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ObjectivesTo estimate referral compliance and examine factors that influence decisions to comply with referral for newborn and maternal complications in Bosaso, Somalia.SettingBosaso, Somalia, is a large port city that hosts a large proportion of internally displaced persons. The study was conducted at the only four primary health centres offering 24/7 delivery services and the only public referral hospital in Bosaso.ParticipantsAll pregnant women who sought care at four primary centres and were referred to the hospital for maternal complications or mothers whose newborns were referred for neonatal complications were approached for enrolment from September to December 2019. In-depth interviews (IDIs) of 54 women and 14 healthcare workers (HCWs) were conducted.Outcome measuresThis study examined timely referral compliance from the primary centre to the hospital. IDIs were analysed for a priori themes investigating the decision-making process and experience of care for maternal and newborn referrals.ResultsOverall, 94% (n=51/54) of those who were referred, 39 maternal and 12 newborns, complied with the referral and arrived at the hospital within 24 hours. Of the three that did not comply, two delivered on the way, and one cited lack of money as the reason for noncompliance. Four themes emerged: trust in medical authority, cost of transportation and care, quality of care, and communications. The factors that facilitated compliance were the availability of transportation, family support, concern for health, and trust in medical authority. HCWs raised the importance of considering the maternal-newborn dyad throughout the referral process, and the need for official standard operating procedures for referrals including communications between the primary care and the hospital.ConclusionsHigh compliance for referral from primary to hospital care for maternal and newborn complications was observed in Bosaso, Somalia. Costs associated with transportation and care at the hospital need attention to motivate compliance.

Adolescent have high sense of curiosity but lack opportunity to obtain information and knowledge about reproductive health. Lack of parental support in providing knowledge about sexuality and reproductive health causes them to seek alternative sources of information such as from friends and the internet where they end up accessing pornography. This study aims to analyze the relationship between gender, attitudes about virginity, dating, adolescents’ level of knowledge on reproductive health, parents’ education level as well as parent-to-child communication on reproductive health with pornographic access behavior in high school students in Yogyakarta, Indonesia. We purposively selected370 high school students aged 17-18 years old living with their parents. . The questionnaire was tested for validity and reliability. The chi square analysis showed that there was a significant relationship between gender, attitudes about man virginity, woman virginity and dating, mother's education level, father's education level and mother-child communication about reproductive health with pornographic access behavior (p-value 0.05). The most significant factor that influenced the behavior of access to pornography is mother-to-child communication on reproductive health (p-value 0.003; PR 2.941; CI 95% 1.459-5.928). Improved communication between the mother and child about reproductive health will have a positive impact on reducing the amount of pornographic access by high school students.

Humanitarian crises, driven by disasters, conflict, and disease epidemics, have profound effects on society, including on people’s health and well-being. Occurrences of conflict by state and nonstate actors have increased in the last 2 decades: by the end of 2018, an estimated 41.3 million internally displaced persons and 20.4 million refugees were reported worldwide, representing a 70% increase from 2010. Although public health response for people affected by humanitarian crisis has improved in the last 2 decades, health actors have made insufficient progress in the use of evidence-based interventions to reduce neonatal mortality. Indeed, on average, conflict-affected countries report higher neonatal mortality rates and lower coverage of key maternal and newborn health interventions compared with non–conflict-affected countries. As of 2018, 55.6% of countries with the highest neonatal mortality rate (≥30 per 1000 live births) were affected by conflict and displacement. Systematic use of new evidence-based interventions requires the availability of a skilled health workforce and resources as well as commitment of health actors to implement interventions at scale. A review of the implementation of the Helping Babies Survive training program in 3 refugee responses and protracted conflict settings identify that this training is feasible, acceptable, and effective in improving health worker knowledge and competency and in changing newborn care practices at the primary care and hospital level. Ultimately, to improve neonatal survival, in addition to a trained health workforce, reliable supply and health information system, community engagement, financial support, and leadership with effective coordination, policy, and guidance are required.

Background: Each year, there are 2.5 million stillbirths and 2.6 million neonatal deaths. Intrapartum asphyxia is estimated to underlie nearly 25% of all perinatal mortality. Low/middle-income countries (LMICs) bear a disproportionate burden for asphyxia-related deaths. Helping Babies Breathe (HBB) is a purpose-adapted neonatal resuscitation training and educational program, which has rolled out in 80+ LMICs. This presentation describes the manner by which global scale-up of HBB, underpinned by unique public/private partnerships, has …

Background Increasingly, neonatal mortality is concentrated in settings of conflict and political instability. To promote evidence-based practices, an interagency collaboration developed the Newborn Health in Humanitarian Settings: Field Guide. The essential newborn care component of the Field Guide was operationalized with the use of an intervention package encompassing the training of health workers, newborn kit provisions and the installation of a newborn register. Methods We conducted a quasi-experimental prepost study to test the effectiveness of the intervention package on the composite outcome of essential newborn care from August 2016 to December 2018 in Bossaso, Somalia. Data from the observation of essential newborn care practices, evaluation of providers’ knowledge and skills, postnatal interviews, and qualitative information were analyzed. Differences in two-proportion z-tests were used to estimate change in essential newborn care practices. A generalized estimating equation was applied to account for clustering of practice at the health facility level. Results Among the 690 pregnant women in labor who sought care at the health facilities, 89.9% (n = 620) were eligible for inclusion, 84.7% (n = 525) were enrolled, and newborn outcomes were ascertained in 79.8% (n = 419). Providers’ knowledge improved from pre to posttraining, with a mean difference in score of + 11.9% (95% CI: 7.2, 16.6, p-value p-value Conclusions The intervention package was feasible and effective in improving essential newborn care. Knowledge and skills gained after training were mostly retained at the 18-month follow-up.

Curing and eradicating Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) are to the core principles of the United Nations’ Sustainable Development Goals (SDGs). The incidence of HIV in the world remains high. Although midwives play a pivotal role in PMTCT implementation, the factors associated with midwives’ role in its implementation are not well understood. The aim of this study was to determine factors associated with midwives’ role in implementation of PMTCT. This study used a cross-sectional design. The subjects were 80 midwives at 14 primary health care in Yogyakarta City, Indonesia. The study was conducted from April to August 2017. Data were analyzed through univariate, bivariate with chi-square and Fisher’s exact test, multivariate with logistic regression. The results showed that 47.5% of midwives were in the poor category regarding implementation of PMTCT. Information availability through socialization (p-value = 0.047) and knowledge level (p-value = 0.016) were found to be related to PMTCT implementation. There was no relationship between age, length of work, education level, marital status, availability of information, midwife’s attitude, perception of the availability of facilities and institutional support with midwife behavior in PMTCT implementation. Multivariate analysis showed that level of knowledge was the most dominant factor affecting PMTCT implementation (OR:6.2; CI 95% = 1.8-21.4). We recommend that efforts should be made to continuously improve the knowledge of midwives on PMTCT implementation through peer support and training in order to achieve sustainable development goals.

Despite high sexual activity among adolescent girls in Kenya, contraceptive uptake is very low with only about 26 percent sexually active adolescent girls currently using a contraceptive method. This exposes them to HIV infections and unplanned pregnancies which consequently lead to school dropouts, unsafe abortions, and lack of employment opportunities. This cross-sectional study aimed at assessing the utilization of contraceptives among secondary school adolescent girls in Karuri Town Council, Kiambu County. Overall, 421 girls aged between 13.0 to 19.0 years took part in the study. Findings showed that despite majority (77.5%) of the adolescent girls having had sexual debut by the age of 15 years, contraceptive utilization was very low at 43%. The results revealed that age of the adolescent, knowledge of contraceptives options, perception and accessibility of the contraceptives had positive significant effect on contraceptive utilization. Adolescents aged 18 years and above were more likely to utilize contraceptives as compared to those of a lesser age (p ≤ 0.001; OR: 9.870 (95% CI: 3.781 - 25.763)). Those with knowledge on contraceptives were OR 3.2 times more likely to use contraceptives (p = 0.025), similarly, accessibility was significantly associated with increased contraceptive utilization (p = 0.34, 95% CI: 1.054 - 4.187). Adolescents who perceived use of contraceptives as wise were more likely to use a contraceptive than those of a divergent opinion (OR: 2.053 (95% CI: 1.024 - 4.115), p = 0.041). This revealed that high level of knowledge on contraceptives did not always amount to practice. There is therefore a need to develop age specific reproductive health messages to guide school education curriculum as well as parent or guardian-child communication.

Background: The health needs in poor communities are often dictated by data that is not relevant to the community. The capabilities approach (CA) offers a philosophical and practical way to frame and analyse data and apply it to a community using the World Health Organisation socioeconomic framework. This was part of the NHS Health Education England East Midlands Global Health Exchange Fellow Programme. Methods: A team of 2 Kenyan and 2 UK community clinicians worked together in deprived communities in Kenya and the UK using qualitative research methods to facilitate the communities to define and prioritise their health needs and to explore their potential resources and how they might achieve their needs sustainably. The CA was used in the data collection and data analysis phases. Results: The team of fellows gained personal understanding of the reality of the impact of social determinants on health experiences and outcomes. The CA offers the health systems and services a way to engage hard to reach communities with issues that they know to be important and are then able to prioritise. Clinicians who are taught in the evidence based style need to reframe their understanding of community needs if they are to be effective in their work. Working in this way can challenge their own values and beliefs. With planned support this can be a powerful developmental process and the CA is a set of principles that can be used to facilitate the empowerment of communities, the service planners and providers.

The number of adolescent pregnancies in Indonesia is still very high. Sewon Subdistrict had the highest number of adolescent deliveries in Bantul District in 2015-2016. Adolescent mothers barely practice exclusive breastfeeding. This study aimed to determine factors influencing exclusive breastfeeding among adolescent mothers in Sewon Subdistrict, Bantul District. This study used cross-sectional study design was and a sample size of 45 that were adolescent mothers of 6-24- month-old infants. Data was collected using a structured questionnaire. Data analysis involved bivariate analysis using chi-square test and fisher’s exact test, while multivariate analysis used logistic regression. Results showed that 53.3% of adolescent mothers did not practice exclusive breastfeeding. Bivariate analysis showed that pregnancy status (p value = 0.029), perception of childbirth experience (p value = 0.045), perception of breastfeeding (p value = 0.005), husband support (p value = 0.009) and family support (p value = 0.000) were correlated to exclusive breasfeeding. Multivariate analysis showed that perception of breastfeeding (p value = 0.015; OR = 9.746) and family support (p value = 0.014; OR = 7.637) as the most influential factors to exclusive breastfeeding among adolescent mothers with a probability of 72.7%. There is low practice of exclusive breastfeeding among adolescent mother in Bantul, Yogyakarta and family support are most dominant factors influencing exclusive breastfeeding. AbstrakPersentase kehamilan remaja di Indonesia cukup tinggi. Kecamatan Sewon memiliki angka persalinan remaja tertinggi di Kabupaten Bantul pada tahun 2015-2016. Ibu usia remaja hampir tidak mempraktekkan pemberian ASI eksklusif, meski diketahui bemanfaat bagi bayi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi pemberian ASI eksklusif pada ibu usia remaja di Kecamatan Sewon, Kabupaten Bantul. Penelitian ini menggunakan desain potong lintang dan sampel penelitian berjumlah 45 orang ibu usia remaja yang mempunyai bayi usia 6-24 bulan. Pengumpulan data menggunakan kuesioner terstruktur. Analisis bivariat menggunakan kai kuadrat dan fisher’s exact test, sedangkan analisis multivariat menggunakan regresi logistik. Hasil penelitian menunjukkan bahwa 53.3% ibu usia remaja tidak memberikan ASI eksklusif. Analisis bivariat menunjukkan faktor status kehamilan (nilai p = 0.029), persepsi pengalaman melahirkan (nilai p= 0.045), persepsi menyusui (nilai p= 0.005), dukungan suami (nilai p= 0.009), dukungan keluarga (nilai p = 0,000) berhubungan dengan pemberian ASI eksklusif. Hasil analisis multivariat menunjukkan persepsi menyusui (p=0.015; RP=9.746) dan faktor dukungan keluarga (nilai p =0,014; RP = 7,637) sebagai faktor yang paling berpengaruh terhadap pemberian ASI eksklusif dengan probabilitas sebesar 72.7%. Masih rendahnya pemberian ASI ekslusif pada ibu remaja di Bantul, Yogyakarta, dan dukungan keluarga merupakan faktor paling dominan yang memengaruhi pemberian ASI eksklusif pada ibu usia remaja.