Background: Since 1976, Bicol Region had higher maternal mortality ratio (MMR) than the Philippine average and became the fourth region with the highest MMR in 2012. Looking at trends of maternal health outcomes and determining risk factors among mothers who died may guide interventions to reduce MMR. Objectives: To determine the changes in maternal mortality ratio (MMR) in the Bicol region from 2004 to 2017 and determine the sociodemographic profile of pregnant women who died from 2015 to 2018. Materials and Methods: A records review of Bicol?s Regional Field Health Services Information System from 2004 to 2017 and maternal death review reports from 2015 to 2018 was done. Changes in MMR was determined using Poisson regression. The sociodemographic characteristics and causes of maternal deaths were analyzed using frequencies and proportion. Results: From 2004 to 2017, MMR of 100.9 remained higher than the regional target of 31.6. Significant reductions in MMR were achieved in 2007 to 2008 and in 2011 to 2012 wherein MMR ranged between 75.3 to 89.3. However, by the end of 2012, maternal deaths again increased which reached 122.5 in 2017. From the maternal death reviews, it was observed that 29.5% of maternal deaths were aged 35 years and above and 7.5% were less than 20 years old. Mothers who had more than five pregnancies were 30.1% of total deaths. In terms of place of death, 15.7% died at home or in-transit to referral facilities. Hemorrhage or hypertension-related causes were the leading reasons for maternal deaths. Conclusion Significant reduction in MMR was not sustained after 2012 and higher deaths were reported in the succeeding years. Maternal deaths can be further reduced by using a systems approach, by promoting family planning, and by strengthening service delivery networks to effectively manage hemorrhage and hypertension-related emergencies.
Maternal Mortality ; Maternal Health

Introduction: To address the problem of high maternal death, the Department of Health implemented the Basic Emergency Obstetric and Newborn Care (BEmONC) services at the level of primary care health facilities. These are key life-saving interventions that treat obstetric emergencies. Over a decade later, we need to assess and improve the program’s implementation. Objective: The study aims to select indicators for assessing the functionality of BEmONC facilities. Methods: Electronic Delphi process was used to select the indicators. Results: The two-round Delphi process was accepted by 21 respondents, with a 100% response rate. All 30 proposed indicators were retained following the criteria. Conclusion Thirty indicators to assess the functionality of BEmONC facilities have been selected through the consensus of an expert panel using the Delphi process. These indicators help evaluate BEmONC facilities, formulate policy, and guide new programs that promote maternal health.
Maternal Health

Introduction: Despite implementing various maternal health care programs and integrating these into Service Delivery Networks, the Philippines continues to have high maternal mortality. Identifying factors that impede the utilization of available maternal care services may help reduce maternal morbidity and mortality and bridge the gap between the need and actual use of such services among mothers in the community. Objectives: This study identified barriers, hindrances, and other factors influencing mothers in availing maternal health services in Luzon, the largest island in the country and the area that accounted for more than half of total maternal mortality. Methods: Eight focus group discussions participated in by a total of 78 pregnant women and mothers were conducted across all of the eight regions of Luzon. In each session, the participants were asked to answer questions based on a semi-structured interview guide. The interviews were recorded, translated and back-translated, transcribed, and compiled before analysis by the deductive-dominant approach using NVivo12. Results: Factors affecting maternal health service utilization center on the capacity of health facilities to provide services like evaluation of the progress of pregnancy, laboratory examinations, free medicines, and immunizations; and on region-bound individual factors. The availability of skilled health personnel and lack of financial resources were the most common subthemes. Conclusion This study identified some key factors that deter patients from availing of existing maternal health services in Luzon. Eliminating these barriers will not only help strengthen local health infrastructure and improve service delivery but also promote the utilization of such services, leading to better maternal outcomes.
Maternal Health

Background: Teaching clinics provide low-cost health programs while offering valuable learning opportunities for student clinicians, which then contributes to increasing health care accessibility. To date, there is a paucity of literature exploring the satisfaction of patient seen in rehabilitation teaching clinics in developing countries. The Service Quality (ServQual) Scale is a valid and reliable tool that has been used to measure client satisfaction in different work settings and industries.

Objectives: The aim of this study was to demonstrate the usefulness of ServQual
in measuring the satisfaction of clients in a rehabilitation teaching clinic in a developing country.

Methodology: A cross-sectional survey was conducted for three months among CTS-AA (Clinic for Therapy Services- Adult and Adolescent Section) clients who are at least 18 years old; have attended at least three sessions; and can read. Prior to
administration in CTS-AA, the ServQual scale was translated to Filipino, validated
and pilot tested for reliability.

Results: Thirty-two respondents were included in the analysis. there was no
statistically significant difference between the expectation and the perceptions
of the clients for the domains of reliability (z=1.799, p=0.0721),responsiveness (z=0.839, p=0.4013), assurance (z=1.914, p=0.0556) and empathy (z=1.772, p=0.0764). However, there was a statistically significant difference between the clients' perception and expectation for tangibles (z=4.117, p<0.0001) and between the overall client perception and expectation (z=4.086, p<0.0001).The overall ServQual score for CTS-AA is -0.3782.

Conclusion: The ServQual has been shown to be useful in assessing the satisfaction of clients in rehabilitation clinics and the specific areas that needs improvement. The tool can still be further improved by including items on cost, relationship of students with supervisors and outcomes of treatment.

Introduction: Implementation of Basic Emergency Obstetric and Newborn Care (BEmONC) aims to curb maternal mortality. However, the Philippines failed to significantly reduce the maternal mortality rate (MMR) targeted in the Millennium Development Goals (MDGs). Currently, the country is still far from the targeted Sustainable Development Goals (SDGs). This review describes the historical development of BEmONC in the Philippines over the past 13 years and provides insights on its role in decreasing MMR. Methods: We searched online for journal articles, publications, reports, policies, and other issuances related to BEmONC and maternal health in the Philippines. We accessed updates and data via correspondence with the Department of Health (DOH). Statistics were compiled from public databases. The identified citations were screened, appraised, synthesized, and analyzed in a historical approach. Results: A direct result of the Emergency Obstetric Care Approach, BEmONC was developed to respond to the high MMR in the Philippines, in line with global efforts to improve maternal health. However, BEmONC functionality generally remained inadequate. Conclusions Although the provision of BEmONC services increased facility-based deliveries and skilled birth attendance during childbirth, this failed to decrease MMR and achieve targeted goals substantially. Further capacity-building is needed, especially in rural and resource-poor areas. Government issuances at the national and local levels should be aligned to complement each other. There should be a health systems approach that considers the building blocks of an efficient health care system and the social determinants that impact them.
Maternal Health Services ; Maternal Mortality

Maternal morbidity and mortality remain major global concerns in developing and underdeveloped countries. Various international interventions have been made over the last 50 years but with essentially the same targets and indicators. This review traced the development of programs on maternal and child health based on major global policies, from the 1978 Declaration on Primary Health Care to the Millennium and Sustainable Development Goals, and related the approach they engendered to the Philippine experience. Health outcomes have not significantly improved despite adherence to recommended goals and programs. New strategies purportedly propose novel and innovative methods, but are burdened by essentially the same old presumptions: government resources are limited, and interventions need to be supported by whatever funds are available. Preference for low-cost and measurable programs providing minimal essential care persists with the current socio-economic conditions characterized by neoliberal and conservative policies. There is a need to return to the fundamentals of the Comprehensive Primary Health Care, linking the health of vulnerable groups, like women and children, to social and economic development. Inter-agency and multi-sectoral approach, community participation and empowerment, real political commitment and major rethinking are needed in national and international discourses on health not just to attain better maternal and child health but to achieve health for all.
Maternal Health ; Child Health ; Primary Health Care

Objectives: To A functioning referral system is critical to the maternal health program, especially in the management of obstetric emergencies. This study explored supply-side barriers affecting the effective implementation of the said service delivery network (SDN) in Legazpi, Albay in the Bicol Region of the Philippines. Methods: Face-to-face in-depth interviews using semi-structured questionnaires were performed with health care providers involved in the SDN in Albay. Extensive note taking was done by the primary investigator while participants were observed during performance of duties from June - November 2018. Interviews were audio-recorded, transcribed, translated into English, and analyzed thematically along with the observation notes using NVivo. A deductive-dominant approach was utilized for the data content analysis. Results: Referral system barriers identified were cross-cutting across the different components of the health system such as governance, human health resource, service delivery and information systems. The barriers were further classified into individual, organizational and external-related factors in relation to the SDN. Examples of barriers included lack of knowledge of protocols and guidelines, lack of coordination between facilities, poor data management, inadequate capacity building opportunities, and constantly changing political landscape and policies. Conclusions The study is the first to explore barriers to effective service delivery network in maternal health in the country. Findings from the study provide significant insight to areas of improvement in the SDN that must be addressed to strengthen local health systems, especially with the country’s movement towards Universal Health Care where local health systems play a key role.
Maternal Health Services ; Referral and Consultation

Objective: Mothers are exposed to various functional food components, including probiotics, which have a direct effect on the quality of their breast milk. Probiotics enhance the microbial composition of breast milk, making it more beneficial for the infant’s gut health. This study aimed to explore the extent of knowledge and dietary practices on probiotics among low- to middle-income healthy Filipino mothers in an urban area. Methods: Data was gathered using three focus group discussions (FGD) participated in by low- to middle-income healthy Filipino mothers residing in Barangays West Rembo and Rizal in Makati City, Philippines. Prior to the FGD, preliminary interviews of selected participants and market surveys were done to determine the food items to be included in the FGD questionnaire. Results: A total of 19 mothers participated in the FGDs. The most common probiotic sources identified were yogurt, fermented milk product (Yakult), miso and tausi. The most consumed probiotic source was fermented milk product (94.7% of participants), at least once a month; followed by powdered milk (78.9%), consumed daily. The most commonly reported influence for consumption of these food items was advertisements from television (89.5%). About 53% of the participants related probiotics to better digestion and increased immunity as heard from advertisements and through counselling by physicians. When asked to elaborate on how probiotics influence digestion and immunity, almost all participants had difficulty explaining the benefits. Conclusion Although majority of the participants consumed food sources of probiotics, they had limited knowledge on its other non-food sources and benefits. In addition, the consumed food source was confined to the food item that was most advertised on television. Thus, there is a need for health and nutrition experts to exert a stronger influence in the community by disseminating information regarding probiotics.
Probiotics ; Maternal Health ; Infant Health ; Infant nutrition

Female ; Humans ; Maternal Health Services ; Maternal Mortality ; Pregnancy

Introduction: This action research aimed to make a context-specific and gender-sensitive interventions. Intervention activities was participatory to decrease the barriers to the use of maternal care and family planning (MCFP) services by the disadvantaged Kinh people and Catu ethnic minority people in the mountainous area of Nam Dong District in Central Vietnam. Intervention also aimed to improve communal MCFP services prioritized to training effective communication skills for communal health centers' staff and village health workers. Methods: 2 surveys were conducted before and after intervention among 7 poor communes using a random sample of total 840 mothers with at least one child under the age of 5 years. These data were supplemented by interviews with key informants, focus group discussions and observations. Statistical tests and measurement of effective index (EI) were used in data analysis. Results: - Women having ANC and delivery at local MCFP service were increasing 97.6% and 50% in year 2005 as compared with 86.9% and 31% respectively in year 2003. Midwives paid much attention to non-verbal communication as well as to counseling using demonstrative pictures. - There were a clear evidence of significantly increasing the mother's knowledge of MCFP such as local MCFP service availability, benefit of ANC (p<0.001) supported by performing many different communication channels (safe motherhood talks, village safe motherhood clubs, mass media of video-cassette using Catu speaking language, safe motherhood integration in traditional festival, campaign etc. - There was only statistically significant increase of inject able contraceptive ( EI=58.14%). The number of mothers having ANC>=3 times was significantly increasing (EI=11.98%, p<0.01). - The percentage of mothers who delivered at home was slow down to 19.4% as compared with before intervention was 45.2% respectively (EI= 64.20%, p<0.001) Conclusion: Intervention model was considerably successful in using context-specific and gender sensitive approaches. It contributed to meeting an urgent need for the MCFP services to build both clinical capacity and health promotion activities in a way that is gender sensitive, knowledge on of traditional practices and accessible by both illiterate and minority language speaking people.
Maternal Health Services ; Family Planning Services ; Maternal Behavior