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How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of System Dynamics modelling in Pakistan

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Title: How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of System Dynamics modelling in Pakistan
Authors: Ahmad, R
Zhu, J
Lebcir, MR
Atun, R
Item Type: Journal Article
Abstract: Background: Limited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities. Methods and Findings: A System Dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse, and switch antenatal care services in four provider sectors: public, private, traditional, and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different sub-groups by geographic locations, and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences on if, when and where to seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after Trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within Trimester 2, but for rural women within Trimester 1. Antenatal care access delayed to Trimester 3 had no protective impact on neonatal mortality. Conclusions: System Dynamics modelling enables capturing complexity of health-seeking behaviours and impact on outcomes, informing: intervention design, implementation of targeted policies, and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts, and strong social network influences.
Issue Date: Apr-2019
Date of Acceptance: 1-Feb-2019
URI: http://hdl.handle.net/10044/1/67401
DOI: http://dx.doi.org/10.1136/bmjgh-2018-001242
ISSN: 2059-7908
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Global Health
Volume: 4
Issue: 2
Copyright Statement: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
antenatal care
heath seeking behaviour
neonatal mortality
system dynamics
Publication Status: Published
Article Number: e001242
Online Publication Date: 2019-03-30
Appears in Collections:Department of Infectious Diseases