Global Health: Science and Practice最新文献

{"title":"Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries.","authors":"Gillian Forbes,Shahinoor Akter,Suellen Miller,Hadiza Galadanci,Zahida Qureshi,Fadhlun Alwy Al-Beity,G Justus Hofmeyr,Neil Moran,Sue Fawcus,Mandisa Singata-Madliki,Aminu Ado Wakili,Taiwo Gboluwaga Amole,Baba Maiyaki Musa,Faisal Dankishiya,Adamu Abdullahi Atterwahmie,Abubakar Shehu Muhammad,John Ekweani,Emily Nzeribe,Alfred Osoti,George Gwako,Jenipher Okore,Amani Kikula,Emmy Metta,Ard Mwampashi,Cherrie Evans,Kristie-Marie Mammoliti,Adam Devall,Arri Coomarasamy,Ioannis Gallos,Olufemi T Oladapo,Meghan A Bohren,Fabiana Lorencatto","doi":"10.9745/ghsp-d-23-00387","DOIUrl":"https://doi.org/10.9745/ghsp-d-23-00387","url":null,"abstract":"INTRODUCTIONPostpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.METHODSImplementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.RESULTSImplementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).CONCLUSIONSystematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"5 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142198245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Community Engagement Is Needed to Improve Adherence to Ebola Response Activities and Survivorship During Ebola Outbreaks.","authors":"Gnakub Norbert Soke, Peter Fonjungo, Gisele Mbuyi, Richard Luce, John Klena, Mary Choi, John Kombe, Gerry Makaya, Francis Mbuyi, Henriette Bulambo, Mathias Mossoko, Celestin Mwanzembe, Bienvenu Ikomo, Pierre Adikey, Joel Montgomery, Trevor Shoemaker, Placide Mbala, Giulia Earle-Richardson, Dieudonne Mwamba, Jean-Jacques Muyembe Tamfum","doi":"10.9745/GHSP-D-23-00006","DOIUrl":"10.9745/GHSP-D-23-00006","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good Management Practice Is Correlated With Good Performance of Community-Engaged Primary Health Care Facilities in Peru.","authors":"Laura C Altobelli","doi":"10.9745/GHSP-D-23-00402","DOIUrl":"10.9745/GHSP-D-23-00402","url":null,"abstract":"<p><strong>Background: </strong>Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms.</p><p><strong>Methods: </strong>We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as \"good\" or \"less effective.\" The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, \"higher performance,\" and Group 2, \"lower performance,\" to identify specific practices linked to better performance.</p><p><strong>Results: </strong>We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; <i>P</i><.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2.</p><p><strong>Conclusions: </strong>Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to Address the Health and Well-Being of Married Adolescents: A Systematic Review.","authors":"Manahil Siddiqi, Margaret E Greene, Alexandra Stoppel, Charles Allegar","doi":"10.9745/GHSP-D-23-00425","DOIUrl":"10.9745/GHSP-D-23-00425","url":null,"abstract":"<p><p>Child marriage, defined by the United Nations as marriage before the age of 18 years, is a widespread practice with serious health and social consequences. We systematically reviewed academic and gray literature to learn what is known about the current state of the evidence for interventions to respond to the needs of married adolescents. Our analysis of the 29 included intervention studies identified variability across sectors, with most programs focusing on sexual and reproductive health (SRH) and maternal health. We found that interventions occur mostly at a small scale, are geographically concentrated, and focus on SRH to the neglect of other sectors. There is a need for programs to focus on improving educational and economic outcomes among married girls, as well as increased efforts to support equitable marital relations and engage men and boys. The emphasis on preventing child marriage must be matched by efforts to mitigate and respond to the practice.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Acceptability of Biodegradable Contraceptive Implants in Kenya and Senegal.","authors":"Alice F Cartwright, Rebecca L Callahan, Anna Lawton, Christina Wong, Oliver Muchiri, Samira Matan","doi":"10.9745/GHSP-D-23-00503","DOIUrl":"10.9745/GHSP-D-23-00503","url":null,"abstract":"<p><strong>Background: </strong>Contraceptive implants are popular in Africa, but barriers to removal exist. Biodegradable implants (BDIs) offer an alternative to the need for removal. This study explored potential user, provider, and other stakeholder perspectives on 2 BDI prototypes, revealing opportunities and challenges for introduction.</p><p><strong>Methods: </strong>We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with women, men, family planning (FP) providers, community influencers, and FP policymakers and program staff in Kenya and Senegal. Characteristics of the 2 BDI prototypes were shared, and participants held and interacted with placebo prototypes. Structural coding was used to analyze the data focused on key product attributes, including biodegradation, removal potential, size, material, insertion site, and duration of effectiveness.</p><p><strong>Results: </strong>We conducted 16 FGDs and 35 IDIs with 106 participants in Kenya and 15 FGDs and 43 IDIs with 102 participants in Senegal. Overall, respondents liked the idea of a BDI, noting the avoidance of pain and scarring and reduced transport and costs as benefits of no removal requirement. Kenyan respondents expressed greater understanding of the biodegradation process than those in Senegal, though potential users in both countries expressed concerns about possible side effects associated with the process. In Senegal, mention of cholesterol in a BDI caused concern, while Kenyan participants responded positively to the same BDI being composed of organic materials. The second BDI product was viewed as more similar to existing implants, which providers preferred. Participants suggested increasing the pregnancy protection duration beyond 18 months. No clear preference between products emerged, and participants liked and disliked some characteristics of both.</p><p><strong>Conclusions: </strong>Kenyan and Senegalese participants expressed interest in the BDI concept but expressed some reservations related to biodegradation, material, and side effects. BDIs offer the opportunity to expand contraceptive choice. However, messaging around product characteristics will be required for successful introduction and uptake.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Oxygen Supply Is Not Enough: A Qualitative Analysis of a Pressure Swing Adsorption Oxygen Plant Program in Ethiopian Hospitals.","authors":"Victoria Smith, Alana Changoor, Sarah Rummage, Haileab Fekadu Wolde, Ejigu Gebeye Zeleke, Getahun Mekonnen Belay, David Barash, James Stunkel, Cheri Reynolds","doi":"10.9745/GHSP-D-23-00515","DOIUrl":"10.9745/GHSP-D-23-00515","url":null,"abstract":"<p><strong>Background: </strong>In response to critical gaps in medical oxygen access, 2 pressure swing adsorption (PSA) oxygen production centers were established using an ecosystem-strengthening strategy in Amhara, Ethiopia, in 2019. A qualitative study was conducted to assess enablers and bottlenecks to oxygen access at the hospital level after installation.</p><p><strong>Methods: </strong>A variety of hospital staff (clinicians, biomedical professionals, hospital administrators, and procurement teams) across 13 hospitals procuring oxygen from the plants participated in comprehensive, semistructured focus group discussions. A thematic framework analysis approach was used to identify key themes.</p><p><strong>Findings: </strong>A total of 101 individuals participated in 26 focus groups in 2021, 2 years after plants were installed. Primary themes were accessibility of supply, affordability, and hospital readiness. Respondents indicated a substantial increase in their hospital's ability to access lower-cost oxygen, with many attributing this to the locality of plants and reduced transportation barriers. However, other challenges persisted, and the emergence of COVID-19 1 year after plant installation and a civil conflict exacerbated supply shortages. Investments in equipment, supplies, and training optimized clinical utilization of oxygen and were highlighted as a need for ongoing investment.</p><p><strong>Conclusion: </strong>To achieve maximum impact, investments in large-scale oxygen systems must be accompanied by strategic plans to transport oxygen, reduce costs to hospitals, and provide support to clinical teams through equipment, supply procurement, and clinical training. These findings support comprehensive ecosystem approaches to strengthening oxygen access for sustainable impact.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indicators and Implementation Guidance to Advance Value-Based HIV Care Through People-Centered Metrics.","authors":"Emily Harris, Sameera Ali, Josephine Mungurere-Baker, Atlang Mompe, Chintan Maru, Balkrishna Korgaonkar, Shipra Srihari, Yordanos Molla","doi":"10.9745/GHSP-D-23-00220","DOIUrl":"10.9745/GHSP-D-23-00220","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and Barriers for Private Health Sector Engagement for TB Care in India: A Systematic Review and Meta-Synthesis of Qualitative Research.","authors":"Rakesh Ps, Mohd Shannawaz, Manu E Mathew, Kuldeep Singh Sachdeva","doi":"10.9745/GHSP-D-24-00034","DOIUrl":"10.9745/GHSP-D-24-00034","url":null,"abstract":"<p><strong>Introduction: </strong>Private sector engagement is recognized as one of the most critical interventions to achieve the End TB goals in India. We conducted a systematic review and a meta-synthesis of qualitative studies to identify the barriers and facilitators for private sector engagement in TB care in India.</p><p><strong>Methods: </strong>A systematic search in electronic databases was done. We assessed the methodological limitations of individual studies, synthesized the evidence using thematic analysis, and assessed our confidence in each finding.</p><p><strong>Results: </strong>Of the 19 eligible articles included for the qualitative synthesis, 31.5% (6/19) were conducted in northern states of India. Included studies had details from 31 focus group discussions and 303 in-depth interviews conducted among various stakeholders. The synthesis revealed that barriers to engaging the private sector were lack of coordination mechanisms, lack of the National TB Elimination Program (NTEP) staff capacity to deal with the private sector, lack of private practitioners' knowledge on various programmatic aspects, and perceived complexity of the data exchange mechanism. The private sector felt that NTEP was not sensitive to the patient's confidentiality and demanded too much patient data. The private sector considered nonfinancial incentives like recognition, feedback, involving them in planning, and giving them equal status in partnership as powerful enablers for their engagement in TB care.</p><p><strong>Conclusion: </strong>Factors related to the context in which the engagement occurs, the architecture of the engagement, and interaction among the actors contribute to barriers to engaging the private sector for TB care in India. Strengthening policies to protect patient confidentiality, using behavior change communication to NTEP program managers, providing managerial and soft-skill training to NTEP staff, promoting nonfinancial incentives to private providers, establishing a coordination mechanism between the sectors, and simplifying the data exchange mechanisms need to be done to further strengthen the private-sector engagement.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and Implementation of Brief Interventions to Address Noncommunicable Diseases in Uzbekistan.","authors":"Olakunle Alonge, Maysam Homsi, Mahnoor Syeda Rizvi, Regina Malykh, Karin Geffert, Nazokat Kasymova, Nurshaim Tilenbaeva, Lola Isakova, Maria Kushubakova, Dilbar Mavlyanova, Tursun Mamyrbaeva, Marina Duishenkulova, Adriana Pinedo, Olga Andreeva, Kremlin Wickramasinghe","doi":"10.9745/GHSP-D-23-00443","DOIUrl":"10.9745/GHSP-D-23-00443","url":null,"abstract":"<p><p>In Uzbekistan, NCDs, including cardiovascular diseases, cancer, and diabetes, accounted for over 80% of mortality in 2019. In 2021, national stakeholders, in conjunction with the World Health Organization, identified brief interventions (BIs) to implement in primary health care settings to change unhealthy behaviors and reduce the burden of NCDs in the country. BIs consist of a validated set of questions to identify and measure NCD behavioral risk factors and a short conversation with patients/clients about their behavior, as well as the provision of a referral opportunity for further in-depth counseling or treatment if needed. We used a multimethod approach of document review, participatory workshops, and key informant interviews to describe how BIs were designed and implemented in Uzbekistan and generated a theory of change for its large-scale implementation. BIs in Uzbekistan targeted 4 risk factors (alcohol use, tobacco use, unhealthy diet, and physical inactivity) and entailed training clinicians on how to conduct behavioral change counseling using the 5As and 5Rs toolkit, conducting supportive supervision, and using feedback to improve service delivery. The program was collaboratively designed by multiple stakeholders across sectors, including the Ministries of Health, Higher Education, Science, and Innovations, with buy-in from key political leaders. The potential impact of the program (i.e., reducing the incidence of NCDs) was mediated by several intermediate and implementation outcomes at the individual, primary care, and community levels operating along multiple pathways. Significant health system challenges remain to the program, such as limited human resources, lack of incentives for clinicians, outdated systems and data collection processes for performance monitoring, and coordination among different relevant sectors. These and other challenges will need to be addressed to ensure the effective large-scale implementation of BIs in Uzbekistan and similar LMICs.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Maternal and Newborn Health Mobile Phone E-Cohorts to Track Longitudinal Care Quality in Low- and Middle-Income Countries.","authors":"Katherine Wright, Irene Mugenya, Emma Clarke-Deelder, Laura Baensch, Tefera Taddele, Anagaw Derseh Mebratie, Monica Chaudhry, Prashant Jarhyan, Nompumelelo Gloria Mfeka-Nkabinde, Jacinta Nzinga, Sailesh Mohan, Theodros Getachew, Margaret E Kruk, Catherine Arsenault","doi":"10.9745/GHSP-D-23-00506","DOIUrl":"10.9745/GHSP-D-23-00506","url":null,"abstract":"<p><strong>Background: </strong>The maternal and newborn health (MNH) eCohort is a new mixed-mode (in-person and phone) longitudinal survey aiming to provide data on novel and undermeasured dimensions of quality along the MNH continuum of care. We describe implementation experiences and lessons learned in Ethiopia, India, Kenya, and South Africa to inform future longitudinal mobile phone-based studies on health system quality.</p><p><strong>Methods: </strong>To document the implementation approach and lesson learned, we engaged numerous stakeholders and conducted data reviews, debriefs, and a workshop with participants from all collaborative research organizations.</p><p><strong>Results: </strong>The MNH eCohorts enrolled women during their first antenatal care visit in 2 sentinel sites in Ethiopia, India, Kenya, and South Africa. In India, a site with better health outcomes and a site with poorer outcomes were chosen. In the remaining countries, an urban site and a rural site were chosen. Enrollment facilities reflect care-seeking patterns according to local health information data across public and private facilities and primary and secondary levels. Data collectors had a range of educational and experience profiles, and phone data collection was completed by the same enumerators in some countries and outsourced to data collection firms in others. Adequate infrastructure (including Internet and mobile phone coverage) was essential to implementation. Although follow-up is ongoing in India and South Africa, the eCohort retained 89%-90% of participants throughout the entire pregnancy and 78%-81% until 3 months postpartum in Ethiopia and Kenya, respectively.</p><p><strong>Conclusions: </strong>The MNH eCohort is a complex and long survey. Careful and thoughtful implementation demonstrates that it is a useful tool to gather data on health system quality and continuity and on changes in user experience over the continuum of care. Findings from the eCohort related to care and system competence and user experience will be valuable to program managers and policymakers alike.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}