1
|
Mforteh AAA, Pisoh DW, Boten M, Andoh NEL, Tameh TY, Mbi-Kobenge AFE, Ombaku KS, Takang WA, Mbu RE. Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study. BMC Pregnancy Childbirth 2024; 24:270. [PMID: 38609848 PMCID: PMC11010432 DOI: 10.1186/s12884-024-06486-z] [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: 08/27/2023] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Stillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon. MATERIALS AND METHODS A Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05. RESULTS A total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19-12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17-3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4-84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4-98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0-89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06-149.7;p = 0.045). CONCLUSION The stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.
Collapse
Affiliation(s)
- Achuo Ascensius Ambe Mforteh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon.
- Bamenda Regional Hospital, Bamenda, Cameroon.
| | - Dobgima Walter Pisoh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Merlin Boten
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | | | | | | | | | - William Ako Takang
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | - Robinson Enow Mbu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
- Yaoundé Gyneco-Obstetric and Paediatric Hospital, Yaounde, Cameroon
| |
Collapse
|
2
|
Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG 2024; 131:140-150. [PMID: 37272228 DOI: 10.1111/1471-0528.17562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. OBJECTIVES To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. SEARCH STRATEGY CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. SELECTION CRITERIA Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. DATA COLLECTION AND ANALYSIS A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. MAIN RESULTS Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. CONCLUSIONS The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.
Collapse
Affiliation(s)
- Ankita Mukherjee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Monitoring, Evaluation and Research, New Delhi, India
| | | | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Mee
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
| |
Collapse
|
3
|
Kasa GA, Woldemariam AY, Adella A, Alemu B. The factors associated with stillbirths among sub-saharan African deliveries: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:835. [PMID: 38049743 PMCID: PMC10696713 DOI: 10.1186/s12884-023-06148-6] [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: 05/23/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Globally, more than 2.6 million stillbirths occur each year. The vast majority (98%) of stillbirths occur in low- and middle-income countries, and over fifty percent (55%) of these happen in rural sub-Saharan Africa. METHODS This is a systematic review and meta-analysis developed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. A literature search was performed using PubMed, the Cochrane Library, Google Scholar, EMBASE, Scopus, the Web of Sciences, and gray literature. Rayyan`s software was used for literature screening. A random effects meta-analysis was conducted with STATA version 17. Heterogeneity was checked by using Cochran's Q and I2 tests. Funnel plots and Egger's test were used to examine the risk of publication bias. The protocol of the study was registered in PROSPERO with a registration number of CRD42023391874. RESULTS Forty-one studies gathered from eight sub-Saharan countries with a total of 192,916 sample sizes were included. Nine variables were highly linked with stillbirth. These include advanced maternal age (aOR: 1.43, 95% CI: 1.16, 1.70), high educational attainment (aOR: 0.55, 95% CI: 0.47, 0.63), antenatal care (aOR: 0.45, 95% CI: 0.35, 0.55), antepartum hemorrhage (aOR: 2.70, 95% CI: 1.91, 3.50), low birth weight (aOR: 1.72, 95% CI: 1.56-1.87), admission by referral (aOR: 1.55, 95% CI: 1.41, 1.68), history of stillbirth (aOR: 2.43, 95% CI: 1.84, 3.03), anemia (aOR: 2.62, 95% CI: 1.93, 3.31), and hypertension (aOR: 2.22, 95% CI: 1.70, 2.75). CONCLUSION A significant association was found between stillbirth and maternal age, educational status, antenatal care, antepartum hemorrhage, birth weight, mode of arrival, history of previous stillbirth, anemia, and hypertension. Integrating maternal health and obstetric factors will help identify the risk factors as early as possible and provide early interventions.
Collapse
Affiliation(s)
- Getachew Adela Kasa
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | | | - Alemayehu Adella
- West Shoa Zone Health Bureau, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Bezatu Alemu
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
4
|
Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:288. [PMID: 37101264 PMCID: PMC10131471 DOI: 10.1186/s12884-023-05613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. METHODS A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI]. RESULTS A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS. CONCLUSIONS The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.
Collapse
Affiliation(s)
- Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Shaali Ame
- Public Health Laboratory, Ivo de Carneri, Pemba, Tanzania
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Becker J, Becker C, Oprescu F, Wu CJJ, Moir J, Shimwela M, Gray M. Silent voices of the midwives: factors that influence midwives' achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry. BMC Pregnancy Childbirth 2022; 22:39. [PMID: 35034616 PMCID: PMC8761383 DOI: 10.1186/s12884-021-04339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). METHODS This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. RESULTS Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. CONCLUSIONS Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.
Collapse
Affiliation(s)
- Jan Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia. .,University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia. .,General Division of the Order of Australia, Office of the Official Secretary to the Governor-General, Government House, ACT, 2600, Canberra, Australia.
| | - Chase Becker
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,University of Nicosia Medical School in Partnership with St George's University of London, Makedonitissis 46, Nicosia, 2417, Cyprus
| | - Florin Oprescu
- School of Health and Behavioural Sciences, University of Sunshine Coast (USC), 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), 1 Morton Bay Parade, Petrie, QLD, 4502, Australia.,Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - James Moir
- Midwife Vision Global Ltd, PO BOX 9165, Pacific Paradise, QLD, 4564, Australia.,Clinical Director, QLD Fertility Group Sunshine Coast, 44 Clarkes Road, Diddillibah, QLD, 4559, Australia
| | - Meshak Shimwela
- Internal Medicine, Temeke Regional Referral Hospital, Temeke Road, Adjacent Sterio Market, Dar es Salaam, Tanzania
| | - Marion Gray
- Centre for Health Research/School of Health and Wellbeing; Associate Dean (Clinical), Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Sinnathamby Blvd, Springfield Central, Queensland, 4300, Australia
| |
Collapse
|
6
|
Pai CW, Wiratama BS, Lin HY, Chen PL. Association of Traumatic Injury With Adverse Pregnancy Outcomes in Taiwan, 2004 to 2014. JAMA Netw Open 2021; 4:e217072. [PMID: 33877308 PMCID: PMC8058639 DOI: 10.1001/jamanetworkopen.2021.7072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Literature has suggested that trauma among pregnant women is associated with an increased risk of adverse pregnancy outcomes. However, limited research has investigated the association of trauma with adverse pregnancy outcomes by using a national data set. OBJECTIVE To investigate the association between traumatic injury and adverse pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study of pregnant women in Taiwan linked 3 data sets, the Taiwan Birth Registry, Household Registration Information, and National Health Insurance Research Database, from January 1, 2004, through December 31, 2014. Data, including the characteristics of pregnant women and infants, were extracted from the Taiwan Birth Registry data set; to obtain trauma data, this data set and the Household Registration Information data set were collectively linked to National Health Insurance Research Database data. The combined data set was analyzed from January to July 2019. Adverse pregnancy outcomes and premature delivery were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. EXPOSURES The primary exposures of this study were 2 clinical variables related to injury during pregnancy: medical treatment in the emergency department (yes or no) and hospitalization (yes or no). MAIN OUTCOMES AND MEASURES The main outcome variable was adverse pregnancy outcomes, and the secondary outcome variable was premature delivery. Multivariate logistic regression models were used to investigate the association of injuries with adverse pregnancy outcomes after controlling for demographic characteristics and other pregnancy-related variables. RESULTS A total of 2 973 831 pregnant women (2 475 805 [83.3%] aged 20-34 years) were enrolled between 2004 and 2014, of whom 59 681 (2.0%) sought medical treatments due to injuries. Results of multivariate logistic regression models showed that women receiving emergency treatments more than once were 1.08 times as likely (adjusted odds ratio, 1.08; 95% CI, 1.05-1.10) to have adverse pregnancy outcomes than women who received no emergency treatment. Women with injury-related hospitalization were 1.53 times more likely (adjusted odds ratio, 1.53; 95% CI, 1.41-1.65) to have adverse pregnancy outcomes than women who did not sustain injuries. Furthermore, recurrent injuries were associated with a 572% increase in odds of premature delivery (adjusted odds ratio, 6.72; 95% CI, 2.86-15.80). CONCLUSIONS AND RELEVANCE In this study, trauma among pregnant women was associated with an increased risk of adverse pregnancy outcomes, as were hospitalization and emergency department visits due to injury.
Collapse
Affiliation(s)
- Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Bayu Satria Wiratama
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Hsiao-Yu Lin
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
7
|
Rivenes Lafontan S, Kidanto HL, Ersdal HL, Mbekenga CK, Sundby J. Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania. BMC Pregnancy Childbirth 2019; 19:165. [PMID: 31077139 PMCID: PMC6511185 DOI: 10.1186/s12884-019-2286-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania. METHODS A qualitative design was used to collect data. Five focus group discussions and 10 semi-structured in-depth interviews were carried out. In total, 28 medical doctors and nurse/midwives participated in the study. The data was analyzed using qualitative content analysis. RESULTS The participants in the study perceived that the device was a useful tool that made it possible to monitor several laboring women at the same time and to react faster to fetal distress alerts. It was also perceived to improve the care provided to the laboring women. Prior to the introduction of Moyo, the participants described feeling overwhelmed by the high workload, an inability to adequately monitor each laboring woman, and a fear of being blamed for negative fetal outcomes. Challenges related to use of the device included a lack of adherence to routines for use, a lack of clarity about which laboring women should be monitored continuously with the device, and misidentification of maternal heart rate as fetal heart rate. CONCLUSION The electronic strap-on fetal heart rate monitor, Moyo, was considered to make labor monitoring easier and to reduce stress. The study findings highlight the importance of ensuring that the device's functions, its limitations and its procedures for use are well understood by users.
Collapse
Affiliation(s)
- Sara Rivenes Lafontan
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Hussein L. Kidanto
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Research, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
| | - Hege L. Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Columba K. Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Johanne Sundby
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| |
Collapse
|
8
|
Ljungblad LW, Sandvik SO, Lyberg A. The impact of skilled birth attendants trained on newborn resuscitation in Tanzania: A literature review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.100168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
9
|
Mgaya AH, Kidanto HL, Nyström L, Essén B. Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting. Int J Gynaecol Obstet 2018; 144:199-209. [PMID: 30499099 DOI: 10.1002/ijgo.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/04/2018] [Accepted: 11/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of a criteria-based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. METHODS A cross-sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013-November 2013 and July 2015-June 2016). Outcomes of fetal distress (baseline CBA, n=248; re-audit, n=251) and obstructed labor (baseline CBA, n=260; re-audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification. RESULTS Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09-0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02-1.63) and non-referred (OR 2.78, 95% CI 1.98-3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56-0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25-0.39), and non-referred preterm pregnancies (OR 0.26, 95% CI 0.18-0.36). CONCLUSION Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.
Collapse
Affiliation(s)
- Andrew H Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Hussein L Kidanto
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.,Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Acquiring Knowledge about the Use of a Newly Developed Electronic Fetal Heart Rate Monitor: A Qualitative Study Among Birth Attendants in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122863. [PMID: 30558180 PMCID: PMC6313598 DOI: 10.3390/ijerph15122863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023]
Abstract
In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor ward at two health facilities in Tanzania. The FGDs were analyzed using qualitative content analysis. The study revealed that the participants experienced the training about the device as useful but inadequate. Due to high turnover, a frequently mentioned challenge was that many of the birth attendants who were responsible for training others, were no longer working in the labor ward. Many participants expressed a need for refresher trainings, more practical exercises and more theory on labor management. The study highlights the need for frequent trainings sessions over time with focus on increasing overall knowledge in labor management to ensure correct use of the monitor over time.
Collapse
|
11
|
Hirose A, Alwy F, Atuhairwe S, Morris JL, Pembe AB, Kaharuza F, Marrone G, Hanson C. Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda. Int J Gynaecol Obstet 2018; 144:37-48. [PMID: 30289170 PMCID: PMC7379231 DOI: 10.1002/ijgo.12689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/27/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors. METHODS The present study was an analysis of cross-sectional patient-record and facility-file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level-4 health centers, and five level-3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non-near-miss, and intrapartum near-miss) to calculate stillbirth rates and adjusted prevalence ratios. RESULTS Data from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near-miss was associated with a 3.73- and 4.55-fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near-miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non-near-miss adverse events. CONCLUSION Stillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non-near-miss complications, identifying the opportunity to prevent deterioration by timely actions.
Collapse
Affiliation(s)
- Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Fadhlun Alwy
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Association of Gynaecologists and Obstetricians of Tanzania, Dar es Salaam, Tanzania
| | - Susan Atuhairwe
- Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda.,Mulago National Referral Hospital, Kampala, Uganda
| | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Association of Gynaecologists and Obstetricians of Tanzania, Dar es Salaam, Tanzania
| | - Frank Kaharuza
- Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda.,Makerere University School of Public Health, Kampala, Uganda
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Mdoe PF, Ersdal HL, Mduma E, Moshiro R, Dalen I, Perlman JM, Kidanto H. Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low-resource setting. Int J Gynaecol Obstet 2018; 143:344-350. [PMID: 30120775 DOI: 10.1002/ijgo.12648] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/04/2018] [Accepted: 08/16/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the frequency of abnormal fetal heart rate (FHR) detection between continuous Doppler and intermittent fetoscope monitoring. METHOD A randomized controlled open-label trial was conducted between February 1, 2016, and January 31, 2017, at Haydom Lutheran hospital, Tanzania. Women in active labor with singleton pregnancies and normal FHR at admission were randomly allocated in a 1:1 ratio to receive either continuous or intermittent FHR monitoring. The primary outcome was abnormal FHR detection. RESULTS 2652 women were enrolled; 1340 received continuous monitoring and 1312 received intermittent monitoring. Continuous FHR monitoring detected abnormal FHR in 108 (8.1%) participants versus 40 (3.0%) participants in the intermittent monitoring group (risk ratio [RR] 2.64, 95% confidence interval [CI] 1.8-3.7; P<0.001). The increased detection rate in the continuous versus intermittent monitoring group was associated with an increase in rate of subsequent intrauterine resuscitations (89 [6.6%] vs 42 [3.2%]; RR 2.07, 95% CI 1.4-2.9; P<0.001). In total, 92 (3.5%) infants had adverse perinatal outcomes, with no significant differences between groups. CONCLUSION Continuous FHR monitoring increased identification of abnormal FHR and subsequent intrauterine resuscitations. ClinicalTrials.gov: NCT02790814.
Collapse
Affiliation(s)
- Paschal F Mdoe
- Haydom Lutheran Hospital, Mbulu, Tanzania.,Department of Health Science, University of Stavanger, Stavanger, Norway
| | - Hege L Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Estomih Mduma
- Haydom Lutheran Hospital, Mbulu, Tanzania.,Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Robert Moshiro
- Department of Health Science, University of Stavanger, Stavanger, Norway.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Hussein Kidanto
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Aga Khan University, Dar es Salaam, Tanzania
| |
Collapse
|
13
|
Mendis R, Flatley C, Kumar S. Maternal demographic factors associated with emergency caesarean section for non-reassuring foetal status. J Perinat Med 2018; 46:641-647. [PMID: 29171962 DOI: 10.1515/jpm-2017-0142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/31/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to determine maternal and obstetric factors associated with emergency caesarean section (CS) for non-reassuring foetal status (NRFS). MATERIALS AND METHODS This was a retrospective analysis of term singleton births between January 2007 and December 2015 at the Mater Mother's Hospital in Brisbane. The study group comprised all cases of emergency CS for NRFS, and the control cohort comprised all other births meeting the inclusion criteria but excluding those in the study cohort. RESULTS Over the study period, there were 74,177 births fulfilling the inclusion criteria. The overall rate of emergency CS for NRFS was 4.2% (3132/74,177). Multivariate analysis showed that being overweight and obese, Indian and "other" ethnicity, artificial reproductive techniques, smoking, induction of labour and gestation at 39-42 weeks were associated with an increased risk, whereas being underweight, female sex, hypertension and birth without labour conferred a lower risk. CONCLUSION Many maternal and obstetric factors were associated with emergency CS for NRFS and influenced adverse perinatal outcomes. Recognition of these risk factors could help risk stratify women prior to labour.
Collapse
Affiliation(s)
- Ramali Mendis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Christopher Flatley
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- School of Medicine, The University of Queensland, Brisbane, Australia.,Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia, Tel.: +617 31638844
| |
Collapse
|
14
|
Ngwenya S. Stillbirth rate and causes in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe. Trop Doct 2018; 48:310-313. [PMID: 30089419 DOI: 10.1177/0049475518789030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A global concern is to end preventable stillbirths by the year 2030. The objective of this study was to document the stillbirth rate and causes of stillbirths in a low-resource setting. This was a retrospective descriptive study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in Bulawayo, Zimbabwe during the period January to December 2016. There were 8801 live births and 268 stillbirths (rate: 30.5/1000). The majority(81.3%) were macerated. Pre-term labour, pre-eclampsia, eclampsia and abruptio placenta accounted for 51.1%. In 29.9%, the cause could not be identified. A high proportion of macerated stillbirths were unexplained; hence this calls for a renewed focus on community-based approaches to reduce delays in seeking care. Investment in robust diagnostic means and further training of healthcare workers to improve case definition are both urgently required.
Collapse
Affiliation(s)
- Solwayo Ngwenya
- 1 Consultant Obstetrician and Gynaecologist, Head of Department of Obstetrics & Gynaecology, Clinical Director, Mpilo Central Hospital, Mzilikazi, Zimbabwe.,2 Founder and Chief Executive Officer, Royal Women's Clinic, Hillside, Zimbabwe.,3 Part-Lecturer, National University of Science and Technology, Medical School, Bulawayo, Matabeleland, Zimbabwe
| |
Collapse
|
15
|
Tosif S, Nasi T, Gray A, Sadr-Azodi N, Ogaoga D, Duke T. Assessment of the quality of neonatal care in the Solomon Islands. J Paediatr Child Health 2018; 54:165-171. [PMID: 28905447 DOI: 10.1111/jpc.13686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/15/2017] [Accepted: 07/21/2017] [Indexed: 01/01/2023]
Abstract
AIM To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower-middle-income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under-5 deaths (30.1/1000). METHODS A cross-sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited. RESULTS Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) 'fresh' stillbirths and 96 (1.8%) 'macerated' stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life. CONCLUSIONS Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health-care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.
Collapse
Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Titus Nasi
- Department of Paediatrics, National Referral Hospital, Honiara, Solomon Islands
| | - Amy Gray
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nahad Sadr-Azodi
- Child Survival and Development, United Nations Children's Fund, Suva, Fiji
| | - Divi Ogaoga
- Reproductive and Child Health Division, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Ersdal HL, Eilevstjønn J, Linde JE, Yeconia A, Mduma ER, Kidanto H, Perlman J. Fresh stillborn and severely asphyxiated neonates share a common hypoxic-ischemic pathway. Int J Gynaecol Obstet 2018; 141:171-180. [PMID: 29250782 DOI: 10.1002/ijgo.12430] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/24/2017] [Accepted: 12/15/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize, among non-breathing flaccid neonates at delivery, immediate heartrate and responses to ventilation in relation to the clinical diagnosis of fresh stillbirth (FSB) or early neonatal death (END) within 24 hours. METHODS The present cross-sectional study included all deliveries at Haydom Hospital in rural Tanzania between July 1, 2013, and July 31, 2016. Ventilation parameters and heartrate were recorded by monitors with ventilation and dry-electrocardiography sensors. Perinatal characteristics were recorded on data forms by trained research assistants. RESULTS Among 12 789 neonates delivered, 915 were ventilated; among ventilated neonates, there were 53 (6%) FSBs and 64 (7%) ENDs. Electrocardiography was used in 46 FSBs and 55 ENDs, and these neonates were included in a subanalysis. Initial heartrate was detected in 27 (59%) of 46 FSBs and 52 (95%) of 55 ENDs, and was lower in FSBs (52 ± 19 vs 76 ± 37 bpm; P=0.003). More ENDs responded to ventilation (53% vs 9%; P<0.001), with heartrate increasing above 100 bpm. Heartrate at ventilation discontinuation was higher among ENDs (115 ± 49 vs 52 ± 33 bpm; P<0.001). CONCLUSION Progression to FSB or END after intrapartum hypoxia/anoxia is probably part of the same circulatory end-process. Distinguishing FSB from severely asphyxiated newborns is clinically difficult and probably influences estimated global perinatal mortality rates.
Collapse
Affiliation(s)
- Hege L Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical/Global Health, Stavanger, Norway
| | - Jørgen E Linde
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Anita Yeconia
- Department of Research, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Estomih R Mduma
- Department of Research, Haydom Lutheran Hospital, Haydom, Tanzania.,Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Hussein Kidanto
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Obstetrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jeffrey Perlman
- Department of Pediatrics, Weill Cornell Medical College, New York City, New York, USA
| |
Collapse
|
17
|
Chuwa FS, Mwanamsangu AH, Brown BG, Msuya SE, Senkoro EE, Mnali OP, Mazuguni F, Mahande MJ. Maternal and fetal risk factors for stillbirth in Northern Tanzania: A registry-based retrospective cohort study. PLoS One 2017; 12:e0182250. [PMID: 28813528 PMCID: PMC5557599 DOI: 10.1371/journal.pone.0182250] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/14/2017] [Indexed: 11/18/2022] Open
Abstract
Background Stillbirth is a major cause of perinatal mortality and occurs disproportionately in developing countries including Tanzania. However, there is scant information regarding the predictors of this condition in Tanzania. This study aimed to determine maternal and fetal risk factors for stilbirth in northen Tanzania. Methodology A retrospective cohort study was performed using maternally-linked data from the Kilimanjaro Christian Medical Centre birth registry. A total of 47681 women who had singleton delivery at KCMC between 2000 and 2014 were analyzed. Women with multiple gestations were excluded. Descriptive statistics were summarized using proportions and frequency. Chi-square test was used to determine risk factors for stillbirth in bivariate analysis. A multivariable regression model was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals for maternal and fetal factors associated with stillbirth. A p-value of less than 0.05 was considered statistically significant. Results The frequency of stillbirth was 3.5%. Pre-eclampsia (AOR 3.99; 95% CI: 3.31–4.81) and placental abruption (AOR 22.62; 95% CI: 15.41–33.19) were the strongest maternal risk factors associated with still birth. While non-cephalic presentation (AOR 6.05; 95% CI: 4.77–7.66) and low birth weight (AOR 9.66; 95%CI: 8.66–10.77) were the fetal factors with the greatest impact on stillbirth. Conclusion The rate of stillbirth in our study was consistent with past studies of developing countries. Numerous maternal and fetal factors risk factors were identified. Early identification of at risk pregnancies and appropriate intervention may help to reduce the occurrence of stillbirth.
Collapse
Affiliation(s)
- Francisca S. Chuwa
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Amasha H. Mwanamsangu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Benjamin G. Brown
- Department of Global Health,Weill Cornell Medical College, New York, NY, United States of America
| | - Sia E. Msuya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elizabeth E. Senkoro
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Oresta P. Mnali
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Festo Mazuguni
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J. Mahande
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| |
Collapse
|
18
|
Downes KL, Grantz KL, Shenassa ED. Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review. Am J Perinatol 2017; 34:935-957. [PMID: 28329897 PMCID: PMC5683164 DOI: 10.1055/s-0037-1599149] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes. Methods We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption. Results A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy. Conclusion Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.
Collapse
Affiliation(s)
- Katheryne L. Downes
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Obstetrics and Gynecology, Center for Research in Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Edmond D. Shenassa
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, Maryland
| |
Collapse
|
19
|
Mgaya A, Hinju J, Kidanto H. Is time of birth a predictor of adverse perinatal outcome? A hospital-based cross-sectional study in a low-resource setting, Tanzania. BMC Pregnancy Childbirth 2017; 17:184. [PMID: 28606111 PMCID: PMC5469024 DOI: 10.1186/s12884-017-1358-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/26/2017] [Indexed: 12/25/2022] Open
Abstract
Background Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes. Methods A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients’ socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed for their association with time of delivery and prevalence of fresh stillbirth as a proxy for poor perinatal outcome at a significance level of p = 0.05. Results Off-hour deliveries were nearly twice as likely to occur during the night shift (odds ratio (OR), 1.62; 95% confidence interval (CI), 1.50–1.72), but were unlikely during the evening shift (OR, 0.58; 95% CI, 0.45–0.71) (all p < 0.001). Neonatal distress (O.R, 1.48, 95% CI; 1.07–2.04, p = 0.02), early neonatal deaths (OR, 1.70; 95% CI, 1.07–2.72, p = 0.03) and fresh stillbirths (OR, 1.95; 95% CI, 1.31–2.90, p = 0.001) were more significantly associated with deliveries occurring during night shifts compared to evening and morning shifts. However, fresh stillbirths occurring during the night shift were independently associated with antenatal admission from clinics or wards, referral from another hospital, and abnormal breech delivery (OR 1.9; 95% CI, 1.3–2.9, p = 0.001, for fresh stillbirths; OR, 5.0; 95% CI 1.7–8.3, p < 0.001, for antenatal admission; OR, 95% CI, 1.1–2.9, p < 0.001, for referral form another hospital; and OR 1.6; 95% CI 1.02–2.6, p = 0.004, for abnormal breech deliveries). Conclusion Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of adverse perinatal outcomes, including low Apgar score, early neonatal death and fresh stillbirth, compared to morning and evening shifts. Labour room admissions from antenatal wards, referrals from another hospital and abnormal breech delivery were independent risk factors for poor perinatal outcome, particularly fresh stillbirths.
Collapse
Affiliation(s)
- Andrew Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. .,Department of Women's and Children's Health, International Maternal and Child Health, Academic Hospital, Uppsala, Sweden.
| | - Januarius Hinju
- Department of Obstetrics and Gynaecology, Benjamin Mkapa referral Hospital, Dodoma, Tanzania
| | - Hussein Kidanto
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.,Department of Women's and Children's Health, International Maternal and Child Health, Academic Hospital, Uppsala, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
20
|
Mgaya AH, Kidanto HL, Nystrom L, Essén B. Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania. PLoS One 2016; 11:e0166619. [PMID: 27893765 PMCID: PMC5125608 DOI: 10.1371/journal.pone.0166619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting. Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases that are assigned caesarean section, re-training and supervision on use and interpretation of partograph and, strengthening team work between doctors, mid-wives and theatre staff. After implementing these interventions in March, a re-audit was performed from July 2015 to November, 2015, and the results were compared to those of the baseline audit. Results Two hundred and sixty deliveries in the baseline survey and 250 deliveries in the follow-up survey were audited. Implementing the new criteria improved the diagnosis from 74% to 81% (p = 0.049) and also the management of obstructed labour from 4.2% at baseline audit to 9.2% at re-audit (p = 0.025). Improved detection of prolonged labour through heightened observation of regular contractions, protracted cervical dilatation, protracted descent of presenting part, arrested cervical dilation, and severe moulding contributed to improved standards of diagnosis (all p < 0.04). Patient reviews by senior obstetricians increased from 34% to 43% (p = 0.045) and reduced time for caesarean section intervention from the median time of 120 to 90 minutes (p = 0.001) improved management (all p < 0.05). Perinatal outcomes, neonatal distress and fresh stillbirths, were reduced from 16% to. 8.8% (p = 0.01). Conclusion A criteria-based audit proved to be a feasible and useful tool in improving diagnosis and management of obstructed labour using available resources. Some of the observed changes in practice were of modest magnitude implying demand for further improvements, while sustaining those already put in place.
Collapse
Affiliation(s)
- Andrew H. Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Hussein L. Kidanto
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- Reproductive and Child Health section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Lennarth Nystrom
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
21
|
Mgaya AH, Litorp H, Kidanto HL, Nyström L, Essén B. Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania. BMC Pregnancy Childbirth 2016; 16:343. [PMID: 27825311 PMCID: PMC5101816 DOI: 10.1186/s12884-016-1137-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting. METHODS During 2013-2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for standard diagnosis and management of foetal distress were developed based on international and national guidelines, and literature reviews, and then, stepwise applied, in an audit cycle. During the baseline audit, substandard care was identified, and recommendations for improvement of care were proposed and implemented. The effect of the implementations was assessed by the differences in percentage of standard diagnosis and management between the baseline and re-audit, using Chi-square test or Fisher's exact test, when appropriate. RESULTS In the baseline audit and re-audit, 248 and 251 deliveries with a diagnosis of foetal distress were identified and audited, respectively. The standard of diagnosis increased significantly from 52 to 68 % (p < 0.001). Standards of management improved tenfold from 0.8 to 8.8 % (p < 0.001). Improved foetal heartbeat monitoring using a Fetal Doppler was the major improvement in diagnoses, while change of position of the mother and reduced time interval from decision to perform caesarean section to delivery were the major improvements in management (all p < 0.001). Percentage of cases with substandard diagnosis and management was significantly reduced in both referred public and non-referred private patients (all p ≤ 0.01) but not in non-referred public and referred private patients. CONCLUSION The criteria-based audit was able to detect substandard diagnosis and management of foetal distress and improved care using feedback and available resources.
Collapse
Affiliation(s)
- Andrew H. Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Helena Litorp
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Hussein L. Kidanto
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- Reproductive and Child Health section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health/International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|