from the New Immigrant Survey and Andersen’s behavioral model, a commonly used framework for health care utilization, to examine the utilization patterns of Asian and Hispanic immigrants to the United States. Results indicate that the behavioral framework is well suited to predicting immigrants’ physician visits and dentist visits. However, this model is less appropriate for determining the likelihood of reporting a hospital as the primary source of medical care or immigrants’ use of non Western treatments. Importantly, years in the U.S. exhibits a robust, positive relationship with physician and dental visits for both groups even after controlling for several predisposing characteristics, self-assessed and physician-diagnosed need, pointing to the importance of this as an enabling factor in health care access and use.     

Determinants of temporal and areal variation in infant mortality in Germany, 1871–1933

This article investigates how sociodemographic, economic, medical, and public health factors influence infant mortality by using data about German administrative areas from 1871 to 1933. Marital fertility has the largest impact on infant mortality, followed by illegitimacy, medical care, urbanization, and infant welfare centers. The variables considered here account for most of the variation in infant mortality. Some of the unexplained variance is due to factors associated with regions, such as breastfeeding patterns, and with time periods, such as national health insurance. The analyses found no evidence that advances in medical technology affected infant mortality or that the influence of economic development changed over time.     

Nepal survey shows that "family planning saves lives"

This article presents the results of the Nepal Family Health Survey (NFHS) conducted from January through June 1996. Data on fertility, family planning, and maternal and child health were collected from 8429 ever-married women aged 15-49 years. These women provided information on 29,156 children. Using the method of regression analysis, findings reveal those factors, such as young mothers, large families, and short birth intervals, substantially increase under-five mortality risks. However, socioeconomic factors have only a limited effect on under-five mortality. Statistics have suggested that much of the urban/rural differences in mortality have been due to factors closely related to residence, mother's level of education and economic status. In addition, although positive effects of interventions (antenatal and postpartum checkups, tetanus immunization and assistance at delivery by a traditional birth attendant) have been documented, statistical results show that few children in Nepal are receiving the benefits of maternal health care. In conclusion, results of the 1996 NFHS show that delaying, spacing, and limiting births can substantially reduce infant and child mortality.     

Detection and management of mood disorders in the maternity setting: The Australian Clinical Practice Guidelines

BackgroundMood disorders arising in the perinatal period (conception to the first postnatal year), occur in up to 13% of women. The adverse impact of mood disorders on mother, infant and family with potential long-term consequences are well documented. There is a need for clear, evidence-based, guidelines for midwives and other maternity care providers.AimTo describe the process undertaken to develop the Australian Clinical Practice Guidelines for Depression and Related Disorders in the Perinatal Period and to highlight the key recommendations and their implications for the maternity sector.MethodUsing NHMRC criteria, a rigorous systematic literature review was undertaken synthesising the evidence used to formulate graded guideline recommendations. Where there was insufficient evidence for recommendations, Good Practice Points were formulated. These are based on lower quality evidence and/or expert consensus.FindingsThe quality of the evidence was good in regards to the use of the Edinburgh Postnatal Depression Scale and psychological interventions, but limited as regards medication use and safety perinatally. Recommendations were made for staff training in psychosocial assessment; universal screening for depression across the perinatal period; and the use of evidence based psychological interventions for mild to moderate depression postnatally. Good Practice Points addressed the use of comprehensive psychosocial assessment – including risk to mother and infant, and consideration of the mother–infant interaction – and gave advice around the use and safety of psychotropic medications in pregnancy and breastfeeding. In contrast to their international counterparts, the Australian guidelines emphasize a more holistic, woman and family centred approach to the management of mental health and mood disorders in the perinatal setting.ConclusionThe development of these Guidelines is a first step in translating evidence into practice and providing Australian midwives and other maternity care providers with clear guidance on the psychosocial management of women and families.     

The return of weighing in pregnancy: A discussion of evidence and practice

BackgroundInadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight management strategy for addressing gestational weight gain.DiscussionThe effectiveness of routine maternal weighing as part of maternity care has been debated for more than 30 years. The National Health and Medical Research Council of Australia have recently revised their pregnancy care clinical practice guidelines recommending maternal weight monitoring (clinician and/or self-weighing) be reintroduced into clinical practice. This paper presents a timely discussion of the topic that will contribute new insights to the debate.ConclusionWeight gain in pregnancy is complex. Evaluation of the translation, implementation, acceptability and uptake of the newly revised guidelines is warranted, given that evidence on the practice remains inconclusive. Future research exploring social ecological interventions to assist pregnant women achieve optimal gestational weight gains are suggested to expand the evidence base.     

Measures and effectiveness in controlling omission of reports on infant deaths in Shanghai metropolitan areas]

The infant mortality rate is a sensitive indicator of a country's or area's economic, cultural, and health care conditions, and in particular, it reflects the quality of health care for women and young children. Since liberation, great progress has been achieved in Shanghai's health and medical care in general as well as in health care for women and young children, and the infant mortality rate has dropped notably. However, the omission of reports on infant deaths is still a very serious problem. In order to control such omissions in reporting, the Shanghai municipal government and Department for Public Health have improved the methods of reporting deaths. Health care units are required to fill out a report on births and deaths, and census registers in the city government are responsible for registering all new births and deaths and preparing complete statistics on new births and deaths. At the end of each year, special investigators are sent to various hospitals to check on omissions of reports on infant deaths and they also help households to report infant deaths to census registers. The new measures have proved to be very effective. According to a new report released in 1980, the omission of reports on infant deaths has been reduced by 94.01% as compared with the 1972 statistics.     

Empowerment von chirurgischen PatientInnen — Modelle, Interventionen, Effekte, Erfolgsbedingungen

Empowerment of patients is an important strategy in Health Promotion. Recent discussions within this context stress the relevance of the improvement of health literacy and health behaviour of patients for the improvement of health status. Communication between patients and professionals is emphasised as a main tool and quality factor. In the framework of a model project subsidised by the Austrian Federal Ministry of Social Security and Generations three Austrian Hospitals implemented and evaluated interventions to improve the quality of communication between hospital staff and patients for the improvement of patient information and co-production of health in the care process. Effects of interventions were evaluated in a before-and-after study (baseline n = 257 patients: 113 general surgery, 100 cardiac surgery, 44 thorax surgery; evaluation n = 208 patients: 63 general surgery, 99 cardiac surgery, 46 thorax surgery) with data from a patient questionnaire (satisfaction with care and communication, self reported health status) and documentation of post-surgical health outcome (complications, length of stay in hospital) and by measuring self reported improvement of health literacy and health behaviour of patients after the intervention. Results show that improvement of communication has effects on patient satisfaction as well as on postsurgical health outcome. Especially in cardiac surgery, where communication with patients was improved by interventions covering the whole inpatient care process from admission to discharge, a considerable increase of patient satisfaction and a decrease of postsurgical complications can be reported.     

The Effect of Antenatal Care on Professional Assistance at Delivery in Rural India

Delivering births in a medical institution or at home with professional medical assistance has been shown to promote safe motherhood and child survival. Yet three-quarters of births in rural India continue to take place at home, most of them without the assistance of any trained health worker. This study examines the role of antenatal care (ANC) in promoting professional assistance at delivery, using data from India’s 1992–93 and 1998–99 National Family Health Surveys (NFHS-1 and NFHS-2). We estimate the effect of number of antenatal care visits (0, 1–2, 3+) on professional assistance at delivery (no assistance, professional assistance at home, delivery in a medical institution), using multinomial logistic regression, controlling for demographic, geographic, and socioeconomic factors, pregnancy complications, and two measures of access to health facilities. The results indicate that, after controlling for other variables (including ANC), pregnancy complications and access to health facilities do not have much effect on assistance at delivery. By contrast, ANC has a large effect, even after all other variables are controlled. The effect of ANC on professional assistance at delivery is larger in South India than in North India, and predicted percentages receiving professional assistance are higher in South India than in North India. A policy implication is that increased antenatal care coverage can be an effective means of increasing professional assistance at delivery, especially delivery in a medical institution.