Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India.

Background: Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India. Methods: An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software. Results: The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women. Conclusion: The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review.

(1) Background: Despite ample research, the factors, specific causes, and pathways associated with chronic kidney disease of unknown etiology (CKDu) remain elusive. Therefore, we performed a systematic review to explore the potential etiologies for the development of CKDu globally. (2) Methods: A systematic literature review was conducted using databases CINAHL, Cochrane Library, Embase, Google Scholar, MEDLINE, and PsycINFO on the specific causes and pathophysiology related to CKDu from inception until April 2021. Study selection, data extraction of included articles, and quality appraisal were assessed. The narrative approach was used to summarize and comprehend the findings. (3) Results: Our study included 25 studies, considering 38,351 participants. Twelve studies were case-control, ten were cross-sectional, and three were cohort designs. All articles were from low-and middle-income countries (LMICs). The findings suggest 12 factors are associated with CKDu. Most studies (n = 8) identified farming and water sources as the factors related to CKDu, with heavy metal toxicity coming in second (n = 7). (4) Conclusion: The systematic review reported various factors associated with CKDu, from which most studies reported farming, water sources, and heavy metal poisoning. Considering the findings, the study recommends future strategies and public health initiatives to prevent the epidemiological/environmental factors contributing to CKDu.

Community response towards health care providers delivering health care services during COVID-19 pandemic: A strategy framework based on findings of a qualitative study in Odisha, India.

Context: While there are studies on peoples' behaviour toward health professionals (doctors and nurses) during the Coronavirus diesease (COVID-19) pandemic in hospital settings, there is limited literature on Community Health Workers (CHWs). Our study attempted to explore the behaviour of community people towards CHWs during the pandemic and its underlying reasons. Material and Method: A qualitative study using In-depth interviews (IDI) and focus group discussions (FGD) was conducted among CHWs and community people from six districts of Odisha from February to April 2021. The researchers transcribed the audio recordings in the vernacular language of the Odisha province, i.e., Odia, and later translated them into English. A qualitative content analysis method was used to prepare the detailed report using Max Weber Qualitative Data Analysis (MAXQDA) software. Result: The study found two major categories-Reflection on community behaviour towards CHWs during the COVID-19 pandemic and reflection on availing health care services by community people during a pandemic. Many CHWs revealed that the community people acknowledged their work and dedication and extended all sorts of co-operation and support. However, few community people were non-cooperative and non-supportive. Community reluctance owing to perceptions that the CHWs might be infected, was the significant cause that they faced a lack of support from the community. Further, to create awareness of COVID-19 infection among community people, CHWs adopted different strategies such as door-to-door visits, wall painting, poster display, and awareness through mikes. Conclusion: The efforts made by the CHWs during health emergencies need to be recognized and appraised.

Health literacy on hygiene and sanitation, nutrition, and diseases among rural secondary school children - Findings from a qualitative study in Odisha, India.

Context: Health literacy among school children is a priority to promote their health, hygiene, and nutrition behaviours and practices. Although in schools they learn from their peers and teachers, their domestic and social conditions also contribute to learning and adopting in practice. The level of health literacy is also influenced based on socio-demographic features. Aims: It is imperative to explore and understand the practices including existing gaps and challenges for future improvement. Methods and Material: A qualitative study consisting of 17 focus group discussions (FGDs) among students and teachers in six rural secondary schools was carried out in a rural block of the Cuttack district, Odisha. All FGDs were audio-recorded; transcribed and compiled data were imported into Atlas.ti for analysis. Results: An existing gap in health literacy and healthy practices with respect to hygiene and sanitation, nutrition, and diseases was observed. A low socio-economic status, inaccessibility to clean and safe drinking water, toilet facility, and nutritional food items were major factors preventing their health literacy and practice. Many schools have adopted measures such as poster presentation, practical teaching and demonstration, school play, and competitions at the school and in the community, which were found to be effective for creating awareness. Improving infrastructural facilities, ensuring availability of essential commodities, and having more health-promotional activities are required for improving health literacy and practice. Conclusions: There is an urgent need to improve the health literacy and practice among rural school children. Innovative practical-oriented education at schools and improved awareness among parents and community people would achieve better adherence to healthy practices.

A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries.

Background: Poor menstrual hygiene management (MHM) is linked to adverse health, and quality of life, particularly during emergencies. Although in recent times increased emphasis is being laid upon MHM during humanitarian crises-pandemics, disasters and conflicts, the essential components of complete MHM during an emergency are not clearly spelt out. We conducted a systematic review to examine, analyse and describe the existing evidence related to the challenges experienced by women and girls in practicing MHM during humanitarian crises and / or public health emergencies. Methods: We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD42022328636). We searched online repositories: PubMed, Embase, and PsycINFO for articles published between January 2000 and April 2022. For presenting key findings, we used the descriptive statistics and thematic analysis approach. Results: We identified a total of 1,078 published articles, out of which 78 were selected for a full-text review, and finally 21 articles were included. The pooled prevalence of lack of access to sanitary pads during humanitarian crises was 34 percent (95 percent CI 0.24-0.45). The prevalence of safe and proper sanitary pad disposal practices ranged from 11 to 85 per cent, with a pooled prevalence of 54 per cent (95 per cent CI 0.21-86). Qualitative analyses projected three themes that emerged on MHM during humanitarian crises (1) Availability and affordability of menstrual products, and accessibility to water, sanitation and health (WASH) services, (2) Availability of support system and coping with "period poverty," and (3) Gender dimensions of menstrual hygiene management. Most studies reported non-availability of MHM products and WASH services during emergencies. Existence of barriers at systemic and personal level posed challenges in practicing menstrual hygiene. Privacy was identified as a common barrier, as emergency shelters were reportedly not women-friendly. Conclusion: Availability of limited evidence on the subject is suggestive of the need to invest resources for strengthening primary research in low- and middle-income countries and more specifically during emergencies. Context-specific state level policies on MHM during emergencies would help to guide district and sub-district managers in strengthening systems and address barriers for the provision of MHM services during emergencies. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022328636, identifier CRD42022328636.

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review.

INTRODUCTION: Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services. METHODOLOGY: A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO). RESULTS: Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies. CONCLUSION: The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.

Enablers and barriers towards ensuring routine immunization services during the COVID-19 pandemic: findings from a qualitative study across five different states in India.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to disruption in delivering routine healthcare services including routine immunization (RI) worldwide. Understanding the enablers and barriers for RI services during a pandemic is critically important to develop context-appropriate strategies to ensure uninterrupted routine services. METHODS: A community-based, cross-sectional descriptive study was conducted in five different states of India, nested within an ongoing multicentric study on RI. Telephone in-depth interviews among 56 health workers were carried out and the data were analyzed using a content analysis method. RESULTS: During the COVID-19 pandemic, healthcare providers encountered many challenges at the health system, community and individual level when rendering RI services. Challenges like the limited availability of personal protective equipment and vaccines, deployment for COVID-19 duty at system level, the difficulty in mobilizing people in the community, fear among people at community level, mobility restrictions and limited family support, as well as the stress and stigma at individual level, were barriers to providing RI services. By contrast, the issuing of identification cards to health staff, engaging community volunteers, the support given to health workers by their families and training on COVID-19, were factors that enabled health workers to maintain RI services during the pandemic. CONCLUSIONS: When addressing the COVID-19-related public health emergency, we should not lose sight of the importance of services like RI.

Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India.

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.

Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public Survey in Odisha State, India.

Background: Integration of psychiatric care with public health services and offering mental health care services to patients from lower socioeconomic status remains a global challenge. Scarcity of funds and professional workforce in psychiatric hospitals contribute to this situation. However, negative attitudes in the population are also a known impediment to patients seeking mental health services. This study aimed to assess the attitudes toward psychiatric hospitals among the urban and rural population in India. Subjects and Methods: The study was carried out amongst the general population in Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-setting, and 492 respondents from rural parts of the district. Participants were selected by using simple random-sampling from the Asian Institute of Public Health (AIPH) data base. A standardized seven-item questionnaire was adopted, with responses indicated on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face. Results: Level of education (B = -0.192, ß = -0.320, p < 0.000) and urban-rural comparison (B = -0.272, ß = -0.189, p < 0.000) significantly influenced attitudes toward psychiatric hospitals. Gender, age, and religious beliefs did not show any significant effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with lower education levels showed more negative attitudes toward psychiatric hospitals. Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural areas as well as those with lesser education may be reflective of the lack of availability, accessibility, affordability, and credibility of such mental health services. The Mental Health Care Act in India is a progressive legislation which might improve the situation of the provided services and, consequently, reduce negative attitudes in the years to come.

Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries: A Systematic Review.

Maternal and child health (MCH) has been a global priority for many decades and is an essential public health service. Ensuring seamless delivery is vital for desirable MCH outcomes. This systematic review outlined the challenges in accessing and continuing MCH services during public health emergencies-pandemics and disasters. A comprehensive search approach was built based on keywords and MeSH terms relevant to 'MCH services' and 'pandemics/disasters'. The online repositories Medline, CINAHL, Psyc INFO, and Epistemonikos were searched for studies. We included twenty studies-seven were on the Ebola outbreak, two on the Zika virus, five related to COVID-19, five on disasters, and one related to conflict situations. The findings indicate the potential impact of emergencies on MCH services. Low utilization and access to services have been described as common challenges. The unavailability of personal safety equipment and fear of infection were primary factors that affected service delivery. The available evidence, though limited, indicates the significant effect of disasters and pandemics on MCH. However, more primary in-depth studies are needed to understand better the overall impact of emergencies, especially the COVID-19 pandemic, on MCH. Our synthesis offers valuable insights to policymakers on ensuring the uninterrupted provision of MCH services during an emergency.

Intrapartum monitoring using partograph at secondary level public health facilities-A cross-sectional study in Odisha, India.

CONTEXT: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. AIM: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities. SETTINGS AND DESIGN: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. STATISTICAL ANALYSIS USED: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. RESULTS: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. CONCLUSIONS: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting.