Journal of Global Health

Health systems in low- and middle-income countries (LMICs) like Bangladesh face persistent challenges in delivering timely and equitable care, often exacerbated by poor planning and inefficient resource allocation. Forecasting service utilisation using routine health data can support more responsive and data-driven health system planning, yet such approaches remain underutilised in Bangladesh. By analysing service utilization trends and projecting future service volume at national and regional l...

IntroductionFrom 2013-2015, a CPAP quality improvement program (QIP) was implemented to introduce and monitor CPAP usage and outcomes in the neonatal wards at all government district and central hospitals in Malawi. In 2016 the CPAP QIP was extended into healthcare facilities operated by the Christian Health Association of Malawi. Although clinical outcomes improved, ward assessments indicated that many rural sites lacked other essential equipment and a suitable space to adequately treat sick ne...

BackgroundIn sub-Saharan Africa, maternal and newborn deaths remain disproportionately higher among low-income populations, and they are associated with delivery in poorly equipped facilities and a shortage of staff to manage birth complications. We measured facility readiness to provide essential maternal and newborn health services and its association with womens experience of person-centered maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nair...

BackgroundEffective coverage cascades have been proposed to understand to what extent populations are able to benefit from interventions to address their health needs. Theoretical effective coverage cascades have been developed for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH&N), but there is no consensus regarding the methods to estimate effective coverage cascades. We operationalized the proposed effective coverage cascades for selected RMNCAH&N services;...

BackgroundLack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access. MethodsWe formulated two facility locatio...

INTRODUCTIONThe timing of antenatal care (ANC) attendance may affect outcomes for mother and child health. Using the Zambia Demographic and Health Survey (ZDHS), we describe the adoption of at least four early ANC (ANC4+) visits and early uptake of ANC among women of reproductive age in Zambia between 2007 and 2019. METHODSWe made use of ZDHS data gathered between 2007 and 2019. In this investigation, all women between the ages of 15 and 49 were taken into account. Early ANC4+ was the desired r...

Efforts to improve maternal health in the Democratic Republic of Congo (DRC) have often focused on expanding access and improving structural readiness. These are critical first steps, but this analysis reveals a critical missing link: womens perceptions of care--including how they are treated, how much they trust providers, and how affordable care seems--which are more predictive of health-seeking behavior than objective facility infrastructure or actual cost. Drawing on two rounds of household...

BackgroundGeographic access to healthcare continues to pose a significant challenge for pregnant women in rural areas of sub-Saharan Africa, resulting in consistently high rates of maternal mortality. Geographic barriers can persist even in settings where financial barriers have been reduced and health system strengthening (HSS) efforts are in place. The aim of this study is to combine analyses of a population-representative cohort and geolocated maternal consultation data at the village level t...

AbstractsO_ST_ABSBackgroundC_ST_ABSMaternal mortality remains far above the Sustainable Development Goal (SDG) target in many settings, and global strategies lack an empirically derived coverage threshold for "safe" delivery. MethodsWe assembled a longitudinal panel of 2 184 country-year observations from 182 countries (2000-22), linking UN Maternal Mortality Estimation Inter-agency Group estimates with WHO and World Bank indicators. The primary exposure was institutional-birth coverage (% of l...

BackgroundWhile maternal education is linked to antenatal care (ANC) use, its causal effect remains uncertain. This study applies a machine learning approach, Causal Forests, to estimate the causal impact of maternal education on adequate ANC utilization in Bangladesh. MethodsWe analyzed data from 6,815 ever-married women aged 15-49 years who had a live birth within five years preceding the 2022 Bangladesh Demographic and Health Survey (BDHS). The outcome was adequate ANC utilization, defined a...

BackgroundThe COVID-19 pandemic has overwhelmed hospitals in several areas in high-income countries. An effective response to this pandemic requires healthcare workers (HCWs) to be present at work, particularly in low- and middle-income countries (LMICs) where they are already in critically low supply. To inform whether and to what degree policymakers in Bangladesh, and LMICs more broadly, should expect a drop in HCW attendance as COVID-19 continues to spread, this study aims to determine how HC...

BackgroundThe Covid-19 pandemic led to widespread changes to health and social institutions. The effects of the pandemic on neonatal and infant health outcomes in low- and middle-income countries (LMICs) are poorly understood, and nationally representative data characterizing changes to health care and outcomes is only now emerging. MethodsWe used nationally representative survey data with vital status and perinatal care information on 2,959,203 children born in India, Madagascar, Cambodia, Nep...

BackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children 0-59 months treated in a South African public hospital setting. MethodsA retrospective cohort study was performed on hospital files of children diagnosed...

BackgroundHigh-quality healthcare for pregnant women and newborns, particularly postnatal care (PNC) and small and/or sick newborn care (SSNC), is essential to reducing maternal and newborn morbidity and mortality in low- and middle-income countries (LMICs). Poor quality of care is a major contributor to preventable morbidity and mortality, emphasizing the need for improvements in health service delivery, which requires measuring and monitoring quality of care (QoC). Although indicators measurin...

ObjectiveSaudi Arabia ranks second in the number of coronavirus disease 2019 (COVID-19) cases in the Eastern Mediterranean region. It houses the two most sacred religious places for Muslims: Mecca and Medina. It is important to know what the trend in case numbers will be in the next 4-6 months, especially during the Hajj pilgrimage season. MethodsEpidemiological data on COVID-19 were obtained from the Saudi Arabian Ministry of Health, the World Health Organization, and the Humanitarian Data Exc...

BackgroundThere is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. Method...

BackgroundSmall and nutritionally at-risk infants aged <6 months are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6m admitted to inpatient therapeutic care. MethodsA secondary analysis of 2002-2008 data included 5,034 infants aged <6m from 12 countries. The prevalence, concurrence, and severity of wasted, stunted, underweight, and the Composite Index of Anthr...

BackgroundMaternal and newborn studies in Uganda have primarily focused on measuring coverage of facility-based birth. However, this is inadequate and tends to overestimate the benefits of services provided to women and newborns if the quality of care in the facilities is not considered. Effective coverage of care addresses this limitation and adjusts for the quality of services. This study aimed to assess the effective coverage of maternal and newborn care in Uganda. MethodsWe analyzed the 202...

BackgroundNeonatal encephalopathy (NE) accounts for [~]23% of the 2.4 million annual global neonatal deaths. Most of these deaths occur in sub-Saharan Africa. However, data from low resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with NE from a tertiary neonatal unit in Zimbabwe. MethodsA retrospective review of risk factors of short-term NE mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 - October 2019). Data were...

BackgroundAcute malnutrition, also known as wasting, affected an estimated 45 million children under 5 (CU5) globally in 2023. Wasting is measured using a childs mid upper arm circumference (MUAC), weight-for-height z-score (WHZ), or nutritional edema. In low-resource contexts, MUAC is often the only measurement used to regularly screen for malnutrition, but recent research suggests MUAC alone fails to diagnose 25%-80% of WHZ-wasted children. MUACZ, an age-adjusted MUAC z-score, may identify add...