Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali)

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Study Justification:
– The study aims to assess the impact of the point of entry into the maternal referral system and the configuration of healthcare teams on mother-newborn survival in Kayes, Mali.
– This study is important because it provides insights into the factors that affect maternal and perinatal deaths and can help inform strategies to improve the referral system and reduce mortality rates.
Study Highlights:
– Entering the referral system at the regional hospital (RH) was associated with the best joint mother-newborn survival.
– The more qualified the healthcare team at the community health centers (CHCs) was, the better the mother-newborn survival.
– Distance traveled to access care interacts with the point of entry and the configuration of the CHC team.
– For women coming from far distances (over 50 km), going directly to the RH increased the probability of joint mother-newborn survival by 11.90%.
– Entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50%.
– Physician presence at the CHC increased joint mother-newborn survival compared to having no physician and fewer than three professionals.
– The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less.
Recommendations for Lay Reader and Policy Maker:
– Improve access to the regional hospital for women coming from far distances by providing transportation or mobile healthcare services.
– Strengthen the qualifications and skills of healthcare teams at community health centers to improve mother-newborn survival rates.
– Increase the presence of physicians at community health centers to enhance the quality of care and improve outcomes.
– Consider the distance traveled when determining the appropriate point of entry into the referral system to optimize mother-newborn survival rates.
Key Role Players:
– Regional hospital staff
– Community health center staff
– Physicians
– Healthcare administrators
– Policy makers
– Transportation providers
Cost Items for Planning Recommendations:
– Transportation costs for women coming from far distances
– Training and education programs for healthcare teams at community health centers
– Recruitment and retention of physicians at community health centers
– Infrastructure and equipment upgrades at community health centers
– Monitoring and evaluation of the referral system improvements

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a cross-sectional study with a large sample size, which adds to its credibility. The authors used statistical analysis to evaluate the effects of the point of entry into the referral system and the configuration of healthcare teams on joint mother-newborn survival. However, the abstract does not provide details on the methodology used or the specific statistical tests performed. To improve the strength of the evidence, the authors could include more information on the study design, data collection methods, and statistical analysis techniques used.

Background: Since 2001, a referral system has been operating in Kayes (Mali) to reduce maternal and perinatal deaths. Normal deliveries are managed in community health centers (CHC). Complicated cases are referred to a district health center (DHC) or the regional hospital (RH). Women with obstetric emergencies can directly access the DHC and the RH. Objective. To assess, in women presenting with an obstetric complication: 1) the effects of the point of entry into the referral system on joint mother-newborn survival; and 2) the effects of the configuration of healthcare team at the CHCs on joint mother-newborn survival. Method. Cross-sectional study of 7,214 women users of the referral system in the region of Kayes in 2006-2009. Bivariate probit equations were fitted to estimate joint mother-newborn survival. The marginal effects of the point of entry into the referral system and of the configuration of the healthcare team at the CHCs were evaluated with a probit bivariate regression. Results: Entering the referral system at the RH was associated with the best joint mother-newborn survival; the most qualified the CHCs team was, the best was mother-newborn survival. Distance traveled interacts with the point of entry and the configuration of the CHCs team. For women coming from far (over 50 km), going directly to the RH increased the probability of joint mother-newborn survival by 11.90% (p < 0.001) as compared with entry at the CHC. Entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50% (p < 0.001). Among women who go first to a CHC, physician presence increased joint mother-newborn survival, compared with having no physician and fewer than three professionals. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less. Conclusion: Mother-newborn survival in the Kayes maternal referral system is influenced by combined effects of the point of care, the skill configuration of CHC personnel and distance traveled. © 2011 Dogba et al; licensee BioMed Central Ltd.

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Based on the study “Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali),” here are some innovations that can be developed to improve access to maternal health:

1. Telemedicine or mobile health applications: Implement technology-based solutions to enhance the existing referral system. This can include telemedicine or mobile health applications that facilitate timely and accurate transfer of patient information between community health centers (CHCs), district health centers (DHCs), and the regional hospital (RH).

2. Dedicated emergency obstetric care units: Establish dedicated emergency obstetric care units at the DHC and RH to improve access to emergency obstetric care. These units should be equipped with skilled healthcare professionals and necessary medical equipment to provide immediate and appropriate care to women with obstetric emergencies.

3. Recruitment and training of healthcare professionals: Ensure that CHCs have a sufficient number of skilled healthcare professionals, including physicians, to provide quality care to women during childbirth. This can be achieved by recruiting and training additional healthcare professionals and providing ongoing professional development opportunities to existing staff.

4. Transportation systems or mobile clinics: Address geographical barriers by developing transportation systems or arrangements to overcome the challenges of distance traveled, particularly for women living far from healthcare facilities. This can include providing transportation subsidies or establishing mobile clinics to reach remote areas and provide maternal health services.

5. Monitoring and evaluation: Regularly monitor and evaluate the impact of the implemented innovations on maternal and newborn survival rates. This will help identify areas for improvement and guide future interventions to further enhance access to maternal health services.

By implementing these innovations, the access to maternal health services can be improved, leading to better maternal and newborn outcomes in the Kayes region of Mali.
AI Innovations Description
Based on the study “Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali),” here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Strengthen the referral system: Enhance the existing referral system by ensuring clear and efficient communication channels between community health centers (CHCs), district health centers (DHCs), and the regional hospital (RH). This can be achieved through the use of technology, such as telemedicine or mobile health applications, to facilitate timely and accurate transfer of patient information.

2. Improve access to emergency obstetric care: Implement strategies to enable women with obstetric emergencies to directly access the DHC and RH without having to go through the CHCs. This can be achieved by establishing dedicated emergency obstetric care units at the DHC and RH, equipped with skilled healthcare professionals and necessary medical equipment.

3. Enhance the skill configuration of CHC personnel: Ensure that CHCs have a sufficient number of skilled healthcare professionals, including physicians, to provide quality care to women during childbirth. This can be achieved by recruiting and training additional healthcare professionals, as well as providing ongoing professional development opportunities to existing staff.

4. Address geographical barriers: Develop transportation systems or arrangements to overcome the challenges of distance traveled, particularly for women living far from healthcare facilities. This can include providing transportation subsidies or establishing mobile clinics to reach remote areas.

5. Monitor and evaluate the impact: Regularly monitor and evaluate the impact of the implemented innovations on maternal and newborn survival rates. This will help identify areas for improvement and guide future interventions.

By implementing these recommendations, the access to maternal health services can be improved, leading to better maternal and newborn outcomes in the Kayes region of Mali.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Data collection: Gather data on the current state of the maternal referral system in Kayes, Mali, including the number of community health centers (CHCs), district health centers (DHCs), and the regional hospital (RH), as well as the availability and skill configuration of healthcare professionals at each level. Collect information on the distance traveled by women to access healthcare facilities.

2. Baseline assessment: Analyze the existing data to establish baseline indicators for maternal and newborn survival rates, as well as the current point of entry into the referral system and the configuration of healthcare teams at CHCs.

3. Development of a simulation model: Develop a simulation model that incorporates the main recommendations, taking into account the impact of each recommendation on access to maternal health services. The model should consider factors such as the use of technology for communication, the establishment of emergency obstetric care units, the recruitment and training of healthcare professionals, and the implementation of transportation systems or mobile clinics.

4. Data input: Input the collected data into the simulation model, including the number of healthcare facilities, the skill configuration of healthcare teams, and the distance traveled by women.

5. Simulation runs: Run the simulation model multiple times, varying the parameters related to the main recommendations. For example, simulate scenarios where the referral system is strengthened with improved communication channels, where access to emergency obstetric care is enhanced, where the skill configuration of CHC personnel is improved, and where geographical barriers are addressed.

6. Analysis of results: Analyze the results of the simulation runs to assess the impact of each recommendation on maternal and newborn survival rates. Compare the outcomes of each scenario to the baseline indicators to determine the effectiveness of the recommendations in improving access to maternal health services.

7. Sensitivity analysis: Conduct sensitivity analysis to test the robustness of the simulation results by varying key parameters and assumptions. This will help identify the most influential factors and potential limitations of the recommendations.

8. Recommendations and implementation: Based on the simulation results, identify the most effective combination of recommendations to improve access to maternal health services in the Kayes region of Mali. Develop an implementation plan that outlines the steps, resources, and stakeholders involved in implementing the recommended innovations.

9. Monitoring and evaluation: Establish a monitoring and evaluation framework to track the progress and impact of the implemented innovations. Continuously collect data on maternal and newborn survival rates, as well as other relevant indicators, to assess the long-term effectiveness of the recommendations and make any necessary adjustments.

By following this methodology, policymakers and healthcare professionals can gain insights into the potential impact of the main recommendations on improving access to maternal health services in the Kayes region of Mali.

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