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Abstract Background There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability. Methods A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata. Results Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals. La Strategie mondiale pour la sante de la femme, de l'enfant et de l'adolescent (2016-2030) reconnait que les individus jouent un role central dans l'amelioration de leur propre sante. Nous pensons que la participation communautaire, et notamment des communautes qui travaillent avec les services de sante (coproduction en matiere de soins de sante), sera essentielle pour atteindre les objectifs de la strategie mondiale. La participation communautaire repond plus particulierement au troisieme objectif cle: transformer les societes afin que les femmes, les enfants et les adolescents puissent exercer leur droit dejouirdu meilleur etat de sante et de bien-etre possible. Dans le present rapport, nous examinons ce que ceci suppose dans la pratique. Nous analysons trois domaines interdependants dans le cadre d'une action visant une plus grande participation du public en matiere de sante: ameliorer la capacite de participation des individus et des groupes, developper et assurer la perennite des services de sante axes sur l'etre humain, et favoriser la responsabilisation sociale. Nous donnons par ailleurs un apercu des difficultes liees a la mise en oeuvre et fournissons aux decideurs, aux administrateurs de programmes et aux professionnels de la sante des exemples illustrant les differents types d'approches participatives necessaires dans chaque domaine pour atteindre les objectifs lies a la sante et au developpement. La Estrategia Mundial para la Salud de la Mujer, el Nino y el Adolescente (2016-2030) reconoce que las personas tienen un papel fundamental a la hora de mejorar su propia salud. Proponemos que la participacion comunitaria, concretamente las comunidades que trabajan junto con los servicios sanitarios (coproduccion de atencion sanitaria), sea fundamental para lograr los objetivos de la estrategia mundial. En particular, la participacion comunitaria aborda el tercer objetivo fundamental: transformar las sociedades de modo que las mujeres, los ninos y los adolescentes puedan ejercer sus derechos de salud y bienestar en la mayor medida posible. En este articulo se examina lo que esto implica en la practica. Se debaten tres ambitos de accion interdependientes que se encaminan hacia una mayor participacion del publico en la sanidad: mejorar las capacidades para la participacion individual y en grupo; desarrollar y mantener servicios sanitarios centrados en las personas; y contabilidad social. Se repasan los desafios para su implementacion,y se ofrece a los responsables politicos, gestores de programas y medicos ejemplos ilustrativos de los tipos de enfoques de participacion necesarios en cada ambito para contribuir a alcanzar los objetivos sanitarios y de desarrollo., Introduction The Global strategy for women's, children's and adolescents' health (2016-2030) calls for action towards three objectives for health: survive (end preventable deaths), thrive (ensure health and well-being) and transform [...]

Objective To identify how 10 low-and middle-income countries achieved accelerated progress, ahead of comparable countries, towards meeting millennium development goals 4 and 5A to reduce child and maternal mortality. Methods We synthesized findings from multistakeholder dialogues and country policy reports conducted previously for the Success Factors studies in 10 countries: Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. A framework approach was used to analyse and synthesize the data from the country reports, resulting in descriptive or explanatory conclusions by theme. Findings Successful policy and programme approaches were categorized in four strategic areas: leadership and multistakeholder partnerships; health sector; sectors outside health; and accountability for resources and results. Consistent and coordinated inputs across sectors, based on high-impact interventions, were assessed. Within the health sector, key policy and programme strategies included defining standards, collecting and using data, improving financial protection, and improving the availability and quality of services. Outside the health sector, strategies included Investing in girls' education, water, sanitation and hygiene, poverty reduction, nutrition and food security, and infrastructure development. Countries improved accountability by strengthening and using data systems for planning and evaluating progress. Conclusion Reducing maternal and child mortality in the 10 fast-track countries can be linked to consistent and coordinated policy and programme inputs across health and other sectors. The approaches used by successful countries have relevance to other countries looking to scale-up or accelerate progress towards the sustainable development goals. Objectif Determiner comment dix pays a revenu faible et intermediaire ont reussi a accomplir des progres acceleres, vis-a-vis de pays comparables, en vue d'atteindre les objectifs 4 et 5A du Millenaire pour le developpement visant a reduire la mortalite infantile et maternelle. Methodes Nous avons synthetise les conclusions de dialogues multipartites et de rapports d'orientation nationaux precedemment etablis pour etudier les facteurs de succes dans les dix pays concernes: le Bangladesh, le Cambodge, la Chine, l'Egypte, l'Ethiopie, le Nepal, le Perou, la Republique democratique populaire lao, le Rwanda et leVIet Nam. Une approche de cadre a ete utilisee pour analyser et synthetiser les donnees tirees des rapports nationaux, ce qui a donne Heu a des conclusions descriptives ou explicatives en fonction de differents themes. Resultats Les approches politiques et de programme reussies ont ete classees dans quatre domaines strategiques: leadership et partenariats multipartites; secteur de la sante; secteurs autres que celui de la sante; et responsabilisation en matiere de ressources et de resultats. Les contributions coherentes et coordonnees dans les differents secteurs, basees sur des interventions a fort impact, ont ete evaluees. Dans le secteur de la sante, les principales strategies politiques et de programme incluaient la definition de normes, la collecte et l'utilisation de donnees, l'amelioration de la protection financiere et l'amelioration de l'accessibilite et de la qualite des services. En dehors du secteur de la sante, les strategies Impliquaient des investissements dans l'education des filles, l'eau, l'assainissement et l'hygiene, la reduction de la pauvrete, la nutrition et la securite alimentaire et le developpement des infrastructures. Les pays ont ameliore leur responsabilisation grace au renforcement et a l'utilisation de systemes de donnees permettant de planifier et d'evaluer les progres. Conclusion La reduction acceleree de la mortalite maternelle et infantile dans les dix pays peut etre liee a l'elaboration de politiques et de programmes coherents et coordonnes au sein du secteur de la sante et des autres secteurs. Les approches utilisees par les pays qui enregistrent des succes presentent un interet pour d'autres pays cherchant a augmenter ou a accelerer les progres en vue des objectifs de developpement durable. Objetivo Identificar el modo en que diez paises con ingresos bajos y medios han logrado un progreso acelerado, por delante de paises comparables, camino de cumplir los objetivos de desarrollo del milenio 4 y 5A para reducir la mortalidad infantil y materna. Metodos Se sintetizaron los resultados de dialogos entre varias partes y los informes de politicas de paises redactados anteriormente en relacion con los estudios de los factores de exito en los diez paises: Bangladesh, Camboya, China, Egipto, Etiopia, Nepal, Peru, Republica Democratica Popular Lao, Rwanda y Viet Nam. Se utilizo un enfoque de marco para analizar y sintetizar los datos de los informes de paises, lo que dio lugar a conclusiones descriptivas o explicativas por tema. Resultados Se categorizaron los enfoques de programas y politicas que tuvieron exito en cuatro areas estrategicas: alianzas de liderazgo y de diversas partes interesadas; sector sanitario; sectores no sanitarios; y contabilidad de recursos y resultados. Se evaluaron las contribuciones coherentes y coordinadas en todos los sectores, en base a las intervenciones con gran impacto. Dentro del sector sanitario, las estrategias fundamentales de programas y politicas incluyeron la definicion de estandares, la recopilacion y el uso de datos, la mejora de la proteccion financiera y la mejora de la disponibilidad y calidad de los servicios. Fuera del sector sanitario, las estrategias incluyeron la inversion en la educacion de ninas, agua, saneamiento e higiene, reduccion de la pobreza, nutricion y seguridad alimentaria, y desarrollo de infraestructuras. Los paises mejoraron su contabilidad consolidando y utilizando sistemas de datos para el progreso de planificacion y evaluacion. Conclusion La reduccion de la mortalidad materna e infantil en los diez paises de via rapida puede estar relacionada con las contribuciones coherentes y coordinadas de programas y politicas, tanto en el sector sanitario como en otros. Los enfoques utilizados por los paises que han tenido exito son relevantes para otros paises que buscan aumentar y acelerar el progreso hacia los objetivos de desarrollo sostenible., Introduction Between 1990 and 2015, during the era of the millennium development goals (MDGs), there was unprecedented global progress towards reducing both child and maternal mortality by around 50%. (1,2) [...]

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches In addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector Investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results overtime. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond. La reduction de la mortalite maternelle et infantile est une priorite des objectlfs du Millenaire pour le developpement (OMD) et le restera probablement apres l'echeance de 2015. Il existe des donnees sur les investissements, les interventions et les politiques habilitantes necessaires. On comprend mal pourquoi certains pays ont realise des progres plus rapidement que d'autres pays comparables. Les Facteurs de reussite des etudes sur la sante des femmes et des enfants ont cherche a combler ce manque de connaissances en utilisant les analyses statistiques et econometriques des donnees provenant de 144 pays a faible revenu et a revenu intermediaire et recueillies depuis 20 ans: une analyse comparative qualitative booleenne; une etude bibliographique et des etudes specifiques a chaque pays pour les 10 pays a progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard--les pays a progression rapide ont deploye des strategles personnalisees et se sont adaptes rapidement auxchangements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de reduire la mortalite maternelle et infantile. Premierement, ils impliquent de nombreux secteurs pour traiter les facteurs determinants et cruciaux pour la sante. Pres de la moitie de la reduction de la mortalite infantile dans les pays a faible revenu et a revenu intermediaire depuis 1990 resulte des investissements dans le secteur de la sante, l'autre moitie etant attribuee aux investissements realises dans les secteurs exterieurs a la sante. Deuxiemement, ces pays utilisent des strategies pour mobiliser les partenaires dans la societe, en utilisant des donnees solides et opportunes pour la prise de decisions et la responsabilisation, ainsi qu'une approche de planificaron triple pour prendre en consideration les besoins immediats, la vision a long terme et l'adaptation aux changements. Troisiemement, ces pays etablissent des principes directeurs qui orientent les progres, harmonisent les actions des parties prenantes et generent des resultats dans le temps. Cette synthese de donnees contribue a l'ensemble des connaissances requises pour accelerer les amellorations sur la sante des femmes et des enfants en vue de l'echeance de 2015 et au-dela. La reduccion de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguira siendo despues de 2015. Existen evidencias sobre las inversiones, las intervenciones y las politicas necesarias, pero se sabe menos acerca de por que algunos paises logran un progreso mas rapido que otros paises comparables. Los estudios relativos a los Factores de Exito en la Salud de las Mujeres y los Ninos han tratado de abordar esta brecha de conocimiento por medio de analisis estadisticos y econometricos de datos de 144 paises de ingresos bajos y medianos (PIBM) a lo largo de mas de 20 anos, analisis comparativos cualitativos booleanos, revision de la literatura y revisiones especificas de cada pais en 10 paises bien encarrilados para los ODM 4 y 5a. No existe una formula estandar, estos paises despliegan estrategias a medida y se adaptan rapidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres areas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reduccion de la mortalidad infantil en los PIBM desde 1990 es el resultado de Inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ambito sanitario. En segundo lugar, estos paises utilizan estrategias para movilizara socios a traves de la sociedad, utilizando evidencias oportunas y solidas para la toma de decisiones y la rendicion de cuentas, asi como un enfoque de planificacion triple para considerar las necesidades inmediatas, la vision a largo plazo y la adaptacion al cambio. En tercer lugar, los paises establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre como acelerar las mejoras en la salud de mujeres y ninos hacia el 2015 y mas adelante., Introduction Worldwide, accelerated progress is required to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) as highlighted in the United Nations Secretary-General's Global Strategy [...]

Stakeholders from a range of sectors --including health, finance, planning, water and sanitation, nutrition and education--and from diverse constituencies --including government, nongovernmental organizations, private sector and academic institutions --all contribute [...]

Background: There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.Methods: A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0-3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata.Results: Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70-200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby's father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001).Conclusions: Informal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children. [ABSTRACT FROM AUTHOR]