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Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Kurjak A, Medjedovic E, Stanojević M. Use and misuse of ultrasound in obstetrics with reference to developing countries. J Perinat Med 2023; 51:240-252. [PMID: 36302110 DOI: 10.1515/jpm-2022-0438] [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: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
Abstract
Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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The place of prenatal visits in pregnancy care: Should we reconsider the current approach? Ann Med Surg (Lond) 2023; 85:355-357. [PMID: 36845777 PMCID: PMC9949858 DOI: 10.1097/ms9.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
Abstract
A well-conducted prenatal visit remains of paramount importance because it allows the preservation of mother and child health by reducing the rates of morbidity and mortality for them. However, the quality of prenatal visits remains a serious problem in our environment, and a new approach is urgently needed to improve the quality of prenatal visits in our environment.
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Musse I, Thornton R, Ghimire D. How Do Women Learn They Are Pregnant? The Introduction of Clinics and Pregnancy Awareness in Nepal. Stud Fam Plann 2022; 53:43-59. [PMID: 34878176 PMCID: PMC8957515 DOI: 10.1111/sifp.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant's health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects earlier pregnancy knowledge. Using 10 years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 4.6th month of pregnancy. Living approximately a mile further from a clinic offering pregnancy tests increases the time a woman knows she is pregnant by one week (5 percent increase) and decreases the likelihood of knowing in the first trimester by 4.5 percentage points (16 percent decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge. These results suggest that, while access to clinics can increase pregnancy awareness for women who recognize pregnancy symptoms, other complementary policies are needed to increase pregnancy awareness of women in their first pregnancy.
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Affiliation(s)
- Isabel Musse
- Mathematica Policy Research, Chicago, IL, 60601, USA
| | - Rebecca Thornton
- Department of Economics, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Dirgha Ghimire
- Populations Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48106, USA
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Ashworth HC, Roux TL, Buggy CJ. Healthcare accessibility in the rural plains (terai) of Nepal: physical factors and associated attitudes of the local population. Int Health 2020; 11:528-535. [PMID: 30916330 DOI: 10.1093/inthealth/ihz008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/13/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While access to healthcare has been a focus of international development, populations around the world continue to lack proper access to care. Identifying at-risk demographic groups can help advance efforts both regionally and internationally. There are only a small number of studies that previously have assessed physical barriers and attitudes in Nepal. METHODS This study assessed the factors and attitudes associated with healthcare accessibility in a rural population outside of Lumbini, Nepal. This descriptive cross-sectional study used a volunteer-sampling approach to collect 585 questionnaire responses from the area formerly known as the Madhuwani Village Development Committee. RESULTS The study found that the population was more likely to access private care than public, and reported longer times to access a hospital than the national average. Across almost all findings, those with lower than a secondary education had significantly larger barriers, lower satisfaction and higher reported difficulty in accessing healthcare. Females were shown to have significantly larger transportation barriers in accessing care and lower satisfaction compared with males. CONCLUSIONS Results identify women and the less-educated as having larger barriers to accessing healthcare. Further research should focus on how inequities in access affect health outcomes among these identified vulnerable groups.
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Affiliation(s)
- Henry C Ashworth
- School of Public Health, Physiotherapy and Sports Science, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Thomas L Roux
- School of Public Health, Physiotherapy and Sports Science, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Conor J Buggy
- School of Public Health, Physiotherapy and Sports Science, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
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Kim ET, Singh K, Moran A, Armbruster D, Kozuki N. Obstetric ultrasound use in low and middle income countries: a narrative review. Reprod Health 2018; 15:129. [PMID: 30029609 PMCID: PMC6053827 DOI: 10.1186/s12978-018-0571-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although growing, evidence on the impact, access, utility, effectiveness, and cost-benefit of obstetric ultrasound in resource-constrained settings is still somewhat limited. Hence, questions around the purpose and the intended benefit as well as potential challenges across various domains must be carefully reviewed prior to implementation and scale-up of obstetric ultrasound technology in low-and middle-income countries (LMICs). MAIN BODY This narrative review discusses these issues for those trying to implement or scale-up ultrasound technology in LMICs. Issues addressed in this review include health personnel capacity, maintenance, cost, overuse and misuse of ultrasound, miscommunication between the providers and patients, patient diagnosis and care management, health outcomes, patient perceptions and concerns about fetal sex determination. CONCLUSION As cost of obstetric ultrasound becomes more affordable in LMICs, it is essential to assess the benefits, trade-offs and potential drawbacks of large-scale implementation. Additionally, there is a need to more clearly identify the capabilities and the limitations of ultrasound, particularly within the context of limited training of providers, to ensure that the purpose for which an ultrasound is intended is actually feasible. We found evidence of obstetric uses of ultrasound improving patient management. However, there was evidence that ultrasound use is not associated with reducing maternal, perinatal or neonatal mortality. Patients in various studies reported to have both positive and negative perceptions and experiences related to ultrasound and lastly, illegal use of ultrasound for determining fetal sex was raised as a concern.
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Affiliation(s)
- Eunsoo Timothy Kim
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27516 USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Square, Suite 210, 123 West Franklin St, Chapel Hill, NC 27516 USA
| | - Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27516 USA
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Square, Suite 330, 123 West Franklin St, Chapel Hill, NC 27516 USA
| | - Allisyn Moran
- US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523 USA
| | - Deborah Armbruster
- US Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523 USA
| | - Naoko Kozuki
- International Rescue Committee, 1730 M St. NW Suite 505, Washington, DC 20036 USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205 USA
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Kozuki N, Mullany LC, Khatry SK, Tielsch JM, LeClerq SC, Kennedy CE, Katz J. Perceptions, careseeking, and experiences pertaining to non-cephalic births in rural Sarlahi District, Nepal: a qualitative study. BMC Pregnancy Childbirth 2018; 18:89. [PMID: 29636021 PMCID: PMC5894138 DOI: 10.1186/s12884-018-1724-2] [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: 02/22/2016] [Accepted: 03/29/2018] [Indexed: 11/12/2022] Open
Abstract
Background In low-resource settings, a significant proportion of fetal, neonatal, and maternal deaths can be attributed to intrapartum-related complications. Certain risk factors, such as non-cephalic presentation, have a particularly high risk of complications. This qualitative study describes experiences around non-cephalic births and highlights existing perceptions and care-seeking behavior specific to non-cephalic presentation in rural Sarlahi District, Nepal. Methods We conducted in-depth interviews with 34 individuals, including women who recently gave birth to a non-cephalic infant and female decision-makers in their households. We also conducted two focus groups with mothers (have two or more children, with at least one child under age five) and two focus groups with grandmothers in the community. Results Several women described scenes of obstructed labor and practices like provision of unspecified injections early in labor to assist with the delivery. There were reports of arduous care-seeking processes from primary health centers to tertiary facilities, and mixed quality of care among home birth attendants and facility-based health workers respectively. Very few women were aware of the fetal presentation prior to delivery, and we identified no consistent understanding among participants of the risks of and care strategies for non-cephalic births. Risk perception around non-cephalic presentation varied widely. Some participants were acutely aware of potential dangers, while others had not heard of non-cephalic birth. Many interviewees said that the position in which a pregnant woman sleeps could impact the fetal position. Several participants had either taken or heard of medication intended to rotate the fetus into the correct position. Conclusions Our findings suggest the mixed quality of and access to care associated with non-cephalic birth and a lack of consistent understanding of the risk of and care for non-cephalic births in rural Nepal. The high risk of the condition and the recommended tertiary care present a dilemma in low-resource settings; the logistical difficulties and the mixed quality of care make care-seeking and referral decisions complex. While public health stakeholders strive to improve the quality of and access to the formal health system, those players must also be sensitive to the potential negative implications of promoting institutional care-seeking. Electronic supplementary material The online version of this article (10.1186/s12884-018-1724-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 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 Bloomberg School of Public Health, Baltimore, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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