PMID- 29615443
OWN - NLM
STAT- MEDLINE
DCOM- 20190211
LR  - 20240327
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 8
IP  - 4
DP  - 2018 Apr 3
TI  - Postpartum family planning integration with maternal, newborn and child health 
      services: a cross-sectional analysis of client flow patterns in India and Kenya.
PG  - e018580
LID - 10.1136/bmjopen-2017-018580 [doi]
LID - e018580
AB  - OBJECTIVES: Maternal, newborn and child health (MNCH) services represent 
      opportunities to integrate postpartum family planning (PPFP). Objectives were to 
      determine levels of MNCH-family planning (FP) integration and associations 
      between integration, client characteristics and service delivery factors in 
      facilities that received programmatic PPFP support. DESIGN AND SETTING: 
      Cross-sectional client flow assessment conducted during May-July 2014, over 
      5 days at 10 purposively selected public sector facilities in India (4 hospitals) 
      and Kenya (2 hospitals and 4 health centres). PARTICIPANTS: 2158 client visits 
      tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while 
      pregnant and/or with a child under 2 years. INTERVENTIONS: PPFP/postpartum 
      intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, 
      Kenya (2006-2010). Maternal, infant and young child nutrition/FP 
      integration-Bondo, Kenya (2011-2014). PRIMARY OUTCOME MEASURES: Proportion of 
      visits where clients received integrated MNCH-FP services, client characteristics 
      as predictors of MNCH-FP integration and MNCH-FP integration as predictor of 
      length of time spent at facility. RESULTS: Levels of MNCH-FP integration varied 
      widely across facilities (5.3% to 63.0%), as did proportion of clients receiving 
      MNCH-FP integrated services by service area. Clients travelling 30-59 min were 
      half as likely to receive integrated services versus those travelling under 
      30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services 
      (vs MNCH services only) spent an average of 10.5 min longer at the facility 
      (95% CI -0.1 to 21.9, not statistically significant). CONCLUSIONS: Findings 
      suggest importance of focused programmatic support for integration by MNCH 
      service area. FP integration was highest in areas receiving specific support. 
      Integration does not seem to impose an undue burden on clients in terms of time 
      spent at the facility. Clients living furthest from facilities are least likely 
      to receive integrated services.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2018. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Mackenzie, Devon
AU  - Mackenzie D
AUID- ORCID: 0000-0002-3327-6770
AD  - Jhpiego/Maternal and Child Survival Program, Washington, DC, USA.
FAU - Pfitzer, Anne
AU  - Pfitzer A
AD  - Jhpiego/Maternal and Child Survival Program, Washington, DC, USA.
FAU - Maly, Christina
AU  - Maly C
AD  - Jhpiego, Baltimore, Maryland, USA.
FAU - Waka, Charles
AU  - Waka C
AD  - Jhpiego, Nairobi, Kenya.
FAU - Singh, Gajendra
AU  - Singh G
AD  - Jhpiego, New Delhi, India.
FAU - Sanyal, Abanti
AU  - Sanyal A
AD  - Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, 
      Maryland, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20180403
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - *Child Health Services
MH  - Child, Preschool
MH  - Cross-Sectional Studies
MH  - *Family Planning Services
MH  - Female
MH  - Humans
MH  - India
MH  - Infant, Newborn
MH  - Kenya
MH  - *Maternal Health Services
MH  - Middle Aged
MH  - Postpartum Period
MH  - Pregnancy
MH  - Young Adult
PMC - PMC5892750
OTO - NOTNLM
OT  - child health
OT  - family planning
OT  - integration
OT  - maternal and newborn health
OT  - postpartum
COIS- Competing interests: None declared.
EDAT- 2018/04/05 06:00
MHDA- 2019/02/12 06:00
PMCR- 2018/04/03
CRDT- 2018/04/05 06:00
PHST- 2018/04/05 06:00 [entrez]
PHST- 2018/04/05 06:00 [pubmed]
PHST- 2019/02/12 06:00 [medline]
PHST- 2018/04/03 00:00 [pmc-release]
AID - bmjopen-2017-018580 [pii]
AID - 10.1136/bmjopen-2017-018580 [doi]
PST - epublish
SO  - BMJ Open. 2018 Apr 3;8(4):e018580. doi: 10.1136/bmjopen-2017-018580.