Effect of Delays in Maternal Access to Healthcare on Neonatal Mortality in Sierra Leone: A Social Autopsy Case–Control Study at a Child Health and Mortality Prevention Surveillance (CHAMPS) Site

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Study Justification:
This study aimed to investigate the impact of delays in maternal access to healthcare on neonatal mortality in Sierra Leone. It utilized a social autopsy case-control design to estimate the contribution of various delays in maternal healthcare to subsequent neonatal deaths. The study aimed to complement the use of verbal autopsy questionnaires commonly used to determine the cause of death by incorporating a social autopsy tool in low-resource settings.
Highlights:
– The study was conducted at the Child Health and Mortality Prevention Surveillance (CHAMPS) Sierra Leone site, focusing on Makeni City and surrounding rural areas.
– Cases included neonatal deaths in the catchment area, while controls were living neonates matched by sex and area.
– Of the neonatal deaths, 26.4% of mothers experienced at least one delay during pregnancy or delivery, compared to 46.9% of mothers of stillbirths and 18.6% of control mothers.
– The most commonly reported delay among neonatal deaths was receiving care at the facility (18.9%).
– Experiencing any barrier was weakly associated with neonatal death, while a delay in receiving care at the facility was strongly associated.
– The findings suggest that delays in healthcare, particularly those experienced at the healthcare facility, are associated with neonatal death.
Recommendations:
– Addressing delays in maternal access to healthcare should be a priority in reducing neonatal mortality.
– Strategies should be developed to improve the timeliness and quality of care provided at healthcare facilities.
– Efforts should be made to identify and address specific barriers faced by mothers during pregnancy and delivery.
– Public health policies should be tailored to address the heterogeneity in the prevalence of specific delays in different areas.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies related to maternal and child health.
– Healthcare Providers: Involved in delivering healthcare services and ensuring timely access for pregnant women.
– Community Health Workers: Play a crucial role in educating and supporting pregnant women, especially in rural areas.
– Non-Governmental Organizations (NGOs): Provide resources, support, and advocacy for improving maternal and child health.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers and community health workers on maternal and child health.
– Infrastructure Improvement: Allocate funds for improving healthcare facilities to ensure timely and quality care.
– Outreach Programs: Budget for community-based programs and campaigns to raise awareness and address barriers to healthcare access.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the effectiveness of interventions and policies implemented.
Please note that the information provided is based on the description and does not include actual cost figures.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a case-control design, which allows for comparison between neonatal deaths and living neonates. The odds ratios provide some evidence of an association between delays in healthcare and neonatal death. However, the sample size is relatively small, which may limit the generalizability of the findings. To improve the strength of the evidence, it would be beneficial to conduct a larger study with a more diverse population. Additionally, including a control group of mothers who did not experience delays in healthcare would provide a better comparison. Finally, conducting a multivariate analysis to adjust for potential confounding factors would strengthen the evidence further.

Introduction: In low-resource settings, a social autopsy tool has been proposed to measure the effect of delays in access to healthcare on deaths, complementing verbal autopsy questionnaires routinely used to determine cause of death. This study estimates the contribution of various delays in maternal healthcare to subsequent neonatal mortality using a social autopsy case–control design. Methods: This study was conducted at the Child Health and Mortality Prevention Surveillance (CHAMPS) Sierra Leone site (Makeni City and surrounding rural areas). Cases were neonatal deaths in the catchment area, and controls were sex- and area-matched living neonates. Odds ratios for maternal barriers to care and neonatal death were estimated, and stratified models examined this association by neonatal age and medical complications. Results: Of 53 neonatal deaths, 26.4% of mothers experienced at least one delay during pregnancy or delivery compared to 46.9% of mothers of stillbirths and 18.6% of control mothers. The most commonly reported delay among neonatal deaths was receiving care at the facility (18.9%). Experiencing any barrier was weakly associated (OR 1.68, CI 0.77, 3.67) and a delay in receiving care at the facility was strongly associated (OR 19.15, CI 3.90, 94.19) with neonatal death. Discussion: Delays in healthcare are associated with neonatal death, particularly delays experienced at the healthcare facility. Heterogeneity exists in the prevalence of specific delays, which has implications for local public health policy. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Based on the study titled “Effect of Delays in Maternal Access to Healthcare on Neonatal Mortality in Sierra Leone: A Social Autopsy Case–Control Study at a Child Health and Mortality Prevention Surveillance (CHAMPS) Site,” the following innovations can be developed to improve access to maternal health:

1. Strengthening healthcare facility infrastructure and capacity: This innovation involves investing in equipment, supplies, and skilled healthcare providers to improve the infrastructure and capacity of healthcare facilities. This will ensure timely and quality maternal healthcare.

2. Enhancing transportation and referral systems: Developing innovative transportation solutions, such as mobile clinics or ambulances, can help overcome geographical barriers and ensure that pregnant women can reach healthcare facilities in a timely manner. Additionally, establishing effective referral systems between primary healthcare centers and higher-level facilities can facilitate prompt access to specialized care when needed.

3. Promoting community-based interventions: Engaging communities in maternal health promotion and education can address delays in accessing care during pregnancy and delivery. Community health workers can provide information, conduct antenatal visits, and facilitate timely referrals. Empowering women and their families with knowledge about the importance of early and regular prenatal care can encourage them to seek healthcare services promptly.

4. Implementing telemedicine and digital health solutions: Utilizing telemedicine and digital health technologies can improve access to maternal healthcare, especially in remote or underserved areas. Teleconsultations, remote monitoring of high-risk pregnancies, and mobile health applications can enable healthcare providers to reach and support pregnant women, reducing delays in receiving care.

5. Strengthening health information systems: Enhancing health information systems can facilitate the collection and analysis of data on delays in maternal healthcare. This information can guide evidence-based decision-making, resource allocation, and policy development to address specific barriers and improve access to maternal health services.

By implementing these innovations, access to maternal health can be improved, delays can be reduced, and ultimately, neonatal mortality rates can be decreased.
AI Innovations Description
The study titled “Effect of Delays in Maternal Access to Healthcare on Neonatal Mortality in Sierra Leone: A Social Autopsy Case–Control Study at a Child Health and Mortality Prevention Surveillance (CHAMPS) Site” provides valuable insights into improving access to maternal health. Based on the findings, the following recommendation can be developed into an innovation:

1. Strengthening healthcare facility infrastructure and capacity: Given that delays in receiving care at the facility were strongly associated with neonatal death, it is crucial to improve the infrastructure and capacity of healthcare facilities. This can be achieved by investing in equipment, supplies, and skilled healthcare providers to ensure timely and quality maternal healthcare.

2. Enhancing transportation and referral systems: The study identified delays in accessing healthcare facilities as a significant barrier. Developing innovative transportation solutions, such as mobile clinics or ambulances, can help overcome geographical barriers and ensure that pregnant women can reach healthcare facilities in a timely manner. Additionally, establishing effective referral systems between primary healthcare centers and higher-level facilities can facilitate prompt access to specialized care when needed.

3. Promoting community-based interventions: Engaging communities in maternal health promotion and education can help address delays in accessing care during pregnancy and delivery. Community health workers can play a vital role in providing information, conducting antenatal visits, and facilitating timely referrals. Empowering women and their families with knowledge about the importance of early and regular prenatal care can encourage them to seek healthcare services promptly.

4. Implementing telemedicine and digital health solutions: Utilizing telemedicine and digital health technologies can improve access to maternal healthcare, especially in remote or underserved areas. Teleconsultations, remote monitoring of high-risk pregnancies, and mobile health applications can enable healthcare providers to reach and support pregnant women, reducing delays in receiving care.

5. Strengthening health information systems: Enhancing health information systems can facilitate the collection and analysis of data on delays in maternal healthcare. This information can guide evidence-based decision-making, resource allocation, and policy development to address specific barriers and improve access to maternal health services.

By implementing these recommendations, innovative solutions can be developed to improve access to maternal health, reduce delays, and ultimately contribute to reducing neonatal mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Gather data on the current state of maternal healthcare access in the target area. This can include information on healthcare facility infrastructure, transportation systems, community-based interventions, telemedicine and digital health solutions, and health information systems.

2. Define Indicators: Identify key indicators that reflect the access to maternal healthcare, such as the proportion of pregnant women receiving timely prenatal care, the average time taken to reach a healthcare facility, the availability of skilled healthcare providers, and the utilization of telemedicine and digital health solutions.

3. Intervention Implementation: Implement the recommended interventions in the target area. Strengthen healthcare facility infrastructure and capacity by investing in equipment, supplies, and skilled healthcare providers. Enhance transportation and referral systems by introducing mobile clinics or ambulances and establishing effective referral mechanisms. Promote community-based interventions by engaging community health workers and conducting health education programs. Implement telemedicine and digital health solutions by introducing teleconsultations, remote monitoring, and mobile health applications. Strengthen health information systems to improve data collection and analysis.

4. Data Collection: Collect data on the indicators identified in step 2 after the implementation of the interventions. This can be done through surveys, interviews, and monitoring systems.

5. Data Analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal healthcare. Compare the indicators before and after the implementation of the interventions to determine any changes or improvements.

6. Evaluation: Evaluate the effectiveness of each intervention in improving access to maternal health. Assess the extent to which the recommended interventions have addressed delays in accessing care, reduced neonatal mortality rates, and improved overall maternal health outcomes.

7. Recommendations and Scaling Up: Based on the findings of the evaluation, develop recommendations for scaling up successful interventions and addressing any remaining gaps. These recommendations can guide future policy development and resource allocation to further improve access to maternal healthcare.

By following this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health and assess their effectiveness in reducing delays and improving maternal and neonatal health outcomes.

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