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Pepper M, Campbell OMR, Woodd SL. Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300377. [PMID: 38599685 PMCID: PMC11057794 DOI: 10.9745/ghsp-d-23-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The postpartum period is critical for the health and well-being of women and newborns, but there is limited research on the most effective methods of post-childbirth follow-up. This scoping review synthesizes evidence from high-, middle-, and low-income countries on approaches to following up individuals after discharge from childbirth facilities. METHODS Using a systematic search in Ovid MEDLINE, we identified quantitative studies describing post-discharge follow-up methods deployed up to 12 months postpartum. We searched for English-language, peer-reviewed articles published between January 1, 2007 and November 2, 2022, with search terms covering 2 broad areas: "postpartum/postnatal period" and "surveillance." We single-screened titles and abstracts and double-extracted all included articles, recording study design and location, population, health outcome, method, timing and frequency of data collection, and percentage of study participants reached. RESULTS We identified 1,654 records, of which 31 studies were included. Eight studies used in-person visits to follow up participants, 10 used telephone calls, 7 used self-administered questionnaires, and 6 used multiple methods. Across studies, the minimum length of follow-up was 1 week after delivery, and up to 4 contacts were made within the first year after delivery. Follow-up (response) rates ranged from 23% to100%. Postpartum infection was the most common outcome investigated. Other outcomes included maternal (ill-)health, neonatal (ill-)health and growth, maternal mental health and well-being, care-giving/-seeking behaviors, and knowledge and intentions. CONCLUSION Our scoping review identified multiple follow-up methods after discharge, ranging from home visits to self-administered electronic questionnaires, which could be implemented with high response rates. The studies demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying postpartum illness or complications that would otherwise be missed. Therefore, the identified methods have the potential to become an important component of fostering a continuum of care and measuring and addressing postpartum morbidity.
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Affiliation(s)
- Maxine Pepper
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah L Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Peng R, Tong Y, Yang M, Wang J, Yang L, Zhu J, Liu Y, Wang H, Shi Z, Liu Y. Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study. QJM 2024; 117:24-37. [PMID: 37773990 PMCID: PMC10849872 DOI: 10.1093/qjmed/hcad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal disorders account for substantial health loss across the lifespan from early childhood. These problems may be related to health inequality. AIM To provide evidence for improvement in health policies regarding maternal and neonatal disorder inequity. DESIGN This was a population-based cross-sectional study based on 2019 Global Burden of Disease data. METHODS Annual cases and age-standardized rates (ASRs) of incidence, prevalence, death, and disability-adjusted life-years (DALYs) in maternal and neonatal disorders between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. Concentration curves and concentration indices were used to summarize the degree of socioeconomic-related inequality. RESULTS For maternal disorders, the global ASRs of incidence, prevalence, death and DALYs were 2889.4 (95% uncertainty interval (UI), 2562.9-3251.9), 502.9 (95% UI 418.7-598.0), 5.0 (95% UI 4.4-5.8) and 324.9 (95% UI 284.0-369.1) per 100 000 women in 2019, respectively. The ASRs of maternal disorders were all obviously reduced and remained pro-poor from 1990 to 2019. In neonatal disorders, the global ASRs of incidence, prevalence, death and DALYs were 363.3 (95% UI 334.6-396.8), 1239.8 (95% UI 1142.1-1356.7), 29.1 (95% UI 24.8-34.5) and 2828.3 (95% UI 2441.6-3329.6) per 100 000 people in 2019, respectively. The global ASRs of incidence, death and DALYs in neonatal disorders have remained pro-poor. However, the socioeconomic-related fairness in the ASR of neonatal disorder prevalence is being levelled. CONCLUSIONS The global burden of maternal and neonatal disorders has remained high, and socioeconomic-related inequality (pro-poor) tended not to change between 1990 and 2019.
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Affiliation(s)
- R Peng
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Y Tong
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - M Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - L Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Zhu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Yu Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - H Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, 610041, China
| | - Z Shi
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Ya Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
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Baykemagn FT, Abreha GF, Zelelow YB, Berhe AK, Kahsay AB. Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:11. [PMID: 38166681 PMCID: PMC10759711 DOI: 10.1186/s12884-023-06199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Potentially life-threatening maternal conditions (PLTCs) is an important proxy indicator of maternal mortality and the quality of maternal health services. It is helpful to monitor the rates of severe maternal morbidity to evaluate the quality of maternal care, particularly in low- and lower-middle-income countries. This study aims to systematically identify and synthesize available evidence on PLTCs. METHODS We searched studies in English from 2009‒2023 in PubMed, the National Library of Medicine (NLM) Gateway, the POPLINE database, and the Science Direct website. The study team independently reviewed the illegibility criteria of the articles. Two reviewers independently appraised the included articles using the Joanna Briggs Instrument for observational studies. Disputes between the reviewers were resolved by consensus with a third reviewer. Meta-analysis was conducted in Stata version 16. The pooled proportion of PLTCs was calculated using the random effects model. The heterogeneity test was performed using the Cochrane Q test, and its level was determined using the I2 statistical result. Using Egger's test, the publication bias was assessed. RESULT Thirty-two cross-sectional, five case-control, and seven cohort studies published from 2009 to 2023 were included in the meta-analysis. The highest proportion of PLTC was 17.55% (95% CI: 15.51, 19.79) in Ethiopia, and the lowest was 0.83% (95% CI: 0.73, 0.95) in Iraq. The pooled proportion of PLTC was 6.98% (95% CI: 5.98-7.98). In the subgroup analysis, the pooled prevalence varied based on country income level: in low-income 13.44% (95% CI: 11.88-15.00) I2 = 89.90%, low-middle income 7.42% (95% CI: 5.99-8.86) I2 = 99.71%, upper-middle income 6.35% (95% CI: 4.21-8.50) I2 = 99.92%, and high-income 2.67% (95% CI: 2.34-2.99) I2 = 99.57%. Similarly, it varied based on the diagnosis criteria; WHO diagnosis criteria used 7.77% (95% CI: 6.10-9.44) I2 = 99.96% at P = 0.00, while the Centers for Disease Controls (CDC) diagnosis criteria used 2.19% (95% CI: 1.89-2.50) I2 = 99.41% at P = 0.00. CONCLUSION The pooled prevalence of PLTC is high globally, predominantly in low-income countries. The large disparity of potentially life-threatening conditions among different areas needs targeted intervention, particularly for women residing in low-income countries. The WHO diagnosis criteria minimize the underreporting of severe maternal morbidity. TRIAL REGISTRATION CRD42023409229.
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Affiliation(s)
- Fitiwi Tinsae Baykemagn
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia.
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | | | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Tigray, Ethiopia
| | - Abadi Kidanemariam Berhe
- School of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
- Tigray Health Research Institute, Mekelle, Ethiopia
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Gresh A, Batchelder A, Glass N, Mambulasa J, Kapito E, MacDonald A, Ngutwa N, Plesko C, Chirwa E, Patil CL. Adapting group care to the postpartum period using a human-centered design approach in Malawi. BMC Health Serv Res 2023; 23:1098. [PMID: 37838673 PMCID: PMC10576327 DOI: 10.1186/s12913-023-10036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/14/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi. METHODS We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper. RESULTS All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period. CONCLUSIONS Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Anne Batchelder
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Janet Mambulasa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Amy MacDonald
- Pomelo Care, Hillsborough, North Carolina, USA
- Group Care Global, Philadelphia, PA, USA
| | - Nellie Ngutwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Cori Plesko
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Crystal L Patil
- School of Nursing, University of Michigan, 400 N. Ingalls, Suite 3320, Ann Arbor, MI, 48109, USA
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Abdoli Najmi L, Mohammad-Alizadeh-Charandabi S, Jahanfar S, Abbasalizadeh F, Salehi Poormehr H, Mirghafourvand M. Adaptation and implementation of clinical guidelines on maternal and newborn postnatal care in Iran: study protocol. Reprod Health 2023; 20:135. [PMID: 37700318 PMCID: PMC10496192 DOI: 10.1186/s12978-023-01682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND According to World Health Organization (WHO), the postnatal care provision aims to provide care and treatment with the highest quality and the least intervention to obtain the best health and well-being for the family. The present study aims to adapt international guidelines for the clinical recommendations for the postpartum period and implement and determine its effectiveness. METHODS/DESIGN This study will be done in two phases. In the first phase, international clinical guidelines for mother and newborn postnatal care will be adapted. The second phase is a randomized controlled trial in which the adapted guideline recommendations will be implemented, and maternal and neonatal outcomes will be measured. The ADAPTE method for adaptation of clinical guidelines, is usedg in the first phase. A systematic review was conducted in the databases and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the AGREE-II tool. The WHO clinical guideline obtained the highest evaluation score and was chosen as the main guideline, and the NICE clinical guideline, with a second higher evaluation score, was also used to fill some gaps in the WHO guideline. Based on the pre-determined questions, recommendations will be sent to the relevant experts and stakeholders for their evaluation. After the external evaluation and the finalization of the recommendations, the postpartum clinical guideline will be compiled and used in the second phase of the study. In the second phase, 272 women in the immediate postnatal stage of the maternity and postpartum ward of Taleghani and AL-Zahra Hospitals in Tabriz will be assigned into the intervention (receiving care based on adapted guidline recommendations) and control (receiving routine hospital care) groups uing individual stratified block randomization. At 6 weeks after birth, we will complete the Edinburgh postnatal depression scale, postpartum specific anxiety scale and Barkin index of maternal functioning (to assess the primary outcomes), as well as a maternal health problems checklist, infant care behavior, and violence assessment questionnaires (to asses the seconadary outcomes). Further, the maternal health problems checklist and the Edinburgh postnatal depression scale will be completed in the second week after birth. The data will be analyzed using an independent t-test and ANCOVA. DISCUSSION It is expected that the implementation of evidence-based clinical guidelines improves maternal and neonatal outcomes and experience of the postpartum period. The positive experience can also help to achieve Iran's population policies and the need to increase childbearing in the country. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N76; Date of registration: 27/1/2023. URL: https://en.irct.ir/user/trial/66874/view ; Date of first registration: 27/3/2023.
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Affiliation(s)
- Leila Abdoli Najmi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | | | | | - Fatemeh Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haniyeh Salehi Poormehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
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Swedo EA, D'Angelo DV, Fasula AM, Clayton HB, Ports KA. Associations of Adverse Childhood Experiences With Pregnancy and Infant Health. Am J Prev Med 2023; 64:512-524. [PMID: 36697281 PMCID: PMC10033436 DOI: 10.1016/j.amepre.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Adverse childhood experiences are associated with a host of negative outcomes; however, few have studied cumulative adverse childhood experiences in the context of pregnancy and infant health. This study examines state-level prevalence of adverse childhood experiences and associations with pregnancy- and infant health‒related indicators. METHODS The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states. Analyses were conducted for individual states and grouped states using similar adverse childhood experience items. Thirteen adverse childhood experience measures were included across 3 domains: abuse, neglect, and household challenges. Adverse childhood experience scores were calculated for the number of adverse childhood experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen pregnancy- and infant health‒related indicators were examined, including unwanted pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse, depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes (e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated to examine the associations between pregnancy- and infant health‒related indicators and adverse childhood experience scores. RESULTS Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy. CONCLUSIONS Adverse childhood experiences are associated with risk factors that impact pregnancy and infant health. Preventing and mitigating adverse childhood experiences is an important strategy to improve pregnancy- and infant health‒related indicators.
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Affiliation(s)
- Elizabeth A Swedo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Denise V D'Angelo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather B Clayton
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie A Ports
- and the Health Equity Research Applied, Albuquerque, New Mexico
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Lazarevic N, Pizzuti C, Rosic G, Bœhm C, Williams K, Caillaud C. A mixed-methods study exploring women's perceptions and recommendations for a pregnancy app with monitoring tools. NPJ Digit Med 2023; 6:50. [PMID: 36964179 PMCID: PMC10036977 DOI: 10.1038/s41746-023-00792-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/04/2023] [Indexed: 03/26/2023] Open
Abstract
Digital health tools such as apps are being increasingly used by women to access pregnancy-related information. Conducted during the COVID-19 pandemic, this study investigated: (i) pregnant women's current usage of digital health tools to self-monitor and (ii) their interest in theoretical pregnancy app features (a direct patient-to-healthcare-professional communication tool and a body measurement tool). Using a mixed methods approach, 108 pregnant women were surveyed and 15 currently or recently pregnant women were interviewed online. We found that pregnant women used digital health tools to mainly access pregnancy related information and less so to self-monitor. Most participants were interested and enthusiastic about a patient-to-healthcare-professional communication tool. About half of the survey participants (49%) felt comfortable using a body measurement tool to monitor their body parts and 80% of interview participants were interested in using the body measurement to track leg/ankle swelling. Participants also shared additional pregnancy app features that they thought would be beneficial such as a "Digital Wallet" and a desire for a holistic pregnancy app that allowed for more continuous and personalised care. This study highlights the gaps and needs of pregnant women and should inform all stakeholders designing pregnancy digital healthcare. This study offers a unique insight into the needs of pregnant women during a very particular and unique period in human history.
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Affiliation(s)
- Natasa Lazarevic
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Carol Pizzuti
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Gillian Rosic
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Nepean Blue Mountains Family Metabolic Health Service, Department of Endocrinology, Nepean Hospital, Sydney, NSW, Australia
| | - Céline Bœhm
- School of Physics, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Kathryn Williams
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Nepean Blue Mountains Family Metabolic Health Service, Department of Endocrinology, Nepean Hospital, Sydney, NSW, Australia
| | - Corinne Caillaud
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Olivas ET, Valdez M, Muffoletto B, Wallace J, Stollak I, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales). Int J Equity Health 2023; 21:204. [PMID: 36855147 PMCID: PMC9976365 DOI: 10.1186/s12939-022-01758-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. METHODS We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. RESULTS During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. CONCLUSION The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.
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Affiliation(s)
- Elijah T Olivas
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mario Valdez
- Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | | | | | - Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Bougioukas KI, Pamporis K, Vounzoulaki E, Karagiannis T, Haidich AB. Types and associated methodologies of overviews of reviews in health care: a methodological study with published examples. J Clin Epidemiol 2023; 153:13-25. [PMID: 36351511 DOI: 10.1016/j.jclinepi.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To provide a descriptive insight into the different types of research questions/objectives and associated methodologies of overviews of reviews, supplemented by representative examples from the health care literature. STUDY DESIGN AND SETTING We searched in methodological articles for information on types and methodologies used in overviews and we explored the typology of reviews to identify similar types in literature of overviews. We categorized the types of overviews based on the research question/objective and the methodological approach used. Indicative examples for each category were selected from a sample of 2,121 overviews that were retrieved between 2000 and 2022 from MEDLINE, Scopus, and Cochrane Database of Systematic Reviews. RESULTS Based on type of research question, overviews were classified as overviews of reviews of interventions, associations, prediction, diagnostic accuracy, prevalence/incidence, experiences/views, economic evaluation, and measurement properties. Based on the methodological approach, we identified a variety of methods (systematic, living, rapid, scoping, evidence mapping, framework, and methodological) used in overviews. CONCLUSION The proposed classification and examples provide an essential starting point for future theory-building research on typologies and study designs of overviews of reviews. It is important for methodologists to make vigorous effort to create consensus-based methodological and reporting guidelines to cover these diverse types and key methodological challenges.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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Aderoba AK, Adu-Bonsaffoh K. Antenatal and Postnatal Care. Obstet Gynecol Clin North Am 2022; 49:665-692. [DOI: 10.1016/j.ogc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ertmann RK, Nicolaisdottir DR, Kragstrup J, Overbeck G, Kriegbaum M, Siersma V. The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth. Acta Obstet Gynecol Scand 2022; 102:33-42. [PMID: 36300886 PMCID: PMC9780714 DOI: 10.1111/aogs.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. MATERIAL AND METHODS Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. RESULTS Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications. CONCLUSIONS Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.
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Affiliation(s)
- Ruth Kirk Ertmann
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Dagny Ros Nicolaisdottir
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Jakob Kragstrup
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Gritt Overbeck
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Volkert Siersma
- Research Unit for General Practice and Section for General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
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Ke JXC, Vidler M, Dol J, Carvalho B, Blake LEA, George RB, Bone J, Seligman KM, Coombs M, Chau A, Saville L, Gibbs RS, Sultan P. Incidence, prevalence, and timing of postpartum complications and mortality in Canada and the United States: a systematic review and meta-analysis protocol. JBI Evid Synth 2022; 20:2344-2353. [DOI: 10.11124/jbies-21-00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wood SN, Pigott A, Thomas HL, Wood C, Zimmerman LA. A scoping review on women’s sexual health in the postpartum period: opportunities for research and practice within low-and middle-income countries. Reprod Health 2022; 19:112. [PMID: 35527298 PMCID: PMC9079206 DOI: 10.1186/s12978-022-01399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Women’s sexual health is generally defined and explored solely in relation to reproductive capacity, and often omits elements of sexual function and/or dysfunction. Concerted focus is given to women’s health during pregnancy; however, women’s sexual health is largely neglected after childbirth. This scoping review explored how the sexual health of postpartum women has been defined, measured, and researched in low- and middle-income countries (LMICs). Methods Articles eligible for review were those that investigated women’s sexual health during the first 12 months postpartum and were conducted among women aged 15–49 in LMICs. Eligibility was further restricted to studies that were published within the last 20 years (2001–2021). The initial PubMed search identified 812 articles, but upon further eligibility review, 97 remained. At this time, the decision was made to focus this review only on articles addressing sexual function and/or dysfunction, which yielded 46 articles. Key article characteristics were described and analyzed by outcome. Results Of the final included articles, five studies focused on positive sexual health, 13 on negative sexual health, and the remaining 28 on both positive and negative sexual health or without specified directionality. The most common outcome examined was resumption of sex after childbirth. Most studies occurred within sub-Saharan Africa (n = 27), with geographic spread throughout the Middle East (n = 10), Asia (n = 5), North Africa (n = 3), and cross-geography (n = 1); notably, all five studies on positive sexual health were conducted in Iran. Negative sexual health outcomes included vaginismus, dyspareunia, episiotomy, perineal tears, prolapse, infection, obstetric fistula, female genital cutting, postnatal pain, uterine prolapse, coercion to resume sex, sexual violence, and loss of sexual desire/arousal. Most studies were quantitative, though eight qualitative studies elucidated the difficulties women endured in receiving information specific to sexual health and hesitance in seeking help for sexual morbidities in the postpartum period. Conclusions Overall, the evidence base surrounding women’s sexual health in the postpartum period within LMICs remains limited, with most studies focusing solely on the timing of resumption of sex. Integration of sexual health counseling into postnatal care and nonjudgmental service provision can help women navigate these bodily changes and ultimately improve their sexual health. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01399-6. Women’s sexual health is often studied in relation to reproductive health and childbearing. While reproductive health during pregnancy and immediately after is well documented, it remains unclear how women’s sexual health is addressed, particularly within low- and middle-income countries. The aim of this review is to understand how researchers have measured, defined, and examined postpartum sexual health. In October 2021, we searched PubMed database with the following criteria: published in the last 20 years; conducted in a low- or middle-income context; examined sexual function and/or dysfunction among women aged 15–49 within 1 year after childbirth. From this inclusion criteria, we identified 46 relevant articles. Most studies were conducted in sub-Saharan Africa. Only five studies focused exclusively on positive sexual health, and the majority of studies examined the resumption of sex after childbirth. Multiple qualitative studies described women’s reluctance to seek help for postpartum sexual health issues and highlighted the difficulties they faced in receiving information specific to sexual health. Overall, the evidence base surrounding women’s sexual health after childbirth within low- and middle-income contexts is limited. Future research should examine sexual health beyond resumption of sex after childbirth and explore barriers to help-seeking for women experiencing sexual health issues. Further exploration of positive sexual health is needed across contexts.
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15
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Goodday SM, Karlin E, Brooks A, Chapman C, Karlin DR, Foschini L, Kipping E, Wildman M, Francis M, Greenman H, Li L, Schadt E, Ghassemi M, Goldenberg A, Cormack F, Taptiklis N, Centen C, Smith S, Friend S. Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. NPJ Digit Med 2022; 5:40. [PMID: 35354895 PMCID: PMC8967890 DOI: 10.1038/s41746-022-00579-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The Better Understanding the Metamorphosis of Pregnancy (BUMP) study is a longitudinal feasibility study aimed to gain a deeper understanding of the pre-pregnancy and pregnancy symptom experience using digital tools. The present paper describes the protocol for the BUMP study. Over 1000 participants are being recruited through a patient provider-platform and through other channels in the United States (US). Participants in a preconception cohort (BUMP-C) are followed for 6 months, or until conception, while participants in a pregnancy cohort (BUMP) are followed into their fourth trimester. Participants are provided with a smart ring, a smartwatch (BUMP only), and a smart scale (BUMP only) alongside cohort-specific study apps. Participant centric engagement strategies are used that aim to co-design the digital approach with participants while providing knowledge and support. The BUMP study is intended to lay the foundational work for a larger study to determine whether participant co-designed digital tools can be used to detect, track and return multimodal symptoms during the perinatal window to inform individual level symptom trajectories.
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Affiliation(s)
- S M Goodday
- 4YouandMe, Seattle, WA, USA. .,Department of Psychiatry, University of Oxford, Oxford, UK.
| | | | | | | | - D R Karlin
- 4YouandMe, Seattle, WA, USA.,MindMed, Inc., New York, NY, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - L Foschini
- Evidation Health Inc., Santa Mateo, CA, USA
| | - E Kipping
- Evidation Health Inc., Santa Mateo, CA, USA
| | - M Wildman
- Evidation Health Inc., Santa Mateo, CA, USA
| | | | | | | | | | - M Ghassemi
- Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA.,Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA.,Vector Institute, CIFAR AI Chair, Toronto, Canada
| | - A Goldenberg
- Vector Institute, CIFAR AI Chair, Toronto, Canada.,SickKids Research Institute, Department of Computer Science, University of Toronto, Toronto, Canada
| | - F Cormack
- Cambridge Cognition, Cambridge, GB, USA.,Department of Psychiatry, University of Cambridge, Cambridge, GB, USA
| | | | - C Centen
- Bodyport Inc., San Francisco, CA, USA
| | - S Smith
- Bodyport Inc., San Francisco, CA, USA
| | - S Friend
- 4YouandMe, Seattle, WA, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
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16
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of maternal mortality and severe morbidity during the postpartum period. JBI Evid Synth 2022; 20:2119-2194. [PMID: 35916004 PMCID: PMC9594153 DOI: 10.11124/jbies-20-00578] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. Introduction: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. Inclusion criteria: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2–7, and days 8–42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). Methods: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. Results: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2–7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). Conclusion: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. Systematic review registration number: PROSPERO CRD42020187341
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Leitao S, Manning E, Greene RA, Corcoran P. Maternal morbidity and mortality: an iceberg phenomenon. BJOG 2021; 129:402-411. [PMID: 34455672 DOI: 10.1111/1471-0528.16880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To apply the iceberg model, quantifying absolute and relative incidence, to the four main causes of maternal morbidity and mortality in Ireland: haemorrhage, hypertension, sepsis and thrombosis. DESIGN Secondary analysis of national data on maternal morbidity and mortality. SETTING Republic of Ireland. POPULATION OR SAMPLE Approximately 715 000 maternities, 1 200 000 maternal hospitalisations, 2138 cases of severe maternal morbidity (SMM) and 54 maternal deaths. METHODS Incidence rates and case-fatality ratios were calculated. MAIN OUTCOME MEASURES Maternal death, SMM and hospitalisation. RESULTS At the 'tip of the iceberg', the incidence of maternal death per 10 000 maternities was 0.09 (95% CI 0.03-0.20) due to thrombosis and 0.03 (95% CI 0-0.11) due to haemorrhage, hypertension disorders or sepsis. For one death due to thrombosis there were 35 cases of pulmonary embolism and 257 thrombosis hospitalisations. For one death due to eclampsia, there were 58 eclampsia cases, 13 040 hospitalisations with pre-existing hypertension and 40 781 hospitalisations with gestational hypertension. For one death due to pregnancy-related sepsis, there were 92 cases of septicaemic shock and 9005 hospitalisations with obstetric sepsis. For one maternal death due to haemorrhage, there were 1029 cases of major obstetric haemorrhage and 53 715 maternal hospitalisations with haemorrhage. For every 100 maternities, there were approximately 16 hospitalisations associated with haemorrhage, 12 associated with hypertension disorders, three with sepsis and 0.2 with thrombosis. CONCLUSIONS Haemorrhage and hypertension disorders are leading causes of maternal morbidity in Ireland but they have very low case fatality. This indicates that these morbidities are managed effectively but their prevention requires more focus. TWEETABLE ABSTRACT Study shows that haemorrhage and hypertension are main causes of #maternalmorbidity in Ireland. Timely interventions for #maternalhealth and focus on prevention of severe and non-severe morbidities are needed. @NPEC #maternityservices #clinicalaudit #qualityimprovement.
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Affiliation(s)
- S Leitao
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - E Manning
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - R A Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - P Corcoran
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Tola Y, Ayele G, Boti N, Yihune M, Gethahun F, Gebru Z. Health-Related Quality-of-Life and Associated Factors Among Post-Partum Women in Arba Minch Town. Int J Womens Health 2021; 13:601-611. [PMID: 34188554 PMCID: PMC8232860 DOI: 10.2147/ijwh.s295325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background It is generally accepted that pregnancy and childbirth are natural physiological processes. However, these significantly affect the quality of mothers’ lives. Little is known about the level of quality-of-life and associated factors among postpartum women in Ethiopia, particularly in the study area. Methods A community-based cross-sectional study was conducted among 409 randomly selected post-partum women who were living in Arba Minch town. Systematic random sampling was employed to select the study participants. The standard quality-of-life assessment tool which is known as the short-form SF 36 tool was used to assess health-related quality-of-life. The logistic regression model was used to identify associated factors. Statistically significant variables at a p-value<0.25 in the bi-variable analysis were candidate variables for multi-variable analysis and statistical significance which was declared at a p-value<0.05. Results Among the study participants, 255 (62.3%) had lower level health-related quality-of-life (HRQoL). About 46.2% of the study participants had lower physical HRQoL and about 79% of the study participants had lower mental HRQoL. The overall mean score of HRQoL was 45.15 (±8.13). Factors associated with lower overall HRQoL were age group 17–24 years (AOR=2.73, 95% CI=1.22–6.10), no formal education [AOR 2.02, 95% CI (1.05–3.89)], and cesarean delivery (AOR=0.49, 95% CI=0.24–0.97). A factor associated with lower physical HRQoL was cesarean delivery (AOR=0.34, 95% CI=0.13–0.88). Factors associated with lower mental HRQoL were age group 17–24 (AOR=3.37, 95% CI=1.60–7.04), not receiving antenatal care (AOR=3.65, 95% CI=1.45–9.16), and having postpartum depression (AOR=2.27, 95% CI=1.30–3.93). Conclusion The results suggest that the majority of post-partum women had a lower HRQoL, particularly women’s mental health was compromised. In this study, a suggestion is made that the respective bodies need to give particular attention to mothers during the post-partum period to prevent poor quality-of-life.
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Affiliation(s)
- Yirgalem Tola
- Arba Minch Health Science College, Department of Midwifery, Arba Minch, Ethiopia
| | - Gistane Ayele
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Negussie Boti
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Manaye Yihune
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Firdawek Gethahun
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Zeleke Gebru
- Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Aftab F, Ahmed I, Ahmed S, Ali SM, Amenga-Etego S, Ariff S, Bahl R, Baqui AH, Begum N, Bhutta ZA, Biemba G, Cousens S, Das V, Deb S, Dhingra U, Dutta A, Edmond K, Esamai F, Ghosh AK, Gisore P, Grogan C, Hamer DH, Herlihy J, Hurt L, Ilyas M, Jehan F, Juma MH, Kalonji M, Khanam R, Kirkwood BR, Kumar A, Kumar A, Kumar V, Manu A, Marete I, Mehmood U, Minckas N, Mishra S, Mitra DK, Moin MI, Muhammad K, Newton S, Ngaima S, Nguwo A, Nisar MI, Otomba J, Quaiyum MA, Sarrassat S, Sazawal S, Semrau KE, Shannon C, Singh VP, Soofi S, Soremekun S, Suleiman AM, Sunday V, Dilip TR, Tshefu A, Wasan Y, Yeboah-Antwi K, Yoshida S, Zaidi AK. Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries. PLoS Med 2021; 18:e1003644. [PMID: 34181649 PMCID: PMC8277068 DOI: 10.1371/journal.pmed.1003644] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/13/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. METHODS AND FINDINGS This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. CONCLUSIONS Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. TRIAL REGISTRATION The study is not a clinical trial.
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Affiliation(s)
- Fahad Aftab
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Said Mohammed Ali
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | | | - Shabina Ariff
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rajiv Bahl
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nazma Begum
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Godfrey Biemba
- National Health Research Authority, Ministry of Health, Lusaka, Zambia
| | - Simon Cousens
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vinita Das
- Department of Gynaecology & Obstetrics, King George’s Medical University, Lucknow, India
| | - Saikat Deb
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Usha Dhingra
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Arup Dutta
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | | | - Fabian Esamai
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | | | - Peter Gisore
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Caroline Grogan
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Julie Herlihy
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Lisa Hurt
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Muhammad Ilyas
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Mohammed Hamad Juma
- Public Health Laboratory-IdC, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Michel Kalonji
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Betty R. Kirkwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Alexander Manu
- School of Public Health, University of Ghana, Accra, Ghana
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Irene Marete
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Usma Mehmood
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nicole Minckas
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Shambhavi Mishra
- Community Empowerment Lab, Shivgarh, India
- Department of Statistics, Lucknow University, Lucknow, India
| | | | | | - Karim Muhammad
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sam Newton
- Kwame Nkrumah University of Science & Technology, Kumasi Ghana
| | - Serge Ngaima
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Andre Nguwo
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Muhammad Imran Nisar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - John Otomba
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | | | - Sophie Sarrassat
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sunil Sazawal
- Centre for Public Health Kinetics (CPHK), New Delhi, Delhi, India
| | - Katherine E. Semrau
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America
- Brigham and Women’s Hospital, Division of Global Health Equity, Boston, Massachusetts, United States of America
| | | | | | - Sajid Soofi
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Seyi Soremekun
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Venantius Sunday
- Department of Child Health and Pediatrics, Eldoret, Moi University, Kenya
| | - Thandassery R. Dilip
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Antoinette Tshefu
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Demographic Republic of Congo
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kojo Yeboah-Antwi
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sachiyo Yoshida
- Department of Maternal Newborn Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anita K. Zaidi
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Dol J, Richardson B, Bonet M, Langlois EV, Parker R, Scott H, Curran J. Timing of maternal and neonatal mortality and morbidity in healthy women and newborns during the postnatal period: a systematic review protocol. JBI Evid Synth 2021; 19:629-643. [PMID: 33074983 DOI: 10.11124/jbies-20-00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the timing of overall and cause-specific maternal and neonatal mortality and severe morbidity in healthy women and newborns during the postnatal period. INTRODUCTION Despite significant focus on improving maternal and neonatal outcomes, many women and newborns continue to die or suffer negative health outcomes within the postnatal period. While the maternal and neonatal mortality and morbidity rates and causes are regularly updated, less is known on when they occur during the postnatal period. INCLUSION CRITERIA This review will consider studies that include healthy women and newborns after birth to six weeks' and four weeks' postnatally, respectively, and includes data regarding time to death or complications. Studies that report solely on high risk women (eg, antenatal complications) or preterm or high-risk newborns will not be included in this review. METHODS The search strategy will aim to locate both published and unpublished studies. After the initial search and removal of duplicates, titles and abstracts of all retrieved studies will be screened and the full text of selected reports will be assessed against the eligibility criteria. The reference list of all studies selected for critical appraisal will be screened for additional relevant studies/reports. Screening, critical appraisal, and data extraction will be completed by two independent reviewers. Findings from the studies/reports will be pooled in statistical meta-analysis or presented in narrative form including tables and figures. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020187341.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Brianna Richardson
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Gresh A, Cohen M, Anderson J, Glass N. Postpartum care content and delivery throughout the African continent: An integrative review. Midwifery 2021; 97:102976. [PMID: 33740519 DOI: 10.1016/j.midw.2021.102976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this review was to describe and evaluate the content of postpartum care and models of delivery throughout the African continent. DESIGN Integrative review was used to allow for the combination of studies using diverse research methodologies. DATA SOURCES A comprehensive search strategy using the phrases 'postpartum period', 'healthcare delivery', and 'Africa,' including all spelling variants and countries within the continent, was used in the following databases: PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, and Embase for studies published through September 2019. REVIEW METHOD The integrative review process included five stages: problem identification, literature search, data evaluation, data analysis and presentation. Twelve studies from eight African countries were identified in the search and met the inclusion criteria for the review. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies included in the review. The theoretical framework developed by the World Health Organization Maternal Morbidity Working Group for healthcare interventions to address maternal morbidity was used for data analysis and to synthesize the results for presentation. RESULTS Definitions of the postpartum period varied among studies with service delivery ranging from six weeks to one year postpartum. There was no standard package of postpartum care across studies. Based on the World Health Organization theoretical framework, five primary topics were covered in postpartum care interventions: preventive care and counseling, health systems innovation, a life course approach, family planning, and health literacy and education. In contrast, five gaps in content of postpartum care services and service delivery included: integration of screening and treatment of noncommunicable diseases with maternal healthcare, intimate partner violence screening, social protection, a rights-based approach, and social vulnerability. No study addressed all aspects of the World Health Organization framework to address maternal morbidity. CONCLUSIONS The results from this review indicate the need to address gaps in postpartum care services throughout the African continent in order to reduce maternal morbidity. Re- conceptualizing the paradigm of maternal health to take a life course approach and focusing future research on developing and building interventions to target postpartum care and healthcare delivery of postpartum care are necessary and important in efforts to reduce maternal morbidity and improve health outcomes for mother and child.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Megan Cohen
- Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Jean Anderson
- Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
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Abstract
BACKGROUND Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation. RESEARCH AIM To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research. METHODS We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors. RESULTS In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2-12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings. CONCLUSIONS Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.
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Affiliation(s)
- Emily Wilson
- London School of Hygiene and Tropical Medicine, London, UK.,University College London, University College, London, UK
| | | | - Lenka Benova
- London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Cresswell JA, Barbour KD, Chou D, McCaw-Binns A, Filippi V, Cecatti JG, Barreix M, Petzold M, Kostanjsek N, Cottler-Casanova S, Say L. Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi. BMC Pregnancy Childbirth 2020; 20:518. [PMID: 32894081 PMCID: PMC7487910 DOI: 10.1186/s12884-020-03216-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 08/27/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The World Health Organization's definition of maternal morbidity refers to "a negative impact on the woman's wellbeing and/or functioning". Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. METHODS A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015-2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship between functioning and health conditions. RESULTS Women attending antenatal care had a lower level of functioning than those attending postpartum care. Women with a health condition or associated demographic risk factor were more likely to have a lower level of functioning than those with no health condition. However, the absolute difference in functioning scores typically remained modest. CONCLUSIONS Functioning is an important concept which integrates a woman-centered approach to examining how a health condition affects her life, and ultimately her return to functioning after delivery. However, the WHODAS-12 may not be the optimal tool for use in this population and additional components to capture pregnancy-specific issues may be needed. Challenges remain in how to integrate functioning outcomes into routine maternal healthcare at-scale and across diverse settings.
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Affiliation(s)
- Jenny A Cresswell
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP UNFPA UNICEF WHO World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland.
| | - Kelli D Barbour
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Doris Chou
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP UNFPA UNICEF WHO World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland
| | - Affette McCaw-Binns
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maria Barreix
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP UNFPA UNICEF WHO World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland
| | - Max Petzold
- School of Public Health, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nenad Kostanjsek
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Sara Cottler-Casanova
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Lale Say
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP UNFPA UNICEF WHO World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland
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Maternal morbidity: how to reduce it. Curr Opin Anaesthesiol 2020; 33:612-617. [PMID: 32628411 DOI: 10.1097/aco.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Internationally there has been increased interest in maternal morbidity; both as a strategy to reduce maternal deaths and also because of the significant impact on a woman's life as a result of suffering from maternal morbidity. The present review will evaluate the current knowledge of, and strategies to reduce maternal morbidity. RECENT FINDINGS The study of maternal morbidity and how to reduce it has been hampered for many years by the lack of a standard approach to measurement and evaluation. The World Health Organization has attempted to standardize the approach to maternal morbidity with the development of a new definition that recognizes the multiple dimensions of maternal morbidity, including external factors such as socioeconomic factors. This approach will assist with a more accurate evaluation of maternal morbidity. Maternal morbidity arises from many and varied causes. Many of these are amenable to quality improvement with an associated reduction in maternal morbidity. SUMMARY There have been significant advances in the understanding of maternal morbidity: incidence causes and management. Future research should aim to establish accurate rates for maternal morbidity and further develop ways for healthcare professionals, including anaesthesia care providers, to reduce it.
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Self-Rated Health in Migrant and Non-Migrant Women before, during and after Pregnancy: A Population-Based Study of 0.5 Million Pregnancies from the Swedish Pregnancy Register. J Clin Med 2020; 9:jcm9061764. [PMID: 32517225 PMCID: PMC7356601 DOI: 10.3390/jcm9061764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
Self-rated health is a strong health marker. Migrants have been suggested to have poorer self-rated health than non-migrants (i.e., native-born). However, little is known about whether there are disparities in self-reported health in relation to pregnancy. Therefore, the aim of the current study was to examine the odds of poor self-rated health before, during and after pregnancy in migrant women as compared to women born in Sweden. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women between 2010 and 2018. Self-rated health was reported on a 5-point scale (from very poor to very good). Very poor and poor health were categorized as poor self-rated health. Logistic regression was utilized to calculate odds ratios (ORs) that were unadjusted and adjusted for covariates (age, parity, educational attainment and body mass index). The results demonstrate disparities in self-rated health across birth regions. In comparison to women born in Sweden, women born in Latin America and the Caribbean, South Asia as well as North Africa and the Middle East had consistently higher odds of poor self-rated health before, during and after pregnancy (ORs ranging from 1.14 to 1.96 in both unadjusted and adjusted models). Although women born in Sub-Saharan Africa did have comparable self-rated health as to women born in Sweden before pregnancy, after accounting for covariates, they had lower odds of poor self-rated health during and after pregnancy (ORs: 0.71 and 0.80 respectively). Therefore, additional measures and support may be needed to tackle disparities in health between migrant and non-migrant women before, during and after pregnancy.
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Moran PS, Wuytack F, Turner M, Normand C, Brown S, Begley C, Daly D. Economic burden of maternal morbidity - A systematic review of cost-of-illness studies. PLoS One 2020; 15:e0227377. [PMID: 31945775 PMCID: PMC6964978 DOI: 10.1371/journal.pone.0227377] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Aim To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. Methods Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. Results Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. Conclusion Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
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Affiliation(s)
- Patrick S. Moran
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
- * E-mail:
| | | | | | - Charles Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
- Cicely Saunders Institute, King’s College, London, United Kingdom
| | - Stephanie Brown
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Moller AB, Patten JH, Hanson C, Morgan A, Say L, Diaz T, Moran AC. Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives. Trop Med Int Health 2019; 24:1342-1368. [PMID: 31622524 PMCID: PMC6916345 DOI: 10.1111/tmi.13313] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Over time, we have seen a major evolution of measurement initiatives, indicators and methods, such that today a wide range of maternal and perinatal indicators are monitored and new indicators are under development. Monitoring global progress in maternal and newborn health outcomes and development has been dominated in recent decades by efforts to set, measure and achieve global goals and targets: the Millennium Development Goals followed by the Sustainable Development Goals. This paper aims to review, reflect and learn on accelerated progress towards global goals and events, including universal health coverage, and better tracking of maternal and newborn health outcomes. METHODS We searched for literature of key events and global initiatives over recent decades related to maternal and newborn health. The searches were conducted using PubMed/MEDLINE and the World Health Organization Global Index Medicus. RESULTS This paper describes global key events and initiatives over recent decades showing how maternal and neonatal mortality and morbidity, and stillbirths, have been viewed, when they have achieved higher priority on the global agenda, and how they have been measured, monitored and reported. Despite substantial improvements, the enormous maternal and newborn health disparities that persist within and between countries indicate the urgent need to renew the focus on reducing inequities. CONCLUSION The review has featured the long story of the progress in monitoring improving maternal and newborn health outcomes, but has also underlined current gaps and significant inequities. The many global initiatives described in this paper have highlighted the magnitude of the problems and have built the political momentum over the years for effectively addressing maternal and newborn health and well-being, with particular focus on improved measurement and monitoring.
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Affiliation(s)
- Ann-Beth Moller
- Department of Reproductive Health and Research (RHR) and
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research
Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | | | - Claudia Hanson
- Global Health, Department of Public Health Sciences,
Karolinska Institutet, Stockholm, Sweden
| | - Alison Morgan
- Maternal Sexual and Reproductive Health Unit, Nossal
Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Lale Say
- Department of Reproductive Health and Research (RHR) and
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research
Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent
Health, World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent
Health, World Health Organization, Geneva, Switzerland
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Woodd SL, Montoya A, Barreix M, Pi L, Calvert C, Rehman AM, Chou D, Campbell OMR. Incidence of maternal peripartum infection: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002984. [PMID: 31821329 PMCID: PMC6903710 DOI: 10.1371/journal.pmed.1002984] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Infection is an important, preventable cause of maternal morbidity, and pregnancy-related sepsis accounts for 11% of maternal deaths. However, frequency of maternal infection is poorly described, and, to our knowledge, it remains the one major cause of maternal mortality without a systematic review of incidence. Our objective was to estimate the average global incidence of maternal peripartum infection. METHODS AND FINDINGS We searched Medline, EMBASE, Global Health, and five other databases from January 2005 to June 2016 (PROSPERO: CRD42017074591). Specific outcomes comprised chorioamnionitis in labour, puerperal endometritis, wound infection following cesarean section or perineal trauma, and sepsis occurring from onset of labour until 42 days postpartum. We assessed studies irrespective of language or study design. We excluded conference abstracts, studies of high-risk women, and data collected before 1990. Three reviewers independently selected studies, extracted data, and appraised quality. Quality criteria for incidence/prevalence studies were adapted from the Joanna Briggs Institute. We used random-effects models to obtain weighted pooled estimates of incidence risk for each outcome and metaregression to identify study-level characteristics affecting incidence. From 31,528 potentially relevant articles, we included 111 studies of infection in women in labour or postpartum from 46 countries. Four studies were randomised controlled trials, two were before-after intervention studies, and the remainder were observational cohort or cross-sectional studies. The pooled incidence in high-quality studies was 3.9% (95% Confidence Interval [CI] 1.8%-6.8%) for chorioamnionitis, 1.6% (95% CI 0.9%-2.5%) for endometritis, 1.2% (95% CI 1.0%-1.5%) for wound infection, 0.05% (95% CI 0.03%-0.07%) for sepsis, and 1.1% (95% CI 0.3%-2.4%) for maternal peripartum infection. 19% of studies met all quality criteria. There were few data from developing countries and marked heterogeneity in study designs and infection definitions, limiting the interpretation of these estimates as measures of global infection incidence. A limitation of this review is the inclusion of studies that were facility-based or restricted to low-risk groups of women. CONCLUSIONS In this study, we observed pooled infection estimates of almost 4% in labour and between 1%-2% of each infection outcome postpartum. This indicates maternal peripartum infection is an important complication of childbirth and that preventive efforts should be increased in light of antimicrobial resistance. Incidence risk appears lower than modelled global estimates, although differences in definitions limit comparability. Better-quality research, using standard definitions, is required to improve comparability between study settings and to demonstrate the influence of risk factors and protective interventions.
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Affiliation(s)
- Susannah L. Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Ana Montoya
- Box Hill Hospital, Eastern Health, Victoria, Australia
| | - Maria Barreix
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Li Pi
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrea M. Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Oona M. R. Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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