Home-based records for poor mothers and children in Afghanistan, a cross sectional population based study.

BACKGROUND: No studies have examined distribution, retention and use of maternal and child health (MCH) home-based records (HBRs) in the poorest women in low income countries. Our primary objective was to compare distribution of the new Afghanistan MCH HBR (the MCH handbook) to the poorest women (quintiles 1-2) with the least poor women (quintiles 3-5). Secondary objectives were to assess distribution, retention and use of the handbook across wealth, education, age and parity strata. METHODS: This was a population based cross sectional study set in Kama and Mirbachakot districts of Afghanistan from August 2017 to April 2018. Women were eligible to be part of the study if they had a child born in the last 6 months. Multivariable logistic regression models were constructed to adjust for clustering by district and potential confounders decided a priori (maternal education, maternal age, parity, age of child, sex of child) and to calculate adjusted odds ratios (aOR), 95% confidence intervals (95% CI) and corresponding p values. Principal components analysis was used to create the wealth quintiles using standard methods. Wealth categories were 'poorest' (quintiles 1,2) and 'least poor' (quintiles 3,4,5). RESULTS: 1728/1943 (88.5%) mothers received a handbook. The poorest women (633, 88.8%) had similar odds of receiving a handbook compared to the least poor (990, 91.7%) (aOR 1.26, 95%CI [0.91-1.77], p value 0.165). Education status (aOR 1.03, 95%CI [0.63-1.68], p value 0.903) and age (aOR 1.39, 95%CI [0.68-2.84], p value 0.369) had little effect. Multiparous women (1371, 91.5%) had a higher odds than primiparous women (252, 85.7%) (aOR 1.83, 95%CI [1.16-2.87], p value 0.009). Use of the handbook by health providers and mothers was similar across quintiles. Ten (0.5%) women reported that they received a book but then lost it. CONCLUSIONS: We were able to achieve almost universal coverage of our new MCH HBR in our study area in Afghanistan. The handbook will be scaled up over the next three years across all of Afghanistan and will include close monitoring and assessment of coverage and use by all families.

Adapting home-based records for maternal and child health to users' capacities.

Home-based records have been used in both low- and high-income countries to improve maternal and child health. Traditionally, these were mostly stand-alone records that supported a single maternal and child health-related programme, such as the child vaccination card or growth chart. Recently, an increasing number of countries are using integrated home-based records to support all or part of maternal and child health-related programmes, as in the maternal and child health handbook. Policy-makers' expectations of home-based records are often unrealistic and important functions of the records remain underused, leading to loss of confidence in the process, and to wasted resources and opportunities for care. We need to examine the gaps between the functions of the records and the extent to which users of records (pregnant women, mothers, caregivers and health-care workers) are knowledgeable and skilful enough to make those expected functions happen. Three key functions, with increasing levels of complexity, may be planned in home-based records: (i) data recording and storage; (ii) behaviour change communication, and (iii) monitoring and referral. We define a function-capacity conceptual framework for home-based records showing how increasing number and complexity of functions in a home-based record requires greater capacity among its users. The type and functions of an optimal home-based record should be strategically selected in accordance not only with demands of the health system, but also the capacities of the record users.

Les fiches de santé tenues à domicile sont aussi bien utilisées dans des pays à revenu faible que dans des pays à revenu élevé pour améliorer la santé de la mère et de l'enfant. Habituellement, les fiches utilisées étaient essentiellement des documents indépendants, associés à un programme spécifique de santé de la mère et de l'enfant, tels que les carnets de vaccination ou les courbes de croissance des enfants. Depuis quelque temps, un nombre croissant de pays opte pour des fiches plus complètes, couvrant tout ou partie des programmes de santé de la mère et de l'enfant, comme les manuels de santé de la mère et de l'enfant. Les attentes des décideurs politiques autour des fiches de santé tenues à domicile sont souvent trop ambitieuses, et des fonctions importantes des fiches sont sous-employées, ce qui rend le processus moins fiable, gâche des ressources et fait perdre des opportunités de soins. Il est nécessaire d'examiner l'écart entre les fonctions des fiches et le degré de connaissance et de compétence de leurs utilisateurs (femmes enceintes, mères, aidants, professionnels de santé) pour véritablement tirer parti de toutes les fonctions prévues. Trois principales fonctions, énoncées dans l'ordre croissant de leur degré de complexité, doivent être prévues dans les fiches de santé tenues à domicile: (i) enregistrement et stockage des données; (ii) communication des changements des comportements et (iii) suivi et recommandations pour le parcours de soins. Nous avons défini un cadre conceptuel Fonction-Capacité pour les fiches de santé tenues à domicile, qui montre comment des fonctions plus nombreuses et plus complexes nécessitent de plus grandes capacités chez les utilisateurs. Le type et les fonctions d'une fiche de santé optimale devraient être choisis stratégiquement en fonction, non seulement des exigences des systèmes de santé, mais aussi des capacités des utilisateurs des fiches.

Los registros domiciliarios se han utilizado tanto en países de bajos ingresos como en los de altos ingresos para mejorar la salud materno-infantil. Tradicionalmente, se trataba en su mayoría de registros independientes que apoyaban un único programa relacionado con la salud materno-infantil, como la tarjeta de vacunación infantil o el gráfico de crecimiento. Hace poco, un número cada vez mayor de países ha empezado a utilizar registros integrados domiciliarios para apoyar todos o una parte de los programas relacionados con la salud materno-infantil, como en el manual de salud materno-infantil. Las expectativas de los responsables de la formulación de políticas con respecto a los registros domiciliarios son a menudo demasiado ambiciosas y muchas funciones importantes de los registros no se aprovechan, lo que conduce a una pérdida de confianza en el proceso y a un despilfarro de recursos y oportunidades de atención. Es necesario examinar las brechas entre las funciones de los registros y la medida en que los usuarios de los mismos (mujeres embarazadas, madres, cuidadores y trabajadores de la salud) tienen el conocimiento y la habilidad suficientes para que esas funciones se cumplan. Se pueden planificar tres funciones clave, con niveles crecientes de complejidad, en los registros domiciliarios: (i) registro y almacenamiento de datos, (ii) comunicación de cambios de comportamiento, y (iii) seguimiento y remisión. Se ha definido un marco conceptual de función y capacidad para los registros domiciliarios que muestra cómo un número y una complejidad crecientes de las funciones en un registro domiciliario requiere una mayor capacidad de sus usuarios. El tipo y las funciones de un registro domiciliario óptimo deben seleccionarse estratégicamente de acuerdo no solo con las demandas del sistema de salud, sino también con las capacidades de los usuarios del registro.

Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia.

BACKGROUND: Effectiveness of the Maternal and Child Health Handbook (MCHHB), a home-based booklet for pregnancy, delivery and postnatal/child health, was evaluated on care acquisition and home care in rural Java, a low service-coverage area. METHODS: We conducted a health centre-based randomized trial, with a 2-year follow-up. Intervention included (i) MCHHB provision at antenatal care visits; (ii) records and guides by health personnel on and with the MCHHB; and (iii) sensitization of care by volunteers using the MCHHB. RESULTS: The follow-up rate was 70.2% (183, intervention area; 271, control area). Respondents in the intervention area received consecutive MCH services including two doses of tetanus toxoid injections and antenatal care four times or more during pregnancy, professional assistance during child delivery and vitamin A supplements administration to their children, after adjustment for confounding variables and cluster effects (OR = 2.03, 95% CI: 1.19-3.47). In the intervention area, home care (continued breastfeeding; introducing complementary feeding; proper feeding order; varied foods feeding; self-feeding training; and care for cough), perceived support by husbands, and lower underweight rates and stunting rates among children were observed. CONCLUSION: MCHHB use promoted continuous care acquisition and care at home from pregnancy to early child-rearing stages in rural Java.

Distinct B subunits of PP2A regulate the NF-κB signalling pathway through dephosphorylation of IKKß, IκBα and RelA.

PP2A is composed of a scaffolding subunit (A), a catalytic subunit (C) and a regulatory subunit (B) that is classified into four families including B, B', B'' and B'''/striatin. Here, we found that a distinct PP2A complex regulates NF-κB signalling by dephosphorylation of IKKß, IκBα and RelA/p65. The PP2A core enzyme AC dimer and the holoenzyme AB'''C trimer dephosphorylate IKKß, IκBα and RelA, whereas the ABC trimer dephosphorylates IκBα but not IKKß and RelA in cells. In contrast, AB'C and AB''C trimers have little effect on dephosphorylation of these signalling proteins. These results suggest that different forms of PP2A regulate NF-κB pathway signalling through multiple steps each in a different manner, thereby finely tuning NF-κB- and IKKß-mediated cellular responses.

Effectiveness of the Maternal and Child Health handbook in Burundi for increasing notification of birth at health facilities and postnatal care uptake.

BACKGROUND: In Burundi, birth certificate ownership (56.4%) and postnatal care (PNC) coverage (30%) remain low. Birth certificates prove birth registration and allow clients to receive free medical care including PNC. To obtain birth certificates, notification of birth by witnesses is indispensable. However, use of existing parallel home-based records for mother and child has prevented clients from successfully receiving notification of birth and related information. OBJECTIVE: To assess the effectiveness of the Maternal and Child Health (MCH) handbook for increasing notification of birth at health facilities and PNC uptake. METHODS: Pre- and post-introduction measurement were applied including: (i) structured interviews with two different sets of randomly selected mothers having infants aged less than six weeks at the pre- or post-studies; and (ii) secondary data from the national health management information system. RESULTS: 95.1% of mothers had an MCH handbook post-study. Significant improvement was observed in the proportion of mothers receiving notification of birth at health facilities, from 4.6% to 61.0% (95% confidence interval [CI]: 55.9%-66.2%), and the proportion of mothers receiving guidance on PNC, from 35.9% to 64.2% (95% CI: 59.2%-69.3%). The annual PNC coverage (43.9% to 54.2%; p < 0.05) in the Gitega District significantly increased from 2013 to 2014. Among MCH handbook owners, mothers giving birth at hospitals/clinics had 2.62 higher odds (95% CI: 1.63-4.22) of obtaining notification of birth than mothers giving birth at health centers. Conversely, mothers delivering at hospitals/clinics had 0.51 lower odds (95% CI: 1.63-4.22) of receiving PNC guidance than mothers delivering at health centers. CONCLUSIONS: As previous studies showed, the MCH handbook appeared to help health personnel provide guidance on PNC, thereby it may have increased PNC. Furthermore, this study suggests the handbook contributed to every birth being counted. However, to increase the effectiveness of the handbook, health personnel should be encouraged toward its proper use.

The role of home-based records in the establishment of a continuum of care for mothers, newborns, and children in Indonesia.

BACKGROUND: The provision of appropriate care along the continuum of maternal, newborn, and child health (MNCH) service delivery is a challenge in developing countries. To improve this, in the 1990s, Indonesia introduced the maternal and child health (MCH) handbook, as an integrated form of parallel home-based records. OBJECTIVE: This study aimed to identify the roles of home-based records both before and after childbirth, especially in provinces where the MCH handbook (MCHHB) was extensively promoted, by examining their association with MNCH service uptake. DESIGN: This was a cross-sectional study using nationally representative data sets, the Indonesia Demographic and Health Surveys (IDHSs) from 1997, 2002-2003, and 2007. The IDHS identifies respondents' ownership of home-based records before and after childbirth. Multivariate logistic regression was used to examine associations between record ownership and service utilisation in national data and data from two provinces, West Sumatra and North Sulawesi, where ownership of pre- and post-natal records served as a proxy for MCHHB ownership. RESULTS: Pre- and post-natal record ownership increased from 1997 to 2007. Provincial data from 2007 showed that handbook ownership was associated with having delivery assisted by trained personnel [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.05-4.25], receiving maternal care (aOR: 3.92, 95% CI: 2.35-6.52), completing 12 doses of child immunisation for seven diseases (aOR: 4.86, 95% CI: 2.37-9.95), and having immunisation before and after childbirth (aOR: 5.40, 95% CI: 2.28-12.76), whereas national data showed that service utilisation was associated with ownership of both records compared with owning a single record or none. CONCLUSION: Our results suggest that pre- and post-natal home-based record use may be effective for ensuring service utilisation. In addition, since the handbook is an efficient home-based record for use throughout children's life courses, it could be an effective tool for promoting the continuum of MNCH care in Indonesia.

[Clostridium difficile TOX A/B II TEST evaluation].

We compared the performance of two commercial toxin detection kits, C. difficile toxin A/B (C. difficile TOX A/B II test; TOX A/B II) and C. difficile toxin A (Uniquick), for (i) detection using highly purified toxin A solution; (ii) cross-reactivity using culture supernatants of toxin A-positive and B-positive C. difficile, toxin A-negative and B-positive C. difficile, and toxin A-negative and B-negative C. difficile strains and other bacteria; and (iii) sensitivity and specificity using clinical specimens. Results indicated that TOX A/B II detected toxin A at concentrations of 0.35 ng/mL and Uniquick at concentrations of 0.7 ng/mL. Uniquick performance was specific for detecting toxin A alone, while TOX A/B II detected toxin A/B specifically. Kit performance was then evaluated using 99 fecal specimens--43 specimens from patients with toxin B-positive C. difficile and 56 from those without. Sensitivity of TOX A/B II vs Uniquick was 95.3% vs 76.7%, specificity 98.2% vs 98.2%, positive predictive 97.6% vs 97.1%, and negative predictive value 96.5% vs 84.6%. Findings thus indicate that TOX A/B II is a more suitable diagnostic aid for CDAD than Uniquick because it correlates well with toxin B-positive C. difficile culture results. Stool culture for C. difficile is also required, however.