The Role of Primary Healthcare in Improving the Maternal and Infant Mortality in Pakistan

Main Article Content

Sadaf Dawood
Mehwish Fatima
Anam Daayem

Abstract

Background: Maternal and neonatal mortality remains a significant public health challenge globally, particularly in countries like Pakistan, which exhibit some of the highest rates of such mortalities. Effective primary healthcare interventions are crucial for mitigating these rates, focusing on enhancing the quality of care provided to mothers and newborns. Understanding the scope and impact of these interventions can inform future strategies to improve maternal and neonatal health outcomes.


Objective: This review aims to evaluate the existing literature on primary healthcare interventions targeting maternal and neonatal mortality, identifying the types of interventions employed, their focus areas, and the outcomes achieved, with a specific interest in the context of Pakistan.


Methods: A scoping review methodology was employed, analyzing studies that investigated primary healthcare interventions designed to reduce maternal and neonatal mortality. The review included studies published in English, utilizing a mix of research methodologies, and focused on interventions such as morbidity and mortality review processes, healthcare worker training, and community engagement strategies. Databases searched included Google Scholar, OVID, and the WHO Global Health Library, among others.


Results: Out of 25 studies reviewed, a majority concentrated on healthcare team and program-level interventions rather than systemic healthcare reforms. Key areas of focus included enhancing review processes for maternity and neonatal care, training and education for healthcare workers, and community development initiatives. However, there was a noted lack of interventions directly improving the healthcare experiences of mothers and newborns. Mixed methods were the most common research approach, aligning with the complexity of evaluating health system interventions.


Conclusion: To improve maternal and neonatal health outcomes in Pakistan, a comprehensive approach addressing the entire health system is required. This involves not only focusing on the delivery of healthcare services but also incorporating community insights, continuous education programs, and leadership modifications in healthcare services. Future strategies should prioritize the application of standardized and relevant methods to enhance the quality of maternity and newborn care initiatives, aiming for scalable improvements in healthcare outcomes.

Article Details

How to Cite
Dawood, S., Fatima, M., & Daayem, A. (2024). The Role of Primary Healthcare in Improving the Maternal and Infant Mortality in Pakistan. Journal of Health and Rehabilitation Research, 4(1), 514–518. https://doi.org/10.61919/jhrr.v4i1.417
Section
Articles
Author Biographies

Sadaf Dawood, Love and Trust Hospital Chachro Pakistan.

Consultant, Obstetrician and Gynecologist.

Mehwish Fatima, Memon Medical Institute Karachi Pakistan.

HOD, Consultant Obstetrician & Gynaecologist.

Anam Daayem, Ehad Virtual Health Pakistan.

Director, Clinics and Virtual Health.

References

Wilson AN, Spotswood N, Hayman GS, Vogel JP, Narasia J, Elijah A, et al. Improving the quality of maternal and newborn care in the Pacific region: a scoping review. Lancet Reg Health West Pac. 2020 Oct;3:100028.

Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. Lancet Glob Health. 2019 May;7(5):e624-32.

Seijmonsbergen-Schermers AE, Van Den Akker T, Rydahl E, Beeckman K, Bogaerts A, Binfa L, et al. Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study. PLoS Med. 2020 May 22;17(5):e1003103.

Lippke S, Wienert J, Keller FM, Derksen C, Welp A, Kötting L, et al. Communication and patient safety in gynecology and obstetrics-study protocol of an intervention study. BMC Health Serv Res. 2019 Dec;19(1):1-8.

World Health Organization. What is quality of care and why is it important? World Health Organization; 2017 Nov.

Rohrbasser A, Harris J, Mickan S, Tal K, Wong G. Quality circles for quality improvement in primary health care: their origins, spread, effectiveness and lacunae–a scoping review. PLoS One. 2018 Dec 17;13(12):e0202616.

Hoodbhoy Z, Sheikh SS, Qureshi R, Memon J, Raza F, Kinshella ML, et al. Role of community engagement in maternal health in rural Pakistan: Findings from the CLIP randomized trial. J Glob Health. 2021;11.

Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018 Oct 2;169(7):467-73.

Singh K, Osei-Akoto I, Otchere F, Sodzi-Tettey S, Barrington C, Huang C, et al. Ghana’s National Health insurance scheme and maternal and child health: a mixed methods study. BMC Health Serv Res. 2015 Dec;15(1):1-3.

Abedzadeh-Kalahroudi M, Sehat M, Vahedpour Z, Talebian P. Maternal and neonatal outcomes of pregnant patients with COVID-19: A prospective cohort study. Int J Gynaecol Obstet. 2021 Jun;153(3):449-56.

Khan RE, Bari KM, Raza MA. Socioeconomic determinants of child mortality: Evidence from Pakistan Demographic and Health Survey.

Patel KK, Rai R, Rai AK. Determinants of infant mortality in Pakistan: evidence from Pakistan Demographic and Health Survey 2017–18. J Public Health. 2021 Jun;29:693-701.

Naz L, Patel KK, Dilanchiev A. Are socioeconomic status and type of residence critical risk factors of under-five mortality in Pakistan? Evidence from nationally representative survey. Clin Epidemiol Glob Health. 2021 Apr 1;10:100670.

Nawaz M, Rizvi S. The Determinants of Parental Uptake of Childhood Immunization in Peri-Urban Areas of Karachi-A Cross-Sectional Study. Pak J Med Health Sci. 2022 Jul 30;16(07):130-.

Ali A, Şenturk İ. Justifying the impact of economic deprivation, maternal status and health infrastructure on under-five child mortality in Pakistan: An empirical analysis. Bull Bus Econ (BBE). 2019;8(3):140-54.

Haque M, Choudhury A, Haque A, Blackwood RA. Understanding mother and child health-seeking behavior in urban Pakistan. Health Care Women Int. 2022 Jun 3;43(6):549-67.

Wynn A, Mussa A, Ryan R, Hansman E, Simon S, Bame B, et al. Evaluating the diagnosis and treatment of Chlamydia trachomatis and Neisseria gonorrhoeae in pregnant women to prevent adverse neonatal consequences in Gaborone, Botswana: protocol for the Maduo study. BMC Infect Dis. 2022 Dec;22(1):1-5.

UNFPA, UNICEF, SPC. The State of The Pacific’s Reproductive, Maternal, Newborn, Child and Adolescent Health Workforce. UNFPA Pacific Sub Regional Office; 2019.

Hussain M, Butt AR, Uzma F, Ahmed R, Irshad S, Rehman A, et al. A comprehensive review of climate change impacts, adaptation, and mitigation on environmental and natural calamities in Pakistan. Environ Monit Assess. 2020 Jan;192(1):1-20.

Mahmood MA. Determinants of neonatal and post-neonatal mortality in Pakistan. Pak Dev Rev. 2002 Dec 1;723-44.

Chishtie J, Chishtie F, Jaglal S. Exploring knowledge translation practices in a global health program: case study on the establishment of the Pakistan National Maternal, Neonatal, and Child Health Program. J Public Health. 2021 Feb;29:215-28.

Figueiredo K, Gonçalves GA, Batista HM, Akerman M, Pinheiro WR, Nascimento VB. Actions of primary health care professionals to reduce maternal mortality in the Brazilian Northeast. Int J Equity Health. 2018 Dec;17(1):1-8.

Ahmed I, Ali SM, Amenga-Etego S, Ariff S, Bahl R, Baqui AH, et al. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018 Dec;6(12):e1297-308.

Olita’a D, Barnabas R, Boma GV, Pameh W, Vince J, Duke T. Simplified management protocol for term neonates after prolonged rupture of membranes in a setting with high rates of neonatal sepsis and mortality: a quality improvement study. Arch Dis Child. 2019 Feb;104(2):115-20.

Agha N. Maternal and newborn health in Pakistan: risks, challenges, and the way forward. South Asia@LSE. 2018 Jul 9.

Chang YS, Coxon K, Portela AG, Furuta M, Bick D. Interventions to support effective communication between maternity care staff and women in labour: A mixed-methods systematic review. Midwifery. 2018 Apr;59:4-16.

Ormel H, Kok M, Kane S, Ahmed R, Chikaphupha K, Rashid SF, et al. Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health. 2019 Dec;17(1):1-2.