Linking political exposures to child and maternal health outcomes: a realist review

Background Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. Methods The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories. Results Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations. Conclusion We present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.

Breastfeeding at 1, 3 and 6 Months after Birth according to the Mode of Birth: A Correlation Study

Background: Breastfeeding is a determinant of child and maternal health. However, evidence is limited on how mode of birth influences breastfeeding. Research aim: To examine the mode of birth and breastfeeding duration and the type of lactation at one, three and six months after birth in XXX, during 2017. Methods: Correlation study on breastfeeding duration and type of lactation during the six months after birth, and mode of birth, in a randomised sample. Women ≥18 years of age with term singleton infants, were included. Collected data through interviews and hospital records. Pearson’s and Spearman’s correlation analyses were conducted. SPSSv21 and α = 0.05 were used. Results: Breastfeeding duration was shorter in women with greater parity (−0.055 **) (p < 0.01) and epidural analgesia (0.057 **) (p < 0.01), and longer in mothers with episiotomy (−0.267 **) (p < 0.01). Episiotomy was associated with breastfeeding at one month (0.112 **) (p < 0.01), and at six months (0.347 *) (p < 0.01). The prevalence of breastfeeding was lower in women who received epidural analgesia at three months (−0.140 **) (p < 0.01) and higher at six months (0.013 **) (p < 0.01). The percentages of breastfeeding at three months were significantly greater in women with no perineal tears (2.1) (p < 0.05). At six months, small rates of breastfeeding were found in women with greater parity (0.051 **) (p < 0.01). No significant association was detected, neither between the type of lactation and the mode of birth, nor between breastfeeding duration and the mode of birth. Conclusions: Epidural analgesia, episiotomy, perineal tears and parity influence the type of lactation and duration of breastfeeding during the six months after birth. The results suggest no association between the type of lactation and the mode of birth or between breastfeeding duration and the mode of birth.

Narrative Case study: The most essential determinants to child and maternal health in Sierra Leone

Background Sierra Leone is one of the poorest countries in the world, suffering from some of the worst maternal and child health outcomes. In 2013, it had a maternal mortality ratio of 1165/10000 live births and an under-five mortality of 156/1000 live births. The country has introduced a number of policies and interventions to tackle maternal and child health issues but still retains one of the highest global mortality rates. The purpose of this study is to determine the most essential determinants to infant, child and maternal health and recommend some interventions and policy changes to improve their health outcomes. Methods A small review of relevant policies and papers and analysis of relevant maternal and child health data and statistics was conducted to inform questions for Key Informant Interviews. Interviews were then conducted with relevant stakeholders to child and maternal health from UN Organisations, international NGOs and the Ministry of Health and Sanitation (MoHS). Results Analysis of transcribed Interview data with NVIVO showed that the most essential determinants were the lack of effective coordination between the MoHS and partners due to the emergency mindset, systematic problems with the attitude of the healthcare workforce especially towards women and socio-cultural restriction on women restricting their ability to make choices about their own health and lives Conclusions The study found that there was a focus on policies and interventions targeted at improving clinical determinants and health statistics while consideration of socio-cultural context were negligible. An inclusion of interventions focused on women's empowerment and increasing their voices will help to tackle some of these most essential determinants. Key messages Sierra Leone has the policy environment, political will, and technical expertise to continue making improvements to their high maternal and child mortality problem. An emergency mindset approach, and interventions targeted only at reducing clinical determinants of maternal mortality are missing out on addressing wider socio-cultural issues to improving health.

Diarrhea and associated factors among under-5 children in Ethiopia: A secondary data analysis

Objectives: Diarrhea is a major contributing factor for preventable childhood morbidity and death. Despite the occurrence of diarrhea is decreasing, its effect is increasing at an alarming rate among under-5 children particularly in developing countries. The survey was aimed to assess diarrhea and associated factors among children less than 5 years (0–59 months) in Ethiopia with nationally representative data. Methods: The data were extracted from the Ethiopian National Survey of 2016. A logistic regression model was undertaken to identify the contributing factors for childhood diarrhea. Variables with p < 0.05 were considered as independent predictors of childhood diarrhea. Results: From a total of 10,641 under-5 children, 5483(51.5%) were males and most of the children (62.3%) were above 24 months. About 10.2% had diarrhea 14 days before data collection, and the majority (93.1%) were born to married mothers. Receiving no treatment or advice for fever/cough (adjusted odd ratio (AOR) = 0.170, 95% confidence interval (CI): 0.139–0.208, p = 0.001), being permanent residence (AOR = 0.583, 95% CI: 0.347–0.982, p = 0.043), initiating breastfeeding after 24 h of birth (AOR = 1.553, 95% CI: 1.197–2.015, p = 0.001), and lack of prenatal care (AOR = 2.142, 95% CI: 0.624–0.875, p = 0.001) were independent predictors of diarrhea among under-5 children’s in Ethiopia. Conclusion: The result of this survey indicated that diarrhea is a significant health challenge among under-5 children. To tackle this illness, sufficient education on child and maternal health has to be provided for mothers focusing on predictive factors.