An integrated care pathway for maternal and childcare: evidence from Ethiopia, Tanzania, and Uganda

Abstract   Performance monitoring and evaluation are key to quality improvement in maternal and child healthcare in Sub-Saharan Africa. This study presents the experience of designing and implementing bottom-up and integrated performance evaluation tools for care pathway to monitor and manage maternity healthcare services. The research project involved four health districts and relative reference hospitals, supported by the NGO Doctors with Africa CUAMM in Ethiopia, Tanzania, and Uganda. The maternal and childcare pathway developed consists of 23 indicators, calculated at hospital and district level, relating to pregnancy, childbirth and first year of life phases. The authors developed staves and performance maps, as graphical representation tools, to display longitudinally integrated health services provision performance along the continuum of care. Substantial variation was observed between the phases of each maternal and childcare pathway and across the care pathways of the different analysed settings. The most impressive results across the four settings are: 1) regarding pregnancy phase, that women tend to attend more than four antenatal classes, still with a quite high drop-out rate, and are largely tested for syphilis, 2) with respect to childbirth, that there are varying percentage levels in terms of C-sections, episiotomies and peri/intra-partum asphyxia cases, and 3) as it regards first year of life, there emerges scope for improvement considering the vaccination coverages attained for pentavalent, measles and polio vaccinations. Thanks to the collaboration with local managers and health professionals, the maternal and childcare pathway allowed to monitor the changes in the quality of maternity services provided within the analysed contexts. The benchmarking approach encouraged local professionals to learn from other settings. The use of such tool allowed the development of targeted quality improvement actions, shared among all involved stakeholders. Key messages • In collaboration with local professionals, we designed and implemented an integrated pathway for maternal and childcare, covering the phases of pregnancy, childbirth and first year of life. • Benchmarking performance results encouraged collaboration among professionals and allowed the identification of actions to improve the provision of maternal and childcare services.


Background:
Timely vaccination is essential to protect infants from vaccinepreventable diseases.The aim of the study was to evaluate the determinants of vaccination timeliness for hexavalent (HEXA) and measles-mumps-rubella (MMR) vaccines.

Methods:
The study is part of the PREHMO project funded by Tuscany Region, Italy.Data on the 2017 and 2018 full birth cohorts of Tuscany (N = 41,493) were retrieved from the Birth Registry and linked to those of the Vaccine Registry up to 24 months after birth.Sociodemographic and at birth characteristics of mothers and infants were retrieved.The primary outcome was the timeliness of HEXA 1st and 3rd doses, and MMR 1st dose.Timeliness was defined as the administration of the dose a day after the period recommended by the vaccination schedule.Multiple logistic regression models were performed.

Results:
For all the vaccines considered, a significantly increased risk of delayed vaccination was observed in preterm infants and in infants born in hospital of second level of newborn care, while infants conceived by assisted reproductive technologies and first-born infants showed a significantly decreased risk for delayed vaccination.Multiple births, small for gestational age status, maternal unemployment, and rural residence were significantly associated with an increased risk of delayed HEXA-1 vaccination (OR 1.31,OR 1.12,OR 1.06,and OR 1.1,).As for MMR vaccination, a low maternal education was significantly associated with high risk of delay (OR 1.12, 95%CI 1.06-1.18),while rural residence, maternal foreign nationality and female sex were significantly associated with a decreased risk of delay (OR 0.91,OR 0.82,and OR 0.95,.

Conclusions:
Several common and vaccine-specific predictors of vaccination timeliness were identified.Strategies to improve a timely vaccination should take into account these predictors.

Key messages:
Several maternal and infants factors may influence vaccination timeliness of routine immunization in childhood.
Tailored vaccination strategies are needed to improve vaccination timeliness in infants at high-risk of delayed vaccination.
Abstract citation ID: ckac129.393An integrated care pathway for maternal and childcare: evidence from Ethiopia, Tanzania, and Uganda Ilaria Corazza Health and Management Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy Performance monitoring and evaluation are key to quality improvement in maternal and child healthcare in Sub-Saharan Africa.This study presents the experience of designing and implementing bottom-up and integrated performance evaluation tools for care pathway to monitor and manage maternity healthcare services.The research project involved four health districts and relative reference hospitals, supported by the NGO Doctors with Africa CUAMM in Ethiopia, Tanzania, and Uganda.The maternal and childcare pathway developed consists of 23 indicators, calculated at hospital and district level, relating to pregnancy, childbirth and first year of life phases.The authors developed staves and performance maps, as graphical representation tools, to display longitudinally integrated health services provision performance along the continuum of care.Substantial variation was observed between the phases of each maternal and childcare pathway and across the care pathways of the different analysed settings.The most impressive results across the four settings are: 1) regarding pregnancy phase, that women tend to attend more than four antenatal classes, still with a quite high drop-out rate, and are largely tested for syphilis, 2) with respect to childbirth, that there are varying percentage levels in terms of C-sections, episiotomies and peri/intra-partum asphyxia cases, and 3) as it regards first year of life, there emerges scope for improvement considering the vaccination coverages attained for pentavalent, measles and polio vaccinations.Thanks to the collaboration with local managers and health professionals, the maternal and childcare pathway allowed to monitor the changes in the quality of maternity services provided within the analysed contexts.The benchmarking approach encouraged local professionals to learn from other settings.The use of such tool allowed the development of targeted quality improvement actions, shared among all involved stakeholders.
15th European Public Health Conference 2022

Key messages:
In collaboration with local professionals, we designed and implemented an integrated pathway for maternal and childcare, covering the phases of pregnancy, childbirth and first year of life.
Benchmarking performance results encouraged collaboration among professionals and allowed the identification of actions to improve the provision of maternal and childcare services.

6.O. Workshop: Urban design interventions for fostering mental health and mental health literacy
Abstract citation ID: ckac129.394 Organised by: Darmstadt University of Applied Sciences (Germany) Chair persons: Evangelia Chrysikou (EUPHA-URB) Contact: helena.mueller@h-da.de With roughly half of the global population living in cities and an expected rise up to 85 % by 2050, urban environments are central to public health.Yet, they are often perceived as health risk factors due to e.g., noise, pollution, crowding, and anonymity.Indeed, mental disorders show higher incidence in urban contexts compared to rural areas, generally increasing, e.g., due to the Covid19-pandemic as well as to climate change.However, we argue that there is also a rich potential of urban environments to act as resource for mental health and to address mental health issues in the public space.Design interventions such as urban furniture, art and information elements can act as perceived affordances, signifiers and situative stimuli to influence health behaviour, social discourse and individual mindsets regarding health.Furthermore, by considering their unique potentials and resources during the design process, the specific surroundings of these interventions can become an integral part of the actual design.As a result, this might change citizens' perspective on the urban setting as such.While there exists a large body of literature as well as case studies focusing on physical health promotion by urban design interventions, evidence regarding its mental correlate is still scarce.This workshop aims at collecting and elaborating on features in the urban space as potential resources to foster mental health as well as mental health literacy.To that aim, first, three seven-minutespresentations introduce different disciplinary perspectives on the topic: Starting from a psychological point of view, the relationship between urban environments and mental health will be outlined.Based on insights from human geography, social determinants of urban settings will be elaborated and participatory approaches will be presented as a crucial method for designing effective intervention.Synthesizing these insights, the role of design to influence health behaviour will be discussed and afterwards illustrated using the example of a trail-based design concept as the backdrop for the interactive part.In the second part of this session, first, co-creation methods (such as mindmapping and brainwriting) will be applied together with participants to brainstorm relevant categories, features and potentials of the urban space to foster mental health and mental health literacy.Participants will then be asked to contribute their expertise from their specific field of work particularly with regards to increasing mental health literacy in citizens.This exercise will be highly valuable for participants to acquire interdisciplinary knowledge regarding the influence of urban design interventions and mental health and broaden their perspective and knowledge regarding urban mental health and the built environment.Learnings and variations of this exercise could be also applicable in other settings such as rural communities or semi-public spaces.

Key messages:
This workshop aims at understanding how features of the urban space can be utilised to foster mental health and mental health literacy.By co-creatively sharing and elaborating on insights from various disciplines, participants broaden their horizons regarding the interrelations between the urban built environment and mental health.People shape their physical environments -and vice versa.As such, cities provide both resources (e.g., job opportunities, cultural diversity) as well as stressors (e.g., crowding, noise pollution) to their residents and visitors.In this context, numerous studies illustrate a considerable influence of the built environment (townscape, architecture) on health and well-being of interacting people.This impact ranges from physical aspects (e.g., traffic safety, particulate matter) to psychological processes (e.g., stress, loneliness) and behavioral aspects (e.g., physical activity, social behavior).At the same time, phenomena such as homelessness, crime, or mental disorders (e.g., substance addictions, schizophrenia) occur more frequently in cities compared to rural areas, illustrating causal as well as selective processes in the relation of urban environment and mental health.Increasing overall incidences in mental disorders (especially anxiety disorders and depression), the short-term shortage of psychotherapeutic care as well as the long-term economic burden on the health care system ask for a twofold strategy in public health: a) an extension of preventive measures with low threshold, i.e., accessible by large shares of the population, b) an extension of mental health literacy, which will empower the population to be attentive to mental health issues in themselves and others and which in turn can help to reduce stigmatization.While urban green and blue spaces have been researched in terms of restorative environments -allowing to regenerate resources consumed during the day -the built environment is still a resource for this strategy that has received insufficient attention to date.Utilizing the urban built environment not only as restorative but also informative and engaging environments thus affords an opportunity to address and potentially foster mental health and mental health literacy in citizens across socioeconomic backgrounds.