ABSTRACT
Background: Maternal health services in Indonesia faced significant challenges during the COVID-19 pandemic. The service had to manage the infection and ensure the continuity of maternity service for women. This research explored in depth the way maternal health service was provided in Indonesia during the COVID-19 pandemic and provided suggestions to improve the service in primary care. Methods: We conducted a practical qualitative study using semi-structured interviews and focus groups (FGs) between May and October 2021, with the focus area of study in Yogyakarta province. The participants were general practitioners (GPs), midwives, nurses, obstetricians, and women who had experience providing or accessing maternity care during the pandemic. The data were analysed using an inductive approach of thematic analysis. Results: A total of 23 participants participated in the FGs/interviews. Three overarching themes were identified: applied COVID safety measures, confusion and further expectations. COVID-19 safety measures, such as screening, hygiene and triage, were applied in the service. However, challenges and confusion occurred, particularly regarding the limited clinical resources, limited guidelines and escalation plan and patients' low literacy levels. Participants also expected the development of mobile apps to support care for women. Conclusion: Despite the classical challenges in primary care practice, Indonesia implemented strategies to provide maternity care and limit the spread of COVID-19 infection. Continuous improvements and further research are needed to provide practical recommendations and escalation plans to optimise the quality of maternity service in primary care.
ABSTRACT
Background: Globally, over the past two decades, many countries have significantly reduced the rate of infant mortality. Yet, in Africa, Nigeria remains one of the countries with the highest infant mortality rate (IMR). Methods: We conducted a population-level study using the 2018 Nigeria Demographic Health Survey (NDHS). A total of 41,668 household data were analyzed retrospectively. The association between each exposure and infant mortality was analyzed in logistic regression models (independently adjusted by demographic and socioeconomic status variables) and confirmed by the multiple comparisons analysis. Findings: The overall IMR of 2013-2017 was 61.5 (95% CI 58.0, 65.3) per 1000 live births. In general, the North-West and North-East regions had the highest IMR, whereas the South-West, South-East and South-South regions had the lowest IMR. The regression analysis found women who delivered their babies at the age <=18 years old (odds ratio (OR): 1.37 [1.17, 1.62]), had religion of Islam (OR: 1.35 [1.10, 1.65]), no ANC visit (OR: 1.69 [1.21, 2.35]), >4 ANC visits (OR: 1.70 [1.23, 2.34]), ANC not at home or skilled provider (0.40 [0.35, 0.46]) and the babies as the first child (OR: 1.23 [1.07, 1.42]) to be associated with higher IMR. Interpretation: Our findings imply that Nigeria is not on track to achieving the SDG target of reducing child mortality by 2030. Sustainable interventions are urgently needed to address the challenges for women of reproductive age, particularly those that are living in the rural areas and Northern regions, having limited/no access to health care/skilled providers, and delivered their first child. Funding: None.
