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Ali DA, Mohamed NA, Ismail AI, Hassan GD. The risk factors of infant mortality in Somalia: evidence from the 2018/2019 Somali health & demographic survey. BMC Pediatr 2024; 24:486. [PMID: 39080597 PMCID: PMC11290080 DOI: 10.1186/s12887-024-04964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Globally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data. METHOD In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death. RESULTS The study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618-0.832), sex of the baby (HR = 0.661; 95% CI = 0.484-0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469-0.944), multiple births (HR = 1.369; 1.142-1.910) and place of residence (HR = 1.650; 95% CI = 1.451-2.150) were found to be statistically significantly related to infant death. CONCLUSION The study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country's population. Place of residence, gestational duration, infant's gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates.
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Affiliation(s)
- Dahir Abdi Ali
- Faculty of Economics, SIMAD University, Mogadishu, Somalia.
| | | | | | - Gallad Dahir Hassan
- Faculty of Medicine and Health Science, SIMAD University, Mogadishu, Somalia
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Jabeen S, Mushtaq K, Samie A, Hassan S. Uncovering the rural-urban gap in determinants of infant mortality in Punjab-Pakistan. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 38:100918. [PMID: 37776801 DOI: 10.1016/j.srhc.2023.100918] [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: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The main objective of this research is to observe the various socio-economic, demographic, health-seeking, and environmental factors influencing infant mortality and the rural-urban division in Punjab, Pakistan. METHODS The study used the data of 38,405 households from the Multiple Indicator Cluster Survey that was conducted by the Bureau of Statistics Punjab during 2017-18. This survey assessed 125 indicators i.e., health, education, etc. created by UNICEF to assess the well-being of mothers and children in Punjab, Pakistan. RESULTS AND CONCLUSION The mother, the child, and the family are the three main risk factors for infant death, according to our research in Pakistan. The socioeconomic position of the household, social practices, environment, and usage of medical services are the key factors that help in reducing infant death. Women's education, birth spacing, and household economic position all played a significant role in the decline in infant mortality. The health of infants born in rural Punjab is at risk due to a large rural-urban gap in the determinants of infant mortality. Uncovering and addressing this disparity has become a pressing health priority in Pakistan.
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Affiliation(s)
- Saher Jabeen
- Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
| | - Khalid Mushtaq
- Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
| | - Abdus Samie
- Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
| | - Sarfraz Hassan
- Institute of Agricultural and Resource Economics, University of Agriculture Faisalabad, Punjab, Pakistan.
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Al-Shatanawi TN, Khader Y, Abdel Razeq N, Khader AM, Alfaqih M, Alkouri O, Alyahya M. Disparities in Obstetric, Neonatal, and Birth Outcomes Among Syrian Women Refugees and Jordanian Women. Int J Public Health 2023; 68:1605645. [PMID: 38024216 PMCID: PMC10654197 DOI: 10.3389/ijph.2023.1605645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. Methods: We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020). Results: The proportions of low birthweight (14.1% vs. 11.8%, p < 0.001) and small for gestational age (12.0% vs. 10.0%, p < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, p = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, p < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, p < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1-1.7, p = 0.035). Conclusion: Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women.
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Affiliation(s)
- Tariq N. Al-Shatanawi
- Department of Public Health and Community Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Nadin Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmed M. Khader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud Alfaqih
- Department of Physiology and Biochemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
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Yan T, Mullany LC, Subedi S, Hazel EA, Khatry SK, Mohan D, Zeger S, Tielsch JM, LeClerq SC, Katz J. Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal. BMJ Open 2023; 13:e066931. [PMID: 37709319 PMCID: PMC10503364 DOI: 10.1136/bmjopen-2022-066931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal. DESIGN This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal. SETTING Rural Sarlahi district, Nepal. PARTICIPANTS 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017. MAIN OUTCOME The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality. RESULTS There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >5 years (aHR: 0.75, 95% CI: (0.62 to 0.92)). CONCLUSION SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested. TRIAL REGISTRATION NUMBER NCT01177111.
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Affiliation(s)
- Tingting Yan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seema Subedi
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth A Hazel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Nieuwoudt L, Mackay CA, Mda S. Causes of and Modifiable Factors Contributing to Neonatal Deaths at Dora Nginza Hospital in the Eastern Cape, South Africa. Glob Pediatr Health 2022; 9:2333794X221139413. [PMID: 36479310 PMCID: PMC9720785 DOI: 10.1177/2333794x221139413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/29/2022] [Indexed: 11/26/2023] Open
Abstract
Dora Nginza Hospital (DNH) has a neonatal mortality rate higher than global and national averages. In 2015 to 2016 the neonatal mortality rate in South Africa was 18.1/1000 live births compared with 31.3/1000 live births at DNH. A retrospective study was conducted including neonates less than 28 days of life with a birth weight ≥500 g that demised in DNH neonatal unit. The NMR for the study period was 17.7/1000 live births. There were 101 (70.6%) early and 42 (29.4%) late neonatal deaths. Causes of death included infection (n = 47; 32.9%), immaturity-related (n = 42; 29.4%), congenital abnormalities (n = 26; 18.2%), hypoxia (n = 24; 16.8%) and other (n = 4; 2.8%). There were significant associations between cause of death and administrative-related factors (P < .01), health-personnel related factors (P < .001) and patient-related factors (P = .01). Key strategies to be implemented include improving infection prevention and control, appropriate resource allocation, improved attendance and quality of antenatal care, ongoing skills training, and interventions to maintain normothermia.
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Affiliation(s)
- Liesl Nieuwoudt
- Dora Nginza Hospital, Port Elizabeth,
Eastern Cape, South Africa
| | | | - Siyazi Mda
- Dora Nginza Hospital, Port Elizabeth,
Eastern Cape, South Africa
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Asif MF, Ali S, Ali M, Abid G, Lassi ZS. The Moderating Role of Maternal Education and Employment on Child Health in Pakistan. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101559. [PMID: 36291495 PMCID: PMC9600698 DOI: 10.3390/children9101559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Pakistan has challenges in fulfilling its universal responsibilities of providing better health facilities to everyone. The Sustainable Development Goals (SDGs) aim to reduce maternal and infant mortality rates. Despite declines in mother and child death, the total mortality ratio has marginally increased. However, neonatal death has not decreased significantly. Family planning is important for controlling population growth and improving child as well as maternal health. Pakistan's government has unceasingly tried to enhance the provision of contraceptive facilities, but still, an unmet need for family planning (UMNFP) exists in our country. Women are said to have UMNFP if they want to limit or space childbearing, but they are not using contraception methods for any reason. The study aimed to explore the effect of the UMNFP and to investigate the moderating role of a mother's education and employment status on a child's health. METHODS We analyzed the data of 2,244 women in this study. To investigate the study objectives, we utilized the secondary dataset of the Pakistan Demographic and Health Survey (PDHS) 2017-18 (publicly available on the website of the National Institute of Population Studies) and applied binary logistic regression using SPSS 24. RESULTS Results suggest a positive effect of a woman's age (25 to 39 years), maternal education (higher), father's education (higher), family's wealth status (richest), mass media exposure, and adequate birth spacing (at least for 33 months) on a child's health. On the other hand, there is an indirect association between maternal employment, unmet need for family planning, and a child's health. The moderating role of maternal education and employment on the relationship between household wealth status and a child's health is positive. CONCLUSIONS We conclude that the strong predictors of child health are UMNFP, maternal education, and employment. The link between the met need for family planning and the child's health is positive. The moderating effect of maternal education and household wealth status on a child's health is progressive. Similarly, the interaction effect of a mother's employment and household wealth status on a child's health is positive. Finally, we concluded that the link between the health of the child and household wealth status is much more diverse and positive when the mother is highly educated and currently employed.
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Affiliation(s)
- Muhammad Farhan Asif
- National College of Business Administration and Economics, Lahore 54000, Pakistan
- Department of Statistics, Kohsar University, Murree 43600, Pakistan
| | - Shafaqat Ali
- National College of Business Administration and Economics, Lahore 54000, Pakistan
| | - Majid Ali
- Department of Economics and Agri. Economics, PMAS-UAAR, Rawalpindi 43600, Pakistan
| | - Ghulam Abid
- Kinnaird College for Women, Lahore 54000, Pakistan
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
- Correspondence:
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Putri AWS, Harahap H, Harnani Y, Rany N, Syafrani S. The Risk Factors of Neonatal Mortality in Pekanbaru City, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Neonatal mortality is death during the first 28 days of life, expressed per 1000 live births. In 2020, there was an increase in the number of neonatal mortality from 50 infant to 115 infant in Pekanbaru City, Indonesia.
AIM: The study objective was to analyze factors associated with neonatal mortality in the Pekanbaru City, Indonesia.
METHODS: The sample was 220, consisting of 110 case and 110 control samples. The total sampling technique was used for case and systematic sampling for control samples. The variables analyzed were mother’s age, mother’s education, parity, birth spacing, gestational age, birth weight, and antenatal care. Data were analyzed by multiple logistic regressions.
RESULTS: The results showed that the risk factors for neonatal mortality were antenatal care < 4 times (OR = 8.2; 95% CI = 4.0−17.1), gestational age < 35 weeks (OR = 5.5; 95% CI = 2.2–14.0), mother’s < 20 years or > 35 years (OR = 3.1; 95% CI = 1.3−7.1), and birth spacing < 2 years (OR = 2.6; 95% CI = 1.2−5.7).
CONCLUSION: The antenatal care, gestational age, mother’s age, and birth spacing are preventable or possibly preventable risk factors. As a recommendation, the Health Office of Pekanbaru and Community Health Service should increase promotion of antenatal care for pregnant women and family planning to preserve birth spacing for women of childbearing age.
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Khader Y, Alyahya M, El-Khatib Z, Batieha A, Al-Sheyab N, Shattnawi K. The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study. J Med Internet Res 2021; 23:e29143. [PMID: 34287214 PMCID: PMC8339976 DOI: 10.2196/29143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. OBJECTIVE This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption. METHODS An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and <80%), average (score ≥40 and <60%), and poor (score <40%). RESULTS A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values. CONCLUSIONS The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.
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Affiliation(s)
- Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Anwar Batieha
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya Al-Sheyab
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood Shattnawi
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Karasneh RA, Migdady FH, Alzoubi KH, Al-Azzam SI, Khader YS, Nusair MB. Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan. Ann Med Surg (Lond) 2021; 67:102469. [PMID: 34178318 PMCID: PMC8213882 DOI: 10.1016/j.amsu.2021.102469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a major health issue that poses its risk on pregnancy. It is prevalence has been globally increasing. AIM This study aimed to examine trends in demographic and socioeconomic characteristics, maternal BMI, behavioral factors, obstetric interventions, pregnancy complications, and maternal pre-existing medical conditions and maternal and neonatal outcomes in women with GDM in Jordan. We also aimed to equate the occurrence of emergency cesarean delivery with GDM. METHODS The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared among women who did not develop gestational diabetes mellitus and those who developed gestational diabetes mellitus. RESULTS The overall incidence rate of gestational diabetes mellitus (GDM) was 1.2%. Women with gestational diabetes had a higher weight, and BMI, more likely to be overweight, obese, or morbidly obese and less likelihood to be underweight. A significant association was detected between previous spontaneous abortions/miscarriages, previous preterm, previous stillbirths, previous children born with birth weight less than 2500 g, and previous children born alive and died before 28 days, and the incidence of GDM. Women with GDM were at high risk for complications in pregnancy such as hypertension, preeclampsia, premature delivery and labor induction. The offspring of GDM patients were at high risk of complications such as macrosomia, stillbirth, neonatal hypoglycemia, and neonatal jaundice and admittance to the NICU. CONCLUSIONS The incidence of GDM was linked to several clinical factors. Women with GDM are at high risk for complications of pregnancy and at higher risk of neonatal complications.
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Affiliation(s)
- Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 21163, Jordan
| | - Fedaa H. Migdady
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
| | - Karem H. Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 21110, Jordan
| | - Yousef S. Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad B. Nusair
- Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21110, Jordan
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Sushma R, Norhayati MN, Nik Hazlina NH. Prevalence of neonatal near miss and associated factors in Nepal: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:422. [PMID: 34107909 PMCID: PMC8190855 DOI: 10.1186/s12884-021-03894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The rate of neonatal mortality has declined but lesser than the infant mortality rate and remains a major public health challenge in low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 h after birth and the early neonatal period. Neonatal near miss (NNM) is an emerging concept similar to that of maternal near miss. NNM events occur three to eight times more often than neonatal deaths. The objective of this study was to establish the prevalence of NNM and identify its associated factors. METHODS A hospital-based cross-sectional study was conducted in Koshi Hospital, Morang district, Nepal. Neonates and their mothers of unspecified maternal age and gestational age were enrolled. Key inclusion criteria were pragmatic and management markers of NNM and admission of newborn infants to the neonatal intensive care unit (NICU) in Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size of 1,000 newborn infants was reached. Simple and multiple logistic regression was performed using SPSS® version 24.0. RESULTS One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Severe maternal morbidity (adjusted odds ratio (aOR) 4.52; 95% confidence interval (CI) 2.07-9.84) and no formal education (aOR 2.16; 95% CI 1.12-4.14) had a positive association with NNM, while multiparity (aOR 0.52; 95% CI 0.32-0.86) and caesarean section (aOR 0.44; 95% CI 0.19-0.99) had negative associations with NNM. CONCLUSIONS Maternal characteristics and complications were associated with NNM. Healthcare providers should be aware of the impact of obstetric factors on newborn health and provide earlier interventions to pregnant women, thus increasing survival chances of newborns.
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Affiliation(s)
- Rajbanshi Sushma
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Nik Hussain Nik Hazlina
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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Determinants of infant mortality in Pakistan: evidence from Pakistan Demographic and Health Survey 2017–18. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01175-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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12
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Alyahya MS, Khader YS, Al-Sheyab NA, Shattnawi KK, Altal OF, Batieha A. Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits. Am J Perinatol 2021; 40:731-740. [PMID: 34058760 DOI: 10.1055/s-0041-1730434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan. STUDY DESIGN A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected. RESULTS During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths. CONCLUSION The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors. KEY POINTS · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Medical Education and Biostatistics, Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K Shattnawi
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Altal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abdel Razeq NM, Al-Gamal E. Informing mothers of neonatal death and the need for family-centered bereavement care: A phenomenological qualitative study. J SPEC PEDIATR NURS 2021; 26:e12328. [PMID: 33511740 DOI: 10.1111/jspn.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To understand the lived experience of mothers surrounding the time of being informed of neonatal deaths in intensive care units. DESIGN A phenomenological qualitative approach was employed. METHODS Twelve mothers (age 24-41 years) were identified from the neonatal mortality records of two large neonatal intensive care units with high neonate turnover rates in Amman, Jordan. Data were collected using semistructured interviews with the participants. Interpretive phenomenology was used to generate themes regarding the essence of the mother's experience. RESULTS Critical analyses of mothers' accounts revealed three major themes: (a) Minimize the hurt, which described how mothers intuited overprotection by their families while the news was conveyed indirectly to them; (b) The striking reality of death, which captured mothers' distressing experiences while realizing the loss of their neonates; and (c) Farwell my baby, which accentuated mothers' needs and experiences while neonates' bodies were honored and prepared for burial per the cultural norms in Jordan. PRACTICE IMPLICATIONS Our findings highlighted the complex dynamics of familial interactions and cultural influences on mothers' bereavement experiences at the time of neonatal death. The grieving mothers expressed unfulfilled needs of receiving professional bereavement support at the time of neonatal death. Strategies are needed to optimize the supportive role of specialized nurses in providing family-centered bereavement care to mothers and their families who experience neonatal death.
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Affiliation(s)
- Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ekhlas Al-Gamal
- Psychiatric and Mental Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan.,Psychiatric and Mental Health Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Alhasa, Kingdom of Saudi Arabia
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Walk the Talk: The Transforming Journey of Facility-Based Death Review Committee from Stillbirths to Neonates. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8871287. [PMID: 33855086 PMCID: PMC8019367 DOI: 10.1155/2021/8871287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/06/2021] [Accepted: 03/23/2021] [Indexed: 12/04/2022]
Abstract
Background Facility-based death review committee (DRC) of neonatal deaths and stillbirths can encourage stakeholders to enhance the quality of care during the antenatal period and labour to improve birth outcomes. To understand the benefits and impact of the DRCs, this study was aimed at exploring the DRC members' perception about the role and benefits of the newly developed facility-based DRCs in five pilot hospitals in Jordan, to assess women empowerment, decision-making process, power dynamics, culture and genderism as contributing factors for deaths, and impact of COVID-19 lockdown on births. Methods A descriptive study of a qualitative design—using focus group discussions—was conducted after one year of establishing DRCs in 5 pilot large hospitals. The number of participants in each focus group ranged from 8 to10, and the total number of participants was 45 HCPs (nurses and doctors). Questions were consecutively asked in each focus group. The moderator asked the main questions from the guide and then used probing as needed. A second researcher observed the conversation and took field notes. Results Overall, there was an agreement among the majority of DRC members across all hospitals that the DRC was successful in identifying the exact cause of neonatal deaths and stillbirths as well as associated modifiable factors. There was also a consensus that the DRC contributed to an improvement in health services provided for pregnant women and newborns as well as protecting human rights and enabling women to be more interdependent in taking decisions related to family planning. Moreover, the DRC agreed that a proportion of the neonatal deaths and stillbirths occurring in the hospitals could have been prevented if adequate antenatal care was provided and some traditional harmful practices were avoided. Conclusions Facility-based neonatal death review audit is practical and can be used to identify exact causes of maternal and neonatal deaths and is a valuable tool for hospital quality indicators. It can also change the perception and practice of health care providers, which may be reflected in improving the quality of provided healthcare services.
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Al-Sheyab NA, Khader YS, Shattnawi KK, Alyahya MS, Batieha A. Rate, Risk Factors, and Causes of Neonatal Deaths in Jordan: Analysis of Data From Jordan Stillbirth and Neonatal Surveillance System (JSANDS). Front Public Health 2020; 8:595379. [PMID: 33194998 PMCID: PMC7661434 DOI: 10.3389/fpubh.2020.595379] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: It has been estimated that 27.8 million neonates will die worldwide between 2018 and 2030 if no improvements in neonatal and maternal care take place. The aim of this study was to determine the rate, risk factors, and causes of neonatal mortality in Jordan. Methods: In August 2019, an electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in in three large cities through five hospitals. Data on all births, neonatal mortality and their causes, and other characteristics in the period between August 2019 and January 2020 were exported from the JSANDS and analyzed. Results: A total of 10,328 births [10,226 live births (LB) and 102 stillbirths] were registered in the study period, with a rate of 14.1 deaths per 1,000 LBs; 76% were early neonatal deaths and 24% were late deaths. The odds of deaths in the Ministry of Health hospitals were almost 21 times (OR = 20.8, 95% CI: 2.8, 153.1) higher than that in private hospitals. Low birthweight and pre-term babies were significantly more likely to die during the neonatal period compared to full-term babies. The odds of neonatal mortality were significantly higher among babies born to housewives compared to those who were born to employed women (OR = 2.7; 95% CI: 1.2, 6.0). Main causes of neonatal deaths that occurred pre-discharge were respiratory and cardiovascular disorders (43%) and low birthweight and pre-term (33%). The main maternal conditions that attributed to these deaths were complications of the placenta and cord, complications of pregnancy, and medical and surgical conditions. The main cause of neonatal deaths that occurred post-discharge were low birthweight and pre-term (42%). Conclusions: The rate of neonatal mortality have not decreased since 2012 and the majority of neonatal deaths occurred could have been prevented. Regular antenatal visits, in which any possible diseases or complications of pregnant women or fetal anomalies, need to be fully documented and monitored with appropriate and timely medical intervention to minimize such deaths.
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Affiliation(s)
- Nihaya A. Al-Sheyab
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S. Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K. Shattnawi
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S. Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Khasawneh W, Sindiani A, Rawabdeh SA, Aleshawi A, Kanaan D. Indications and Clinical Profile of Neonatal Admissions: A Cross-Sectional Descriptive Analysis from a Single Academic Center in Jordan. J Multidiscip Healthc 2020; 13:997-1006. [PMID: 33061405 PMCID: PMC7520145 DOI: 10.2147/jmdh.s275267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To review the indications and clinical profile of neonatal admissions at King Abdullah University Hospital in Jordan. MATERIALS AND METHODS We conducted a cross-sectional review of all neonates admitted to the neonatal intensive care unit between September 2016 and September 2018. Collected data include demographic characteristics, indications for admission, morbidities and mortality, and discharge outcomes. Findings were reported among term and preterm infants. RESULTS A total of 1444 infants were admitted during the study period of whom 1332 (92.2%) were inborn and 612 (42.4%) were term neonates. Of the 832 preterm infants, 545 were late preterm (34-36 6/7 gestation) and 125 had very low birth weight (˂ 1500 grams); 925 (64%) were born by cesarean section. Respiratory failure of the newborn (41.2%) and prematurity (33.3%) were the main indications for admission among the whole cohort. Maternal prolonged premature rupture of membranes (PROM) was observed in nearly half the admissions of term infants. Hypoxic ischemic encephalopathy (3.2% vs 0.7%, p 0.01) and congenital anomalies (5% vs 1.2%, p 0.03) were more common in term infants. The rate of bronchopulmonary dysplasia was 39% among <28-week and 28% among <32-week premature infants. Sepsis was encountered in 59 infants. The overall mortality rate was 3.8%. Prematurity was the main predisposing factor for mortality (Adjusted OR: 9.9, 95% CI: 3.5, 27.6). CONCLUSION The majority of neonatal admissions at our institution are term and late preterm infants delivered by cesarean section. Prematurity, respiratory failure of the newborn, and suspected sepsis due to maternal PROM are the leading causes of admission. The mortality rate is within WHO target to achieve Sustainable Development Goal 3. Population-based studies are needed to make better conclusions that represent the whole Jordanian population. A revisit for the indications of cesarean deliveries may help to improve the neonatal outcomes.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saif Aldeen Rawabdeh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdelwahhab Aleshawi
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Dana Kanaan
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Khader YS, Bawadi H, Khasawneh W, Alyahya MS, Shattnawi K, Al-Sheyab NA, Al Obeisat S, Asad M, Khatatneh K, Alkhdour MM, Al-Hamdan Z, Batieha A. Sociocultural, political, and health system-related determinants of perinatal deaths in Jordan from the perspectives of health care providers: a qualitative study. J Matern Fetal Neonatal Med 2020; 35:2765-2774. [PMID: 32727234 DOI: 10.1080/14767058.2020.1800632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perinatal mortality is a fundamental indicator of the quality of the healthcare provided to women during pregnancy and childbirth, as well as the healthcare provided to neonates in the first week of life. At the national level, determining the direct and indirect causes of these deaths is vital, as it will assist in tracking the quality of antenatal, natal and postnatal care and help to detect the areas for avoidance. This study aimed to identify the main determinants of perinatal deaths in Jordan from the perspectives of health care providers (HCPs). METHODS A descriptive qualitative approach using focus group discussion was used. Four focus groups were conducted in each of the four hospitals where the approached HCPs are employed. An average of 5 HCPs were interviewed in each focus group with a total of 80 HCPs participating in the 16 focus groups. Thematic analysis was carried out to analyze the data. RESULTS The HCPs provided a detailed description of the determinants of perinatal and neonatal death from their points of view. Four main themes with multiple subthemes emerged, namely maternal factors (ignorance, concealment of medical condition, and husbands' negligence), sociocultural factors (socioeconomic status, tribal and consanguineous marriage, and harmful cultural practices), political factors (early marriage driven by displacement and war consequences on maternal health), and health system-related factors (services management including capabilities and logistics, overcrowding of emergency rooms, discharge against medical advice, and unskilled general practitioners in private maternity clinics). CONCLUSIONS As perceived by HCPs, maternal factors, sociocultural factors, political factors, and health system-related factors are the main determinants of perinatal deaths in Jordan. Improvement in the quality of maternal and neonatal health care services, maternal health education, and maternity staff training are strongly recommended.
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Affiliation(s)
- Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hala Bawadi
- Maternal and Child Health Nursing Department, The University of Jordan, Amman, Jordan
| | - Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood Shattnawi
- Department of Maternal and Child Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Child and Maternal Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Salwa Al Obeisat
- Maternal-Child Health Nursing Department, Faculty of Nursing/WHO Collaborating Center, Jordan University of Science and Technology, Irbid, Jordan
| | - Majed Asad
- Non-Communicable Diseases, MOH, Amman, Jordan
| | - Khalaf Khatatneh
- Department of Computer Science, Al-Balqa Applied University, Salt, Jordan
| | | | - Zaid Al-Hamdan
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abdel Razeq NM, Alduraidi H, Halasa S, Cuttini M. Clinicians' Self-Reported Practices Related to End-of-Life Care for Infants in NICUs in Jordan. J Obstet Gynecol Neonatal Nurs 2019; 49:78-90. [PMID: 31811824 DOI: 10.1016/j.jogn.2019.11.005] [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] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how clinical decisions are made at the end of life for infants born with specific fatal and disabling conditions in NICUs in Jordan from the perspectives of neonatal health care providers. DESIGN A cross-sectional survey of neonatal nurses and physicians. SETTING Twenty-four NICUs in Jordan. PARTICIPANTS Participants included 213 nurses and 75 physicians who provided direct care for infants in NICUs. METHODS Using the EURONIC questionnaire, we asked participants to recall the last experiences of end-of-life decision making in which they were involved. The participants described factors and outcomes related to those experiences, and we used descriptive and inferential statistics to examine these factors. RESULTS In 83% of the recalled situations, the physicians in charge of the infants' care or who were on duty were the primary decision makers. Parents, nurses, ethics committees, and NICU heads were less involved. The infants' primary diagnoses were significantly associated with the nature of decisions regarding end-of-life care (p < .001). Age, importance of religion, having their own children, and involvement in research activities were factors that significantly predicted nurses' perceived levels of involvement in decision making (χ2[4] = 23.140, p < .001). CONCLUSION Our results suggest the need to improve clinical approaches to decision making regarding end-of-life care for infants in NICUs in Jordan to be more family focused and team based. This process should include parents, physicians, neonatal nurses, and ethics committees.
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Abdel Razeq NM. Physicians' standpoints on end-of-life decisions at the neonatal intensive care units in Jordan. J Child Health Care 2019; 23:579-595. [PMID: 30606043 DOI: 10.1177/1367493518814926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this cross-sectional descriptive study is to explore pediatricians' and neonatologists' attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns' prognosis and the potential burden of the neonates' disabilities on their families. The general attitude of the physicians (59-88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56-88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL-focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers' efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan's intensive care units.
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Affiliation(s)
- Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
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Daemi A, Ravaghi H, Jafari M. Risk factors of neonatal mortality in Iran: a systematic review. Med J Islam Repub Iran 2019; 33:87. [PMID: 31696081 PMCID: PMC6825378 DOI: 10.34171/mjiri.33.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Reducing neonatal mortality is an important measure to reduce the overall under-five-years' mortality. Identifying the risk factors is the first step in this regard. This study performed with the aim of determining the risk factors of the neonatal mortality in Iran. Methods: Databases of SID, MagIran, IranMedex, IronDoc and Google Scholar for the Persian resources and Scopus, Science Direct, PubMed, Ovid, EMBASE, ISI web of science and Cochrane for English resources were searched up to January 2017. The inclusion criteria were the studies analyzing at least one risk factor for neonatal mortality in Iran with a control group and multivariate regression analysis. Eight papers met the inclusion criteria. The risk factors were extracted and tabulated. Results: Of the 1713 records retrieved, 8 were eligible to include in the analysis. Preterm birth, low birth weight, smoking and addiction, and anomaly were the important risk factors of neonatal mortality in Iran. Moreover, an extended list of potential risk factors identified on most of which the evidence was controversial and insufficient. The factors categorized into modifiable and identifiable ones. Conclusion: On the modifiable risk factors, proper intervention, and on the non-modifiable ones, early detection and special care may be helpful in preventing the babies from death. Population-based studies with large sample size and multivariate analysis are needed to make clear the effect size of the identified risk factors.
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Affiliation(s)
- Amin Daemi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
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Alyahya MS, Khader YS, Batieha A, Asad M. The quality of maternal-fetal and newborn care services in Jordan: a qualitative focus group study. BMC Health Serv Res 2019; 19:425. [PMID: 31242940 PMCID: PMC6595569 DOI: 10.1186/s12913-019-4232-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/07/2019] [Indexed: 01/06/2023] Open
Abstract
Background The antenatal, intrapartum, and postnatal periods are considered high-risk periods for the health of mothers and their newborns. Although the current utilization rate of some maternal and child care services in Jordan is encouraging, detailed information about the quality of these services is limited. Therefore, this study aimed to explore the quality of maternal-fetal and newborn antenatal care (ANC), delivery, and postnatal care (PNC) services in Jordan. Methods We conducted 12 focus group discussions (FGDs) with pregnant and postpartum women who attended maternal-child care services in three major hospitals in Jordan. All FGDs were recorded and transcribed verbatim. An inductive thematic analysis approach was used to identify themes and subthemes. Results The content analysis of the FGDs revealed a consensus among the discussants regarding the importance of ANC and PNC services for the health of mothers and their newborns. However, the participating women viewed ANC to be much more important than PNC. With regards to the choice between public and private antenatal care services, some of the discussants were disposed towards the private sector. Reasons for this included longer consultation time, a higher quality of services, better interpersonal and communication skills of healthcare providers, better treatment, more advanced equipment and devices, availability of female obstetricians, and more flexible appointment times. These women only perceived public hospital services to be necessary in cases of pregnancy-related complications and labor, as the costs of private sector services in such cases are too high. The findings also revealed that mothers usually only seek PNC services to check up on their newborn’s health and not their own. Conclusion Visiting private ANC clinics throughout pregnancy while giving birth in public facilities leads to the discontinuity and fragmentation in maternal-fetal and child healthcare services. To address this fragmentation, healthcare systems are proposed to establish interprofessional teamwork that requires different healthcare providers with complementary skills and practices in both public and private settings to work co-operatively and collectively. Investment in new technologies and interventions which enhance coordination and collaboration between public and private healthcare settings is necessary for the provision of non-traditional maternal healthcare. Electronic supplementary material The online version of this article (10.1186/s12913-019-4232-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Majed Asad
- Jordan Ministry of Health, Directorate of non-communicable diseases, Amman, Jordan
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Ali RA, Obeisat SM, Tarawneh LH. Improving nursing knowledge and care for neonates with respiratory distress in Jordan. Int Nurs Rev 2019; 66:338-345. [PMID: 30937901 DOI: 10.1111/inr.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study evaluates the effectiveness of an educational intervention in the area of nursing knowledge and practice relating to neonatal respiratory distress syndrome. BACKGROUND In Jordan, respiratory distress is the leading cause of death among neonates. Recent studies have revealed a knowledge deficit relating to respiratory distress among nurses in neonatal intensive care units, hence the need for advanced training and specialization in this area. METHODS A quasi-experimental, repeated-measures, one-group pre-test-post-test design was used to assess the effectiveness of the educational intervention. A convenience sample of 48 nurses was recruited from three hospitals in northern Jordan. A self-reporting questionnaire was used to assess the respondents' knowledge of respiratory distress and an observational checklist to assess their practice. The study intervention consisted of 12 two-hour lecture-based interactive teaching sessions lasting 4 weeks. A follow-up assessment was conducted 1 month after the post-test. RESULTS The baseline assessment revealed that more than half of the nurses scored low on knowledge and the majority scored low on practice. One-way repeated ANOVA showed that post-test and follow-up test scores on nursing knowledge and practice were significantly higher than the baseline scores. CONCLUSION The study findings show the efficacy of educational interventions in enhancing nursing knowledge and practice relating to the care of neonates with respiratory distress. IMPLICATIONS FOR NURSING AND HEALTH POLICY For neonatal nurses, periodic teaching and training interventions are essential to ensuring the quality nursing care required to reduce morbidity and mortality rates among neonates. Health policymakers should support nurses in pursuing educational opportunities aimed at enhancing their knowledge of advanced neonate care.
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Affiliation(s)
- R A Ali
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - S M Obeisat
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
| | - L H Tarawneh
- Department of Maternal and Child Health Nursing, Faculty of Nursing - Jordan University of Science and Technology, Irbid, Jordan
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Khader Y, Alyahya M, Batieha A. Barriers to Implementation of Perinatal Death Audit in Maternity and Pediatric Hospitals in Jordan: Cross-Sectional Study. JMIR Public Health Surveill 2019; 5:e11653. [PMID: 30839277 PMCID: PMC6425304 DOI: 10.2196/11653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/01/2018] [Accepted: 12/07/2018] [Indexed: 01/25/2023] Open
Abstract
Background Perinatal death audit is a feasible and cost-effective quality improvement tool that helps to improve the quality of health care and reduce perinatal deaths. Perinatal death audit is not implemented in almost all hospitals in Jordan. Objective This study aimed to assess health professionals’ attitude toward perinatal death auditing and determine the main barriers for effective implementation of perinatal death auditing as perceived by health professionals in Jordanian hospitals. Methods A cross-sectional study was conducted among health professionals in 4 hospitals in Jordan. All physicians (pediatricians and obstetricians) and nurses working in these hospitals were invited to participate in the study. The study questionnaire assessed the attitude of health professionals toward perinatal death audit and assessed barriers for implementation of perinatal death audit in their hospitals. Results This study included a total of 84 physicians and 218 nurses working in the 4 selected maternity hospitals. Only 35% (29/84) of physicians and 36.2% (79/218) of nurses reported that perinatal death audit would help to improve the quality of prenatal health care services to a great or very great extent. Lack of time was the first-mentioned barrier for implementing perinatal death audit by both physicians (35/84, 42%) and nurses (80/218, 36.7%). Almost the same proportions of health professionals reported inadequate patient information being documented in hospital records as a barrier. Lack of a health information system was the third-mentioned barrier by health professionals. Fear of having conflicts with the family of the dead baby was reported by almost one-third of physicians and nurses. Only 28% (23/83) of physicians and 16.9% (36/213) of nurses reported that they would like to be involved in perinatal death audit in their health facilities. Conclusions Health professionals in Jordan had poor attitude toward perinatal death audit. The main barriers for implementing perinatal death audit in Jordanian hospitals were lack of time, inadequate patient information being documented in hospital records, and lack of health information systems.
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Affiliation(s)
- Yousef Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Alyahya MS, Khader YS. Health care professionals' knowledge and awareness of the ICD-10 coding system for assigning the cause of perinatal deaths in Jordanian hospitals. J Multidiscip Healthc 2019; 12:149-157. [PMID: 30858712 PMCID: PMC6385764 DOI: 10.2147/jmdh.s189461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives There is a lack of studying vital registration and disease classification systems in low- and middle-income countries. This study aimed to assess health care professionals’ (HCPs’) level of awareness, knowledge, use, and perceived barriers of the International Classification of Diseases, 10th version (ICD-10) as well as their perceptions of the electronic neonatal death registration system. Participants and methods A mixed method approach including descriptive cross-sectional quantitative and focus groups with HCPs (physicians, nurses, and midwives) was used to collect data from four major selected hospitals in Jordan. A total of 16 focus groups were conducted. Also, a survey, which included three case studies about the ability of nurses and physicians to identify cause of death, was completed using structured face-to-face interviews. Results Overall, there was congruency between both the quantitative results and the qualitative findings. The majority of nurses and physicians in the four hospitals were not familiar with the ICD-10 coding system and hence reported minimal use of the coding system. Additionally, the majority of HCPs were not aware whether or not their departments used the ICD-10 to record perinatal mortality. These HCPs identified that lack of knowledge, time, staff and support, and an effective and comprehensive electronic system that allows physicians to accurately choose the exact cause of death were their main barriers to the use of the ICD-10 coding system. Conclusion Our findings emphasize the importance of developing an effective and comprehensive electronic system which allows HCPs to accurately report and register all perinatal deaths. This system needs to account for the direct and indirect causes of death and for contributing factors such as maternal conditions at the time of perinatal death. Training HCPs on how to use the system is vital for the success and accuracy of the data registration process.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan,
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
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Abdel Razeq NM. End-of-life Decisions at Neonatal Intensive Care Units: Jordanian Nurses Attitudes and Viewpoints of Who, When, and How. J Pediatr Nurs 2019; 44:e36-e44. [PMID: 30420167 DOI: 10.1016/j.pedn.2018.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/04/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore factors predicting neonatal nurses' attitude towards end-of-life decisions in neonates, and to describe the nurses' viewpoints on end-of-life decisions; barriers to end-of-life decision making; parents', nurses', and ethical committees' involvement in the process of end-of-life decision making; and who should regulate end-of-life decisions regarding neonates. DESIGN AND METHODS A cross-sectional descriptive correlational design was applied. Sample included 279 neonatal nurses working in 24 neonatal intensive care units across Jordan. Data were collected using internationally-accepted questionnaires. Descriptive and inferential statistics were applied in data analysis. RESULTS Most nurses perceived that everything possible should be done to ensure a neonate's survival, even when they suffer severe prognosis (80%) and irrespective of the burden of the child's disability on the family (75%). Almost all nurses (96%) were against administering drugs with the purpose of ending the neonate's life and 63% were against continuing current treatment without adding others. The nurses' perceived effect of end-of-life decisions on their everyday life, and the importance of religious values to the nurses' personal lives, significantly predicted pro-life attitude scores. According to 80% of the nurses, legal constraints were the most significant barriers to end-of-life decision making. The majority of nurses (84%) indicated that non-religious bodies should establish end-of-life regulations for neonates. CONCLUSION Generally, nurses' attitude was supportive of life saving decisions at end-of-life, regardless of the survival odds and the probable health outcomes of the neonates. PRACTICE IMPLICATIONS Neonates' end-of-life care, and parents' bereavement care, should be standard practices in every NICU, worldwide.
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Affiliation(s)
- Nadin M Abdel Razeq
- The University of Jordan - School of Nursing, Maternal and Child Health Nursing Department, Amman Jordan.
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Al Kibria GM, Khanam R, Mitra DK, Mahmud A, Begum N, Moin SMI, Saha SK, Baqui A. Rates and determinants of neonatal mortality in two rural sub-districts of Sylhet, Bangladesh. PLoS One 2018; 13:e0206795. [PMID: 30462674 PMCID: PMC6248927 DOI: 10.1371/journal.pone.0206795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/20/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Reducing neonatal mortality rate (NMR) is a challenge in many low- and middle-income countries including Bangladesh. In 2014, the estimated NMR in this country was 28 per 1,000 live births. This rate is higher in rural regions compared to the national average. Currently, Sylhet Division has the highest NMR in Bangladesh. Investigating rates and determinants of neonatal mortality in rural regions of this high-risk division is particularly important to implement evidence-based programs. This study examined rates and determinants of neonatal deaths in a large rural cohort in Sylhet Division. METHODS We analyzed data from a multi-country cohort study, Aetiology of Neonatal Infections in South Asia. From November 2011 to December 2013, this study was conducted in two rural sub-districts in Sylhet Division. Community health workers followed 28,960 pregnant women and their newborns up to two months postpartum and collected data on pregnancy outcomes and newborns' survival status. The NMR was obtained by dividing total number of neonatal deaths with all studied newborns. Logistic regression was employed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with neonatal mortality. Stata 14.0 was used for data analysis. RESULTS This study analyzed data of 21,227 newborns. The NMR was 43.4 (95% CI: 39.3-48.0) per 1,000 live births (N = 922). Multivariable analysis showed that the odds of neonatal mortality were significantly higher among male newborns (AOR: 1.5, 95% CI: 1.2-1.8), babies born before 34 weeks of gestation (AOR: 5.0, 95% CI: 4.1-6.1), those who were twins or triplets (AOR: 6.2, 95% CI: 3.6-10.9), and first-born child (AOR: 2.9, 95% CI: 1.6-5.3). Additionally, maternal age 30-35 years (AOR: 1.4, 95% CI: 1.-1.8), history of child death (AOR: 1.6, 95% CI: 1.2-2.2), and delivery complications (AOR: 2.1, 95% CI: 1.6-2.6) had positive associations with neonatal deaths. CONCLUSION Public health programs in Bangladesh need to adopt a comprehensive strategy to address the individual, maternal, and intrapartum factors associated with neonatal mortality in rural regions. Interventions should aim to prioritize managing pre-term deliveries, first-born child, and delivery complications among pregnant women.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, MD, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail: ,
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Syed Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Samir Kumar Saha
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Abdullah Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Khader Y, Al-Sheyab N, Alyahya M, Batieha A. Registration, documentation, and auditing of stillbirths and neonatal deaths in Jordan from healthcare professionals' perspectives: reality, challenges and suggestions. J Matern Fetal Neonatal Med 2018; 33:3338-3348. [PMID: 30348027 DOI: 10.1080/14767058.2018.1531120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: The current study aimed to explore healthcare professionals' (HCPs) perceptions towards the registration and reporting process of stillbirth and neonatal mortality and their causes. Another aim is to explore HCPs' perceived importance of registering stillbirths and neonatal deaths as well as the perceived challenges and suggestions of building a new surveillance and auditing system to report stillbirths and neonatal deaths in Jordan.Methods: A descriptive qualitative approach using an in-depth focus group discussion was used. A total of 16 focus groups were conducted in four major representative hospitals that cover different geographical areas in Jordan. An average of five healthcare providers (HCPs) was interviewed in each focus group with a total of 80 HCPs. All recorded focus group interviews were transcribed in a full verbatim, which was checked for accuracy by the project team. The whole content thematic analysis process was conducted in its original Arabic language to conserve credibility of the findings. Healthcare providers' perceptions were derived from the group discussions using a group-interview guide.Results: Overall, the majority of HCPs across all hospitals agreed that it is important to document neonatal deaths and stillbirths in the hospital records mainly for statistical purposes. HCPs usually document neonatal deaths but not stillbirths. The causes of stillbirths and neonatal deaths are inaccurately recorded and not usually completed by the attending physician. Surprisingly, only neonates who live more than 4 h after delivery are registered as neonatal deaths but any neonate who dies before 4 h after delivery is not registered or registered as stillbirth. The majority of HCPs said that they were not aware of having neonatal death review committee in their hospitals. Importantly, the majority of HCPs in the four hospitals were enthusiastic about the development of a new surveillance system to register neonatal deaths and stillbirths in Jordan. Several suggestions were conveyed by the HCPs to better build, develop, implement, and sustain the proposed surveillance system.Conclusions: Electronic health information system and centralized database for compiling audit, registering births and deaths, and assigning causes of deaths should be developed and implemented. Designing and implementing an electronic registry or surveillance system that adopts ICD-10 codes is expected not only improve the completeness and timeliness of registration but also results in accurate recording of the causes of deaths.
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Affiliation(s)
- Yousef Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya Al-Sheyab
- Faculty of Applied Medical Science, Allied Medical Sciences Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Faculty of Medicine, Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Khader YS, Batieha A, Khader A, Hamadneh S. Stillbirths in Jordan: rate, causes, and preventability. J Matern Fetal Neonatal Med 2018; 33:1307-1314. [PMID: 30153760 DOI: 10.1080/14767058.2018.1517326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: This study aimed to determine the stillbirth rate in Jordan and to determine the leading causes of stillbirths. Analyzing the stillbirth data from a large sample size of Jordanian women would be very valuable for planning the resources and improving the services.Methods: The data from the national study of perinatal mortality in Jordan were analyzed. A total of 21,980 women who delivered at a gestational age ≥20 weeks in any of the 18 selected hospitals during the study period (March 2011-April 2012) were analyzed. The stillbirth rate was calculated as the number of stillbirths per 1000 total births. The deaths were also classified according to NICE classification system.Results: The rates of stillbirths were 11.6/1000 total births born after 20 weeks of gestation, 11.2/1000 total births born ≥22 weeks of gestation, 10.6/1000 total births born ≥24 weeks of gestation, and 9.0/1000 total births born ≥28 weeks of gestation. According to NICE classification, the main causes of stillbirths were maternal diseases (19.5%), unexplained immaturity (18.8%), congenital anomalies (17.6%), unexplained antepartum stillbirths (17.6%), obstetric complications (8.4%), placental abruption (5.7%), and multiple births (5%). The expert Panel judged that 34.5% of all fetal deaths were preventable and 30.3% were possibly preventable with optimal care.Conclusions: This study highlighted stillbirth risks in Jordan, which could encourage maternal-infant health-care providers, other researchers, policymakers, and stakeholders to implement solutions and to develop a feasible intervention.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Albaraa Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shereen Hamadneh
- Faculty of Nursing, Department of Maternal and Child Health, Al Albayt University, Mafraq, Jordan
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Khader YS, Alyahya MS, Al-Sheyab NA, Shattnawi KK, Saqer HR, Batieha A. Evaluation of maternal and newborn health services in Jordan. J Multidiscip Healthc 2018; 11:439-456. [PMID: 30233201 PMCID: PMC6130273 DOI: 10.2147/jmdh.s171982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives This study aimed to assess the maternal and newborn services in Jordanian hospitals to provide policymakers, health professionals, and researchers with a clear picture about the current status of maternal and newborn health services. Methods A total of 32 main hospitals that provide maternity services in Jordan were assessed. The study involved direct observations of these hospitals and interviews with basic health and hospital staff, with the purpose of assessing and evaluating the availability of various services for mothers and newborns, availability of resources, equipment and supplies, documentation and staff training, and provision of the health care services. Results Some hospitals had shortages of obstetricians and gynecologists, pediatricians, neonatologists, and midwives/nurses. Antenatal care was not provided systematically in many hospitals across the country. A lack of necessary equipment, drugs, and supplies was evident in some hospitals. Admission departments of some hospitals had insufficient supplies. The operation theaters in many hospitals lacked a variety of necessary equipment including some basic items such as thermometers and some advanced items such as resuscitation sets for babies. Only two-thirds of all delivery rooms in the selected hospitals had radiant heaters and obstetrical stethoscopes available. A significant lack of neonatal ICU equipment was found such as incubators, resuscitation tables, continuous positive airway pressure, O2 oximeters, and phototherapy. Conclusion The findings revealed an overall satisfactory quality of maternal and newborn care and services, however, some deficiencies existed. The findings are expected to aid policymakers, health professionals, and researchers to recognize the gaps in the processes, supplies, and quality of care related to the provided services at maternal facilities and help them to design and implement evidence-based health programs in order to provide effective health services and promote the health of mothers and newborns.
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Affiliation(s)
- Yousef S Khader
- Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan,
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Child and Adolescent Health, Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood K Shattnawi
- Maternal and Child Health Nursing Department, Faculty of Nursing/WHO Collaborating Center, Jordan University of Science and Technology, Irbid, Jordan
| | - Hind Rajeh Saqer
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Epidemiology Department of Community Medicine, Public Health and Family, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Mrayan L, Abujilban S, Abuidhail J, Alshraifeen A. Traditional neonatal care practices in Jordan: A qualitative study. Nurs Health Sci 2018; 20:486-493. [DOI: 10.1111/nhs.12540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/13/2018] [Accepted: 04/29/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Lina Mrayan
- Department of Maternal, Child and Family Health Nursing; Hashemite University; Zarqa Jordan
| | - Sanaa Abujilban
- Department of Maternal, Child and Family Health Nursing; Hashemite University; Zarqa Jordan
| | - Jamila Abuidhail
- Department of Maternal, Child and Family Health Nursing; Hashemite University; Zarqa Jordan
| | - Ali Alshraifeen
- Department of Maternal, Child and Family Health Nursing; Hashemite University; Zarqa Jordan
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Traditional open bay neonatal intensive care units can be redesigned to better suit family centered care application. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2017.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Predictors of death in infants with probable serious bacterial infection. Pediatr Res 2018; 83:784-790. [PMID: 29166376 DOI: 10.1038/pr.2017.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/14/2017] [Indexed: 11/08/2022]
Abstract
BackgroundBacterial infections account for a significant proportion of neonatal and infant mortality globally. We aimed to identify predictors of death in infants with probable serious bacterial infection (PSBI) defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein (CRP) ≥12 mg/l.MethodsWe did a secondary analysis using the data collected from 700 infants with PSBI who participated in a randomized controlled trial in India in which zinc or placebo was given in addition to the standard antibiotics. Logistic regression was used to estimate the associations between relevant variables and death within 21 days.ResultsThose infants who were fed cow's milk or formula before the illness episode had 3.7-fold (95% confidence interval (CI) 1.5-9.3) and 5.3-fold (95% CI 2.0-13.6) higher odds of death, respectively. Lethargy (odds ratio (OR) 2.4, 95% CI 1.1-5.4) and CRP (OR 1.9, 95% CI 1.1-3.3) were also independent predictors of death. In the model including only clinical features, female gender (OR 2.25, 95% CI 1.0-5.0), abdominal distention (3.7, 95% CI 1.1-12.3), and bulging fontanelle (5.8, 95% CI 1.1-30.5) were also independent predictors for death.ConclusionFormula or cow milk feeding prior to the illness, lethargy at the time of presentation, and high serum CRP levels predicted death in infants with PSBI.
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Shaban IA, Al-Awamreh K, Mohammad K, Gharaibeh H. Postnatal women's perspectives on the feasibility of introducing postpartum home visits: a Jordanian study. Home Health Care Serv Q 2018; 37:247-258. [PMID: 29558322 DOI: 10.1080/01621424.2018.1454865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In Jordan, there is a deficiency in postnatal care provided to women and their newborns. This study investigated the feasibility of initiating postnatal home visits in Jordan. Thirty Jordanian mothers who had recently given birth were recruited from two governmental hospitals in the northern region of Jordan to participate in a qualitative study through face-to-face, voice-recorded interviews. The findings revealed that initiating postnatal home visits as part of postnatal care was well-received by the participants. Mothers' views and perceptions regarding postpartum home visits play an integral role in finding areas to improve postnatal services.
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Affiliation(s)
- Insaf A Shaban
- a Faculty of Nursing , Al al-Bayt University , Marfraq , Jordan
| | | | - Khitam Mohammad
- b Faculty of Nursing , Jordan University of Science and Technology , Irbid , Jordan
| | - Huda Gharaibeh
- b Faculty of Nursing , Jordan University of Science and Technology , Irbid , Jordan
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Khader YS, Batieha A, Al Fursan RK, Al-Hader R, Hijazi SS. Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0075/ijamh-2017-0075.xml. [PMID: 28782350 DOI: 10.1515/ijamh-2017-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022]
Abstract
Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged <20 years were more likely to deliver prematurely compared to women aged 20-35 years [odds ratio (OR)=1.5, 95% CI: 1.2, 1.9; p < 0.005)]. However, the two groups of women did not differ significantly in low birth weight delivery (OR = 1.2, 95% CI: 0.9, 1.5; p = 0.167) and neonatal mortality (OR = 1.2, 95% CI: 0.8, 1.3; p = 0.491) in the multivariate analysis. Conclusion Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.
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Affiliation(s)
- Yousef S Khader
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan, Phone: +962796802040
| | - Anwar Batieha
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Kareem Al Fursan
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rami Al-Hader
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sa'ad S Hijazi
- Department of Public Health/Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abdel Razeq NM, Khader YS, Batieha AM. The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013). Turk J Obstet Gynecol 2017; 14:28-36. [PMID: 28913132 PMCID: PMC5558315 DOI: 10.4274/tjod.62582] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/01/2017] [Indexed: 12/11/2022] Open
Abstract
Objective: To explore the incidence of preterm delivery, maternal risk factors for having a preterm neonate, and preterm neonates’ mortality in Jordan. Materials and Methods: A cross-sectional population-based design was applied. Socio-demographic, perinatal, delivery risk factors, and survival information were gathered in pre- and post-hospital discharge interviews with 21075 women who gave birth to live neonates at ≥20 weeks of gestation in 18 hospitals in Jordan. Women were interviewed between 2012 and 2013. The sample was limited to singleton women who gave birth to live neonates. Women who gave birth to stillborn babies were excluded. Results: Preterm delivery incidence was 5.8%, of which 85% were in 32-36 gestational weeks. Male sex, primigravidity, hypertension, preeclampsia, and diabetes were significantly associated with an increased risk of preterm delivery. Women aged 20-35 years had the lowest risk of preterm delivery. Mother’s weight <50 kg, hospitalization at 24-34 gestational weeks, lack of antenatal care visits or <8 visits during pregnancy, a history of preterm delivery, and a history of stillbirth/neonatal death were associated with increased risks of preterm delivery. The neonatal mortality rate was 4/1000 live births among full-term and 123/1000 live births among preterm babies. Prematurity, congenital anomalies, and maternal diseases were the causes of 84% of preterm neonatal deaths. Conclusion: The mortality rate was considerably higher among preterm neonates than among term neonates; discrepancies between Jordan and other countries existed. Systematic prenatal risk assessment and quality postnatal health care improvements are required to improve the survival rates of preterm neonates.
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Affiliation(s)
- Nadin M Abdel Razeq
- The University of Jordan Faculty of Nursing, Department of Maternal and Child Health Nursing, Amman, Jordan
| | - Yousef S Khader
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Department of Community Medicine and Public Health, Irbid, Jordan
| | - Anwar M Batieha
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Department of Community Medicine and Public Health, Irbid, Jordan
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Khader YS, Batieha A, Al-Njadat RA, Hijazi SS. Preeclampsia in Jordan: incidence, risk factors, and its associated maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2017; 31:770-776. [PMID: 28274172 DOI: 10.1080/14767058.2017.1297411] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To estimate the incidence of preeclampsia among Jordanian pregnant women, determine its risk factors and its associated neonatal morbidity and mortality. METHODS The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared between women who developed preeclampsia and who did not. RESULTS This study included a total of 21,928 women. The overall incidence rate of preeclampsia was 1.3%. Obesity (OR = 2.6) and high blood pressure (OR = 11.9) were significantly associated with increasing odds of preeclampsia. The risk of preeclampsia was 2.3 times higher in first pregnancies than that in second or more pregnancies. The rates of low birth weight (LBW) delivery (32.5% vs. 8.3%), and prematurity (30.8% vs. 7%), and the neonatal mortality rate (81 vs. 12 per 1000 live births) were significantly higher among women with preeclampsia. CONCLUSIONS The overall incidence rate of preeclampsia was 1.3%. Preeclampsia was significantly associated with maternal and neonatal morbidity and mortality as well as increasing vaginal operative delivery, cesarean section, LBW, and birth asphyxia.
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Affiliation(s)
- Yousef S Khader
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Anwar Batieha
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Rania Ali Al-Njadat
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
| | - Sa'ad S Hijazi
- a Department of Public Health/Faculty of Medicine , Jordan University of Science & Technology , Irbid , Jordan
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Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens VEHJ, Steggerda SJ, Te Pas AB, Lopriore E. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study. Front Pediatr 2017; 5:142. [PMID: 28676849 PMCID: PMC5477168 DOI: 10.3389/fped.2017.00142] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan-Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25-5.41], male gender (HR 2.63, 95% CI 1.17-5.90), and higher birth weight (HR 1.04, 95% CI 1.002-1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12-0.52) was associated with a decreased risk. CONCLUSION In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.
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Affiliation(s)
- Gerdina H Dubbink-Verheij
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Iris C M Pelsma
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Erik W van Zwet
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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