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For more than two decades, maternal health policy in sub-Saharan Africa has been guided by a powerful and intuitive idea: if women can physically reach a health facility, maternal deaths will fall. This logic has driven billions of dollars in investment toward building clinics, training health workers, subsidising care, and expanding coverage. On paper, the strategy has worked. Skilled birth attendance in sub-Saharan Africa rose from just 38% in 2000 to approximately 74% by 2023.1 Facility density has increased; user fees have been reduced or abolished in many countries; and maternal health has remained central to global development agendas. Yet maternal mortality remains catastrophically high. Sub-Saharan Africa still accounts for nearly 70% of all maternal deaths globally, with an estimated 182,000 maternal deaths recorded in 2023 alone.2 The region’s maternal mortality ratio, 454 deaths per 100,000 live births, is more than 150 times higher than that of high-income countries.2 Maternal health interventions have long operated under what might be called the access fallacy: the assumption that availability naturally leads to use. Build clinics and women will come. Train midwives and women will trust them. Remove fees and financial barriers will disappear. This logic has shaped national strategies and donor priorities across the region. But evidence increasingly shows that access alone is a weak predictor of care utilisation. In several sub-Saharan African countries, facility availability is near universal, yet only around two-thirds of births occur in health facilities.1 Even when services are free or subsidised, women frequently opt for home births attended by traditional birth attendants.

Three decades after the Beijing Declaration and Platform for Action, Africa has made progress in maternal, reproductive, and child health1. Improvements in healthcare policies, increased access to family planning, and reductions in maternal mortality in some African countries reflect the continent's commitment to advancing women's health1. Significant barriers, however, remain, including high maternal and child mortality rates, limited access to reproductive health services, and the persistence of harmful practices that threaten the well-being of women and girls1. Achieving the key objectives of the Beijing Declaration Platform for Action remains a persistent challenge in Africa1.

IntroductionBenzodiazepine receptor agonists (BZRA) deprescribing interventions are needed to tackle high BZRA use in the older population. This study aims to assess the feasibility of the D-PRESCRIBE intervention, adapted from Canada to the Belgian community setting. This pharmacist-led intervention comprises a patient educational brochure and a pharmacist-to-prescriber communication tool.Methods and analysisWe will conduct a feasibility study of a cluster randomised controlled trial involving 8–10 community pharmacies (clusters) and aiming to recruit 56–80 patients (≥65 years). Intervention pharmacies will deliver the adapted D-PRESCRIBE intervention and control pharmacies, usual care. Patients will be blinded to group allocation. Quantitative data will be collected at baseline, 3 months and 6 months through patients’ and pharmacists’ questionnaires, aiming: (1) to test the feasibility of the intervention, (2) to test the feasibility of the study design needed for its evaluation and (3) to perform an exploratory cost-effectiveness analysis. Hence, data about implementation outcomes, mechanisms of impact (ie, mechanisms through which the intervention is supposed to be effective) and contextual factors will be gathered. Patient-centred outcomes will also be collected as they would be in a full cost-effectiveness trial. The feasibility of the study design will be assessed through participation rate, completeness of the data and a satisfaction survey, sent to participants after the 6-month data collection. Data will be analysed using descriptive statistics. To gain a deeper understanding of pharmacists and patients’ experience with the intervention, interviews will be conducted after the 6-month data collection and the Theoretical Domains Framework will be used as a deductive framework for analysis.Ethics and disseminationThis study was approved by the Ethics Committee of CHU UCL Namur (NUB: B0392023000036). Participants will receive a summary of the results. Results will also be disseminated through the organisation of a local symposium and a peer-reviewed publication.Trial registration number NCT05929417.

IntroductionDespite several calls to deprescribe benzodiazepine receptor agonists (BZRA) in older adults, their use among nursing home residents (NHRs) remains high. Therefore, we developed an intervention targeting general practitioners’ and healthcare professionals’ behaviours regarding BZRA deprescribing in nursing homes (NHs): The END-IT NH (bENzodiazepines Deprescribing InTerventions Nursing homes) 6-component intervention. Before moving on to a large-scale effectiveness and cost-effectiveness evaluation, this feasibility study aims at: (1) assessing the feasibility of the intervention implementation in NHs, (2) assessing the feasibility of conducting a larger-scale evaluation, in terms of recruitment and data collection and (3) conducting an exploratory cost-effectiveness evaluation.Methods and analysisWe will conduct a cluster-randomised controlled trial in a sample of 6 NHs, with 10–15 NHRs included per NHs. Four NHs will be randomised into the intervention group, and two NHs will deliver usual care (control group). Data collection will occur at baseline, 3, and 6 months (study end). We will collect information to explore implementation fidelity, mechanisms of impact and contextual factors at patient-level, NH-level and healthcare professional-level, using both quantitative and qualitative measures. The feasibility of the study conduction will be assessed by measuring recruitment and attrition rates and completeness of data collection. An exploratory cost-effectiveness evaluation will be conducted based on quality of life and healthcare use and cost data.Ethics and disseminationThis study protocol received approval from the ethical committee of CHU UCL Namur on the 20 June 2023. All data are confidential and will be anonymised prior to analysis. De-identified data will be shared on a data depository with a 2-year embargo. The results of the study will be disseminated through a scientific paper and will be communicated to local stakeholders and policymakers through a local symposium.Trial registration numberNCT05929443.

Despite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria's Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels. The objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results. The study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies. There were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital. We conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.

While behavioural change interventions are utilized in low- and lower-middle-income countries and may be essential in reducing maternal and child mortality, evidence on the effectiveness of such interventions is lacking. This review provides evidence on the effectiveness of behavioural change interventions designed to improve maternal and child healthcare-seeking behaviour in low- and lower-middle-income countries. We searched three electronic databases (PUBMED, EMBASE, and PsycINFO) for articles published in English and French between January 2013 and December 2022. Studies that evaluated interventions to increase maternal and child healthcare utilization, including antenatal care, skilled birth care, postnatal care, immunization uptake, and medication or referral compliance, were included. We identified and included 17 articles in the review. Overall, 11 studies found significant effects of the behavioural change interventions on the desired healthcare outcomes, 3 found partially significant effects, and 3 did not observe any significant impact. A major gap identified in the literature was the lack of studies reporting the effect of behavioural change interventions on women's non-cognitive and personality characteristics, as recent evidence suggests the importance of these factors in maternal and child healthcare-seeking behaviour in low-resource settings. This review highlights some intervention areas that show encouraging trends in maternal and child healthcare-seeking behaviours, including social influence, health education, and nudging through text message reminders. Bien que les interventions visant à modifier les comportements soient utilisées dans les pays à faibles et moyens revenus et qu'elles pourraient être essentielles pour réduire la mortalité maternelle et infantile, les preuves de l'efficacité de telles interventions font défaut. Cette revue synthétise les preuves de l'efficacité des interventions de changement de comportement conçues pour améliorer le recours aux soins maternels et infantiles dans les pays à faibles et moyens revenus. Nous avons identifiés dans trois bases de données électroniques (PUBMED, EMBASE et PsycINFO) les articles publiés en anglais et en français entre janvier 2013 et décembre 2022. Les études qui évaluaient les interventions visant à accroître l'utilisation des soins de santé maternelle et infantile, y compris les soins prénatals, les soins d'accouchement par du personnel qualifié, les soins postnatals, la vaccination et l'observance des traitements médicamenteux ou de référence, ont été incluses. Nous avons identifié et inclus 17 articles dans la revue. Dans l'ensemble, 11 études mettent en évidence des effets significatifs des interventions visant à modifier les comportements en matière de soins de santé, 3 mettent en évidence des effets partiellement significatifs et 3 n'observent pas d'impact significatif. Une lacune majeure dans la littérature est le manque d'études rapportant l'effet des interventions de changement de comportement sur les caractéristiques non cognitives et de personnalité des femmes, alors que des travaux récents suggèrent l'importance de ces facteurs pour le recours aux soins de santé pour la mère et l'enfant dans les environnements à faibles ressources. Cette étude met en lumière certains domaines d'interventions qui encourageraient les comportements de recours aux soins des mères et des enfants, notamment l'influence sociale, l'éducation à la santé et l'incitation par le biais de rappels par SMS.