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Asian Journal of Healthy and Science p-ISSN:
2980-4302
e-ISSN: 2980-4310
Vol. 3 No. August
8, 2024
A Literature Review of Maternal Mortality in the Countryside. What are the
Policies and Prevention?
Irmawati Mathar1*, Mertisa Dwi Klevina², Cintika Yorinda Sebtalesy3
1,2,3 Bhakti Husada
Mulia College of Health Sciences, Madiun City, East Java, Indonesia Email: cintikayorindas@gmail.com
Abstract
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Maternal mortality in rural areas is still high and is a health problem that is a priority for intervention and policy. Various studies have been conducted to create a prevention model and various policies implemented in several countries have been carried out to deal with maternal mortality in rural areas. This study aims to determine the policies and models or concepts of preventing maternal mortality
in rural areas. This study is a literature review using the Scopus database. The strategy in finding articles uses
PICOS (Population, Intervention, Comparison,
Outcome and Study design). 6 articles that fit the
criteria and are relevant to the research objectives. Policy and prevention of maternal mortality in rural areas: (1) Fulfillment of health workers, (2) Fulfillment of health facilities, (3) Maternity
waiting homes, (4) Community-based continuous training programmes, (5) HEP (Health
Extension Program) and HDA (Health Development Army) policies, (6)
Health Insurance. The findings
of this study
indicate that some of the policies and prevention
models implemented were successful in reducing maternal
mortality in rural areas, so policies and models for preventing maternal mortality can be applied in rural areas.
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Keywords: Policy, Prevention, Maternal Mortality, Rural.
INTRODUCTION
Maternal mortality rates globally are very high and
about 830 women die from pregnancy or
childbirth complications worldwide every day. In 2000 WHO, UNICEF and UNFPA estimated
the maternal mortality rate to reach 400 per 100,000 live births. This means that every minute,
one woman in the world,
dies. As many as 99% of the average
maternal mortality occurs in developing countries
(Maternal Mortality, n.d.; Respati et al., 2019). In 2-17 years,
94% of maternal deaths occurred
in countries with low and lower
middle incomes (Oruh, 2021)
The global target
by 2030 is that all countries must reduce the maternal mortality ratio, the maternal
mortality rate decreases
to 70 per 100,000 live births and geographical constraints are one of the
causes of difficulties for people to access health facilities, especially those
in remote areas. This is in line with research conducted in Pakistan's Chitral region,
where maternal mortality rates are particularly high(Andini & Aan Julia,
2022) due to women's inability to access skilled care due to the high costs associated with travel and use of such services (Tunηalp
et al., 2014).
To effectively overcome this problem, it is necessary to prevent maternal death early. Some of the factors that affect
maternal health include social, economic, political, environmental and cultural
health determinants (Tabazzum firos et al., 2016). Apart from
these causes, difficult access to health services is also one of
the
causes of maternal death.
. The pattern of seeking health
help from the community, the importance of supporting
infrastructure to get health services
for people in remote areas such as transportation,
electricity networks, clean water and sanitation has a very big role (Diajeng
Sri Andriani Permatasari &
lutfan lazuardi, 2019; Heru Santoso Wahito Nugroho et al., 2019).
In the countryside, emergency transportation is often
unavailable and private transportation is unreliable(D'Ambruoso, 2012). In addition,
an important influence on maternal health
is that it includes political, economic, social, cultural and environmental
dimensions (Tabazzum firos
et al., 2016).
Prevention of maternal mortality can be done through
strategies to empower communities to actively participate in the process of identifying and analyzing their own health problems, this statement is also in
line with the WHO statement
that maternal mortality
can be prevented with a human rights approach to maternal and newborn health,
which includes women, girls, families and communities by enabling participation and thus influencing how the system health work . so as to reduce maternal mortality rate, it needs
the cooperation of many parties (Prasetyo
et al., 2018; Tabazzum firos et al., 2016; WHO, 2015)
Health problems are closely related to the ability of the community to access or reach health care facilities (Diajeng Sri Andriani Permatasari &
Lutfan Lazuardi, 2019). A similar view is according to the results of the research of Respati et al, 2019 that the indirect
causative factors that cause maternal death include transportation factors, family social
and economic status,
education, and culture, delays in obtaining childbirth assistance or difficulty
in reaching service facilities due to transportation and remote residences.
(Respati et al., 2019)
The importance of engaging communities at all levels to
design targeted and contextualized solutions.
Multisectoral collaboration is needed to effectively
address and promote maternal health so as to reduce maternal mortality rates (Tabazzum firos et al.,
2016).
Because maternal mortality rates are still high in rural
areas and many studies provide some prevention for maternal mortality, this literature review aims to provide an overview
of prevention with various interventions to prevent maternal mortality in rural
areas. Furthermore, it is hoped that it can answer questions
related to policies in several
rural areas, strategies and factors that affect maternal mortality. The
review can also inform health policy actors and practitioners to address maternal mortality in rural areas.
This review of the literature
is guided by the following question: What are the prevention
and policies that can be done to address maternal
mortality in rural areas. The purpose of this
literature review is to identify prevention and policies implemented to address
maternal mortality in rural areas
RESEARCH
METHODS
Article search was conducted on May 12, 2024 on the pubmed
database Search is not limited by publication date.
Article search through strategy using PICOS Tools (population, intervention, comparison, outcome and study design).
Keywords included in the Scopus database
"maternal OR mother AND prevention OR policy AND death AND
rural"
Table 1. Data selection: Inclusion
and exclusion criteria
|
PICOS
Strategy
|
Inclusion criteria
|
Exclusion criteria
|
|
Population
|
Pregnant women, mothers who have undergone childbirth (42 days after childbirth) in rural areas
|
·
Not pregnant women,
·
Mothers who do not have childbirth
·
Mothers who have been in labor for more than 42 days
· Pregnant women
who do not live in rural areas
|
|
Intervention
|
·
There were no specific interventions.
·
Eligible studies were preventive
and policy interventions for maternal mortality or mothers
who had given
birth 42 days after termination of
pregnancy in rural areas
|
Prevention in pregnant women who do not live in rural areas
|
|
Comparation
|
There were no comparison groups
for this study.
|
There is no comparison.
|
|
Outcome
|
§ Cases of female
deaths in rural areas caused by their
pregnancy or management, but not due to other causes
§ Cases of maternal deaths in rural areas after preventive measures and policies
|
§ Cases of female
deaths that are not caused by pregnancy or its
management, such as traffic accidents, falls, natural disaster
factors and others.
|
|
Study design
|
§ Published the last
10 years between 2014-
2024
§ Publication to the final publication stage
§
English
§ Source type : journal
§ Document Type : Article
§
Accessible
|
§ Published over the last 10 years
§ Article is still in process/ has not been published
§ Published in a language other than English
§ Source Type : Conference proceedings,
Book,
Book series, Trade journal
§ Document type in the form of
Policy brief,
Reviews Conference paper, Letter,
Book chapter, Note,
|
_files/image005.gif)
Editorial
Erratum, United States Conference review, Book,
Short survey, Data paper, Retracted, Undefined
§ Inaccessible
Table 1 shows the use of the PICOS strategy
in setting inclusion and exclusion criteria.
Population or Problem is a problem or goal in
research. In this literature review, the population or group/target that wants to be researched is mothers in rural areas. The
mother in question
is a pregnant woman or a mother who has given birth or 42 days after
giving birth in the countryside. Intevention is a program, concept,
prevention model and policy that is applied to reduce
maternal mortality in rural areas. Compration is a comparator. In this literature
review, no comparators were determined. The outcome is a case of maternal
death or maternal death in rural areas and the last is a study design.
Data screening and selection
Articles taken from
searches in the Scopus database are selected by setting inclusion and exclusion criteria.
The first screening is the year of the article,
then continued with the publication stage, then continued
with the language, then filtered by source type, continued with Document type filtering, then continued with open access filtering and finally relevant articles. At this stage, a reference list of full-text articles that meet the review criteria
is checked to identify and include more relevant articles that may have been
missed by the database (e.g., not indexed).
The article selection process is
according to the inclusion and exclusion criteria with the help of PRISMA flowchart tools.
_files/image008.jpg)
Figure 1. PRISMA Flow Diagram
Based on figure 1, it can be seen that the articles obtained in the Scopus database by entering keywords totaling 403. Then 179 articles published between 2014 and May 2024 were selected. Furthermore, the selection of articles that have been published is carried out, excluding articles that are still in process. There is 1 article that is still in the process of publication. Then continued with the selection of articles based on the language
used in the article,
English articles were selected, 217 articles were obtained in English. After the selection of articles based on language, the
selection was continued based on the source of the article,
articles published in the journal were selected, articles that did not match the source were published
in a total of 4 articles, 3 came from books, 1 came from Conference
proceedings. The results of the articles selected based on published sources were 213. Then the selection of articles based on document
type, articles that do not meet the
criteria according to the criteria are 27 consisting of 18 articles
of the type of literature review document, 6 in the form of reports, 3 editorial. Furthermore, articles were selected based on readable
articles/open access, 30 articles were
obtained that were incomplete and could not be accessed.
The final selection is based on the relevance of the research
objectives to be discussed. 6 articles were found that were relevant to the research objectives and will be
reviewed.
Quality assessment
In this study, quality assessment was carried out. According to Salleh, 2011, Quality assessment
to estimate the credibility and validity of research. A tool as a 'structured instrument of any kind
that aims to help users assess quality (Sanderson et al., 2007; Wahyudiana &
Andayani, 2020).
Table 2. Study Quality Checklist
|
It
|
Items
|
Answer
|
|
1
|
What the article refereed?
|
Yes/No/Partially
|
|
2
|
Were the aim(s) of the study clearly stated?
|
Yes/No/Partially
|
|
3
|
Were the study participants or observational units adequately described? For example, students'
programming experience, year of study etc
|
Yes/No/Partially
|
|
4
|
Were the data collections carried out very well? For
example, discussion of procedures used for collection, and how the study setting may have influenced the data
collected?
|
Yes/No/Partially
|
|
5
|
Were potential confounders adequately controlled for in
the analysis?
|
Yes/No/Partially
|
|
6
|
Were the approach to and formulation of the analysis well conveyed? For example, description of the form of the original data, rationale for choice of
method/tool/package?
|
Yes/No/Partially
|
|
7
|
Were the findings credible? For example, the study was methodologically explained so that
we can trust the findings; findings/conclusions are resonant with other
knowledge and experience?
|
Yes/No/Partially
|
Data Extraction and Synthesis
This review literature is carried out to search for information that is in accordance with the research objectives or research questions. An extraction and synthesis process is needed in the article, an article that discusses prevention
models/concepts/methods and policies related to the death of pregnant women in rural areas is chosen.
RESULTS AND DISCUSSION
Table 3. List of selected articles
|
Author
|
Heading
|
Year
|
Country
|
Results
|
|
Uneke C.J.; Sombie I.; Uro- Chukwu H.C.;
Johnson E.
|
Developing equity- focused interventions
for maternal and child health in nigeria: An evidence synthesis for
policy, based on equitable impact sensitive tool (EQUIST)( Uneke
et al., 2019)
|
2019
|
Nigeria
|
Family health care, budget
allocation in the health sector, Placement
of skilled professionals, cooperation with the
private sector, health insurance.
|
|
Conlon C.M.; Serbanescu F.; Marum L.; Healey
J.; LaBrecque J.; Hobson R.; Levitt M.; Kekitiinwa A.;
Picho B.; Soud F.;
|
Saving Mothers, Giving Life: It Takes a System to Save a
Mother(Conlon et al., 2019)
|
2019
|
Uganda Zambia
|
Saving Mothers, Giving Life (SMGL):
interventions in the form of fulfilling health human resources,
fulfilling health
facilities, increasing the
|
|
Spigel L.; Steffen M.; Velasco J.; Cohen R.; Weiss
W.
|
|
|
|
salaries of health
workers in rural areas
|
|
Buser J.M.; Munro-Kramer,
M.L.; Carney M.; Kofa A.; Cole
G.G.; Lori
J.R.
|
Maternity waiting homes as a cost- effective intervention in rural Liberia(Buser
et al., 2019)
|
2019
|
Liberia
|
Maternity waiting
homes
|
|
Moshi F.V.;
Kibusi S.M.; Fabian
F.
|
The effectiveness of community-based
continuous training on promoting positive behaviors towards birth preparedness, male involvement, and maternal services
utilization among expecting couples in rukwa,
Tanzania: A theory of planned behavior quasi- experimental study
(Moshi et al., 2018)
|
2018
|
Tanzani a
|
Community Based Continuous Training: an
intervention in the form of increasing knowledge and training
for mothers and husbands
|
|
Yang L.; Wang H.
|
Primary health care among rural pregnant
women in China: achievements and challengesin maternal mortality ratio(Yang & Wang, 2019)
|
2019
|
China
|
Fulfilling the basic health of
pregnant women through interventions to increase
the number of health workers in rural areas, increase the accessibility of health services for rural
pregnant women at home,
standardize and regulate the
implementation of cesarean sections, as well as provide
health service standards and reduce risks in
pregnancy
|
|
Matthias Rieger , Natascha Wagner
, Anagaw
Mebratie , Getnet Alemu , Arjun Bedi
|
The impact of the Ethiopian health extension program
and health
development army on maternal mortality: A synthetic control approach(Rieger et
al., 2019)
|
2019
|
Ethiopia
|
Health Extension
Program (HEP)
Health Development Army
(HDA)
|
Based on table 3,
it is
known that the number of articles that meet the inclusion criteria is 6 articles.
5 articles published in 2019 and 1 article published in 2018. Countries
that implement policies to prevent maternal mortality in rural areas based on the article
obtained are Nigeria,
Uganda, Zambia, Liberia,
China, Tanzania and Ethiopia
Discussion
Fulfillment of Human Resources (HR) and increasing incentives for Human
Resources (HR) in Rural Health Facilities
UNICEF designed the EQUitable Impact Sensitive Tool
(EQUIST) to enable the global health community to address the issue of equity in maternal, newborn
and child health(Uneke et al., 2018). The number of Human Resources
(HR) in health facilities is insufficient in rural Nigeria. The
existence of these problems by using the EQUitable Impact Sensitive
Tool (EQUIST) to reduce maternal mortality rates, the need for policies
to fulfill Health Human Resources (HR), the need for skilled professionals in childbirth,
emergency obstetrics in rural Nigeria
(Uneke et al., 2019)
The countries of Zambia and
Uganda have also implemented policies to increase the number
of health workers placed in health
facilities in rural areas to reduce maternal mortality rates. The
number of health workers in villages in Uganda and the Safe Motherhood
Action Group (SMAG) in Zambia,
set up by the Government, is insufficient. Healthcare
facilities are short of 24-hour staff consisting of training midwives, anesthesiologists, and surgeons. Through the intervention of the SMGL (Saving Mothers,
Giving Life) program, the distribution of health workers was carried out in several rural areas that were used as pilots.
In addition, there is an increase in salaries for health workers
who are stationed in rural areas. Doctors receive a salary increase to work in Puskesmas
IV in rural areas rather than in hospitals,
an incentive that was later adopted nationwide
by the Ministry of Health. The maternal health outcomes achieved after 5
years of implementation in the pilot
villages were considerable: There was
a 44% reduction in maternal mortality
in villages in Uganda, as well as a 38% reduction
in maternal mortality in health facilities and a 41% reduction in maternal mortality
in all villages in Zambia. The shortage of medical
personnel also occurs
in rural and remote areas of China.
The policy implemented to reduce maternal mortality in rural areas is to strengthen primary
health services in rural areas, one of which is through the placement of
skilled health workers to reduce
the risk of pregnancy in several remote
areas in China (Conlon et al.,
2019; Schiff et al., 2017).
Several factors greatly influence pregnant women to take
advantage of health services in rural areas, one of which is the lack of health human resources so that many maternity service centers in rural areas are forced to close (Damayanti et al., 2023)
Skilled health workers are fundamental to be handled in
rural areas. With the placement of health workers in accordance with the number of ratios and competencies
needed, it can improve the degree of public
health and provide treatment to pregnant women.
Fulfillment of Health Facilities in Rural Areas
In order to reduce
the maternal mortality rate in Nigeria, it is necessary
to fulfill adequate health
facilities in rural areas. Based on the EQUIST analysis,
it was obtained that the government could not meet all health-related needs optimally, so the private sector was needed to be involved
in the mechanism
of
providing facilities and so on (Uneke et
al.,
2019). In addition, Zambia and Uganda also carry
out the same policy in terms of fulfilling and improving health facilities to reduce the number of maternal deaths in rural areas. Maternity rooms in many hospitals and
health centers are damaged and overcrowded, as well as a shortage of air, electricity, and functioning toilets. Equipment
is missing, non-functional, or
insufficient for patients, so maternity wards and operating rooms are being renovated to increase the capacity of the
facility. In addition, to overcome low antenatal visits and realize timely
access to health facilities, interventions are carried
out to facilitate access for mothers to health facilities in the form of
subsidies for motorcycle transportation vouchers and special protocols for the
transportation of pregnant women (Conlon
et al., 2019)
Many women still lack access to quality health care, hindering their ability to achieve the best level of health. Pregnant
women in the archipelago tend to be unable to access
health services due to transportation
cost barriers(Suparmi et al., 2019)..
Many pregnant women who live in rural areas or far from urban centers, do not take advantage of health service facilities, so
it is necessary to improve and fulfill health facilities
in rural areas for pregnant women so that mothers are not late in getting
treatment such as childbirth.
Maternity waiting homes
Health facilities in the form of maternity waiting
houses are also important in preventing maternal deaths
in rural areas.
A maternity shelter
is a place to live close to health facilities where women live waiting for childbirth and postpartum. The maternity
home service is used by women to settle down during the last weeks of their pregnancy
and is available free of charge to all pregnant women, and access does not
depend on referrals or distances
between a woman's
home and a rural primary
health clinic. Each maternity shelter has a minimum of eight beds equipped with mosquito nets, outdoor toilet
facilities, and an outdoor kitchen
equipped with cooking
utensils The use of maternity shelter facilities is reported
monthly. The total
number of women's
lives saved through maternity home intervention for 3 years is 10. The difference in maternal mortality rates without
maternity waiting houses is 17 maternal deaths while with maternity waiting house facilities, 7 maternal deaths. The benefits of maternity waiting houses are that they can reduce the incidence of perinatal mortality
and complications, reduce the
incidence of maternal complications and mortality, and have good access to health services
(Buser et al., 2019; Gurara et al., 2022).
The results of the maternity waiting house intervention can save the mother's life so that it can be applied in rural areas in reducing the risk of maternal death.
Community-based continuous training/CBCT
This community-based continuous training (CBCT) program is carried out in rural Tanzania to prevent maternal deaths in
rural areas. The provision of counseling and training to women is designed to raise awareness of safe maternal
and newborn health. Counseling and training were given to mothers and husbands from each
village group who were the research samples. This community-based continuous training program aims to
improve maternity
readiness, male involvement, and the use of maternal services among pregnant couples. The program includes discussions on behavioral beliefs, normative beliefs, and behavioral
control beliefs that hinder childbirth
readiness in health facilities, male involvement, and the use of maternal services. In addition, the program also provides
knowledge about birth readiness (antenatal services, danger
signs, and preparation for childbirth in health facilities), labor signs, and newborn
care. The training program provided includes readiness to give birth before 24 weeks of pregnancy and signs of
labor as well as newborn care. The counseling
provided discussed family planning; Nutrients;
preparation for pregnancy
and childbirth; and danger signs during pregnancy, childbirth
and postpartum. The results of the intervention of community-based continuous training
programs involving mothers and husbands can reduce three delays, namely
delays in decision-making to seek health services,
delays in reaching
health facilities, and delays in getting
the right services when reaching health facilities and increasing antenatal visits.
(Moshi et al., 2018)
CBCT intervention programs in encouraging positive
behavior in childbirth readiness and readiness to face complications. CBCT
intervention programs can encourage pregnant
women to complete antenatal visits
and prepare for labor well so that they have twice as good pregnancy
outcomes as mothers who do not have antenatal visits (Swain
et al., 2019). In the Mertisa and Irma study, 2022, it was found that husband
support was related to the accuracy of Antenatal Care visits for pregnant
women. Husbands greatly influence ANC
visits, the better the husband's support given, the lower
the level of inaccuracy
of ANC visits. Therefore, health workers should provide education
to mothers and husbands
about the importance of support during pregnancy (Mertisa Dwi Klevina & Irma Mathar, 2022).
Community-based continuous training programs
through increasing maternal knowledge about labor danger signs and delivery times and husband involvement can help in
decision-making so that it is not too late to reach health facilities in rural
areas. Punctuality of arrival at health facilities can reduce the risk of maternal death.
HEP (Health
Extension Program) and HDA (Health
Development Army) Program Policies
The maternal mortality rate in Ethiopia
decreased from 728 to 357 between 2003 and
2016, a 46% decline due to combined
interventions from HEP and HDA. The HEP (Health Extension Program) program
is one of the most innovative community-based health programs
in Ethiopia. This is based on the assumption that access to and quality of
basic health services
in rural communities can be improved through the transfer of health
knowledge and skills to households. The Health Development Army (HDA) is a women-
centered community movement inspired by military structure and
discipline. The particular goal is to improve maternal health outcomes
(Rieger et al., 2019).
HEP and HDA interventions may improve
antenatal visits. increasing the use of maternal
health services so that it
can be a solution in reducing maternal mortality
rates. Health Insurance
The health insurance scheme is one of the intervention packages that has a very high potential in improving
public health such as reducing
maternal mortality.(Uneke et al.,
2019)
Health insurance ownership is significantly related to increased chances of childbirth in hospitals, mothers who have health insurance and have higher economic status have a greater opportunity to take advantage of maternal health services (Suparmi et al., 2019).
Health insurance is very beneficial to people who have a low economic
level, who cannot afford to pay for treatment
if they are treated in a health facility. With the existence
of a health insurance scheme for the community and specifically for pregnant women, it can have an impact on the desire of pregnant women to use health facilities as a place to improve their health, get treatment and childbirth.
CONCLUSION
The high maternal mortality rate in rural areas is an important thing for the state to pay attention to. Nigeria, Zambia,
Uganda, Liberia, China, Tanzania and Ethiopia have implemented prevention policies and concepts that are able to
reduce maternal
mortality rates in rural areas. The policies and prevention models or concepts implemented are the fulfillment of health human resources and health facilities in rural areas, maternity waiting
houses, community-based continuous training programs, and health insurance schemes.
BIBLIOGRAPHY
Andini, T. D., &
Aan Julia. (2022). Pengaruh
Tingkat Pendidikan, Jumlah
Bidan, dan Tingkat Pendapatan terhadap Angka Kematian Ibu di 9 Provinsi Indonesia Tahun 2010-2020.
Bandung Conference Series: Economics Studies, 2(2). https://doi.org/10.29313/bcses.v2i2.3599
Buser, J. M., Munro‐Kramer, M. L., Carney, M., Kofa, A., Cole,
G. G., & Lori, J. R. (2019). Maternity waiting homes as a cost‐effective intervention in rural Liberia. International Journal of Gynecology & Obstetrics, 146(1), 7479. https://doi.org/10.1002/ijgo.12830
Conlon, C. M., Serbanescu, F., Marum, L., Healey, J., LaBrecque, J., Hobson, R., Levitt, M., Kekitiinwa, A., Picho, B., Soud, F., Spigel, L., Steffen, M., Velasco, J., Cohen,
R., & Weiss, W. (2019).
Saving Mothers, Giving Life: It Takes a System to Save a Mother. Global Health: Science and Practice, 7(Supplement 1),
S6S26. https://doi.org/10.9745/GHSP-D-18-00427
Damayanti, N. A., Wulandari, R. D., & Ridlo, I. A.
(2023). Maternal Health Care Utilization Behavior, Local Wisdom, and Associated
Factors Among Women in Urban and Rural Areas,
Indonesia. International Journal of Womens Health, Volume 15, 665677. https://doi.org/10.2147/IJWH.S379749
DAmbruoso, L. (2012). Relating the construction and maintenance of maternal ill-health in rural Indonesia. Global Health Action, 5(1). https://doi.org/10.3402/GHA.V5I0.17989
Diajeng Sri Andriani Permatasari, & lutfan lazuardi.
(2019). Aksesibilitas Kesehatan Maternal Dalam Upaya menurunkan Angka Kematian
Ibu di Kabupaten Gunungkidul (Kajian dengan ACCESSMOD 5.0). Journal of Information Systems for Public Health, 4(1), 5262.
Gurara, M. K., Jacquemyn, Y., Ukke, G. G., Van
Geertruyden, J.-P., & Draulans, V. (2022).
Benefits, barriers and enablers of maternity waiting
homes utilization in Ethiopia:
an integrative review of national implementation experience to date. BMC Pregnancy
and Childbirth, 22(1), 675.
https://doi.org/10.1186/s12884-022-04954-y
Heru Santoso Wahito Nugroho, Suparji,
& Sunarto. (2019).
Determinan Kematian Ibu di
Kabupaten Ngawi (Tinuk Esti Handayan, Ed.; 2nd ed.). Aliansi Aktivis Kesehatan / Alliance of Health Activists (AloHA).
Maternal mortality. (n.d.). Retrieved 16 May 2024, from https://www.who.int/en/news- room/fact-sheets/detail/maternal-mortality
Mertisa Dwi Klevina, & Irma
Mathar. (2022). Dukungan Eomosional Suami Dengan Ketepatan Jadwal Kunjungan Antenatal Care (ANC)
Pada Ibu Hamil Trimester
III Selama Pandemi COVID 19 Di
Wilayah Kerja Puskesmas Pialngkenceng Kabupaten Madiun. Jurnal Ilmu Kebidanan Dan Kesehatan (Journal of
Midwifery Science and Health), 13(2), 2124. https://doi.org/10.52299/jks.v13i2.118
Moshi, F. V., Kibusi, S. M., & Fabian, F. (2018). The Effectiveness of Community-Based
Continuous Training on Promoting Positive Behaviors towards Birth Preparedness,
Male Involvement, and Maternal Services
Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of
Planned Behavior Quasi-Experimental Study. Journal of Environmental and Public Health,
2018, 19. https://doi.org/10.1155/2018/1293760
Oruh, S. (2021).
Literatur Review: Kebijakan
dan Strategi Pemberdayaan Masyarakat Dalam Menurunkan Angka Kematian Ibu dan Bayi. Preventif :
Jurnal Kesehatan Masyarakat, 12(1), 135148. https://doi.org/10.22487/preventif.v12i1.297
Prasetyo, B., Damayanti, H. E., Pranadyan, R., Habibie, P. H., Romdhoni, A., & Islami,
D. (2018). Maternal Mortality Audit Based On District Maternal
health performance in East Java Province, Indonesia. Bali Medical
Journal, 7(1), 61. https://doi.org/10.15562/bmj.v7i1.761
Respati, S. H., Sulistyowati, S., & Nababan, R.
(2019). Analisis Faktor Determinan Kematian Ibu di Kabupaten Sukoharjo Jawa Tengah Indonesia. Jurnal Kesehatan
Reproduksi, 6(2), 52. https://doi.org/10.22146/jkr.43463
Rieger, M., Wagner, N., Mebratie, A., Alemu, G., &
Bedi, A. (2019). The impact of the Ethiopian
health extension program
and health development army on maternal mortality: A synthetic control
approach. Social Science &
Medicine,
232, 374381. https://doi.org/10.1016/j.socscimed.2019.05.037
Sanderson, S., Tatt, I. D., & Higgins, J. P. (2007).
Tools for assessing quality and susceptibility
to bias in observational studies in epidemiology: a systematic review and annotated
bibliography. International Journal of Epidemiology, 36(3), 666676.
https://doi.org/10.1093/ije/dym018
Schiff, G. D., Bearden, T., Hunt, L. S., Azzara,
J., Larmon, J., Phillips, R. S., Singer,
S., Bennett, B., Sugarman, J. R., Bitton, A., & Ellner, A. (2017).
Primary Care Collaboration to Improve Diagnosis and Screening for Colorectal
Cancer. Joint
Commission Journal on Quality and Patient Safety, 43(7), 338350. https://doi.org/10.1016/J.JCJQ.2017.03.004
Suparmi, Iram Barida Maisya,
& Heny Lestari.
(2019). Jaminan Kesehatan sebagai
solusi mengatasi hambatan akses dan biaya dalam pemanfaatan pelayanan
kesehatan ibu di Indonesia.
Swain, D., Parida, S. P., Jena,
S. K., Das, M., & Das, H. (2019). Impact of Community-
Based Continuous Training on Promoting Birth Preparedness and Pregnancy Outcome
in Rural Odisha, India: An Interventional Study. The Journal of Obstetrics and Gynecology of India, 69(6), 520528. https://doi.org/10.1007/s13224-019-01255- x
Tabazzum firos,
Marianne Vidler, & Prestige tatenda.
(2016). Community Perspectives on the determinants of
maternal health in rural southern Mozambique: A Qualitative study.
Reprouctive Health.
Tunηalp, Φ., Souza, J. P., Hindin, M. J., Santos, C. A.,
Oliveira, T. H., Vogel, J. P., Togoobaatar, G., Ha, D. Q., Say, L., Gόlmezoglu,
A. M., & WHO Multicountry Survey on Maternal. (2014). Education and severe maternal outcomes in developing
countries: a multicountry cross-sectional survey. BJOG : An International Journal of Obstetrics and Gynaecology, 121 Suppl 1, 5765.
https://doi.org/10.1111/1471-
0528.12634
Uneke, C. J., Sombie, I., Uro-Chukwu, H. C., &
Johnson, E. (2018). Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed
policymaking to improve
maternal and child health outcomes: A focus on six West African Countries. Globalization
and Health, 14(1). https://doi.org/10.1186/s12992- 018-0422-1
Uneke, C. J., Sombie, I., Uro-Chukwu, H. C., & Johnson, E. (2019). Developing equity- focused interventions for maternal and
child health in Nigeria:
an evidence
synthesis for policy, based on equitable
impact sensitive tool (EQUIST).
Pan
African
Medical Journal, 34.
https://doi.org/10.11604/pamj.2019.34.158.16622
Wahyudiana, E., & Andayani, F. (2020). Tinjauan Literatur Sistemtik Tentang Kesehatan Mental Siswa di Sekolah
Daar. PARAMETER: Jurnal Pendidikan Universitas Negeri Jakarta, 32(2), 115152. https://doi.org/10.21009/parameter.322.03
WHO. (2015). Strategies toward ending preventable
maternal mortality (EPMM) Executive Summary.
Yang, L., & Wang, H. (2019). Primary health care among rural pregnant women in China: achievements and challenges in maternal mortality ratio. Primary Health Care
Research & Development, 20, e97.
https://doi.org/10.1017/S1463423619000306
Copyright holders:
Irmawati Mathar, Mertisa Dwi Klevina, Cintika Yorinda Sebtalesy (2024)
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AJHS - Asian Journal of Healthy and Science
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