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Malaju MT, Alene GD, Azale T. Impact of maternal morbidities on the longitudinal health-related quality of life trajectories among women who gave childbirth in four hospitals of Northwest Ethiopia: a group-based trajectory modelling study. BMJ Open 2022; 12:e057012. [PMID: 35288392 PMCID: PMC8921913 DOI: 10.1136/bmjopen-2021-057012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To identify distinct trajectories of health-related quality of life and its predictors among postpartum women in Northwest Ethiopia. DESIGN Health facility-linked community-based prospective follow-up study. SETTING South Gondar zone, Northwest Ethiopia. PARTICIPANTS We recruited 775 mothers (252 exposed and 523 non-exposed) after childbirth and before discharge. Exposed and non-exposed mothers were identified based on the criteria published by the WHO Maternal Morbidity Working Group. OUTCOME MEASURES The primary outcome measure of this study was trajectories of health-related quality of life. The Stata Traj package was used to determine the trajectories using a group-based trajectory modelling. Multinomial logistic regression model was used to identify predictors of trajectory membership. RESULTS Four distinct trajectories for physical and psychological and five trajectories for the social relationships and environmental health-related quality of life were identified. Direct and indirect maternal morbidities, lower educational status, poor social support, being government employed and merchant/student in occupation, vaginal delivery, lower monthly expenditure, stress, fear of childbirth and anxiety were found to be predictors of lower health-related quality of life trajectory group membership. CONCLUSIONS Health professionals should target maternal morbidities and mental health problems when developing health intervention strategies to improve maternal health-related quality of life in the postpartum period. Developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to avert the decrease in health-related quality of life trajectories of postpartum women.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | - Telake Azale
- Department of Health Promotion and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Solomon H, Henry EG, Herlihy J, Yeboah-Antwi K, Biemba G, Musokotwane K, Bhutta A, Hamer DH, Semrau KEA. Intended versus actual delivery location and factors associated with change in delivery location among pregnant women in Southern Province, Zambia: a prespecified secondary observational analysis of the ZamCAT. BMJ Open 2022; 12:e055288. [PMID: 35256443 PMCID: PMC8905985 DOI: 10.1136/bmjopen-2021-055288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This prespecified, secondary analysis of the Zambia Chlorhexidine Application Trial (ZamCAT) aimed to determine the proportion of women who did not deliver where they intended, to understand the underlying reasons for the discordance between planned and actual delivery locations; and to assess sociodemographic characteristics associated with concordance of intention and practice. DESIGN Prespecified, secondary analysis from randomised controlled trial. SETTING Recruitment occurred in 90 primary health facilities (HFs) with follow-up in the community in Southern Province, Zambia. PARTICIPANTS Between 15 February 2011 and 30 January 2013, 39 679 pregnant women enrolled in ZamCAT. SECONDARY OUTCOME MEASURES The location where mothers gave birth (home vs HF) was compared with their planned delivery location. RESULTS When interviewed antepartum, 92% of respondents intended to deliver at an HF, 6.1% at home and 1.2% had no plan. However, of those who intended to deliver at an HF, 61% did; of those who intended to deliver at home, only 4% did; and of those who intended to deliver at home, 2% delivered instead at an HF. Among women who delivered at home, women who were aged 25-34 and ≥35 years were more likely to deliver where they intended than women aged 20-24 years (adjusted OR (aOR)=1.31, 95% CI=1.11 to 1.50 and aOR=1.32, 95% CI=1.12 to 1.57, respectively). Women who delivered at HFs had greater odds of delivering where they intended if they received any primary schooling (aOR=1.34, 95% CI=1.09 to 1.72) or more than a primary school education (aOR=1.54, 95% CI=1.17 to 2.02), were literate (aOR=1.33, 95% CI=1.119 to 1.58), and were not in the lowest quintile of the wealth index. CONCLUSION Discrepancies between intended and actual delivery locations highlight the need to go beyond the development of birth plans and exposure to birth planning messaging. More research is required to address barriers to achieving intentions of a facility-based childbirth. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01241318).
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Affiliation(s)
- Hiwote Solomon
- Doctor of Public Health Program, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie Herlihy
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kojo Yeboah-Antwi
- Public Health Unit, Fr Thomas Alan Rooney Memorial Hospital, Kumasi, Asankrangwa, Ghana
| | - Godfrey Biemba
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Zambia National Health Research Authority, Lusaka, Zambia
| | | | - Afsah Bhutta
- MBBS Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine E A Semrau
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Kumar MS, Metilda RSA. Confidential review of maternal deaths in a South Indian state: current status and the way forward. Sex Reprod Health Matters 2022; 29:2009657. [PMID: 34928195 PMCID: PMC8725740 DOI: 10.1080/26410397.2021.2009657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
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Ahmad D, Mohanty I, Niyonsenga T. Improving birth preparedness and complication readiness in rural India through an integrated microfinance and health literacy programme: evidence from a quasi-experimental study. BMJ Open 2022; 12:e054318. [PMID: 35190433 PMCID: PMC8860014 DOI: 10.1136/bmjopen-2021-054318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Recently, a novel community health programme-the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women's only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India's poorest states-Uttar Pradesh-adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages. DESIGN Quasi-experimental study using cross-sectional survey data. SETTINGS Secondary survey data from the IMFHL programme were used. PARTICIPANTS Survey data were collected from 17 244 women in households with SHG member and non-member households in rural India. PRIMARY OUTCOMES Multivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy. RESULTS Membership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model. CONCLUSIONS The results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings.
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Affiliation(s)
- Danish Ahmad
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Indian Institute of Public Health Gandhinagar (IIPH-G), Gandhinagar, Gujarat, India
- Public Health Foundation of India, New Delhi, India
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Theophile Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Zegeye B, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Olorunsaiye CZ, Yaya S. Disparities in use of skilled birth attendants and neonatal mortality rate in Guinea over two decades. BMC Pregnancy Childbirth 2022; 22:56. [PMID: 35062893 PMCID: PMC8783403 DOI: 10.1186/s12884-021-04370-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Maternal mortality remains high in sub-Saharan African countries, including Guinea. Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. However, within-country inequalities prevent a large proportion of women from receiving skilled birth attendance. Scarcity of evidence related to this exists in Guinea. Hence, this study investigated the magnitude and trends in socioeconomic and geographic-related inequalities in SBA in Guinea from 1999 to 2016 and neonatal mortality rate (NMR) between 1999 and 2012. METHODS We derived data from three Guinea Demographic and Health Surveys (1999, 2005 and 2012) and one Guinea Multiple Indicator Cluster Survey (2016). For analysis, we used the 2019 updated WHO Health Equity Assessment Toolkit (HEAT). We analyzed inequalities in SBA and NMR using Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D) and Ratio (R). These summary measures were computed for four equity stratifiers: wealth, education, place of residence and subnational region. We computed 95% Uncertainty Intervals (UI) for each point estimate to show whether or not observed SBA inequalities and NMR are statistically significant and whether or not disparities changed significantly over time. RESULTS A total of 14,402 for SBA and 39,348 participants for NMR were involved. Profound socioeconomic- and geographic-related inequalities in SBA were found favoring the rich (PAR = 33.27; 95% UI: 29.85-36.68), educated (PAR = 48.38; 95% UI: 46.49-50.28), urban residents (D = 47.03; 95% UI: 42.33-51.72) and regions such as Conakry (R = 3.16; 95% UI: 2.31-4.00). Moreover, wealth-driven (PAF = -21.4; 95% UI: -26.1, -16.7), education-related (PAR = -16.7; 95% UI: -19.2, -14.3), urban-rural (PAF = -11.3; 95% UI: -14.8, -7.9), subnational region (R = 2.0, 95% UI: 1.2, 2.9) and sex-based (D = 12.1, 95% UI; 3.2, 20.9) inequalities in NMR were observed between 1999 and 2012. Though the pattern of inequality in SBA varied based on summary measures, both socioeconomic and geographic-related inequalities decreased over time. CONCLUSIONS Disproportionate inequalities in SBA and NMR exist among disadvantaged women such as the poor, uneducated, rural residents, and women from regions like Mamou region. Hence, empowering women through education and economic resources, as well as prioritizing SBA for these disadvantaged groups could be key steps toward ensuring equitable SBA, reduction of NMR and advancing the health equity agenda of "no one left behind."
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Jolivet RR, Gausman J, Adanu R, Bandoh D, Belizan M, Berrueta M, Chakraborty S, Kenu E, Khan N, Odikro M, Pingray V, Ramesh S, Saggurti N, Vázquez P, Langer A. Multisite, mixed methods study to validate 10 maternal health system and policy indicators in Argentina, Ghana and India: a research protocol. BMJ Open 2022; 12:e049685. [PMID: 35039284 PMCID: PMC8765031 DOI: 10.1136/bmjopen-2021-049685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Most efforts to assess maternal health indicator validity focus on measures of service coverage. Fewer measures focus on the upstream enabling environment, and such measures are typically not research validated. Thus, methods for validating system and policy-level indicators are not well described. This protocol describes original multicountry research to be conducted in Argentina, Ghana and India, to validate 10 indicators from the monitoring framework for the 'Strategies toward Ending Preventable Maternal Mortality' (EPMM). The overall aim is to improve capacity to drive and track progress towards achieving the priority recommendations in the EPMM strategies. This work is expected to contribute new knowledge on validation methodology and reveal important information about the indicators under study and the phenomena they target for monitoring. Validating the indicators in three diverse settings will explore the external validity of results. METHODS AND ANALYSIS This observational study explores the validity of 10 indicators from the EPMM monitoring framework via seven discrete validation exercises that will use mixed methods: (1) cross-sectional review of policy data, (2) retrospective review of facility-level patient and administrative data and (3) collection of primary quantitative and qualitative cross-sectional data from health service providers and clients. There is a specific methodological approach and analytic plan for each indicator, directed by unique, relevant validation research questions. ETHICS AND DISSEMINATION The protocol was approved by the Office of Human Research Administration at Harvard University in November 2019. Individual study sites received approval via local institutional review boards by January 2020 except La Pampa, Argentina, approved June 2020. Our dissemination plan enables unrestricted access and reuse of all published research, including data sets. We expect to publish at least one peer-reviewed publication per validation exercise. We will disseminate results at conferences and engage local stakeholders in dissemination activities in each study country.
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Affiliation(s)
- R Rima Jolivet
- Global Health & Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jewel Gausman
- Women and Health Initiative; Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Richard Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Maria Belizan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | | | - Magdalene Odikro
- Department of Epidemiology and Disease Control, University of Ghana, Legon, Greater Accra, Ghana
| | - Veronica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ana Langer
- Department of Global Health and Population, Harvard University, Boston, Massachusetts, USA
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Shannon C, Hurt C, Soremekun S, Edmond K, Newton S, Amenga-Etego S, Tawiah-Agyemang C, Hill Z, Manu A, Weobong B, Kirkwood B, Hurt L. Implementing effective community-based surveillance in research studies of maternal, newborn and infant outcomes in low resource settings. Emerg Themes Epidemiol 2022; 19:1. [PMID: 35022044 PMCID: PMC8756712 DOI: 10.1186/s12982-021-00109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Globally adopted health and development milestones have not only encouraged improvements in the health and wellbeing of women and infants worldwide, but also a better understanding of the epidemiology of key outcomes and the development of effective interventions in these vulnerable groups. Monitoring of maternal and child health outcomes for milestone tracking requires the collection of good quality data over the long term, which can be particularly challenging in poorly-resourced settings. Despite the wealth of general advice on conducting field trials, there is a lack of specific guidance on designing and implementing studies on mothers and infants. Additional considerations are required when establishing surveillance systems to capture real-time information at scale on pregnancies, pregnancy outcomes, and maternal and infant health outcomes. Main body Based on two decades of collaborative research experience between the Kintampo Health Research Centre in Ghana and the London School of Hygiene and Tropical Medicine, we propose a checklist of key items to consider when designing and implementing systems for pregnancy surveillance and the identification and classification of maternal and infant outcomes in research studies. These are summarised under four key headings: understanding your population; planning data collection cycles; enhancing routine surveillance with additional data collection methods; and designing data collection and management systems that are adaptable in real-time. Conclusion High-quality population-based research studies in low resource communities are essential to ensure continued improvement in health metrics and a reduction in inequalities in maternal and infant outcomes. We hope that the lessons learnt described in this paper will help researchers when planning and implementing their studies.
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Affiliation(s)
- Caitlin Shannon
- Impact and Innovation Team, CARE USA, 115 Broadway, 5th Floor, New York, NY, 10006, USA
| | - Chris Hurt
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Seyi Soremekun
- Maternal and Child Health Intervention Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Karen Edmond
- Department of Women and Children's Health, Kings College London, Strand, London, WC2R 2LS, UK
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Bono East and Bono Regions, Ghana
| | | | - Zelee Hill
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Alexander Manu
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, P.O. Box LG 25, Accra, Ghana
| | - Ben Weobong
- Department of Social and Behavioural Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Betty Kirkwood
- Maternal and Child Health Intervention Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Lisa Hurt
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
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Straneo M, Beňová L, van den Akker T, Pembe AB, Smekens T, Hanson C. No increase in use of hospitals for childbirth in Tanzania over 25 years: Accumulation of inequity among poor, rural, high parity women. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000345. [PMID: 36962703 PMCID: PMC10021586 DOI: 10.1371/journal.pgph.0000345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Abstract
Improving childbirth care in rural settings in sub-Saharan Africa is essential to attain the commitment expressed in the Sustainable Development Goals to leave no one behind. In Tanzania, the period between 1991 and 2016 was characterized by health system expansion prioritizing primary health care and a rise in rural facility births from 45% to 54%. Facilities however are not all the same, with advanced management of childbirth complications generally only available in hospitals and routine childbirth care in primary facilities. We hypothesized that inequity in the use of hospital-based childbirth may have increased over this period, and that it may have particularly affected high parity (≥5) women. We analysed records of 16,080 women from five Tanzanian Demographic and Health Surveys (1996, 1999, 2004, 2010, 2015/6), using location of the most recent birth as outcome (home, primary health care facility or hospital), wealth and parity as exposure variables and demographic and obstetric characteristics as potential confounders. A multinomial logistic regression model with wealth/parity interaction was run and post-estimation margins analysis produced percentages of births for various combinations of wealth and parity for each survey. We found no reduction in inequity in this 25-year period. Among poorest women, lowest use of hospital-based childbirth (around 10%) was at high parity, with no change over time. In women having their first baby, hospital use increased over time but with a widening pro-rich gap (poorest women predicted use increased from 36 to 52% and richest from 40 to 59%). We found that poor rural women of high parity were a vulnerable group requiring specifically targeted interventions to ensure they receive effective childbirth care. To leave no one behind, it is essential to look beyond the average coverage of facility births, as such a limited focus masks different patterns and time trends among marginalised groups.
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Affiliation(s)
- Manuela Straneo
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Athena Institute, VU University, Amsterdam, The Netherlands
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Tom Smekens
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- London School of Hygiene &Tropical Medicine, London, United Kingdom
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Malaju MT, Alene GD, Azale T. Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling. BMJ Glob Health 2022; 7:e007483. [PMID: 35039310 PMCID: PMC8764995 DOI: 10.1136/bmjgh-2021-007483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Unlike physiological recovery, return to full functional status following childbirth takes longer than 6 weeks (42 days) of the traditionally defined postnatal period, and women with maternal morbidity usually require a longer period to recover. However, the extent to which this morbidity collectively impacts on women's functional status is not well investigated in Ethiopia. We aim to determine the distinct trajectories and predictors of functional status among postpartum women in Northwest Ethiopia. METHODS Health facility linked community-based follow-up study was conducted in Northwest Ethiopia from October 2020-March 2021. A sample of 779 delivering women was recruited after childbirth and before discharge using the criteria published by the WHO Maternal Morbidity Working Group. Functional status was measured by the Amharic version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) instrument. The Stata Traj package was used to determine trajectories of functional status using group-based multi-trajectory modelling. The multinomial logistic regression model was used to identify predictors of trajectory group membership. RESULTS A total of 775 women participated at the first, second and third follow-up of the study (6th week, 12th week and 18th week of postpartum period). Three distinct functional status trajectory groups with different longitudinal patterns were identified across the six domains of WHODAS 2.0. Direct and indirect maternal morbidities, lower educational status, poor social support, vaginal delivery, stress, anxiety, posttraumatic stress disorder and fear of childbirth were found to be predictors of poor functioning trajectories. CONCLUSION Early diagnosis and treatment of maternal morbidities and mental health problems, developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to improve functioning trajectories of postpartum women.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Calvert C, John J, Nzvere FP, Cresswell JA, Fawcus S, Fottrell E, Say L, Graham WJ. Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review. Glob Health Action 2021; 14:1974677. [PMID: 35377289 PMCID: PMC8986253 DOI: 10.1080/16549716.2021.1974677] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies. OBJECTIVE To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic. METHODS We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality. RESULTS The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda. CONCLUSIONS Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development.
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Affiliation(s)
- Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Jeeva John
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Farirai P Nzvere
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Jenny A. Cresswell
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sue Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Rondebosch, South Africa
| | - Edward Fottrell
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Wendy J. Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
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Taras J, Raghavan G, Downey K, Balki M. Obstetric Emergencies requiring Rapid response team activation: A retrospective cohort study in a high-risk tertiary care centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:167-174.e5. [PMID: 34656770 DOI: 10.1016/j.jogc.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to better understand obstetric codes requiring rapid response team (RRT) activation by examining their incidence, indications, team response and patient outcomes. METHODS This was a retrospective study in peripartum women who required activation of "Code 77 (C77)" (obstetric emergency), "Code Blue (CB)" (cardiopulmonary compromise) or "Code Omega (CO)" (massive transfusion) during hospitalization during January 2014-May 2018. Hospital database and health records were interrogated to identify and review cases. Data on code characteristics, resuscitative measures, and maternal/ neonatal outcomes were collected. RESULTS 147 codes were identified (C77, n=110; CO, n=25; CB, n=12) during the study period, with an incidence of 1:203 deliveries (C77 - 1:271 deliveries, CO - 1:1,194 deliveries and CB - 1:2,488 deliveries). The common indications for C77 were cord prolapse (33%) and fetal bradycardia (32%), and for CO and CB were postpartum hemorrhage (84%) and cardiac arrest (42%), respectively. Most (67%) codes occurred afterhours. The median (IQR) decision-to-delivery interval (DDI) was 8 (5, 15) min after C77. Emergency cesarean delivery (CD) was performed after 57% of obstetric emergencies and general anesthesia was administered in 63% of CDs. Maternal and neonatal mortality rates were 0.68% and 7%, respectively. Major maternal morbidity was seen in 33% cases. Debrief was documented in 4% codes. CONCLUSION RRT activation was required more commonly in C77 than in CO or CB. Their response time and DDIs were rapid. Mortality was low, however, one-third parturients had major morbidity. We suggest closer patient monitoring, immediate availability of resources, and appropriate documentation and debriefing.
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Affiliation(s)
- Jillian Taras
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON
| | - Gita Raghavan
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | - Kristi Downey
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | - Mrinalini Balki
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON; Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON; Department of Physiology, Mount Sinai Hospital, University of Toronto, Toronto, ON; Lunenfeld-Tanenbaum Research Institute, Toronto, ON.
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Straneo M, Benova L, Hanson C, Fogliati P, Pembe AB, Smekens T, van den Akker T. Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015-16 Tanzania Demographic and Health Survey. Health Policy Plan 2021; 36:1428-1440. [PMID: 34279643 PMCID: PMC8505858 DOI: 10.1093/heapol/czab079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015-16 Tanzania Demographic and Health Survey with a live birth in the preceding 5 years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (≥5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30-51%). The poorest women utilized it at intermediate parity, but at parity ≥5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women.
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Affiliation(s)
- Manuela Straneo
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Lenka Benova
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London WC1E 7HT, UK
| | - Claudia Hanson
- Karolinska Institutet, 171 77 Stockholm, Sweden
- Faculty of Infectious and Tropical Diseases, LSHTM, Keppel Street, London WC1E 7HT, UK
| | - Piera Fogliati
- Doctors with Africa-CUAMM, Av. Mártires da Machava n.º 859 R/C, Cidade de Maputo, Moçambique
| | - Andrea B Pembe
- Department of Obstetrics and Gynecology, Muhimbili University of Helath and Allied Sciences, PO Box 65001, Dar es Salaam, United Republic of Tanzania
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Thomas van den Akker
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of obstetrics and Gynecology, Leiden University Medical Center, Rapenburg 70, 2311 EZ Leiden, The Netherlands
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Huang H, Ma J, Ling S, Han L, Jiang G, Xu W. Incidence and disability-adjusted life years of maternal disorders at the global, regional, and national levels from 2007 to 2017: A systematic analysis for the Global Burden of Disease Study 2017. Int J Gynaecol Obstet 2021; 157:618-639. [PMID: 34561869 DOI: 10.1002/ijgo.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/26/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To report the global burden of maternal disorders and their main subcategories in 195 countries and territories between 2007 and 2017. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimated maternal disease burden at global, regional, and country levels. Maternal disorders were disaggregated into 10 categories, and estimated incidence and disability-adjusted life years (DALYs) of maternal disorders were reported separately. Indicators were estimated in different geographic settings and different sociodemographic index (SDI) regions. Based on GBD 2017 estimates, we systematically examined the incidence and DALYs of maternal disorders and their main subcategories at the global, regional, and national levels during the period from 2007 to 2017 by age and SDI. RESULTS Globally, a total of 7.98 million maternal disorders occurred in 2017, with a 4.33% (95% uncertainty interval [UI] 3.24%-5.60%) decrease in age-standardized incidence rate and a more significant decrease (30.26%) in the age-standardized rate of DALYs. Most incidences and DALYs were found in low-income and middle-income countries, especially in the sub-Saharan region. The greatest incidence of maternal disorders was found to be in maternal abortion and miscarriage (2.00 million), and the highest disease burden was in maternal hemorrhage (2.23 million). CONCLUSION A slight increase in the incidence of maternal disorders and substantial reductions in DALYs of overall maternal disorders and their main subcategories were found from 2007 to 2017, especially in low-income countries and the sub-Saharan region. Maternal hemorrhage, hypertensive disorders, and indirect maternal death were the top three causes of maternal disorders disease burden.
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Affiliation(s)
- Hui Huang
- Department of Obstetrics and Gynecology, the Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Junrong Ma
- Department of Public Health and Preventive Medicine, School of Basic Medicine, Jinan University, Guangzhou, China
| | - Shiliang Ling
- Department of Oncology, Ningbo Hospital of Traditional Chinese Medicine, Ningbo, Zhejiang, China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wenjie Xu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China.,Department of Infectious Disease, Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Radovich E, Banke-Thomas A, Campbell OMR, Ezeanochie M, Gwacham-Anisiobi U, Ande ABA, Benova L. Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria. BMC Health Serv Res 2021; 21:927. [PMID: 34488752 PMCID: PMC8420846 DOI: 10.1186/s12913-021-06945-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems. METHODS The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis. RESULTS We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources. CONCLUSIONS Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.
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Affiliation(s)
- Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Ezeanochie
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adedapo B A Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Heys S, Downe S, Thomson G. 'I know my place'; a meta-ethnographic synthesis of disadvantaged and vulnerable women's negative experiences of maternity care in high-income countries. Midwifery 2021; 103:103123. [PMID: 34425255 DOI: 10.1016/j.midw.2021.103123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/24/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE During pregnancy and childbirth, vulnerable and disadvantaged women have poorer outcomes, have less opportunities,face barriers in accessing care,and are at a greater risk of experiencing a traumatic birth. A recent synthesis of women's negative experiences of maternity care gathered data from predominantly low-income countries. However, these studies did not focus on vulnerable groups, and are not easily transferable into high-income settings due to differences in maternity care provision. The aim of this study was to synthesise existing qualitative literature focused on disadvantaged and vulnerable women's experience of maternity care in high-income countries. METHODS A systematic literature search and meta-ethnographic methods were used. Search methods included searches on four databases, author run, and backward and forward chaining. Searches were conducted in March 2016 and updated in May 2020. FINDINGS A total of 13,330 articles were identified and following checks against inclusion / exclusion criteria and quality appraisal 20 studies were included. Meta-ethnographic translation analytical methods were used to identify reciprocal and refutational findings, and to undertake a line of argument synthesis. Three third order reciprocal constructs were identified, 'Prejudiced and deindividualized care', 'Interpersonal relationships and interactions' and 'Creating and enhancing insecurities.' A line of argument synthesis entitled 'I know my place' encapsulates the experiences of disadvantaged and vulnerable women across the studies, acknowledging differential care practices, stigma and judgmental attitudes. A refutational translation was conceptualised as 'Being seen, being heard' acknowledging positive aspects of maternity care reported by women. CONCLUSION Insights highlight how women's vulnerability was compounded by complex life factors, judgmental and stigmatizing attitudes by health professionals, and differential care provision. Further research is needed to identify suitable care pathways for disadvantaged and vulnerable women and the development of suitable training to highlight negative attitudes towards these women in maternity care settings.
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Affiliation(s)
- Stephanie Heys
- School of Community Health and Midwifery, University of Central Lancashire, Preston PR1 2HE, Lancashire, England; The North West Ambulance Service, Ladybridge Hall HQ. Bolton, BL1 5DD.
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston PR1 2HE, Lancashire, England; Research in Childbirth and Health/THRIVE Centre, University of Central Lancashire, Preston PR1 2HE, Lancashire, England.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, University of Central Lancashire, Preston PR1 2HE, Lancashire, England; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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Carvajal L, Wilson E, Harris Requejo J, Newby H, de Carvalho Eriksson C, Liang M, Dennis M, Gohar F, Simen-Kapeu A, Idele P, Amouzou A. Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate. J Glob Health 2021; 10:021401. [PMID: 33312517 PMCID: PMC7719354 DOI: 10.7189/jogh.10.021401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background In the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region. Methods We used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman’s socio-demographic and socio-economic characteristics. Results The median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18. Conclusion Coverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.
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Affiliation(s)
- Liliana Carvajal
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Harris Requejo
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | | | | | - Mengjia Liang
- Population and Development Branch, Technical Division, United Nations Population Fund (UNFPA), New York, New York, USA
| | - Mardieh Dennis
- London School of Hygiene and Tropical Medicine LSHTM, London, UK
| | - Fatima Gohar
- Regional Office for Eastern and Southern Africa ESARO, UNICEF, Nairobi, Kenya
| | - Aline Simen-Kapeu
- Regional Office for West and Central Africa, WCARO, UNICEF, Dakar, Senegal
| | | | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Tola Y, Ayele G, Boti N, Yihune M, Gethahun F, Gebru Z. Health-Related Quality-of-Life and Associated Factors Among Post-Partum Women in Arba Minch Town. Int J Womens Health 2021; 13:601-611. [PMID: 34188554 PMCID: PMC8232860 DOI: 10.2147/ijwh.s295325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is generally accepted that pregnancy and childbirth are natural physiological processes. However, these significantly affect the quality of mothers’ lives. Little is known about the level of quality-of-life and associated factors among postpartum women in Ethiopia, particularly in the study area. Methods A community-based cross-sectional study was conducted among 409 randomly selected post-partum women who were living in Arba Minch town. Systematic random sampling was employed to select the study participants. The standard quality-of-life assessment tool which is known as the short-form SF 36 tool was used to assess health-related quality-of-life. The logistic regression model was used to identify associated factors. Statistically significant variables at a p-value<0.25 in the bi-variable analysis were candidate variables for multi-variable analysis and statistical significance which was declared at a p-value<0.05. Results Among the study participants, 255 (62.3%) had lower level health-related quality-of-life (HRQoL). About 46.2% of the study participants had lower physical HRQoL and about 79% of the study participants had lower mental HRQoL. The overall mean score of HRQoL was 45.15 (±8.13). Factors associated with lower overall HRQoL were age group 17–24 years (AOR=2.73, 95% CI=1.22–6.10), no formal education [AOR 2.02, 95% CI (1.05–3.89)], and cesarean delivery (AOR=0.49, 95% CI=0.24–0.97). A factor associated with lower physical HRQoL was cesarean delivery (AOR=0.34, 95% CI=0.13–0.88). Factors associated with lower mental HRQoL were age group 17–24 (AOR=3.37, 95% CI=1.60–7.04), not receiving antenatal care (AOR=3.65, 95% CI=1.45–9.16), and having postpartum depression (AOR=2.27, 95% CI=1.30–3.93). Conclusion The results suggest that the majority of post-partum women had a lower HRQoL, particularly women’s mental health was compromised. In this study, a suggestion is made that the respective bodies need to give particular attention to mothers during the post-partum period to prevent poor quality-of-life.
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Affiliation(s)
- Yirgalem Tola
- Arba Minch Health Science College, Department of Midwifery, Arba Minch, Ethiopia
| | - Gistane Ayele
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Negussie Boti
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Manaye Yihune
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Firdawek Gethahun
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Zeleke Gebru
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Kundu S, Jharna DE, Banna MHA, Khan MSI. Factors associated with dietary diversity and physical activity of pregnant women in Bangladesh: A cross‐sectional study at an antenatal care setting. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Satyajit Kundu
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Dilruba Easmin Jharna
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md. Hasan Al Banna
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
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Lange IL, Nalwadda CK, Kiguli J, Penn-Kekana L. The Ambiguity Imperative: "Success" in a Maternal Health Program in Uganda. Med Anthropol 2021; 40:458-472. [PMID: 34106797 DOI: 10.1080/01459740.2021.1922901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Global health programs are compelled to demonstrate impact on their target populations. We study an example of social franchising - a popular healthcare delivery model in low/middle-income countries - in the Ugandan private maternal health sector. The discrepancies between the program's official profile and its actual operation reveal the franchise responded to its beneficiaries, but in a way incoherent with typical evidence production on social franchises, which privileges simple narratives blurring the details of program enactment. Building on concepts of not-knowing and the production of success, we consider the implications of an imperative to maintain ambiguity in global health programming and academia.
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Affiliation(s)
- Isabelle L Lange
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine Kayemba Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Aftab F, Ahmed I, Ahmed S, Ali SM, Amenga-Etego S, Ariff S, Bahl R, Baqui AH, Begum N, Bhutta ZA, Biemba G, Cousens S, Das V, Deb S, Dhingra U, Dutta A, Edmond K, Esamai F, Ghosh AK, Gisore P, Grogan C, Hamer DH, Herlihy J, Hurt L, Ilyas M, Jehan F, Juma MH, Kalonji M, Khanam R, Kirkwood BR, Kumar A, Kumar A, Kumar V, Manu A, Marete I, Mehmood U, Minckas N, Mishra S, Mitra DK, Moin MI, Muhammad K, Newton S, Ngaima S, Nguwo A, Nisar MI, Otomba J, Quaiyum MA, Sarrassat S, Sazawal S, Semrau KE, Shannon C, Singh VP, Soofi S, Soremekun S, Suleiman AM, Sunday V, Dilip TR, Tshefu A, Wasan Y, Yeboah-Antwi K, Yoshida S, Zaidi AK. Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries. PLoS Med 2021; 18:e1003644. [PMID: 34181649 PMCID: PMC8277068 DOI: 10.1371/journal.pmed.1003644] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/13/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. METHODS AND FINDINGS This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. CONCLUSIONS Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. TRIAL REGISTRATION The study is not a clinical trial.
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Affiliation(s)
- Fahad Aftab
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Said Mohammed Ali
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | | | - Shabina Ariff
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rajiv Bahl
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nazma Begum
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Godfrey Biemba
- National Health Research Authority, Ministry of Health, Lusaka, Zambia
| | - Simon Cousens
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vinita Das
- Department of Gynaecology & Obstetrics, King George’s Medical University, Lucknow, India
| | - Saikat Deb
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Usha Dhingra
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Arup Dutta
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | | | - Fabian Esamai
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | | | - Peter Gisore
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Caroline Grogan
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Julie Herlihy
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Lisa Hurt
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Muhammad Ilyas
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Mohammed Hamad Juma
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Michel Kalonji
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Betty R. Kirkwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Alexander Manu
- School of Public Health, University of Ghana, Accra, Ghana
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Irene Marete
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Usma Mehmood
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nicole Minckas
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Shambhavi Mishra
- Community Empowerment Lab, Shivgarh, India
- Department of Statistics, Lucknow University, Lucknow, India
| | | | | | - Karim Muhammad
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sam Newton
- Kwame Nkrumah University of Science & Technology, Kumasi Ghana
| | - Serge Ngaima
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Andre Nguwo
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Muhammad Imran Nisar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - John Otomba
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | | | - Sophie Sarrassat
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sunil Sazawal
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Katherine E. Semrau
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Division of Global Health Equity, Boston, Massachusetts, United States of America
| | | | | | - Sajid Soofi
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Seyi Soremekun
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Venantius Sunday
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Thandassery R. Dilip
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Antoinette Tshefu
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kojo Yeboah-Antwi
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sachiyo Yoshida
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anita K. Zaidi
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Brar AS, Hedt-Gauthier BL, Hirschhorn LR. Mixed Methods Lot Quality Assurance Sampling: A novel, rapid methodology to inform equity focused maternal health programming in rural Rajasthan, India. PLoS One 2021; 16:e0250154. [PMID: 33914763 PMCID: PMC8084134 DOI: 10.1371/journal.pone.0250154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
India has experienced a significant increase in facility-based delivery (FBD) coverage and reduction in maternal mortality. Nevertheless, India continues to have high levels of maternal health inequity. Improving equity requires data collection methods that can produce a better contextual understanding of how vulnerable populations access and interact with the health care system at a local level. While large population-level surveys are valuable, they are resource intensive and often lack the contextual specificity and timeliness to be useful for local health programming. Qualitative methods can be resource intensive and may lack generalizability. We describe an innovative mixed-methods application of Large Country-Lot Quality Assurance Sampling (LC-LQAS) that provides local coverage data and qualitative insights for both FBD and antenatal care (ANC) in a low-cost and timely manner that is useful for health care providers working in specific contexts. LC-LQAS is a version of LQAS that combines LQAS for local level classification with multistage cluster sampling to obtain precise regional or national coverage estimates. We integrated qualitative questions to uncover mothers' experiences accessing maternal health care in the rural district of Sri Ganganagar, Rajasthan, India. We interviewed 313 recently delivered, low-income women in 18 subdistricts. All respondents participated in both qualitative and quantitative components. All subdistricts were classified as having high FBD coverage with the upper threshold set at 85%, suggesting that improved coverage has extended to vulnerable women. However, only two subdistricts were classified as high ANC coverage with the upper threshold set at 40%. Qualitative data revealed a severe lack of agency among respondents and that household norms of care seeking influenced uptake of ANC and FBD. We additionally report on implementation outcomes (acceptability, feasibility, appropriateness, effectiveness, fidelity, and cost) and how study results informed the programs of a local health non-profit.
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Affiliation(s)
- Aneel Singh Brar
- Mata Jai Kaur Maternal and Child Health Centre, Sri Ganganagar, Rajasthan, India
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bethany L. Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard Chan School, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Ryan LM, Mahmood MA, Laurence CO. Incidence of concomitant illnesses in pregnancy in Indonesia: Estimates from 1990-2019, with projections to 2030. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 10:100139. [PMID: 34327350 PMCID: PMC8315454 DOI: 10.1016/j.lanwpc.2021.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
Background ‘Indirect’ causes of maternal death including concomitant illnesses such as infectious and non-communicable diseases (NCDs), accounted for 23% of maternal deaths in Indonesia in 2010. Reproductive-age women in Indonesia face a “double burden” of disease with increasing rates of NCDs and persisting rates of infectious disease. However, there is a lack of data on the burden of these diseases in pregnancy. The aim of this study was to estimate incidence of concomitant illnesses among pregnant women in Indonesia from 1990–2030. Methods Publicly available data was accessed including incidence of concomitant illnesses in Indonesian reproductive-age women, population data and crude birth rate data from 1990–2019, and formed basis for projections to 2030. A dataset of estimates for all variables was generated for each year and sampled from a binomial distribution. Using these estimates, pregnancy estimates and incidence in pregnant women were calculated. A cubic splines model was fitted to generate estimates of incidence of concomitant illnesses in pregnancy. Findings Past trends to 2019 show a decline in incident cases of infectious diseases except for HIV/AIDs, and an increase in most NCDs. In 2019, the most common disease was sexually transmitted infections. From 2020–2030, incidences of diabetes and lower respiratory infections are estimated to continue to increase. Interpretation With an increasing incidence of NCDs and high-incidence of infectious diseases in pregnancy, Indonesian policymakers and stakeholders should consider what evidence-based strategies and interventions are best to reduce potential impacts of concomitant illnesses on pregnancy outcomes. Funding Australian Government Research Training Program Scholarship.
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Affiliation(s)
- Lareesa M Ryan
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mohammad A Mahmood
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia.,Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Caroline O Laurence
- School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
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73
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Iqbal U, Khan HAA, Li YCJ. The global challenges for quality improvement and patient safety. Int J Qual Health Care 2021; 33:5850234. [PMID: 32484223 DOI: 10.1093/intqhc/mzaa046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Usman Iqbal
- Master's Program in Global Health Department, PhD Program in Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan
| | - Hafsah Arshed Ali Khan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. No. 172-1, Sec. 2, Keelung Rd, Daan District, Taipei City 106, Taiwan.,Dermatology Department,Wan-Fang Hospital, Taipei, Taiwan. No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City 116, Taiwan.,International Medical Informatics Association, Geneva, Switzerland. Health On the Net, Chemin du Petit-Bel-Air 2, CH-1225 Chene-Bourg, Geneva, Switzerland
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74
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Roos N, Kovats S, Hajat S, Filippi V, Chersich M, Luchters S, Scorgie F, Nakstad B, Stephansson O. Maternal and newborn health risks of climate change: A call for awareness and global action. Acta Obstet Gynecol Scand 2021; 100:566-570. [PMID: 33570773 DOI: 10.1111/aogs.14124] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 01/04/2023]
Abstract
Climate change represents one of the largest global health threats of the 21st century with immediate and long-term consequences for the most vulnerable populations, especially in the poorest countries with the least capacity to adapt to climate change. Pregnant women and newborns are increasingly being recognized as vulnerable populations in the context of climate change. The effects can be direct or indirect through heat stress, extreme weather events and air pollution, potentially impacting both the immediate and long-term health of pregnant women and newborns through a broad range of mechanisms. In 2008, the World Health Organization passed a resolution during the 61st World Health Assembly, recognizing the need for research to identify strategies and health-system strengthening to mitigate the effects of climate change on health. Climate adaptation plans need to consider vulnerable populations such as pregnant women and neonates and a broad multisectoral approach to improve overall resilience of societies.
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Affiliation(s)
- Nathalie Roos
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Sari Kovats
- Centre for Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shakoor Hajat
- Centre for Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Chersich
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Stanley Luchters
- Department of Population Health, Medical College, The Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fiona Scorgie
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Britt Nakstad
- Division of Child and Adolescent Health, Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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75
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Maurya AP, Rajkumari J, Pandey P. Enrichment of antibiotic resistance genes (ARGs) in polyaromatic hydrocarbon-contaminated soils: a major challenge for environmental health. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:12178-12189. [PMID: 33394421 DOI: 10.1007/s11356-020-12171-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Polyaromatic hydrocarbons (PAHs) are widely spread ecological contaminants. Antibiotic resistance genes (ARGs) are present with mobile genetic elements (MGE) in the bacteria. There are molecular evidences that PAHs may induce the development of ARGs in contaminated soils. Also, the abundance of ARGs related to tetracycline, sulfonamides, aminoglycosides, ampicillin, and fluoroquinolones is high in PAH-contaminated environments. Genes encoding the efflux pump are located in the MGE and, along with class 1 integrons, have a significant role as a connecting link between PAH contamination and enrichment of ARGs. The horizontal gene transfer mechanisms further make this interaction more dynamic. Therefore, necessary steps to control ARGs into the environment and risk management plan of PAHs should be enforced. In this review, influence of PAH on evolution of ARGs in the contaminated soil, and its spread in the environment, has been described. The co-occurrence of antibiotic resistance and PAH degradation abilities in bacterial isolates has raised the concerns. Also, presence of ARGs in the microbiome of PAH-contaminated soil has been discussed as environmental hotspots for ARG spread. In addition to this, the possible links of molecular interactions between ARGs and PAHs, and their effect on environmental health has been explored.
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Affiliation(s)
| | - Jina Rajkumari
- Department of Microbiology, Assam University, Silchar, Assam, 788011, India
| | - Piyush Pandey
- Department of Microbiology, Assam University, Silchar, Assam, 788011, India.
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76
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Jury I, Thompson K, Hirst JE. A scoping review of maternal antibiotic prophylaxis in low- and middle-income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection. Int J Gynaecol Obstet 2021; 155:319-330. [PMID: 33608872 DOI: 10.1002/ijgo.13648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. OBJECTIVE A scoping review comparing peripartum prophylactic antimicrobial use in low- and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. SEARCH STRATEGY Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. SELECTION CRITERIA Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourth-degree perineal tears. DATA COLLECTION AND ANALYSIS Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed. MAIN RESULTS Of 1886 studies, 27 studies from 13 countries involving 43 774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. CONCLUSION There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist. Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.
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Affiliation(s)
- Imogen Jury
- Medical Sciences Division, University of Oxford Medical School, Oxford, UK
| | - Kelly Thompson
- Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, Australia
| | - Jane E Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, Oxford, UK
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77
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Rahman AS, Chao TE, Trelles M, Dominguez L, Mupenda J, Kasonga C, Akemani C, Kondo KM, Chu KM. The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States. World J Surg 2021; 45:1400-1408. [PMID: 33560502 DOI: 10.1007/s00268-021-05972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified. METHODS This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008-December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period. RESULTS There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention. CONCLUSION Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.
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Affiliation(s)
- Arifeen S Rahman
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tiffany E Chao
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Miguel Trelles
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Lynette Dominguez
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Jerome Mupenda
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Cheride Kasonga
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Clemence Akemani
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kalla Moussa Kondo
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Dr, Tygerberg Hospital, Cape Town, 7505, South Africa.
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Galle A, Semaan A, Huysmans E, Audet C, Asefa A, Delvaux T, Afolabi BB, El Ayadi AM, Benova L. A double-edged sword-telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers. BMJ Glob Health 2021; 6:e004575. [PMID: 33632772 PMCID: PMC7908054 DOI: 10.1136/bmjgh-2020-004575] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. METHODS The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. RESULTS Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. CONCLUSIONS Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
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Affiliation(s)
- Anna Galle
- ICRH, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Elise Huysmans
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Constance Audet
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Alison Marie El Ayadi
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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79
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Merriel A, Dembo Z, Hussein J, Larkin M, Mchenga A, Tobias A, Lough M, Malata A, Makwenda C, Coomarasamy A. Assessing the impact of a motivational intervention to improve the working lives of maternity healthcare workers: a quantitative and qualitative evaluation of a feasibility study in Malawi. Pilot Feasibility Stud 2021; 7:34. [PMID: 33514442 PMCID: PMC7844964 DOI: 10.1186/s40814-021-00774-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. METHODS Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. RESULTS The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. CONCLUSIONS We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.
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Affiliation(s)
- Abi Merriel
- Institute for Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zione Dembo
- Parent and Child Health Initiative, Lilongwe, Malawi
| | - Julia Hussein
- Independent Maternal Health Consultant, Aberdeen, UK
| | - Michael Larkin
- Department of Psychology, Aston University, Birmingham, UK
| | - Allan Mchenga
- Parent and Child Health Initiative, Lilongwe, Malawi
| | - Aurelio Tobias
- Institute for Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mark Lough
- Independent Psychotherapist and Organisational Consultant, Aberdeen, UK
| | - Address Malata
- Malawi University of Science and Technology, Thyolo, Malawi
| | | | - Arri Coomarasamy
- Institute for Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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80
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Barrett PM. Editorial: Adverse Pregnancy Outcomes-A Missed Opportunity to Prevent Chronic Disease? Int J Public Health 2021; 66:582810. [PMID: 34366764 PMCID: PMC8336677 DOI: 10.3389/ijph.2021.582810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter M Barrett
- 1School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
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81
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Ahmad D, Mohanty I, Hazra A, Niyonsenga T. The knowledge of danger signs of obstetric complications among women in rural India: evaluating an integrated microfinance and health literacy program. BMC Pregnancy Childbirth 2021; 21:79. [PMID: 33485310 PMCID: PMC7824939 DOI: 10.1186/s12884-021-03563-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India's most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. METHODS Secondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program's effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level. RESULTS SHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics. CONCLUSIONS The findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.
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Affiliation(s)
- Danish Ahmad
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia.
- Public Health Foundation of India, and Indian Institute of Public Health-Gandhinagar (IIPH-G), New Delhi and Gandhinagar, India.
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
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82
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Luckett R, Nassali M, Melese T, Moreri-Ntshabele B, Moloi T, Hofmeyr GJ, Chobanga K, Masunge J, Makhema J, Pollard M, Ricciotti HA, Ramogola-Masire D, Bazzett-Matabele L. Development and launch of the first obstetrics and gynaecology master of medicine residency training programme in Botswana. BMC MEDICAL EDUCATION 2021; 21:19. [PMID: 33407415 PMCID: PMC7789389 DOI: 10.1186/s12909-020-02446-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces a severe shortage of Obstetrician Gynaecologists (OBGYNs). While the Lancet Commission for Global Surgery recommends 20 OBGYNs per 100,000 population, Botswana has only 40 OBGYNs for a population of 2.3 million. We describe the development of the first OBGYN Master of Medicine (MMed) training programme in Botswana to address this human resource shortage. METHODS We developed a 4-year OBGYN MMed programme at the University of Botswana (UB) using the Kern's approach. In-line with UB MMed standards, the programme includes clinical apprenticeship training complemented by didactic and research requirements. We benchmarked curriculum content, learning outcomes, competencies, assessment strategies and research requirements with regional and international programmes. We engaged relevant local stakeholders and developed international collaborations to support in-country subspecialty training. RESULTS The OBGYN MMed curriculum was completed and approved by all relevant UB bodies within ten months during which time additional staff were recruited and programme financing was assured. The programme was advertised immediately; 26 candidates applied for four positions, and all selected candidates accepted. The programme was launched in January 2020 with government salary support of all residents. The clinical rotations and curricular development have been rolled out successfully. The first round of continuous assessment of residents was performed and internal programme evaluation was conducted. The national accreditation process was initiated. CONCLUSION Training OBGYNs in-country has many benefits to health systems in SSA. Curricula can be adjusted to local resource context yet achieve international standards through thoughtful design and purposeful collaborations.
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Affiliation(s)
- R Luckett
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana.
- The Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA.
- Harvard Medical School, Boston, USA.
| | - M Nassali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - T Melese
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - B Moreri-Ntshabele
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - T Moloi
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - G J Hofmeyr
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - K Chobanga
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - J Masunge
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - J Makhema
- The Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - M Pollard
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
| | - H A Ricciotti
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - D Ramogola-Masire
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - L Bazzett-Matabele
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
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Sapkota VP, Bhusal UP, Acharya K. Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001-2016). BMC Public Health 2021; 21:8. [PMID: 33397359 PMCID: PMC7784024 DOI: 10.1186/s12889-020-10066-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services. Methods The study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis. Results The study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016. Conclusion Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.
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Affiliation(s)
- Vishnu Prasad Sapkota
- Central Department of Public Health (CDPH), Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal
| | - Umesh Prasad Bhusal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kiran Acharya
- New ERA, Rudramati Marga, Kalopul, Kathmandu, 44621, Nepal.
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84
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Gon G, de Barra M, Dansero L, Nash S, Campbell OMR. Birth attendants' hand hygiene compliance in healthcare facilities in low and middle-income countries: a systematic review. BMC Health Serv Res 2020; 20:1116. [PMID: 33267879 PMCID: PMC7713338 DOI: 10.1186/s12913-020-05925-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background With an increasing number of women delivering in healthcare facilities in Low and Middle Income Countries (LMICs), healthcare workers’ hand hygiene compliance on labour wards is pivotal to preventing infections. Currently there are no estimates of how often birth attendants comply with hand hygiene, or of the factors influencing compliance in healthcare facilities in LMICs. Methods We conducted a systematic review to investigate the a) level of compliance, b) determinants of compliance and c) interventions to improve hand hygiene during labour and delivery among birth attendants in healthcare facilities of LMICs. We also aimed to assess the quality of the included studies and to report the intra-cluster correlation for studies conducted in multiple facilities. Results We obtained 797 results across four databases and reviewed 71 full texts. Of these, fifteen met our inclusion criteria. Overall, the quality of the included studies was particularly compromised by poorly described sampling methods and definitions. Hand hygiene compliance varied substantially across studies from 0 to 100%; however, the heterogeneity in definitions of hand hygiene did not allow us to combine or compare these meaningfully. The five studies with larger sample sizes and clearer definitions estimated compliance before aseptic procedures opportunities, to be low (range: 1–38%). Three studies described two multi-component interventions, both were shown to be feasible. Conclusions Hand hygiene compliance was low for studies with larger sample sizes and clear definitions. This poses a substantial challenge to infection prevention during birth in LMICs facilities. We also found that the quality of many studies was suboptimal. Future studies of hand hygiene compliance on the labour ward should be designed with better sampling frames, assess inter-observer agreement, use measures to improve the quality of data collection, and report their hand hygiene definitions clearly.
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Affiliation(s)
- Giorgia Gon
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mícheál de Barra
- Brunel University London, Department of Life Sciences, Uxbridge, UK
| | | | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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85
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Tamburlini G, Bacci A, Daniele M, Hodorogea S, Jeckaite D, Siupsinskas G, Valente EP, Stillo P, Vezzini F, Bucagu M, Lincetto O. Use of a participatory quality assessment and improvement tool for maternal and neonatal hospital care. Part 1: Review of implementation features and observed quality gaps in 25 countries. J Glob Health 2020; 10:020432. [PMID: 33403104 PMCID: PMC7750018 DOI: 10.7189/jogh.10.020432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A substantial proportion of maternal and neonatal mortality and morbidity is attributable to gaps in quality of care. A systematic, standard-based tool for quality assessment and improvement for maternal and neonatal hospital care (QA/QI MN tool) was developed in 2009 by the World Health Organization (WHO). The tool guides the assessment process along the whole continuum from admission to discharge, collects the views of the recipients of care and engages hospital mangers and staff in identifying gaps and drafting an action plan. METHODS Publications describing use of the WHO QA/QI MN tool from 2009 to 2017 and reports retrievable from WHO or other development partners' websites were searched and considered for inclusion in the review. Only assessments of hospitals were considered. Quality gaps were classified as regarding case management in maternal care, case management in neonatal care, hospital infrastructure, hospital policies and according to severity and frequency. Quotations from women regarding key issues in effective communication, respect and dignity, emotional support and costs incurred were selected. RESULTS In the period 2009-2017, use of the WHO QA/QI MN tool was documented in 25 countries, belonging to Central and Eastern Europe (8), Central Asia (4), Sub-Saharan Africa (11), Latin America (1) and Middle East (1). Overall, 133 hospitals were assessed. The tool allowed to identify in great detail serious quality gaps including: insufficient or incomplete adherence to recommended evidence-based procedures for normal childbirth and maternal and neonatal complications; excess of inappropriate or unnecessary interventions; insufficient infection control; failure to provide respectful care, adequate communication and emotional support to mothers and babies; poor use of information generated locally to analyse processes and outcomes. These gaps were observed in all countries. Significant differences were observed among facilities belonging to the same health systems, ie, with very similar staffing, infrastructure and equipment. CONCLUSIONS The experience made, the largest of this kind, provides comprehensive and detailed insight into the existing quality gaps in a wide variety of settings. QI cycles at facility level should be primarily based on assessments made by multidisciplinary teams of professionals to identify the parts of the care pathways which require improvement through a participatory approach involving managers, staff and patients.
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Affiliation(s)
| | - Alberta Bacci
- International perinatal care consultant, Trieste, Italy
| | - Marina Daniele
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Stelian Hodorogea
- Department of Obstetrics and Gynecology, State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Dalia Jeckaite
- International midwifery and perinatal care consultant, Panevezys, Lithuania
| | | | - Emanuelle Pessa Valente
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy and Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Paola Stillo
- Paediatric Emergency Department and Trauma center Meyer Hospital, Florence, Italy
| | | | - Maurice Bucagu
- WHO Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland
| | - Ornella Lincetto
- WHO Department of Maternal, Newborn, Child, Adolescent Health and Ageing, Geneva, Switzerland
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Carvajal L, Wilson E, Harris Requejo J, Newby H, de Carvalho Eriksson C, Liang M, Dennis M, Gohar F, Simen-Kapeu A, Idele P, Amouzou A. Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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87
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von Wissmann B, Wastnedge E, Waters D, Gadama LA, Dube Q, Masesa C, Chodzaza E, Stock SJ, Reynolds RM, Norrie J, Makwakwa E, Freyne B, Campbell H, Norman JE, Wood R. Informing prevention of stillbirth and preterm birth in Malawi: development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration. BMJ Open 2020; 10:e038859. [PMID: 33234630 PMCID: PMC7689106 DOI: 10.1136/bmjopen-2020-038859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/27/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials. DESIGN Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility. SETTING Antenatal, maternity and specialist neonatal care in Malawi. RESULTS The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes. CONCLUSIONS Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research.
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Affiliation(s)
- Beatrix von Wissmann
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
- Public Health, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Elizabeth Wastnedge
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Donald Waters
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Luis A Gadama
- Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
| | - Clemens Masesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Elizabeth Chodzaza
- Faculty of Midwifery, Neonatal and Reproductive Health Studies, University of Malawi Kamuzu College of Nursing, Blantyre, Malawi
| | - Sarah Jane Stock
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Queen's Medical Research Institute, The University of Edinburgh Centre for Cardiovascular Science, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Enita Makwakwa
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Bridget Freyne
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Harry Campbell
- Centre for Global Health Research, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Rachael Wood
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
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Lorenze DL. Women's Lived Experiences of Giving Birth in Ghana: A Metasynthesis of the Literature. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDThe purpose of this metasynthesis is to analyze women's lived experiences of giving birth in Ghana during and after the Millennium Development Goals (MDGs), when health policy in Ghana was changed to urge women to birth in health services with skilled attendants.METHODAn interpretive phenomenological framework guided the review of the literature. Three electronic databases were searched as well as reference lists and author searches. Articles that met the screening criteria for inclusion were coded and thematically analyzed, then drawn together to construct the essence of women's experiences of giving birth in Ghana.RESULTSSeven themes were constructed from the data and these were poor quality health services, maltreatment by midwives, mixed emotions about pregnancy and childbirth, supernatural fears, women wanting safe births with skilled birth attendants, uncertainty about reaching a health facility, and decision-making hierarchy. There were three counter themes and these were women wanting a home birth with a traditional midwife, defiance against dominant decision-makers by some women, and a belief that “not all nurses are bad.”CONCLUSIONGhanaian women have heeded the MDGs and health policy messages to birth with skilled attendants, but in reality, they are not always accessible, available, appropriate, or of high quality. Maternal health services still need much improvement including more resources such as staff, essential services, medicines, and quality assurance standards.
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89
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McCauley M, Zafar S, van den Broek N. Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: a systematic literature review. BMC Pregnancy Childbirth 2020; 20:637. [PMID: 33081734 PMCID: PMC7574312 DOI: 10.1186/s12884-020-03303-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background For every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women’s health and wellbeing during pregnancy and after childbirth. Methods We systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted. Results Included were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies. Conclusions There is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity. Systematic review registration number PROSPERO CRD42018079526.
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Affiliation(s)
- Mary McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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90
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Sharma S, Sarathi Mohanty P, Omar R, Viramgami AP, Sharma N. Determinants and Utilization of Maternal Health Care Services in Urban Slums of an Industrialized City, in Western India. J Family Reprod Health 2020; 14:95-101. [PMID: 33603800 PMCID: PMC7865198 DOI: 10.18502/jfrh.v14i2.4351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To assess the status of utilization of Maternal Health Care (MHC) services in slums of an industrialized city and elucidating the various determinants influencing the utilization. Materials and methods: A Cross-sectional study using multi stage sampling methodology was conducted in slums of an industrialized city. The study participants were the women who had given a live birth in the last one year before 4 weeks of the study starts. Total one hundred eighty families were interviewed & analysed. Results: The utilization of MHC services was poor as compared to national averages in urban slums. There was no association between age of mother, birth order, educational and occupational status of head of family with utilization of services while education and employment of mother, category and type of family, distance and time to reach health facility, were significantly associated. Conclusion: The reduction of maternal mortality and morbidity mostly depends on the utilization of MHC services. The findings of this study have important implications for improving utilization of maternal health care services.
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Affiliation(s)
- Sandeep Sharma
- Department of Epidemiology, ICMR-National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Partha Sarathi Mohanty
- Department of Epidemiology, ICMR-National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Ruchi Omar
- Department of Epidemiology, ICMR-National JALMA Institute of Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Ankit P Viramgami
- Department of Clinical Epidemiology, ICMR-National Institute of Occupational Health Ahmedabad, Gujrat, India
| | - Namita Sharma
- Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
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Grenier L, Lori JR, Darney BG, Noguchi LM, Maru S, Klima C, Lundeen T, Walker D, Patil CL, Suhowatsky S, Musange S. Building a Global Evidence Base to Guide Policy and Implementation for Group Antenatal Care in Low- and Middle-Income Countries: Key Principles and Research Framework Recommendations from the Global Group Antenatal Care Collaborative. J Midwifery Womens Health 2020; 65:694-699. [PMID: 33010115 PMCID: PMC9022023 DOI: 10.1111/jmwh.13143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/13/2020] [Accepted: 03/03/2020] [Indexed: 11/28/2022]
Abstract
Evidence from high‐income countries suggests that group antenatal care, an alternative service delivery model, may be an effective strategy for improving both the provision and experience of care. Until recently, published research about group antenatal care did not represent findings from low‐ and middle‐income countries, which have health priorities, system challenges, and opportunities that are different than those in high‐income countries. Because high‐quality evidence is limited, the World Health Organization recommends group antenatal care be implemented only in the context of rigorous research. In 2016 the Global Group Antenatal Care Collaborative was formed as a platform for group antenatal care researchers working in low‐ and middle‐income countries to share experiences and shape future research to accelerate development of a robust global evidence base reflecting implementation and outcomes specific to low‐ and middle‐income countries. This article presents a brief history of the Collaborative's work to date, proposes a common definition and key principles for group antenatal care, and recommends an evaluation and reporting framework for group antenatal care research.
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Affiliation(s)
| | - Jody R Lori
- Department of Health Behavior and Biological Science, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon.,National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | | | - Sheela Maru
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carrie Klima
- Department of Women, Children, and Family Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Tiffany Lundeen
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California.,Department of Obstetrics, Gynecology, and Reproductive Health Sciences and Institute for Global Health Sciences, University of California San Francisco, San Francisco, California
| | - Crystal L Patil
- Department of Women, Children, and Family Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | | | - Sabine Musange
- University of Rwanda, School of Public Health, Kigali, Rwanda
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Wigley AS, Tejedor-Garavito N, Alegana V, Carioli A, Ruktanonchai CW, Pezzulo C, Matthews Z, Tatem AJ, Nilsen K. Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa. BMC Med 2020; 18:237. [PMID: 32895051 PMCID: PMC7487649 DOI: 10.1186/s12916-020-01707-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. METHODS Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. RESULTS Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. CONCLUSION While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.
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Affiliation(s)
- A S Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - N Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - V Alegana
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya
- Faculty of Science and Technology, Lancaster University, Lancaster, LA1 4YR, UK
| | - A Carioli
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - C W Ruktanonchai
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - C Pezzulo
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Z Matthews
- Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - A J Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - K Nilsen
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
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Robbers G, Vogel JP, Mola G, Bolgna J, Homer CSE. Maternal and newborn health indicators in Papua New Guinea - 2008-2018. Sex Reprod Health Matters 2020; 27:1686199. [PMID: 31790637 PMCID: PMC7888046 DOI: 10.1080/26410397.2019.1686199] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health care – especially in rural areas, where most people live – is challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.
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Affiliation(s)
- Gianna Robbers
- International Health Project Officer, Maternal and Child Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Principal Research Fellow, Maternal and Child Health Program, Burnet Institute, Melbourne, Australia
| | - Glen Mola
- Professor of Obstetrics and Gynecology, Port Moresby General Hospital, Papua New Guinea and the University of Papua New Guinea
| | - John Bolgna
- Obstetrician and Gynaecologist, Modilion Hospital, Madang and the PNG Institute for Medical Research, Papua New Guinea
| | - Caroline S E Homer
- Co-Director, Maternal and Child Health Program, Burnet Institute, Melbourne; Visiting Distinguished Professor of Midwifery, University of Technology Sydney, Australia
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Yount KM, James-Hawkins L, Abdul Rahim HF. The Reproductive Agency Scale (RAS-17): development and validation in a cross-sectional study of pregnant Qatari and non-Qatari Arab Women. BMC Pregnancy Childbirth 2020; 20:503. [PMID: 32873247 PMCID: PMC7466495 DOI: 10.1186/s12884-020-03205-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background Sustainable Development Goal (SDG) 5 prioritizes women’s empowerment and gender equality, alone and as drivers of other SDGs. Efforts to validate universal measures of women’s empowerment have eclipsed efforts to develop refined measures in local contexts and lifecycle stages. Measures of women’s empowerment across the reproductive lifecycle remain limited, including in the Arab Middle East. Methods In this sequential, mixed-methods study, we developed and validated the Reproductive Agency Scale 17 (RAS-17) in 684 women having a normal pregnancy and receiving prenatal care at Hamad Medical Corporation in Doha, Qatar. Participants varied in age (19–46 years), trimester, gravidity (M3.3[SD2.1], range 1–14), and parity (M2.1[SD1.5], range 0–7). Using qualitative research and questionnaire reviews, we developed 44 pregnancy-specific and non-pregnancy-specific agency items. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples and multiple-group CFA to assess measurement invariance of the scale across Qatari (n = 260) and non-Qatari Arab (n = 342) women. Results Non-Qatari women agreed more strongly than Qatari women that every woman should have university education, and working outside home benefitted women. Qatari women agreed more strongly than non-Qatari women that a woman should be free to sell her property. Qatari women reported more influence than non-Qatari women in decisions about spending their money (M4.6 versus M4.4), food they can eat (M4.4 versus M4.2), and rest during pregnancy (M4.5 versus M4.2). Qatari and non-Qatari women typically reported going most places with permission if accompanied. A 17-item, three-factor model measuring women’s intrinsic agency or awareness of economic rights (5 items) and instrumental agency in decision-making (5 items) and freedom of movement (7 items) had good fit and was partially invariant across groups. Conclusions The RAS-17 is a contextual, multidimensional measure of women’s reproductive agency validated in pregnant Qatari and non-Qatari Arab women. This scale integrates pregnancy-specific and non-pregnancy-specific items in dimensions of intrinsic agency and instrumental agency relevant to Arab women of reproductive age. The RAS-17 may be useful to screen for low reproductive agency as a predictor of maternal and perinatal outcomes. The RAS-17 should be validated in other samples to assess its full applicability across the reproductive life cycle.
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Affiliation(s)
- Kathryn M Yount
- Hubert Department of Global Health and Department of Sociology, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
| | - Laurie James-Hawkins
- Department of Sociology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Hanan F Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, P.O.Box 2713, Doha, Qatar
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Akter S, Davies K, Rich JL, Inder KJ. Barriers to accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women's experiences. PLoS One 2020; 15:e0237002. [PMID: 32780774 PMCID: PMC7419110 DOI: 10.1371/journal.pone.0237002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. METHODS Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. RESULTS Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff. CONCLUSION Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options.
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Affiliation(s)
- Shahinoor Akter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Kate Davies
- School of Humanities and Social Science, Faculty of Education and Arts, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jane Louise Rich
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerry Jill Inder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders. J Pregnancy 2020; 2020:7864816. [PMID: 32802511 PMCID: PMC7416270 DOI: 10.1155/2020/7864816] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.
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Maternal morbidity: how to reduce it. Curr Opin Anaesthesiol 2020; 33:612-617. [PMID: 32628411 DOI: 10.1097/aco.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Internationally there has been increased interest in maternal morbidity; both as a strategy to reduce maternal deaths and also because of the significant impact on a woman's life as a result of suffering from maternal morbidity. The present review will evaluate the current knowledge of, and strategies to reduce maternal morbidity. RECENT FINDINGS The study of maternal morbidity and how to reduce it has been hampered for many years by the lack of a standard approach to measurement and evaluation. The World Health Organization has attempted to standardize the approach to maternal morbidity with the development of a new definition that recognizes the multiple dimensions of maternal morbidity, including external factors such as socioeconomic factors. This approach will assist with a more accurate evaluation of maternal morbidity. Maternal morbidity arises from many and varied causes. Many of these are amenable to quality improvement with an associated reduction in maternal morbidity. SUMMARY There have been significant advances in the understanding of maternal morbidity: incidence causes and management. Future research should aim to establish accurate rates for maternal morbidity and further develop ways for healthcare professionals, including anaesthesia care providers, to reduce it.
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Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
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Nair M, Bezbaruah B, Bora AK, Bora K, Chhabra S, Choudhury SS, Choudhury A, Deka D, Deka G, Ismavel VA, Kakoty SD, Koshy RM, Kumar P, Mahanta P, Medhi R, Nath P, Rani A, Roy I, Sarma U, V CS, Talukdar RK, Zahir F, Hill M, Kansal N, Nakra R, Baigent C, Knight M, Kurinczuk JJ. Maternal and perinatal Health Research Collaboration, India (MaatHRI): methodology for establishing a hospital-based research platform in a low and middle income country setting. F1000Res 2020; 9:683. [PMID: 33500775 PMCID: PMC7812614 DOI: 10.12688/f1000research.24923.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/15/2023] Open
Abstract
Background: Maternal and perinatal Health Research collaboration, India (MaatHRI) is a research platform that aims to improve evidence-based pregnancy care and outcomes for mothers and babies in India, a country with the second highest burden of maternal and perinatal deaths. The objective of this paper is to describe the methods used to establish and standardise the platform and the results of the process. Methods: MaatHRI is a hospital-based collaborative research platform. It is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India - Assam, Meghalaya, Uttar Pradesh and Maharashtra. The research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. MaatHRI has advanced standardisation of data and laboratory parameters, real-time monitoring of data and participant safety, and secure transfer of data. Four observational epidemiological studies are presently being undertaken through the platform. MaatHRI has enabled bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board, a process that is not normally used, but was found to be highly effective in ensuring data safety and equitable partnerships in the context of low and middle income countries (LMICs). Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a LMIC setting. The model is built on existing methods but applies new standardisation processes to develop a collaborative research platform that can be replicated in other LMICs.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Babul Bezbaruah
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Amrit Krishna Bora
- Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, Assam, 781001, India
| | - Krishnaram Bora
- Nagaon Bhogeswari Phukanani Civil Hospital, Haibargaon, Daccapatty, Nagaon, Assam, 782001, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Saswati S. Choudhury
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Arup Choudhury
- Dhubri Civil Hospital, Jhagrarpar, Dhubri, Assam, 783324, India
| | - Dipika Deka
- Srimanta Sankaradeva University of Health Sciences, Narkashur Hilltop, Bhangagarh, Assam, 781032, India
| | - Gitanjali Deka
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Vijay Anand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Swapna D. Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Roshine M. Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 442102, India
| | - Pranabika Mahanta
- Jorhat Medical College and Hospital, Kushal Konwar Path, Barbheta, Jorhat, Assam, 785001, India
| | - Robin Medhi
- Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta-Hospital-Jania Rd, Joti Gaon, Assam, 781301, India
| | - Pranoy Nath
- Silchar Medical College and Hospital (SMCH), Ghungoor Road, Masimpur, Assam, 788014, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Aurobindo Colony, Banaras Hindu University Campus, Varanasi, Uttar Pradesh, 221005, India
| | - Indrani Roy
- Nazareth Hospital, Arbuthnot Rd, Nongkynrih, Laitumkhrah, Shillong, Meghalaya, 793003, India
| | - Usha Sarma
- Tezpur Medical College, NH 15, Tezpur, Assam, 784153, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Karimganj, Assam, 788727, India
| | - Ratna Kanta Talukdar
- Gauhati Medical College and Hospital (GMCH), Bhangagarh, Guwahati, Assam, 781032, India
| | - Farzana Zahir
- Assam Medical College (AMC), Barbari, Dibrugarh, Assam, 786002, India
| | - Michael Hill
- NDPH Wolfson Laboratories, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Nimmi Kansal
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Reena Nakra
- National Reference Laboratory, Dr Lal PathLabs, B7 Rd, Block E, Sector 18, Rohini, New Delhi, Delhi, 110085, India
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Jenny J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, Oxfordshire, OX3 7LF, UK
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100
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Alves LC, Costa JR, Monteiro JCDS, Gomes-Sponholz FA. Women's sexual health six months after a severe maternal morbidity event. Rev Lat Am Enfermagem 2020; 28:e3293. [PMID: 32578751 PMCID: PMC7304979 DOI: 10.1590/1518-8345.3500.3293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM). METHOD a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed. RESULTS FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM. CONCLUSION white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.
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Affiliation(s)
- Lisiane Camargo Alves
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Jessica Ribeiro Costa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Juliana Cristina Dos Santos Monteiro
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Flávia Azevedo Gomes-Sponholz
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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