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dc.contributor.authorAhmad, Raheelah
dc.contributor.authorZhu, Nina J
dc.contributor.authorLebcir, Mohamed
dc.contributor.authorAtun, Rifat A.
dc.date.accessioned2019-04-11T14:07:50Z
dc.date.available2019-04-11T14:07:50Z
dc.date.issued2019-03-30
dc.identifier.citationAhmad , R , Zhu , N J , Lebcir , M & Atun , R A 2019 , ' How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan ' , BMJ Global Health , vol. 4 , no. 2 , e001242 , pp. e001242 . https://doi.org/10.1136/bmjgh-2018-001242
dc.identifier.otherPURE: 16575071
dc.identifier.otherPURE UUID: 10fef69b-f682-4656-a67f-1b7c4d21bd1c
dc.identifier.otherScopus: 85063696550
dc.identifier.urihttp://hdl.handle.net/2299/21256
dc.description© Author(s) 2019.
dc.description.abstractBackground 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 subgroups by geographical 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 the 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.en
dc.format.extent10
dc.language.isoeng
dc.relation.ispartofBMJ Global Health
dc.subjectantenatal care
dc.subjectheath seeking behaviour
dc.subjectneonatal mortality
dc.subjectsystem dynamics
dc.subjectHealth Policy
dc.subjectPublic Health, Environmental and Occupational Health
dc.titleHow the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistanen
dc.contributor.institutionHertfordshire Business School
dc.description.statusPeer reviewed
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85063696550&partnerID=8YFLogxK
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1136/bmjgh-2018-001242
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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