Strengthening Maternal and Infant Health in an impoverished peri urban community in Lima, Peru: The SAMI Project
Anna Kohler-Smith, Karen Ramos, Carmen Contreras, Milagros Dueñas, Leonid Lecca, Jerome T. Galea
Published Online: November 30, 2019
While Peru has made strides in preventing maternal mortality, a more comprehensive and systematic approach towards reducing maternal morbidity and improving infant health is critical. In this paper, we present the preliminary results of the ‘Strengthening Maternal and Child Health in the District of Carabayllo’ or SAMI Project, developed by non-governmental organization Socios en Salud (Partners in Health). The project offers an innovative and multifaceted community approach to preventing maternal morbidity through management of the clinical, emotional, and nutritional health needs of pregnant women, postpartum women and infants in Lima, Peru. In collaboration with local stakeholders and the Peruvian Ministry of Health, the intervention utilizes the critical role of Community Health Workers as project collaborators. Local NGO team members include project coordinator, psychologists, nutritionists, and midwifes. Women are enrolled during pregnancy, give birth during the project, and are monitored alongside their infants until 1-year post birth. Project activities include accompaniment to clinical health appointments by community health workers for women until three months postpartum, birth education classes in the second and third trimesters, birth planning, depression screening, and the World Health Organization’s (WHO) ‘Thinking Healthy Programme’ to reduce symptoms of mild to moderate perinatal depression. Between August 2016 to August 2018, 89 pregnant women were screened for SAMI participation and until August 2018, 59 women participated in the intervention. 75% had completed 6 or more prenatal visits. 35% had anemia at some point during their pregnancy and 24% of participants screened positive for depression and participated in the Thinking Healthy Programme. Of the 40 participants who had given birth, 92.5% of newborns had normal birthweight between 2.5 to 4 kilos. These initial results are encouraging, and the project anticipates positive results in new communities where it will be extended in the future. Additionally, the project serves as a model for comprehensive maternal infant health services in low income communities.
Testing the Dual-State-Process assumption in the preventive care services use
Published Online: November 30, 2019
Introduction: Health services use is often measured as a count variable that is characterized by an excess of zeros. Ζeros are generally considered to be generated from a dual-state process, i.e., sampling zeros concern a group of at-risk individuals, while structural zeros concern a group of not-at-risk individuals. However, in several studies, especially those regarding preventive services use, the dual-state-process assumption is questionable. In this sense, the objective of this paper is to investigate whether the dual-state-process assumption holds in the case of preventive services use.
Methods: For the purpose of this study, we analyzed data from a Panhellenic cross-sectional survey that was conducted in 2017. The survey used stratified random sampling, and the sample selection strata were defined by age, gender, urbanity status of permanent residence and prefecture. The sample consisted of 2003 adults. A computer-assisted telephone interviewing method was used for the data collection. Since the outcome variable was the number of times that preventive health services were used, the analysis was based on the comparison between a zero-inflated negative binomial model and a standard negative binomial model through the corrected Vuong test. Several health, socioeconomic, demographic and structural factors of the Greek health care system were used as independent variables.
Results: According to the analysis, the dual-state-process assumption does not hold in the case of preventive services use and since the need for receiving preventive care exists in most age and gender groups, this is probably due to the fact that preventive services use is infrequent, meaning that the majority of zeros are sampling zeros.
Discussion and Conclusion: The results highlight the need for testing the assumption if zero-inflated count models are to be used.