51
|
The contributions of maternity care to reducing adverse pregnancy outcomes: a cohort study in Dabat district, northwest Ethiopia. Matern Child Health J 2015; 18:1336-44. [PMID: 24045911 DOI: 10.1007/s10995-013-1367-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21%) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6%) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits, <4 ANC visits and delivery by skilled attendant showed 25% (OR 0.75; 95% CI 0.25, 2.75), 9% (OR 0.91; 95% CI 0.43, 1.69) and 31% (OR 0.69; 95% CI 0.36, 1.33) reduction in the occurrence of adverse pregnancy outcomes, respectively. Skilled maternal care showed reduction in adverse pregnancy outcomes (complications and deaths). However, the associations were not significant. Improving the quality of maternity care services and ensuring continuum of care in the health care system are imperative for effective maternal health care in the study area.
Collapse
|
52
|
Lassi ZS, Cometto G, Huicho L, Bhutta ZA. Quality of care provided by mid-level health workers: systematic review and meta-analysis. Bull World Health Organ 2015; 91:824-833I. [PMID: 24347706 DOI: 10.2471/blt.13.118786] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of care provided by mid-level health workers. METHODS Experimental and observational studies comparing mid-level health workers and higher level health workers were identified by a systematic review of the scientific literature. The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria and data were analysed using Review Manager. FINDINGS Fifty-three studies, mostly from high-income countries and conducted at tertiary care facilities, were identified. In general, there was no difference between the effectiveness of care provided by mid-level health workers in the areas of maternal and child health and communicable and noncommunicable diseases and that provided by higher level health workers. However, the rates of episiotomy and analgesia use were significantly lower in women giving birth who received care from midwives alone than in those who received care from doctors working in teams with midwives, and women were significantly more satisfied with care from midwives. Overall, the quality of the evidence was low or very low. The search also identified six observational studies, all from Africa, that compared care from clinical officers, surgical technicians or non-physician clinicians with care from doctors. Outcomes were generally similar. CONCLUSION No difference between the effectiveness of care provided by mid-level health workers and that provided by higher level health workers was found. However, the quality of the evidence was low. There is a need for studies with a high methodological quality, particularly in Africa - the region with the greatest shortage of health workers.
Collapse
Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, PO Box 3500, Karachi 74550, Pakistan
| | - Giorgio Cometto
- Global Health Workforce Alliance Secretariat, World Health Organization, Geneva, Switzerland
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, PO Box 3500, Karachi 74550, Pakistan
| |
Collapse
|
53
|
Kidanto H, Msemo G, Mmbando D, Rusibamayila N, Ersdal H, Perlman J. Predisposing factors associated with stillbirth in Tanzania. Int J Gynaecol Obstet 2015; 130:70-3. [PMID: 25842995 DOI: 10.1016/j.ijgo.2015.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/01/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether specific medical conditions and/or fetal compromise during labor are associated with fresh stillbirth (FSB), and whether absent fetal heart rate (FHR) before delivery can increase risk of FSB. METHODS An observational cohort study was conducted at three university referral hospitals in Tanzania between January and September 2013. Maternal, labor, and neonatal characteristics were recorded for all deliveries. FSB was defined as an Apgar score of 0 at 1 and 5minutes, with intact skin and suspected death during labor or delivery. RESULTS Among 15 305 deliveries, there were 499 stillbirths (243 FSBs and 256 macerated stillbirths). Stillbirth was significantly more likely than a live birth after maternal transfer (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.73-3.92; P<0.001) and when FHR was absent (OR 996.29; 95% CI 632.19-1570.09; P<0.001). Risk of stillbirth increased with uterine rupture (OR 138.62; 95% CI 60.73-316.44), placental abruption (OR 40.96; 95% CI 28.97-57.91), cord prolapse (OR 13.49; 95% CI 6.97-26.11), and prematurity (OR 6.87; 95% CI 4.71-10.03; P<0.001 for all). CONCLUSION In low-resource settings, FSB may be prevented by using a combined strategy of clinical risk identification, early detection of abnormal FHR, and expedited delivery.
Collapse
Affiliation(s)
- Hussein Kidanto
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Donan Mmbando
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | | | - Hege Ersdal
- Stavanger Acute medicine Foundation for Education and Research, Stavanger University Hospital, Stavanger, Norway
| | - Jeffrey Perlman
- Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
54
|
Noordam AC, Carvajal-Velez L, Sharkey AB, Young M, Cals JWL. Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality. PLoS One 2015; 10:e0117919. [PMID: 25706531 PMCID: PMC4338250 DOI: 10.1371/journal.pone.0117919] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022] Open
Abstract
Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.
Collapse
Affiliation(s)
- Aaltje Camielle Noordam
- Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
- * E-mail:
| | - Liliana Carvajal-Velez
- Division of Policy and Strategy, Data and Analytics Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Alyssa B. Sharkey
- Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Mark Young
- Health Section, United Nations Children Fund (UNICEF), New York, New York, United States of America
| | - Jochen W. L. Cals
- Maastricht University, School for Public Health and Primary Care (CAPHRI), Maastricht, the Netherlands
| |
Collapse
|
55
|
Jiménez Puñales S, Pentón Cortés R. Mortalidad perinatal. Factores de riesgo asociados. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
56
|
Ntambue A, Malonga F, Dramaix-Wilmet M, Donnen P. [Perinatal mortality: extent and causes in Lubumbashi, Democratic Republic of Congo]. Rev Epidemiol Sante Publique 2014; 61:519-29. [PMID: 24409524 DOI: 10.1016/j.respe.2013.07.684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The present study was initiated in order to determine the rate, the causes and the risk factors for perinatal mortality in Lubumbashi, Democratic Republic of Congo. METHODS Data for this cross-sectional study were collected by interviewing participating women and by analysis of medical files. Women who gave birth in 2010 and were residents of Lubumbashi during the same year were included.Women were included irrespective of the pregnancy outcome and perinatal survival was determined for newborns aged at least seven days.Women were recruited from households selected by cluster sampling for healthcare zones. Perinatal mortality was defined as stillbirths and early neonatal deaths per 1000 births. Risk factors were sought using the odds ratio method adjusted by logistic regression using a 5% threshold. RESULTS Among 11,536 surveyed women, there were 11,633 births including 177 stillbirths and 133 early neonatal deaths. Perinatal mortality was 27% (95%IC = 23.7–29.6%). The causes of this mortality were respiratory distress (58.2%), neonatal infection (pneumonia and neonatal meningitis, 13.5%), complications of prematurity (9.0%), neonatal tetanus (1.6%), congenital malformations (0.6%). The cause of perinatal death was unknown for 17.1%. Risk factors for perinatal mortality were: unmarried mother; home delivery; complicated delivery; dystocia; caesareansection; multiple pregnancy; low birth weight; prematurity. CONCLUSION Action should be taken to improve availability, use and quality of Emergency obstetrical and neonatal care. Women should be better informed concerning the danger signs of pregnancy and childbirth.
Collapse
|
57
|
Berhan Y, Berhan A. Commentary: Reasons for persistently high maternal and perinatal mortalities in Ethiopia: Part III-Perspective of the "three delays" model. Ethiop J Health Sci 2014; 24 Suppl:137-48. [PMID: 25489188 PMCID: PMC4249213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yifru Berhan
- Hawassa University, College of Medicine and Health Sciences, Department of Gynecology-Obstetrics
| | - Asres Berhan
- Hawassa University, College of Medicine and Health Sciences, Department of Pharmacology
| |
Collapse
|
58
|
Lassi ZS, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health. Reprod Health 2014; 11 Suppl 1:S2. [PMID: 25178042 PMCID: PMC4145858 DOI: 10.1186/1742-4755-11-s1-s2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period.
Collapse
Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tarab Mansoor
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
59
|
Lassi ZS, Kumar R, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential interventions: implementation strategies and proposed packages of care. Reprod Health 2014; 11 Suppl 1:S5. [PMID: 25178110 PMCID: PMC4145859 DOI: 10.1186/1742-4755-11-s1-s5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In an effort to accelerate progress towards achieving Millennium Development Goal (MDG) 4 and 5, provision of essential reproductive, maternal, newborn and child health (RMNCH) interventions is being considered. Not only should a state-of-the-art approach be taken for services delivered to the mother, neonate and to the child, but services must also be deployed across the household to hospital continuum of care approach and in the form of packages. The paper proposed several packages for improved maternal, newborn and child health that can be delivered across RMNCH continuum of care. These packages include: supportive care package for women to promote awareness related to healthy pre-pregnancy and pregnancy interventions; nutritional support package for mother to improve supplementation of essential nutrients and micronutrients; antenatal care package to detect, treat and manage infectious and noninfectious diseases and promote immunization; high risk care package to manage preeclampsia and eclampsia in pregnancy; childbirth package to promote support during labor and importance of skilled birth attendance during labor; essential newborn care package to support healthy newborn care practices; and child health care package to prevent and manage infections. This paper further discussed the implementation strategies for employing these interventions at scale.
Collapse
Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rohail Kumar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tarab Mansoor
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
60
|
Iyengar K, Jain M, Thomas S, Dashora K, Liu W, Saini P, Dattatreya R, Parker I, Iyengar S. Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India. BMC Pregnancy Childbirth 2014; 14:270. [PMID: 25117856 PMCID: PMC4141099 DOI: 10.1186/1471-2393-14-270] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 07/19/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND After the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled "Parijaat" was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund. METHODS The intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period. RESULTS Use of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing. CONCLUSIONS An intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.
Collapse
Affiliation(s)
- Kirti Iyengar
- />Action Research & Training for Health, Udaipur, Rajasthan India
| | - Motilal Jain
- />State Institute of Health and Family Welfare, Government of Rajasthan, Jaipur, Rajasthan India
| | - Sunil Thomas
- />United Nations Population Fund, Jaipur, Rajasthan India
| | - Kalpana Dashora
- />Action Research & Training for Health, Udaipur, Rajasthan India
| | - William Liu
- />Northwestern Feinberg School of Medicine, Chicago, Illinois USA
| | - Paramsukh Saini
- />Action Research & Training for Health, Udaipur, Rajasthan India
| | | | - Indrani Parker
- />Action Research & Training for Health, Udaipur, Rajasthan India
| | - Sharad Iyengar
- />Action Research & Training for Health, Udaipur, Rajasthan India
| |
Collapse
|
61
|
Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E, de Graft Johnson J, von Xylander S, Rafique N, Sylla M, Mwansambo C, Daelmans B, Lawn JE. Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet 2014; 384:438-54. [PMID: 24853600 DOI: 10.1016/s0140-6736(14)60582-1] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Universal coverage of essential interventions would reduce neonatal deaths by an estimated 71%, benefit women and children after the first month, and reduce stillbirths. However, the packages with the greatest effect (care around birth, care of small and ill newborn babies), have low and inequitable coverage and are the most sensitive markers of health system function. In eight of the 13 countries with the most neonatal deaths (55% worldwide), we undertook a systematic assessment of bottlenecks to essential maternal and newborn health care, involving more than 600 experts. Of 2465 bottlenecks identified, common constraints were found in all high-burden countries, notably regarding the health workforce, financing, and service delivery. However, bottlenecks for specific interventions might differ across similar health systems. For example, the implementation of kangaroo mother care was noted as challenging in the four Asian country workshops, but was regarded as a feasible aspect of preterm care by respondents in the four African countries. If all high-burden countries achieved the neonatal mortality rates of their region's fastest progressing countries, then the mortality goal of ten or fewer per 1000 livebirths by 2035 recommended in this Series and the Every Newborn Action Plan would be exceeded. We therefore examined fast progressing countries to identify strategies to reduce neonatal mortality. We identified several key factors: (1) workforce planning to increase numbers and upgrade specific skills for care at birth and of small and ill newborn babies, task sharing, incentives for rural health workers; (2) financial protection measures, such as expansion of health insurance, conditional cash transfers, and performance-based financing; and (3) dynamic leadership including innovation and community empowerment. Adapting from the 2005 Lancet Series on neonatal survival and drawing on this Every Newborn Series, we propose a country-led, data-driven process to sharpen national health plans, seize opportunities to address the quality gap for care at birth and care of small and ill newborn babies, and systematically scale up care to reach every mother and newborn baby, particularly the poorest.
Collapse
Affiliation(s)
| | | | - Mary V Kinney
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Universidad Nacional Mayor de San Marcos and Instituto Nacional de Salud del Niño, Lima, Peru
| | | | - Eve Lackritz
- Global Alliance for Preventing Prematurity and Stillbirths, Seattle, WA, USA
| | | | - Severin von Xylander
- Maternal, Child and Adolescent Health Department, World Health Organization, Geneva, Switzerland
| | | | - Mariame Sylla
- UNICEF, West and Central Africa Regional Office, Dakar, Senegal
| | | | - Bernadette Daelmans
- Maternal, Child and Adolescent Health Department, World Health Organization, Geneva, Switzerland
| | - Joy E Lawn
- Saving Newborn Lives, Save the Children, Cape Town, South Africa; Centre for Maternal Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
62
|
King ML, Aden A, Tapa S, Jumah R, Khan S. Evidence-based stillbirth prevention strategies: combining empirical and theoretical paradigms to inform health planning and decision-making. Worldviews Evid Based Nurs 2014; 11:258-65. [PMID: 25040460 DOI: 10.1111/wvn.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A global health project undertaken in Qatar on the Arabian Peninsula immersed undergraduate nursing students in hands-on learning to address the question: What strategies are effective in preventing stillbirth? Worldwide stillbirth estimates of 2.6 million per year and the high rate in the Eastern Mediterranean Region of 27 per 1,000 total live births provided the stimulus for this inquiry. METHODS We used a dual empirical and theoretical approach that combined the principles of evidence-based practice and population health planning. Students were assisted to translate pre-appraised literature based on the 6S hierarchical pyramid of evidence. The PRECEDE-PROCEED (P-P) model served as an organizing template to assemble data extracted from the appraisal of 21 systematic literature reviews ± meta-analyses, 2 synopses of synthesized reports, and 9 individual studies summarizing stillbirth prevention strategies in low, middle, and high income countries. Consistent with elements of the P-P model, stillbirth prevention strategies were classified as social, epidemiological, educational, ecological, administrative, or policy. RESULTS Ten recommendations with clear evidence of effectiveness in preventing stillbirth in low, middle, or high income countries were identified. Several other promising interventions were identified with weak, uncertain, or inconclusive evidence. These require further rigorous testing. LINKING EVIDENCE TO ACTION Two complementary paradigms--evidence-based practice and an ecological population health program planning model--helped baccalaureate nursing students transfer research evidence into useable knowledge for practice. They learned the importance of comprehensive assessments and evidence-informed interventions. The multidimensional elements of the P-P model sensitized students to the complex interrelated factors influencing stillbirth and its prevention.
Collapse
Affiliation(s)
- Mary Lou King
- Assistant Professor, University of Calgary-Qatar, Doha, Qatar
| | | | | | | | | |
Collapse
|
63
|
Saleem S, McClure EM, Goudar SS, Patel A, Esamai F, Garces A, Chomba E, Althabe F, Moore J, Kodkany B, Pasha O, Belizan J, Mayansyan A, Derman RJ, Hibberd PL, Liechty EA, Krebs NF, Hambidge KM, Buekens P, Carlo WA, Wright LL, Koso-Thomas M, Jobe AH, Goldenberg RL. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries. Bull World Health Organ 2014; 92:605-12. [PMID: 25177075 DOI: 10.2471/blt.13.127464] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 02/13/2014] [Accepted: 03/10/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. METHODS A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. FINDINGS Between 2010 and 2012, 214,070 of 220,235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100,000 live births, ranging from 69 per 100,000 in Argentina to 316 per 100,000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97-11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26-5.67) and 7-day (RR: 3.94; 95% CI: 2.74-5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54-9.77). CONCLUSION Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
Collapse
Affiliation(s)
- Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Elizabeth M McClure
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | | | - Fabian Esamai
- Department of Pediatrics, Moi University, Eldoret, Kenya
| | - Ana Garces
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University of Zambia, Lusaka, Zambia
| | | | - Janet Moore
- Social, Statistical and Environmental Sciences, RTI International, PO Box 12194, 3040 East Cornwallis Road, Durham, NC 27709-2194, United States of America (USA)
| | | | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jose Belizan
- Institute of Clinical Effectiveness, Buenos Aires, Argentina
| | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Christiana Health Care, Newark, USA
| | - Patricia L Hibberd
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - K Michael Hambidge
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | | | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, USA
| | | | | |
Collapse
|
64
|
Timpka T, Spreco A, Gursky E, Eriksson O, Dahlström Ö, Strömgren M, Ekberg J, Pilemalm S, Karlsson D, Hinkula J, Holm E. Intentions to perform non-pharmaceutical protective behaviors during influenza outbreaks in Sweden: a cross-sectional study following a mass vaccination campaign. PLoS One 2014; 9:e91060. [PMID: 24608557 PMCID: PMC3946657 DOI: 10.1371/journal.pone.0091060] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/07/2014] [Indexed: 12/24/2022] Open
Abstract
Failure to incorporate the beliefs and attitudes of the public into theoretical models of preparedness has been identified as a weakness in strategies to mitigate infectious disease outbreaks. We administered a cross-sectional telephone survey to a representative sample (n = 443) of the Swedish adult population to examine whether self-reported intentions to improve personal hygiene and increase social distancing during influenza outbreaks could be explained by trust in official information, self-reported health (SF-8), sociodemographic factors, and determinants postulated in protection motivation theory, namely threat appraisal and coping appraisal. The interviewees were asked to make their appraisals for two scenarios: a) an influenza with low case fatality and mild lifestyle impact; b) severe influenza with high case fatality and serious disturbances of societal functions. Every second respondent (50.0%) reported high trust in official information about influenza. The proportion that reported intentions to take deliberate actions to improve personal hygiene during outbreaks ranged between 45–85%, while less than 25% said that they intended to increase social distancing. Multiple logistic regression models with coping appraisal as the explanatory factor most frequently contributing to the explanation of the variance in intentions showed strong discriminatory performance for staying home while not ill (mild outbreaks: Area under the curve [AUC] 0.85 (95% confidence interval 0.82;0.89), severe outbreaks AUC 0.82 (95% CI 0.77;0.85)) and acceptable performance with regard to avoiding public transportation (AUC 0.78 (0.74;0.82), AUC 0.77 (0.72;0.82)), using handwash products (AUC 0.70 (0.65;0.75), AUC 0.76 (0.71;0.80)), and frequently washing hands (AUC 0.71 (0.66;0.76), AUC 0.75 (0.71;0.80)). We conclude that coping appraisal was the explanatory factor most frequently included in statistical models explaining self-reported intentions to carry out non-pharmaceutical health actions in the Swedish outlined context, and that variations in threat appraisal played a smaller role in these models despite scientific uncertainties surrounding a recent mass vaccination campaign.
Collapse
Affiliation(s)
- Toomas Timpka
- Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Armin Spreco
- Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elin Gursky
- National Strategies Support Directorate, ANSER/Analytic Services Inc, Arlington, Virginia, United States of America
| | - Olle Eriksson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Örjan Dahlström
- Linnaeus Centre HEAD, Department of Behavioural Sciences, Linköping University, Linköping, Sweden
| | - Magnus Strömgren
- Department of Geography and Economic History, Umeå University, Umeå, Sweden
| | - Joakim Ekberg
- Department of Public Health, Östergötland County Council, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofie Pilemalm
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - David Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jorma Hinkula
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Einar Holm
- Department of Geography and Economic History, Umeå University, Umeå, Sweden
| |
Collapse
|
65
|
Desta BF, Mohammed H, Barry D, Frew AH, Hepburn K, Claypoole C. Use of Mobile Video Show for Community Behavior Change on Maternal and Newborn Health in Rural Ethiopia. J Midwifery Womens Health 2014; 59 Suppl 1:S65-72. [DOI: 10.1111/jmwh.12111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
66
|
|
67
|
Nalwadda CK, Waiswa P, Kiguli J, Namazzi G, Namutamba S, Tomson G, Peterson S, Guwatudde D. High compliance with newborn community-to-facility referral in eastern Uganda:.an opportunity to improve newborn survival. PLoS One 2013; 8:e81610. [PMID: 24312326 PMCID: PMC3843697 DOI: 10.1371/journal.pone.0081610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/15/2013] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Seventy-five percent of newborn deaths happen in the first-week of life, with the highest risk of death in the first 24-hours after birth.WHO and UNICEF recommend home-visits for babies in the first-week of life to assess for danger-signs and counsel caretakers for immediate referral of sick newborns. We assessed timely compliance with newborn referrals made by community-health workers (CHWs), and its determinants in Iganga and Mayuge Districts in rural eastern Uganda. METHODS A historical cohort study design was used to retrospectively follow up newborns referred to health facilities between September 2009 and August 2011. Timely compliance was defined as caretakers of newborns complying with CHWs' referral advice within 24-hours. RESULTS A total of 724 newborns were referred by CHWs of whom 700 were successfully traced. Of the 700 newborns, 373 (53%) were referred for immunization and postnatal-care, and 327 (47%) because of a danger-sign. Overall, 439 (63%) complied, and of the 327 sick newborns, 243 (74%) caretakers complied with the referrals. Predictors of referral compliance were; the newborn being sick at the time of referral- Adjusted Odds Ratio (AOR) = 2.3, and 95% Confidence-Interval (CI) of [1.6 - 3.5]), the CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: [1.2 -2.7]); and age of mother (25-29) and (30-34) years, (AOR =0.4; 95% CI: [0.2 - 0.8]) and (AOR = 0.4; 95% CI: [0.2 - 0.8]) respectively. CONCLUSION Caretakers' newborn referral compliance was high in this setting. The newborn being sick, being born to a younger mother and a reminder visit by the CHW to a referred newborn were predictors of newborn referral compliance. Integration of CHWs into maternal and newborn care programs has the potential to increase care seeking for newborns, which may contribute to reduction of newborn mortality.
Collapse
Affiliation(s)
- Christine Kayemba Nalwadda
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ; Health System Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
68
|
Curry LA, Byam P, Linnander E, Andersson KM, Abebe Y, Zerihun A, Thompson JW, Bradley EH. Evaluation of the Ethiopian Millennium Rural Initiative: impact on mortality and cost-effectiveness. PLoS One 2013; 8:e79847. [PMID: 24260307 PMCID: PMC3832618 DOI: 10.1371/journal.pone.0079847] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/25/2013] [Indexed: 11/28/2022] Open
Abstract
Main Objective Few studies have examined the long-term, impact of large-scale interventions to strengthen primary care services for women and children in rural, low-income settings. We evaluated the impact of the Ethiopian Millennium Rural Initiative (EMRI), an 18-month systems-based intervention to improve the performance of 30 primary health care units in rural areas of Ethiopia. Methods We assessed the impact of EMRI on maternal and child survival using The Lives Saved Tool (LiST), Demography (DemProj) and AIDS Impact Model (AIM) tools in Spectrum software, inputting monthly data on 6 indicators 1) antenatal coverage (ANC), 2) skilled birth attendance coverage (SBA), 3) post-natal coverage (PNC), 4) HIV testing during ANC, 5) measles vaccination coverage, and 6) pentavalent 3 vaccination coverages. We calculated a cost-benefit ratio of the EMRI program including lives saved during implementation and lives saved during implementation and 5 year follow-up. Results A total of 134 lives (all children) were estimated to have been saved due to the EMRI interventions during the 18-month intervention in 30 health centers and their catchment areas, with an estimated additional 852 lives (820 children and 2 adults) saved during the 5-year post-EMRI period. For the 18-month intervention period, EMRI cost $37,313 per life saved ($42,366 per life if evaluation costs are included). Calculated over the 18-month intervention plus 5 years post-intervention, EMRI cost $5,875 per life saved ($6,671 per life if evaluation costs are included). The cost effectiveness of EMRI improves substantially if the performance achieved during the 18 months of the EMRI intervention is sustained for 5 years. Scaling up EMRI to operate for 5 years across the 4 major regions of Ethiopia could save as many as 34,908 lives. Significance A systems-based approach to improving primary care in low-income settings can have transformational impact on lives saved and be cost-effective.
Collapse
Affiliation(s)
- Leslie A. Curry
- Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America
- * E-mail:
| | - Patrick Byam
- Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America
| | - Erika Linnander
- Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America
| | | | | | | | - Jennifer W. Thompson
- Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America
| | - Elizabeth H. Bradley
- Yale School of Public Health and Global Health Leadership Institute, New Haven, Connecticut, United States of America
| |
Collapse
|
69
|
Manasyan A, Saleem S, Koso-Thomas M, Althabe F, Pasha O, Chomba E, Goudar SS, Patel A, Esamai F, Garces A, Kodkany B, Belizan J, McClure EM, Derman RJ, Hibberd P, Liechty EA, Hambidge KM, Carlo WA, Buekens P, Moore J, Wright LL, Goldenberg RL. Assessment of obstetric and neonatal health services in developing country health facilities. Am J Perinatol 2013; 30:787-94. [PMID: 23329566 PMCID: PMC3664648 DOI: 10.1055/s-0032-1333409] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the staffing and availability of medical equipment and medications and the performance of procedures at health facilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. STUDY DESIGN In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/medications, and procedures including cesarean section. RESULTS The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. CONCLUSIONS Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required.
Collapse
|
70
|
Mukherjee S, Roy P, Mitra S, Samanta M, Chatterjee S. Measuring new born foot length to identify small babies in need of extra care: a cross-sectional hospital based study. IRANIAN JOURNAL OF PEDIATRICS 2013; 23:508-12. [PMID: 24800008 PMCID: PMC4006497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 02/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The neonatal mortality rate (NMR) continues to remain quite high, one important cause being preterm deliveries. The main obstacle in the pathway towards decreasing NMR is identification of babies in need of extra care. To analyze the utility of newborn foot length as a proxy measure for birth weight and gestational age. METHODS A cross-sectional study done in a hospital of eastern India with 351 babies during 4 months. Right foot length of each recorded using a plastic, stiff ruler. FINDINGS 48.1% babies were preterm, 51.8% low birth weight (LBW) and 33.3% very low birth weight (VLBW). Foot length less than 7.75 cm has 92.3% sensitivity and 86.3% specificity for identification of preterm neonates. For identification of LBW babies (<2500 gm) a foot length less than 7.85cm has 100% sensitivity and 95.3% specificity. Foot length less than 6.85 cm has 100% sensitivity and 94.9% specifity for identification of VLBW babies (<1500 gm). CONCLUSION Foot length may be used in the identification of LBW and preterm babies who are in need of extra care.
Collapse
Affiliation(s)
- Satarupa Mukherjee
- Corresponding Author:Address: 517, Brahmapur, Badamtolla, Kolkata-700096, West Bengal, India. E-mail:
| | | | | | | | | |
Collapse
|
71
|
Lori JR, Wadsworth AC, Munro ML, Rominski S. Promoting access: the use of maternity waiting homes to achieve safe motherhood. Midwifery 2013; 29:1095-102. [PMID: 24012018 DOI: 10.1016/j.midw.2013.07.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/27/2013] [Accepted: 07/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to examine the structural and sociocultural factors influencing maternity waiting home (MWH) use through the lens of women, families, and communities in one rural county in postconflict Liberia. DESIGN an exploratory, qualitative descriptive design using focus groups and in-depth, individual interviews was employed. Content analysis of data was performed using Penchansky and Thomas's (1981) five A's of access as a guiding framework. SETTING rural communities in north-central Liberia. PARTICIPANTS a convenience sampling was used to recruit participants. Eight focus groups were held with 75 participants from congruent groups of (1) MWH users, (2) MWH non-users, (3) family members of MWH users, and (4) family members of MWH non-users. Eleven individual interviews were conducted with clinic staff or community leaders. FINDINGS the availability of MWHs decreased the barrier of distance for women to access skilled care around the time of childbirth. Food insecurity while staying at a MWH was identified as a potential barrier by participants. KEY CONCLUSIONS examining access as a general concept within the specific dimensions of availability, accessibility, accommodation, affordability, and acceptability provides a way to describe the structural and sociocultural factors that influence access to a MWH and skilled attendance for birth. IMPLICATIONS FOR PRACTICE MWHs can address the barrier of distance in accessing skilled care for childbirth in a rural setting with long distances to a facility.
Collapse
Affiliation(s)
- Jody R Lori
- Division of Health Promotion and Risk Reduction, University of Michigan, School of Nursing, 400 N. Ingalls, Room 3352, Ann Arbor, MI 48109, USA.
| | | | | | | |
Collapse
|
72
|
Mutale W, Bond V, Mwanamwenge MT, Mlewa S, Balabanova D, Spicer N, Ayles H. Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study. BMC Health Serv Res 2013; 13:291. [PMID: 23902601 PMCID: PMC3734193 DOI: 10.1186/1472-6963-13-291] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary bottleneck to achieving the MDGs in low-income countries is health systems that are too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is one of the countries that are lagging behind in achieving millennium development targets. Several barriers have been identified as hindering the progress towards health related millennium development goals. Designing an intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship (BHOMA) project was designed to address the challenges in the Zambia's MOH using a system wide approach. We applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system strengthening. METHODS A qualitative study was conducted looking at the status of the Six WHO building blocks for health systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9. RESULTS The study showed that building block specific weaknesses had cross cutting effect in other health system building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. Several barriers were identified as hindering access to health services by the local communities. These included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side barriers: Long distance to health facility, cost of transport and cultural practices. Participating communities seemed to lack the capacity to hold health workers accountable for the drugs and services. CONCLUSION The study has shown that building block specific weaknesses had cross cutting effect in other health system building blocks. These linkages emphasised the need to use system wide approaches in assessing the performance of health system strengthening interventions.
Collapse
Affiliation(s)
- Wilbroad Mutale
- Department of Community Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
| | | | | | | | | | | | | |
Collapse
|
73
|
Colbourn T, Nambiar B, Bondo A, Makwenda C, Tsetekani E, Makonda-Ridley A, Msukwa M, Barker P, Kotagal U, Williams C, Davies R, Webb D, Flatman D, Lewycka S, Rosato M, Kachale F, Mwansambo C, Costello A. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial. Int Health 2013; 5:180-95. [PMID: 24030269 PMCID: PMC5102328 DOI: 10.1093/inthealth/iht011] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. METHODS We evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14,576 and 20,576 births were recorded during baseline (June 2007-September 2008) and intervention (October 2008-December 2010) periods. RESULTS For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60-1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72-0.97). We did not observe any intervention effects on maternal mortality. CONCLUSIONS Despite implementation problems, a combined community and facility approach using participatory women's groups and quality improvement at health centres reduced newborn mortality in rural Malawi.
Collapse
Affiliation(s)
- Tim Colbourn
- UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
74
|
Lassi ZS, Majeed A, Rashid S, Yakoob MY, Bhutta ZA. The interconnections between maternal and newborn health – evidence and implications for policy. J Matern Fetal Neonatal Med 2013; 26 Suppl 1:3-53. [DOI: 10.3109/14767058.2013.784737] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
75
|
McDougal L, Strathdee SA, Rangel G, Martinez G, Vera A, Sirotin N, Stockman JK, Ulibarri MD, Raj A. Adverse pregnancy outcomes and sexual violence among female sex workers who inject drugs on the United States-Mexico border. VIOLENCE AND VICTIMS 2013; 28:496-512. [PMID: 23862312 PMCID: PMC3963834 DOI: 10.1891/0886-6708.11-00129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study examines the prevalence of miscarriage/stillbirth among female sex workers who inject drugs (FSW-IDUs) and measures its associations with physical and sexual violence. Baseline data from 582 FSW-IDUs enrolled in an HIV intervention study in Tijuana and Ciudad Juárez, Mexico were used for current analyses. 30% of participants had experienced at least one miscarriage/stillbirth, 51% had experienced sexual violence, and 49% had experienced physical violence. History of miscarriage/stillbirth was associated with sexual violence (adjusted odds ratio [aOR] = 1.7, p = .02) but not physical violence. Additional reproductive risks associated with miscarriage/stillbirth included high numbers of male clients in the previous month (aOR = 1.1 per 30 clients, p = 0.04), history of abortion (aOR = 3.7, p < .001), and higher number of pregnancies (aOR = 1.4 per additional pregnancy, p < .001). Programs and research with this population should integrate reproductive health and consider gender-based violence.
Collapse
Affiliation(s)
- Lotus McDougal
- San Diego State University/University of California, San Diego, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Beckingham A. Maternal Health and Care in India: Why a Major Public Health Strategy Is Essential. INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.2.86] [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
India has large inequalities in maternal health and high maternal mortality and morbidity rates. A social model of maternal health was used as a framework for a broad review of online published literature to appraise the approaches used by India to address these issues and to examine the potential for reducing the country’s maternal health inequalities.The review found the following:• An apparent lack of coordinated economic, social, and health strategy and policies focused on improving maternal health• No acknowledgment in national health policy of the limitations of the medical model of maternal health and little apparent mention of the social model• No evident national frameworks for quality assurance in maternity care• Lack of recognition of the importance of woman-centered care• No evident comprehensive maternal health needs assessment to underpin coordinated multisector working• An apparent lack of reliable national data collection for setting inequality targets and monitoring progress• No apparent performance-focused management system for improving maternity care nationally.Although India has made large increases in maternal health care provision over recent decades, a pragmatic review of government policies, the reports of international agencies, and the findings of published research studies indicate that major barriers exist to reducing maternal health inequalities and to achieving good quality care for disadvantaged women. The main barrier appears to be the widespread use at all levels, including government, of the medical model of maternal health, which focuses mostly on obstetric interventions and fails to address the wider economic and social determinants of maternal health or to use a woman-centered approach to maternity care.We recommend that Indian governments adopt instead a “social model” approach to maternal health improvement and urgently employ a public health strategy led by a national multisector task force to reduce inequalities in maternal health.
Collapse
|
77
|
Chopra M, Sharkey A, Dalmiya N, Anthony D, Binkin N. Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition. Lancet 2012; 380:1331-40. [PMID: 22999430 DOI: 10.1016/s0140-6736(12)61423-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels--ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions-and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.
Collapse
Affiliation(s)
- Mickey Chopra
- Health Section, UNICEF, UN Plaza, New York, NY 10017, USA
| | | | | | | | | |
Collapse
|
78
|
|
79
|
|
80
|
Bhutta ZA, Cabral S, Chan CW, Keenan WJ. Reducing maternal, newborn, and infant mortality globally: an integrated action agenda. Int J Gynaecol Obstet 2012; 119 Suppl 1:S13-7. [PMID: 22883919 DOI: 10.1016/j.ijgo.2012.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been increasing awareness over recent years of the persisting burden of worldwide maternal, newborn, and child mortality. The majority of maternal deaths occur during labor, delivery, and the immediate postpartum period, with obstetric hemorrhage as the primary medical cause of death. Other causes of maternal mortality include hypertensive diseases, sepsis/infections, obstructed labor, and abortion-related complications. Recent estimates indicate that in 2009 an estimated 3.3 million babies died in the first month of life and that overall, 7.3 million children under 5 die each year. Recent data also suggest that sufficient evidence- and consensus-based interventions exist to address reproductive, maternal, newborn, and child health globally, and if implemented at scale, these have the potential to reduce morbidity and mortality. There is an urgent need to put elements in place to promote integrated interventions among healthcare professionals and their associations. What is needed is the political will and partnerships to implement evidence-based interventions at scale.
Collapse
|
81
|
Stillbirth in cases of severe acute maternal morbidity. Int J Gynaecol Obstet 2012; 119:53-6. [DOI: 10.1016/j.ijgo.2012.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/09/2012] [Accepted: 07/10/2012] [Indexed: 11/24/2022]
|
82
|
Bellad MB, Goudar SS, Edlavitch SA, Mahantshetti NS, Naik V, Hemingway-Foday JJ, Gupta M, Nalina HR, Derman R, Moss N, Kodkany BS. Consanguinity, prematurity, birth weight and pregnancy loss: a prospective cohort study at four primary health center areas of Karnataka, India. J Perinatol 2012; 32:431-7. [PMID: 21852769 DOI: 10.1038/jp.2011.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether consanguinity adversely influences pregnancy outcome in South India, where consanguinity is a common means of family property retention. STUDY DESIGN Data were collected from a prospective cohort of 647 consenting women, consecutively registered for antenatal care between 14 and 18 weeks gestation, in Belgaum district, Karnataka in 2005. Three-generation pedigree charts were drawn for consanguineous participants. χ (2)-Test and Student's t-test were used to assess categorical and continuous data, respectively, using SPSS version 14. Multivariate logistic regression adjusted for confounding variables. RESULT Overall, 24.1% of 601 women with singleton births and outcome data were consanguineous. Demographic characteristics between study groups were similar. Non-consanguineous couples had fewer stillbirths (2.6 vs 6.9% P=0.017; adjusted P=0.050), miscarriages (1.8 vs 4.1%, P=0.097; adjusted P=0.052) and lower incidence of birth weight <2500 g (21.8 vs 29.5%, P=0.071, adjusted P=0.044). Gestation <37 weeks was 6.2% in both the groups. Adjusted for consanguinity and other potential confounders, age <20 years was protective of stillbirth (P=0.01), pregnancy loss (P=0.023) and preterm birth (P=0.013), whereas smoking (P=0.015) and poverty (P=0.003) were associated with higher rates of low birth weight. CONCLUSION Consanguinity significantly increases pregnancy loss and birth weight <2500 g.
Collapse
Affiliation(s)
- M B Bellad
- Department of Medical Education, Jawaharlal Nehru Medical College, Belgaum, India
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
83
|
Abstract
Background Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs. Conclusions/Significance Effective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with government offices that oversee front-line providers, and committed community leadership to succeed.
Collapse
|
84
|
Lassi ZS, Bhutta ZA. Mid-level health workers for improving the delivery of health services. Hippokratia 2012. [DOI: 10.1002/14651858.cd009649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Zohra S Lassi
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Zulfiqar A Bhutta
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
| |
Collapse
|
85
|
Affiliation(s)
- Gary L Darmstadt
- Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, WA 98102, USA.
| |
Collapse
|
86
|
Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E, Buchmann E, Goldenberg RL. Stillbirths: what difference can we make and at what cost? Lancet 2011; 377:1523-38. [PMID: 21496906 DOI: 10.1016/s0140-6736(10)62269-6] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Worldwide, 2·65 million (uncertainty range 2·08 million to 3·79 million) stillbirths occur yearly, of which 98% occur in countries of low and middle income. Despite the fact that more than 45% of the global burden of stillbirths occur intrapartum, the perception is that little is known about effective interventions, especially those that can be implemented in low-resource settings. We undertook a systematic review of randomised trials and observational studies of interventions which could reduce the burden of stillbirths, particularly in low-income and middle-income countries. We identified several interventions with sufficient evidence to recommend implementation in health systems, including periconceptional folic acid supplementation or fortification, prevention of malaria, and improved detection and management of syphilis during pregnancy in endemic areas. Basic and comprehensive emergency obstetric care were identified as key effective interventions to reduce intrapartum stillbirths. Broad-scale implementation of intervention packages across 68 countries listed as priorities in the Countdown to 2015 report could avert up to 45% of stillbirths according to a model generated from the Lives Saved Tool. The overall costs for these interventions are within the general estimates of cost-effective interventions for maternal care, especially in view of the effects on outcomes across maternal, fetal, and neonatal health.
Collapse
Affiliation(s)
- Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
| | | | | | | | | | | | | | | |
Collapse
|
87
|
Lee ACC, Cousens S, Darmstadt GL, Blencowe H, Pattinson R, Moran NF, Hofmeyr GJ, Haws RA, Bhutta SZ, Lawn JE. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect. BMC Public Health 2011; 11 Suppl 3:S10. [PMID: 21501427 PMCID: PMC3231883 DOI: 10.1186/1471-2458-11-s3-s10] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. Funding This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.
Collapse
Affiliation(s)
- Anne C C Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
88
|
Baqui AH, Choi Y, Williams EK, Arifeen SE, Mannan I, Darmstadt GL, Black RE. Levels, timing, and etiology of stillbirths in Sylhet district of Bangladesh. BMC Pregnancy Childbirth 2011; 11:25. [PMID: 21453544 PMCID: PMC3088895 DOI: 10.1186/1471-2393-11-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 04/01/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Lack of data is a critical barrier to addressing the problem of stillbirth in countries with the highest stillbirth burden. Our study objective was to estimate the levels, types, and causes of stillbirth in rural Sylhet district of Bangladesh. METHODS A complete pregnancy history was taken from all women (n=39 998) who had pregnancy outcomes during 2003-2005 in the study area. Verbal autopsy data were obtained for all identified stillbirths during the period. We used pre-defined case definitions and computer programs to assign causes of stillbirth for selected causes containing specific signs and symptoms. Both non-hierarchical and hierarchical approaches were used to assign causes of stillbirths. RESULTS A total of 1748 stillbirths were recorded during 2003-2005 from 48,192 births (stillbirth rate: 36.3 per 1000 total births). About 60% and 40% of stillbirths were categorized as antepartum and intrapartum, respectively. Maternal conditions, including infections, hypertensive disorders, and anemia, contributed to about 29% of total antepartum stillbirths. About 50% of intrapartum stillbirths were attributed to obstetric complications. Maternal infections and hypertensive disorders contributed to another 11% of stillbirths. A cause could not be assigned in nearly half (49%) of stillbirths. CONCLUSION The stillbirth rate is high in rural Bangladesh. Based on algorithmic approaches using verbal autopsy data, a substantial portion of stillbirths is attributable to maternal conditions and obstetric complications. Programs need to deliver community-level interventions to prevent and manage maternal complications, and to develop strategies to improve access to emergency obstetric care. Improvements in care to avert stillbirth can be accomplished in the context of existing maternal and child health programs. Methodological improvements in the measurement of stillbirths, especially causes of stillbirths, are also needed to better define the burden of stillbirths in low-resource settings.
Collapse
Affiliation(s)
- Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
89
|
Lawn JE, Bahl R, Bergstrom S, Bhutta ZA, Darmstadt GL, Ellis M, English M, Kurinczuk JJ, Lee ACC, Merialdi M, Mohamed M, Osrin D, Pattinson R, Paul V, Ramji S, Saugstad OD, Sibley L, Singhal N, Wall SN, Woods D, Wyatt J, Chan KY, Rudan I. Setting research priorities to reduce almost one million deaths from birth asphyxia by 2015. PLoS Med 2011; 8:e1000389. [PMID: 21305038 PMCID: PMC3019109 DOI: 10.1371/journal.pmed.1000389] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Joy Lawn and colleagues used a systematic process developed by the Child Health Nutrition Research Initiative (CHNRI) to define and rank research options to reduce mortality from intrapartum-related neonatal deaths (birth asphyxia) by the year 2015.
Collapse
Affiliation(s)
- Joy E. Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
- * E-mail:
| | - Rajiv Bahl
- Department for Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Staffan Bergstrom
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden, and Averting Maternal Death and Disability Program, Columbia University, New York, New York, United States of America
| | - Zulfiqar A. Bhutta
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
| | - Gary L. Darmstadt
- Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Matthew Ellis
- Community Child Health Partnership, Southmead Hospital, Bristol, United Kingdom
| | - Mike English
- KEMRI–Wellcome Trust Programme, Centre for Geographic Medicine Research–Coast, Nairobi, Kenya, and Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- The National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Anne C. C. Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mario Merialdi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mohamed Mohamed
- George Washington University, Washington, D.C., United States of America
| | - David Osrin
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
| | - Robert Pattinson
- MRC Maternal and Infant Heath Care Strategies Research Unit at the University of Pretoria, Pretoria, South Africa
| | - Vinod Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddarth Ramji
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Norway
| | - Lyn Sibley
- Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Steven N. Wall
- Saving Newborn Lives/Save the Children, Washington, D.C., United States of America
| | - Dave Woods
- University of Cape Town and the Perinatal Education Programme, Observatory, South Africa
| | - John Wyatt
- Centre for Philosophy, Justice and Health, University College of London, London, United Kingdom, and Center for Women's Health, University College of London, London, United Kingdom
| | - Kit Yee Chan
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia
| | - Igor Rudan
- Croatian Centre for Global Health, University of Split Medical School, Split, Croatia, and the Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, United Kingdom
| |
Collapse
|
90
|
Bhutta ZA, Lassi ZS, Blanc A, Donnay F. Linkages among reproductive health, maternal health, and perinatal outcomes. Semin Perinatol 2010; 34:434-45. [PMID: 21094418 DOI: 10.1053/j.semperi.2010.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention packages, emergency obstetrical care, elective induction for postterm delivery, Cesarean delivery for breech presentation, and prophylactic corticosteroids in preterm labor reduce perinatal mortality; and early initiation of breastfeeding and birth and newborn care preparedness through community-based intervention packages reduce neonatal mortality. This review demonstrates that RHMNH are inextricably linked, and that, therefore, health policies and programs should link them together. Such potential integration of strategies would not only help improve outcomes for millions of mothers and newborns but would also save scant resources. This would also allow for greater efficiency in training, monitoring, and supervision of health care workers and would also help families and communities to access and use services easily.
Collapse
Affiliation(s)
- Zulfiqar A Bhutta
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan.
| | | | | | | |
Collapse
|
91
|
Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA. Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol 2010; 34:387-94. [PMID: 21094413 DOI: 10.1053/j.semperi.2010.09.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The annual global burden of stillbirths amounts to an estimated 3.2 million%, 98% of which occur in low- and middle-income countries (LMICs). Of these, 1.02 million (32%) are intrapartum, ie, taking place during labor. The most important causes of stillbirths in LMICs include obstructed or prolonged labor, hypertensive diseases of pregnancy, syphilis and gram-negative infections, malaria in endemic areas, and undernutrition. Interventions that target these causes can play an important role in reducing stillbirths. There is a clear benefit of emergency obstetrical care, particularly Cesarean delivery, on intrapartum rates in LMICs when Cesarean rates are less than 8% to 10%. Provision of a skilled birth attendant is another important intervention whereby labor complications can be prevented, identified, managed, and/or referred. Among interventions for infections, syphilis screening and treatment can prevent as many as 50% of all stillbirths in areas with high syphilis prevalence, reducing the risk of stillbirths among treated women to that of untreated women. Intermittent preventive treatment of malaria and insecticide-treated mosquito nets are also interventions with strong recommendation, especially in the first 2 pregnancies. Balanced energy protein supplementation is an important nutritional intervention to prevent stillbirths in undernourished women, especially in LMICs. Creation of increased demand for health services within communities and increasing their uptake also can play a role in averting stillbirths. Other potential social and behavioral interventions include birth spacing, smoking cessation and indoor air pollution control, although the evidence for these is weak.
Collapse
|
92
|
Marchant T, Jaribu J, Penfold S, Tanner M, Armstrong Schellenberg J. Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania. BMC Public Health 2010; 10:624. [PMID: 20959008 PMCID: PMC2975655 DOI: 10.1186/1471-2458-10-624] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/19/2010] [Indexed: 12/03/2022] Open
Abstract
Background Neonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting. Methods A cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life. Results In hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight. Conclusion Measurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival
Collapse
Affiliation(s)
- Tanya Marchant
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, UK.
| | | | | | | | | |
Collapse
|
93
|
Nga NT, Målqvist M, Eriksson L, Hoa DP, Johansson A, Wallin L, Persson LÅ, Ewald U. Perinatal services and outcomes in Quang Ninh province, Vietnam. Acta Paediatr 2010; 99:1478-83. [PMID: 20528791 DOI: 10.1111/j.1651-2227.2010.01866.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. METHODS Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. RESULTS Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. CONCLUSION A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality.
Collapse
Affiliation(s)
- Nguyen T Nga
- Vietnam Sweden General Hospital, Uongbi, Vietnam.
| | | | | | | | | | | | | | | |
Collapse
|
94
|
De Brouwere V, Richard F, Witter S. Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Trop Med Int Health 2010; 15:901-9. [DOI: 10.1111/j.1365-3156.2010.02558.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
95
|
Affiliation(s)
- Vinod K Paul
- All India Institute of Medical Sciences, New Delhi 110029, India.
| |
Collapse
|
96
|
Pattinson R, Kerber K, Waiswa P, Day LT, Mussell F, Asiruddin SK, Blencowe H, Lawn JE. Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. Int J Gynaecol Obstet 2010; 107 Suppl 1:S113-21, S121-2. [PMID: 19815206 DOI: 10.1016/j.ijgo.2009.07.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In high-income countries, national mortality audits are associated with improved quality of care, but there has been no previous systematic review of perinatal audit in low- and middle-income settings. OBJECTIVES To present a systematic review of facility-based perinatal mortality audit in low- and middle-income countries, and review information regarding community audit. RESULTS Ten low-quality evaluations with mortality outcome data were identified. Meta-analysis of 7 before-and-after studies indicated a reduction in perinatal mortality of 30% (95% confidence interval, 21%-38%) after introduction of perinatal audit. The consistency of effect suggests that audit may be a useful tool for decreasing perinatal mortality rates in facilities and improving quality of care, although none of these evaluations were large scale. Few of the identified studies reported intrapartum-related perinatal outcomes. Novel experience of community audit and social autopsy is described, but data reporting mortality outcome effect are lacking. There are few examples of wide-scale, sustained perinatal audit in low-income settings. Two national cases studies (South Africa and Bangladesh) are presented. Programmatic decision points, challenges, and key factors for national or wide scale-up of sustained perinatal mortality audit are discussed. As a minimum standard, facilities should track intrapartum stillbirth and pre-discharge intrapartum-related neonatal mortality rates. CONCLUSION The effect of perinatal audit depends on the ability to close the audit loop; without effectively implementing the solutions to the problems identified, audit alone cannot improve quality of care.
Collapse
Affiliation(s)
- Robert Pattinson
- MRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa.
| | | | | | | | | | | | | | | |
Collapse
|
97
|
Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet 2010; 107 Suppl 1:S21-44, S44-5. [PMID: 19815204 DOI: 10.1016/j.ijgo.2009.07.017] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. OBJECTIVE We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. RESULTS Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. CONCLUSIONS While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.
Collapse
|
98
|
Lee ACC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, Wall SN, Nandakumar AK, Syed U, Darmstadt GL. Linking families and facilities for care at birth: what works to avert intrapartum-related deaths? Int J Gynaecol Obstet 2010; 107 Suppl 1:S65-85, S86-8. [PMID: 19815201 DOI: 10.1016/j.ijgo.2009.07.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. OBJECTIVE We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. RESULTS There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 36% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. CONCLUSIONS Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of "old" strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation.
Collapse
Affiliation(s)
- Anne C C Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
99
|
Delva W, Yard E, Luchters S, Chersich MF, Muigai E, Oyier V, Temmerman M. A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT. Trop Med Int Health 2010; 15:584-91. [PMID: 20230571 DOI: 10.1111/j.1365-3156.2010.02499.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration-intervention project for Safe Motherhood and prevention of mother-to-child transmission of HIV in Kenya. METHODS Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single-dose nevirapine (sd-NVP). RESULTS About half of women in rural and urban settings (52.2% and 49.2%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30% (5894/19 432) of women. By mid-2006, provision of nevirapine to HIV-positive women had increased from 32.5% and 11.7% in rural and urban clinics, to 67.0% and 74.6%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate. CONCLUSION Provision of ANC services, including sd-NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence-based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.
Collapse
Affiliation(s)
- W Delva
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
| | | | | | | | | | | | | |
Collapse
|
100
|
Victora CG, Rubens CE. Global report on preterm birth and stillbirth (4 of 7): delivery of interventions. BMC Pregnancy Childbirth 2010; 10 Suppl 1:S4. [PMID: 20233385 PMCID: PMC2841777 DOI: 10.1186/1471-2393-10-s1-s4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. BARRIERS TO SCALING UP INTERVENTIONS Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. STRATEGIES AND EXAMPLES Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. CONCLUSION Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.
Collapse
|