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Muhumuza Kananura R. Unmasking the complexities of healthcare access in low-resource settings: a health systems approach to obstetric and under-5 healthcare in rural settings of Eastern Uganda. Glob Health Action 2024; 17:2397163. [PMID: 39246167 PMCID: PMC11391869 DOI: 10.1080/16549716.2024.2397163] [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: 10/06/2023] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Access to appropriate obstetric and under-5 healthcare services in low-resource settings is a challenge in countries with high mortality rates. However, the interplay of multiple factors within an ecological system affects the effectiveness of the health system in reaching those in need. OBJECTIVE This study examined how multiple factors concurrently affect access to obstetric and child healthcare services in resource-poor settings. METHODS The research used social autopsies [in-depth interview] with mothers who experienced newborn death [n = 29], focus group discussions [n = 8] with mothers [n = 32], and fathers [n = 28] of children aged 6-59 months, and the author's field observations in Eastern Uganda's rural settings. The research employed narrative and inductive thematic analysis, guided by concepts of social interactions, behaviour, and health institutional systems drawn from system theory. RESULTS The study unmasked multiple concurrent barriers to healthcare access at distinct levels. Within families, the influence of mothers-in-law and gender dynamics constrains women's healthcare-seeking autonomy and agency. At the community level, poor transport system, characterised by long distances and challenging road conditions, consistently impede healthcare access. At the facility level, attitudes, responsiveness, and service delivery of health workers critically affect healthcare access. Negative experiences at health facilities profoundly discourage the community from seeking future health services. CONCLUSION The findings emphasise the persistent influence of structural and social factors that, although well documented, are often overlooked and continue to limit women's agency and autonomy in healthcare access. Enhancing universal access to appropriate healthcare services requires comprehensive health systems interventions that concurrently address the healthcare access barriers.
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Affiliation(s)
- Rornald Muhumuza Kananura
- African Population and Health Research Center, Nairobi, Kenya
- Centre of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- School of Economics and Political Science, Department of International Development, Houghton St, London, UK
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2
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Ronen K, Pothan LC, Apondi V, Otieno FA, Mwakanema D, Otieno FO, Osborn L, Dettinger JC, Shrestha P, Manguerra H, Mukumbang F, Masinde M, Waweru E, Amulele M, Were C, Wasunna B, John-Stewart G, Weiner B, Means AR, Richardson BA, Hedstrom AB, Unger JA, Kinuthia J. Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial. Trials 2024; 25:657. [PMID: 39367450 DOI: 10.1186/s13063-024-08501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/23/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Provision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya's national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow. METHODS The effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO's effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data. DISCUSSION We hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention's integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented. TRIAL REGISTRATION ClinicalTrials.gov, NCT05187897 . The CHV-NEO study was registered on January 12, 2022.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Lincoln C Pothan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Violet Apondi
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix A Otieno
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Felix O Otieno
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Lusi Osborn
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Priyanka Shrestha
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Helena Manguerra
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Millicent Masinde
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | | | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Anna B Hedstrom
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Brown University, Women and Infants Hospital, Providence, RI, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
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Vadla MS, Mduma ER, Kvaløy JT, Mdoe P, Hhoki BH, Sarangu S, Michael P, Oftedal B, Ersdal H. Increase in Newborns Ventilated Within the First Minute of Life and Reduced Mortality After Clinical Data-Guided Simulation Training. Simul Healthc 2024; 19:271-280. [PMID: 37462472 PMCID: PMC11446515 DOI: 10.1097/sih.0000000000000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Birth asphyxia-related deaths is a major global concern. Rapid initiation of ventilation within the "Golden Minute" is important for intact survival but reported to be challenging, especially in low-/middle-income countries. Helping Babies Breathe (HBB) is a simulation-based training program for newborn resuscitation. The aim of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes. METHOD Prospective observational QI study in a rural Tanzanian hospital, October 1, 2017, to August 31, 2021, first-year baseline, second-year QI/simulation intervention, and 2-year postintervention. Trained research assistants observed wide-ranging information from all births (N = 12,938). The intervention included monthly targeted HBB simulation training addressing documented gaps in clinical care, clinical debriefings, and feedback meetings. RESULTS During the QI/simulation intervention, 68.5% nonbreathing newborns were ventilated within 60 seconds after birth compared with 15.8% during baseline and 42.2% and 28.9% during the 2 postintervention years ( P < 0.001). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds ( P < 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds after intervention. More nonbreathing newborns were ventilated in the intervention period (12.9%) compared with baseline (8.5%) and the postintervention years (10.6% and 9.4%) ( P < 0.001). Assumed fresh stillborns decreased significantly from baseline to intervention (3.2%-0.7%) ( P = 0.013). CONCLUSIONS This QI study demonstrates an increase in nonbreathing newborns being ventilated within the Golden Minute and a significant reduction in fresh stillborns after introduction of an HBB QI/simulation intervention. Improvements are partially reversed after intervention, highlighting the need for continuous simulation-based training and research into QI efforts essential for sustainable changes.
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Boah M, Abanga EA, Adokiya MN. Quality of antenatal care services received by women of reproductive age prior to delivery in selected public health facilities in the northern zone of Ghana. BMC Health Serv Res 2024; 24:1063. [PMID: 39272145 PMCID: PMC11401296 DOI: 10.1186/s12913-024-11491-1] [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: 07/04/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Over the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana. METHODS We conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable. RESULTS Of the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women's background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99). CONCLUSIONS A significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study's setting for pregnant women to benefit from comprehensive ANC services.
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Affiliation(s)
- Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana.
- Center for Population Health, Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda.
| | - Emmanuel Akolgo Abanga
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
- Department of Paediatrics and Child Welfare, Tamale Teaching Hospital, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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5
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Mazumder T, Mohanty I, Ahmad D, Niyonsenga T. An explanation of the stagnant under-5 mortality rate in Bangladesh using multilevel, multivariable analysis of three Demographic and Health Surveys. Sci Rep 2024; 14:19823. [PMID: 39191813 PMCID: PMC11349969 DOI: 10.1038/s41598-024-69924-0] [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: 11/21/2023] [Accepted: 08/09/2024] [Indexed: 08/29/2024] Open
Abstract
Despite remarkable success in the Millennium Development Goal era, Bangladesh experienced a sluggish reduction in the under-5 mortality rate (U5MR) between 2014 and 2017-18. Our study aimed to explain this stagnancy by examining the variation in the key predictor-specific mortality risks over time, using the Bangladesh Demographic and Health Survey 2011, 2014 and 2017-18 data. We applied multilevel mixed effects logistic regression to examine the extent to which the under-5 mortality (U5M) risks were associated with the key sociodemographic and health service-specific predictors. We found that the rise in mortality risks attributable to maternal age 18 years or below, low maternal education, mother's overweight or obesity and the absence of a handwashing station within the household were the key contributors to the stagnant U5MR between 2014 and 2017-18. Poverty and low education aggravated the mortality risks. Besides, antenatal care (ANC) and postnatal care (PNC) did not impact U5M risks as significantly as expected. Compulsory use of ANC and PNC cards and strict monitoring of their use may improve the quality of these health services. Leveraging committees like the Upazila Hospital Management Committee can bring harmony to implementing policies and programmes in the sectors related to U5M.
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Affiliation(s)
- Tapas Mazumder
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, 2617, Australia.
| | - Itismita Mohanty
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, 2617, Australia
| | - Danish Ahmad
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, 2617, Australia
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia
| | - Theo Niyonsenga
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, 2617, Australia
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6
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Shafiq Y, Fung A, Driker S, Rees CA, Mediratta RP, Rosenberg R, Hussaini AS, Adnan J, Wade CG, Chou R, Edmond KM, North K, Lee AC. Predictive Accuracy of Infant Clinical Sign Algorithms for Mortality in Young Infants Aged 0 to 59 Days: A Systematic Review. Pediatrics 2024; 154:e2024066588E. [PMID: 39087802 DOI: 10.1542/peds.2024-066588e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/02/2024] Open
Abstract
CONTEXT Clinical sign algorithms are a key strategy to identify young infants at risk of mortality. OBJECTIVE Synthesize the evidence on the accuracy of clinical sign algorithms to predict all-cause mortality in young infants 0-59 days. DATA SOURCES MEDLINE, Embase, CINAHL, Global Index Medicus, and Cochrane CENTRAL Registry of Trials. STUDY SELECTION Studies evaluating the accuracy of infant clinical sign algorithms to predict mortality. DATA EXTRACTION We used Cochrane methods for study screening, data extraction, and risk of bias assessment. We determined certainty of evidence using Grading of Recommendations Assessment Development and Evaluation. RESULTS We included 11 studies examining 26 algorithms. Three studies from non-hospital/community settings examined sign-based checklists (n = 13). Eight hospital-based studies validated regression models (n = 13), which were administered as weighted scores (n = 8), regression formulas (n = 4), and a nomogram (n = 1). One checklist from India had a sensitivity of 98% (95% CI: 88%-100%) and specificity of 94% (93%-95%) for predicting sepsis-related deaths. However, external validation in Bangladesh showed very low sensitivity of 3% (0%-10%) with specificity of 99% (99%-99%) for all-cause mortality (ages 0-9 days). For hospital-based prediction models, area under the curve (AUC) ranged from 0.76-0.93 (n = 13). The Score for Essential Neonatal Symptoms and Signs had an AUC of 0.89 (0.84-0.93) in the derivation cohort for mortality, and external validation showed an AUC of 0.83 (0.83-0.84). LIMITATIONS Heterogeneity of algorithms and lack of external validation limited the evidence. CONCLUSIONS Clinical sign algorithms may help identify at-risk young infants, particularly in hospital settings; however, overall certainty of evidence is low with limited external validation.
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Affiliation(s)
- Yasir Shafiq
- Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università degli Studi del Piemonte Orientale "Amedeo Avogadro," Novara, Italy
- Center of Excellence for Trauma and Emergencies and Community Health Sciences, The Aga Khan University, Karachi, Pakistan
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
| | - Alastair Fung
- Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Driker
- Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Rishi P Mediratta
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Rebecca Rosenberg
- Department of Pediatrics, School of Medicine, New York University, New York, New York, United States
| | - Anum S Hussaini
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
| | - Jana Adnan
- American University of Beirut, Beirut, Lebanon
| | - Carrie G Wade
- Countway Library, Harvard Medical School, Boston, Massachusetts, United States
| | - Roger Chou
- Departments of Medicine and Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | | | - Krysten North
- Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Anne Cc Lee
- Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
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Kabajassi O, Reiter A, Tagoola A, Kenya-Mugisha N, O'Brien K, Wiens MO, Feeley N, Duby J. Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda. Acta Paediatr 2024; 113:1845-1851. [PMID: 38411347 DOI: 10.1111/apa.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
AIM Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.
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Affiliation(s)
| | - Anna Reiter
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | | | | | - Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew O Wiens
- Walimu, Kampala, Uganda
- Centre for International Child Health, BC Children's & Women's Hospital, Vancouver, British Columbia, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
- Centre for Nursing Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Jessica Duby
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Hukill JF, Blanco MA, ElSeed Peterson EE, Torres CM. Maternal Postpartum Depression Screening and Early Intervention in the Neonatal Intensive Care Unit. Adv Pediatr 2024; 71:55-67. [PMID: 38944489 DOI: 10.1016/j.yapd.2024.01.004] [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] [Indexed: 07/01/2024]
Abstract
Families with infants admitted to the neonatal intensive care unit (NICU) are at a markedly increased risk of developing postpartum depression (PPD) because of the stressors they experience by having an infant in this intensive setting. Routine screening for PPD is not regularly performed for these families because many NICUs do not offer it and well-child visits are missed while the infant is hospitalized. Because the identification and treatment of PPD is often missed in these families, screening needs to be administered in the NICU to ensure improved outcomes.
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Affiliation(s)
- Jessica F Hukill
- Department of Pediatrics, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
| | - Michelle A Blanco
- Division of General Academic Pediatrics, Department of Pediatrics, University of South Florida, 17 Davis Boulevard Suite #100, Tampa, FL 33606, USA
| | - Erica E ElSeed Peterson
- Division of Neonatology, Department of Pediatrics, University of South Florida, 5 Tampa General Circle, 4th Floor Suite 450, Tampa, FL 33606, USA
| | - Chelsea M Torres
- Division of General Academic Pediatrics, Department of Pediatrics, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024; 42:843-863. [PMID: 38819718 PMCID: PMC11249496 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
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10
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Meher S. Clinical algorithms in labour and childbirth care: Prospects and challenges. BJOG 2024; 131 Suppl 2:3-5. [PMID: 36468347 DOI: 10.1111/1471-0528.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Bonet M, Ciabati L, De Oliveira LL, Souza R, Browne JL, Rijken M, Fawcus S, Hofmeyr GJ, Liabsuetrakul T, Gülümser Ç, Blennerhassett A, Lissauer D, Meher S, Althabe F, Oladapo OT. Constructing evidence-based clinical intrapartum care algorithms for decision-support tools. BJOG 2024; 131 Suppl 2:6-16. [PMID: 35411684 DOI: 10.1111/1471-0528.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
AIM To describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours. POPULATION Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility. SETTING Health facilities in low- and middle-income countries. SEARCH STRATEGY Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google. CASE SCENARIOS Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes. CONCLUSIONS Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts. TWEETABLE ABSTRACT Evidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience.
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Affiliation(s)
- M Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - L Ciabati
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L L De Oliveira
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - R Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - J L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - M Rijken
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - S Fawcus
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G J Hofmeyr
- Effective Care Research Unit, Walter Sisulu University and Eastern Cape Department of Health, University of the Witwatersrand, East London, South Africa
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - T Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ç Gülümser
- Department of Obstetrics and Gynecology, University of Health Science School of Medicine, Ankara, Turkey
| | - A Blennerhassett
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- World Health Organization Collaborating Centre for Global Women's Health Research, Birmingham, UK
| | - D Lissauer
- Malawi-Liverpool-Wellcome Trust Research Institute, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, William Henry Duncan Building, University of Liverpool, Liverpool, UK
| | - S Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - F Althabe
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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12
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Wilson EB, Niehaus L, Jiwani SS, Hazel EA, Maïga A, Amouzou A. Delivery and postnatal care among women in 71 low- and middle-income countries: analyzing coverage gaps using household surveys. BMC Pregnancy Childbirth 2024; 24:505. [PMID: 39060978 PMCID: PMC11282627 DOI: 10.1186/s12884-024-06681-y] [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: 03/06/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND High levels of maternal morbidity and mortality persist in low- and middle-income countries, despite increases in coverage of facility delivery and skilled assistance at delivery. We compared levels of facility birth to a summary delivery care measure and quantified gaps. METHODS We approximated a delivery care score from type of delivery (home, lower-level facility, or hospital), skilled attendant at delivery, a stay of 24-or-more-hours after delivery, and a health check within 48-h after delivery. Data were obtained from 333,316 women aged 15-49 who had a live birth in the previous 2 years, and from 71 countries with nationally representative surveys between 2013 and 2020. We computed facility delivery and delivery care coverage estimates to assess the gap. We stratified the analysis by country characteristics, including the national maternal mortality ratio (MMR), to assess the size of coverage gaps, and we assessed missed opportunities through coverage cascades. We looked at the association between MMR and delivery care coverage. RESULTS Delivery care coverage varied by country, ranging from 24% in Sudan to 100% in Cuba. Median coverage was 70% with an interquartile range of 30 percentage points (55% and 85%). The cascade showed that while 76% of women delivered in a facility, only 41% received all four interventions. Coverage gaps exist across all MMR levels. Gaps between highest and lowest wealth quintiles were greatest in countries with MMR levels of 100 or higher, and the gap narrowed in countries with MMR levels below 100. The delivery care indicator had a negative association with MMR. CONCLUSIONS In addition to providing high-quality evidenced-based care to women during birth and the postpartum period, there is also a need to address gaps in delivery care, which occur within and between countries, wealth quintiles, and MMR phases.
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Affiliation(s)
- Emily B Wilson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lori Niehaus
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Safia S Jiwani
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Hazel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdoulaye Maïga
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Agbessi Amouzou
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Strunk T, Molloy EJ, Mishra A, Bhutta ZA. Neonatal bacterial sepsis. Lancet 2024; 404:277-293. [PMID: 38944044 DOI: 10.1016/s0140-6736(24)00495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 07/01/2024]
Abstract
Neonatal sepsis remains one of the key challenges of neonatal medicine, and together with preterm birth, causes almost 50% of all deaths globally for children younger than 5 years. Compared with advances achieved for other serious neonatal and early childhood conditions globally, progress in reducing neonatal sepsis has been much slower, especially in low-resource settings that have the highest burden of neonatal sepsis morbidity and mortality. By contrast to sepsis in older patients, there is no universally accepted neonatal sepsis definition. This poses substantial challenges in clinical practice, research, and health-care management, and has direct practical implications, such as diagnostic inconsistency, heterogeneous data collection and surveillance, and inappropriate treatment, health-resource allocation, and education. As the clinical manifestation of neonatal sepsis is frequently non-specific and the current diagnostic standard blood culture has performance limitations, new improved diagnostic techniques are required to guide appropriate and warranted antimicrobial treatment. Although antimicrobial therapy and supportive care continue as principal components of neonatal sepsis therapy, refining basic neonatal care to prevent sepsis through education and quality improvement initiatives remains paramount.
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Affiliation(s)
- Tobias Strunk
- Neonatal Directorate, King Edward Memorial Hospital, Child and Adolescent Health Service, Perth, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, University of Dublin and Trinity Research in Childhood Centre, Dublin, Ireland; Children's Health Hospital at Tallaght, Tallaght University Hospital, Dublin, Ireland; Trinity Translational Medicine Institute, St James Hospital, Dublin, Ireland; Neonatology, Children's Health Hospital at Crumlin, Dublin, Ireland; Paediatrics, Coombe Women's and Infant's University Hospital, Dublin, Ireland
| | - Archita Mishra
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Institute for Global Health and Development, The Aga Khan University South-Central Asia, Karachi, Pakistan
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14
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Dako-Gyeke P, Asampong E, Glozah FN, Hornuvo R, Tabong PTN, Gittelman D, Nwameme A, Oteng B, Peprah NY, Chandi GM, Adongo PB. Assessing LLIN distribution implementation using evidence-informed intervention core elements: a qualitative study in a resource-constrained setting. BMC Health Serv Res 2024; 24:790. [PMID: 38982325 PMCID: PMC11234562 DOI: 10.1186/s12913-024-11223-5] [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: 11/17/2023] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The National Malaria Elimination Programme implements the mass LLIN Distribution Campaigns in Ghana. Implementation science promotes the systematic study of social contexts, individual experiences, real-world environments, partnerships, and stakeholder consultations regarding the implementation of evidence-informed interventions. In this paper, we assess the core elements of the mass LLIN distribution campaign in a resource constrained setting to learn best implementation practices. Three core domains were assessed through the application of Galbraith's taxonomy (i.e., implementation, content, and pedagogy) for evidence-informed intervention implementation. METHODS Six districts in two regions (Eastern and Volta) in Ghana participated in this study. Fourteen Focus Group Discussions (FGDs) were conducted across these communities. Eligible participants were purposively sampled considering age, occupation, gender, and care giving for children under 5 years and household head roles. All audio-recorded FGDs were transcribed verbatim, data was assessed and coded through deductive and inductive processes. NVivo software version 13 was used for the coding process. Themes were refined, legitimized, and the most compelling extracts selected to produce the results. RESULTS Sixty-nine (69) caregivers of children under 5 years and sixty (60) household heads participated in the FGDs. All caregivers were females (69), whilst household heads included more males (41). Core elements identified under implementation domain of the LLIN distribution campaign in Ghana include the registration and distribution processes, preceded by engagement with traditional authorities and continuous involvement of community health volunteers during implementation. For pedagogy domain, core elements include delivery of intervention through outreaches, illustrations, demonstrations, and the use of multiple communication channels. Core elements realized within the content domain include information on effective malaria prevention, and provision of information to enhance their self-efficacy. Yet, participants noted gaps (e.g., misuse) in the desired behavioural outcome of LLIN use and a heavy campaign focus on women. CONCLUSION AND RECOMMENDATIONS Although the implementation of the mass LLIN distribution campaigns exhibit components of core elements of evidence informed interventions (implementation, content and pedagogy), it has not achieved its desired behavioural change intentions (i.e. continuous LLIN use). Future campaigns may consider use of continuous innovative pedagogical approaches at the community level and lessons learnt from this study to strengthen the implementation process of evidence-based health interventions. There is also the need for standardization of core elements to identify the number of core elements required within each domain to achieve efficacy. ETHICAL APPROVAL Ethical clearance was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 002/06/21) before the commencement of all data collection.
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Affiliation(s)
- Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana.
| | - Franklin N Glozah
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Ruby Hornuvo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - David Gittelman
- Advisor, Health Campaign Effectiveness Coalition, Task Force for Global Health, Decatur, GA, USA
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Gloria M Chandi
- Ghana Health Service, Ga North Municipal Health Directorate, Greater Accra, Ghana
| | - Philip B Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
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15
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McDonald CM, Wessells KR, Stewart CP, Dewey KG, de Pee S, Rana R, Hafeez-Ur-Rehman H, Mwangi MN, Hess SY. Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13681. [PMID: 38949186 DOI: 10.1111/mcn.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Saskia de Pee
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | - Ritu Rana
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | | | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
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16
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Ward VC, Lee AC, Hawken S, Otieno NA, Mujuru HA, Chimhini G, Wilson K, Darmstadt GL. Overview of the Global and US Burden of Preterm Birth. Clin Perinatol 2024; 51:301-311. [PMID: 38705642 DOI: 10.1016/j.clp.2024.02.015] [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] [Indexed: 05/07/2024]
Abstract
Preterm birth (PTB) is the leading cause of morbidity and mortality in children globally, yet its prevalence has been difficult to accurately estimate due to unreliable methods of gestational age dating, heterogeneity in counting, and insufficient data. The estimated global PTB rate in 2020 was 9.9% (95% confidence interval: 9.1, 11.2), which reflects no significant change from 2010, and 81% of prematurity-related deaths occurred in Africa and Asia. PTB prevalence in the United States in 2021 was 10.5%, yet with concerning racial disparities. Few effective solutions for prematurity prevention have been identified, highlighting the importance of further research.
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Affiliation(s)
- Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA.
| | - Anne Cc Lee
- Department of Pediatrics, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research, 501 Smyth Road, Box 201-B, Ottawa, Ontario K1H 8L6, Canada
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Division of Global Health Protection, Box 1578 Kisumu 40100, Kenya
| | - Hilda A Mujuru
- Department of Child Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Gwendoline Chimhini
- Department of Child Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research, 501 Smyth Road, Box 201-B, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON K1N 5C8, Canada
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
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17
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Mendis L, Palaniswami M, Keenan E, Brownfoot F. Rapid detection of fetal compromise using input length invariant deep learning on fetal heart rate signals. Sci Rep 2024; 14:12615. [PMID: 38824217 PMCID: PMC11144251 DOI: 10.1038/s41598-024-63108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
Standard clinical practice to assess fetal well-being during labour utilises monitoring of the fetal heart rate (FHR) using cardiotocography. However, visual evaluation of FHR signals can result in subjective interpretations leading to inter and intra-observer disagreement. Therefore, recent studies have proposed deep-learning-based methods to interpret FHR signals and detect fetal compromise. These methods have typically focused on evaluating fixed-length FHR segments at the conclusion of labour, leaving little time for clinicians to intervene. In this study, we propose a novel FHR evaluation method using an input length invariant deep learning model (FHR-LINet) to progressively evaluate FHR as labour progresses and achieve rapid detection of fetal compromise. Using our FHR-LINet model, we obtained approximately 25% reduction in the time taken to detect fetal compromise compared to the state-of-the-art multimodal convolutional neural network while achieving 27.5%, 45.0%, 56.5% and 65.0% mean true positive rate at 5%, 10%, 15% and 20% false positive rate respectively. A diagnostic system based on our approach could potentially enable earlier intervention for fetal compromise and improve clinical outcomes.
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Affiliation(s)
- Lochana Mendis
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia.
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia
| | - Emerson Keenan
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, 3010, VIC, Australia
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, 3084, VIC, Australia
| | - Fiona Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, 3084, VIC, Australia
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Israel‐Ballard K, LaRose E, Mansen K. The global status of human milk banking. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 4:e13592. [PMID: 38318679 PMCID: PMC11184569 DOI: 10.1111/mcn.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 02/07/2024]
Abstract
Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health.
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Affiliation(s)
| | - Emily LaRose
- Harvard School of Public HealthBostonMassachusettsUSA
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19
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Dandona R, Kumar GA, Majumder M, Akbar M, Prasad Dora SS, Dandona L. Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100332. [PMID: 39021484 PMCID: PMC467073 DOI: 10.1016/j.lansea.2023.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 07/20/2024]
Abstract
Background Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. Methods All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. Findings A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. Interpretation With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. Funding The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Moutushi Majumder
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Md Akbar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - S Siva Prasad Dora
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - ENHANCE 2020 team
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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20
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Belay DM, Erku D, Bayih WA, Kassie YT, Minuye Birhane B, Assefa Y. Improving the quality of neonatal health care in Ethiopia: a systematic review. Front Med (Lausanne) 2024; 11:1293473. [PMID: 38841585 PMCID: PMC11150606 DOI: 10.3389/fmed.2024.1293473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. Methods We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Results We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. Conclusions This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.
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Affiliation(s)
- Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Erku
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Wubet Alebachew Bayih
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Terefe B, Belachew TB, Asmamaw DB, Wassie GT, Azene AG, Eshetu HB, Muchie KF, Bantie GM, Bogale KA, Negash WD. Determinants of early initiation of breastfeeding following birth in West Africa: A multilevel analysis using data from multi-country national health surveys. PLoS One 2024; 19:e0302143. [PMID: 38753614 PMCID: PMC11098389 DOI: 10.1371/journal.pone.0302143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF), within the first hour of birth, is crucial for promoting exclusive breastfeeding and establishing optimal nursing practices. However, global EIBF rates remain low, with even lower rates observed in Africa. Despite existing research gaps, this study aims to determine the prevalence of EIBF and identify maternal and child-related factors associated with its practice in West Africa. METHODS This study utilized West African Demographic and Health Survey (DHS) data from 13 countries, including 146,964 children's records. To assess model fit, likelihood test and deviance were used. Similarly, intraclass correlation coefficient, median odds ratio, and proportional change in variance were employed for random effect. A multilevel logistic regression model was used to identify individual- and community-level factors influencing EIBF due to the hierarchical nature of the data. Variables with p-values ≤0.2 in the binary model and <0.05 in the final analysis were considered significantly associated with EIBF. RESULTS The pooled prevalence of EIBF in West African nations was 50.60% (95% CI; 50.34-50.85%). The highest prevalence rate was observed in Serra Leone (75.33%) and the lowest prevalence was found in Senegal (33.94%). In the multilevel multiple logistic regression model, maternal education (AOR = 1.10, 95% CI, 1.03,1.16), marital status AOR = 1.07, 95% CI, 1.01,1.13), birth weight (AOR = 0.91, CI 0.86,0.96), birth orders (AOR = 1.09, CI 1.03,1.16), and (AOR = 1.11, CI 1.03,1.19), place of residence (AOR = 1.14, CI 1.07,1.21), and mode of delivery type (AOR = 0.26, CI 0.24,0.29) were significantly correlated with EIBF in West Africa. CONCLUSIONS The incidence of EIBF in West Africa was found to be low. The study emphasizes the need for targeted behavioral change communication programs to address timely breastfeeding initiation, specifically targeting mothers and child characteristics. Factors such as education, delivery mode, marital status, birth weight, birth order, and place of residence were significantly associated with EIBF. Special attention should be given to improving EIBF rates among women undergoing caesarean sections, infants with low birth weight, and primiparous mothers, along with structural improvements in the healthcare sector in West Africa.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Palmer T, Leiva Granados R, Draper C, Norris SA, Batura N. Cost-effectiveness of a complex continuum of care intervention targeting women and children: protocol for an economic evaluation of the Bukhali trial in South Africa. BMJ Open 2024; 14:e080166. [PMID: 38740501 PMCID: PMC11097888 DOI: 10.1136/bmjopen-2023-080166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION As nearly two-thirds of women presenting at their first antenatal visit are either overweight or obese in urban South Africa, the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and non-communicable diseases. This protocol describes the planned economic evaluation of an individually randomised controlled trial of a complex continuum of care intervention targeting women and children in Soweto, South Africa (Bukhali trial). METHODS AND ANALYSIS The economic evaluation of the Bukhali trial will be conducted as a within-trial analysis from both provider and societal perspectives. Incremental costs and health outcomes of the continuum of care intervention will be compared with standard care. The economic impact on implementing agencies (programme costs), healthcare providers, participants and their households will be estimated. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of child adiposity at age years averted. Additionally, ICERs will also be reported in terms of cost per quality-adjusted life year gained. If Bukhali demonstrates effectiveness, we will employ a decision analytical model to examine the cost-effectiveness of the intervention over a child's lifetime. A Markov model will be used to estimate long-term health benefits, healthcare costs and cost-effectiveness. Probabilistic sensitivity analyses will be conducted to explore uncertainty and ensure robust results. An analysis will be conducted to assess the equity impact of the intervention, by comparing intervention impact within quintiles of socioeconomic status. ETHICS AND DISSEMINATION The Bukhali trial economic evaluation has ethical approval from the Human Ethics Research Committee of the University of the Witwatersrand, Johannesburg, South Africa (M240162). The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR201903750173871; https://pactr.samrc.ac.za).
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Catherine Draper
- MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
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Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett C. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health 2024; 12:e744-e755. [PMID: 38614628 DOI: 10.1016/s2214-109x(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). METHODS We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. FINDINGS A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). INTERPRETATION Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
| | - Judite Gonçalves
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Rudi Rocha
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil; São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Indrani Gupta
- Institute of Economic Growth, University of Delhi, Delhi, India
| | - Vinayak Bhardwaj
- South African Medical Research Council and Wits Centre for Health Economics and Decision Science, PRICELESS South Africa, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Taufik Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia; Department of Economics, University of Sussex, Brighton, UK
| | - Chang Cai
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, UK; Luxembourg Institute of Socio-economic Research, Esch-sur-Alzette, Luxembourg
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Alem AZ, Tegegne BA, Aragaw FM, Teklu RE, Baykeda TA. Multilevel negative binomial analysis of factors associated with numbers of antenatal care contacts in low and middle income countries: Findings from 59 nationally representative datasets. PLoS One 2024; 19:e0301542. [PMID: 38635815 PMCID: PMC11025891 DOI: 10.1371/journal.pone.0301542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is one of the recommended interventions to reduce stillbirth, maternal, neonatal, and child mortality through early identification and management of pregnancy complications or pre-existing conditions. Although increasing number of ANC is a key priority of the 2016 WHO recommendations, ANC uptake in Low and Middle Income Countries (LMICs) is insufficient. Therefore, this study aimed to investigate factors associated with the number of ANC contacts in LMICs. METHODS Data for the study were drawn from 59 recent Demographic and Health Surveys (DHS) conducted in LMICS. We included a total sample of 520,377 mothers who gave birth in the five years preceding the survey. A multilevel negative binomial regression model was applied to identify factors that may affect number of ANC. Adjusted incidence rate ratios (AIRR) with 95% Confidence Interval (CI) were reported to show association. RESULTS This study found that mothers and their partner with higher educational attainment, mothers aged >35 years, mothers who had decision making autonomy, mothers from female headed household, mothers from richer and richest household, mothers exposed to media, and residing in urban areas had significantly more ANC contacts. However, number of ANC contacts were significantly lower among mothers who initiated ANC after 12 weeks of gestation and perceived healthcare access to be a big problem. CONCLUSION Our results suggest that individual, household, and community-level factors were associated with number of ANC contacts among pregnant mothers in LMICs. Hence, local and international policymakers, and programmers should focus on improving community awareness about maternal health care services through mass media and outreach programs with especial emphasis on women's and their partners educational attainment, rural mothers, women's empowerment, and household socioeconomic status.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Australia
| | - Biresaw Ayen Tegegne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare Baykeda
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
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Maharjan M, Sharma S, Kaphle HP. Factors associated with bypassing primary healthcare facilities for childbirth among women in Devchuli municipality of Nepal. PLoS One 2024; 19:e0302372. [PMID: 38635554 PMCID: PMC11025753 DOI: 10.1371/journal.pone.0302372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND It is crucial to deliver a child at nearby primary healthcare facilities to prevent subsequent maternal or neonatal complications. In low-resource settings, such as Nepal, it is customary to forgo the neighboring primary healthcare facilities for child delivery. Reports are scanty about the extent and reasons for bypassing local health centers in Nepal. This study sought to determine the prevalence and contributing factors among women bypassing primary healthcare facilities for childbirth. METHOD A community-based cross-sectional study was carried out in the Devchuli municipality of Nawalparasi East district of Nepal. Utilizing an online data collection tool, structured interviews were conducted among 314 mothers having a child who is less than one year of age. RESULTS This study showed that 58.9% of the respondents chose to bypass their nearest primary healthcare facility to deliver their babies in secondary or tertiary hospitals. Respondent's husband's employment status; informal employment (AOR: 4.2; 95% CI: 1.8-10.2) and formal employment (AOR: 3.2; 95% CI: 1.5-6.8), wealth quintile (AOR: 3.7; 95% CI: 1.7-7.7), parity (AOR): 3.0; 95% CI: 1.6-5.7], distance to nearest primary healthcare facility by the usual mode of transportation (AOR: 3.0; 95% CI: 1.5-5.6) and perceived service quality of primary healthcare facility (AOR: 3.759; 95% CI: 2.0-7.0) were associated with greater likelihood of bypassing primary healthcare facility. CONCLUSION Enhancing the quality of care, and informing beneficiaries about the importance of delivering children at primary healthcare facilities are essential for improving maternal service utilization at local primary healthcare facilities.
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Affiliation(s)
- Manisha Maharjan
- School of Health and Allied Sciences, Pokhara University, Lekhnath, Nepal
| | - Sudim Sharma
- Faculty of Public Health, Mahidol University, Salaya, Thailand
| | - Hari Prasad Kaphle
- School of Health and Allied Sciences, Pokhara University, Lekhnath, Nepal
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Kong SYJ, Acharya A, Basnet O, Haaland SH, Gurung R, Gomo Ø, Ahlsson F, Meinich-Bache Ø, Axelin A, Basula YN, Pokharel SM, Subedi H, Myklebust H, KC A. Mothers' acceptability of using novel technology with video and audio recording during newborn resuscitation: A cross-sectional survey. PLOS DIGITAL HEALTH 2024; 3:e0000471. [PMID: 38557601 PMCID: PMC10984542 DOI: 10.1371/journal.pdig.0000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation. SETTING This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal. DESIGN This is a cross-sectional survey. DATA COLLECTION AND ANALYSIS Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1-5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis. RESULTS The median age of 21 mothers who completed the survey was 25 years (range 18-37). Among them, 11 mothers (52.4%) completed their bachelor's or master's level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant's care during resuscitation. There was no statistical difference in mothers' acceptability of MALA system, when stratified by mothers' age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers' education level (up to higher secondary level vs. bachelor's level or higher), mothers with Bachelor's degree or higher more strongly felt that they were comfortable with the infant's care being video recorded (p = 0.026) and someone using a tablet when observing the infant's care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 14.3%) (p = 0.024). CONCLUSION The novel technology using video and audio recordings for newborn resuscitation was accepted by mothers in this study. Its application has the potential to improve resuscitation quality in low-and-middle income settings, given proper informed consent and data protection measures are in place.
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Affiliation(s)
| | | | | | | | - Rejina Gurung
- Golden Community, Chakupat, Lalitpur, Nepal
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Fredrik Ahlsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | | | - Ashish KC
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [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] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
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Wylie BJ, Ali SA. Late-Preterm Corticosteroids in Low-Resource Settings. Obstet Gynecol 2024; 143:465-467. [PMID: 38330408 DOI: 10.1097/aog.0000000000005539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Blair J Wylie
- Blair J. Wylie is from Columbia University Medical Center, New York, New York. Syed Asad Ali is from the Department of Community Health Sciences at Aga Khan University, Karachi, Pakistan
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Idris H, Anisah ZY. Disparity of Neonatal Care Visits by Region in Indonesia: A Secondary Data from Basic Health Research. Matern Child Health J 2024; 28:691-699. [PMID: 37955836 DOI: 10.1007/s10995-023-03841-y] [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: 10/27/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Neonatal care visit is one of the efforts to reduce the neonatal mortality rate. In Indonesia, few studies have analyzed neonatal care visits by region in the last decade. The purpose of this study was to analyze factors associated with neonatal care visits by region in Indonesia. METHOD This study was a quantitative study with a cross-sectional design. It used secondary data from Riskedas (Basic Health Research). The total sample size was 64,321 female respondents of childbearing age who had babies aged 29 days to 59 months. The dependent variable was the completeness of neonatal care visits measured through at least one at the first neonatal care visit (KN 1), at least one at the second neonatal care visit (KN 2), and at least one at the third neonatal care visit (KN 3). Data were analysed using a statistical binary logistic regression test. RESULTS The respondents who had complete neonatal care visits in Indonesia was 47.9%. The region with the highest proportion was Java-Bali at 58.5%, while the region with the lowest proportion was Papua at 23.8%. Variables influencing the completeness of neonatal care visits were delivery attendant, urban residence, secondary and higher education background, parity, delivery at a healthcare facility and compete antenatal care visits. Of these variables, delivery attendant (p < 0.05) was the most significant variable in all regions. CONCLUSION This study showed that there were significant differences in complete neonatal care visits between regions in particularly between the ones in the west and east part of Indonesia. The government is expected to be able to provide equal distribution of and access to health facilities in rural and eastern Indonesia, especially neonatal services.
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Affiliation(s)
- Haerawati Idris
- Department of Health Policy and Administration, Faculty of Public Health, Sriwijaya University, Indralaya, Ogan Ilir, South Sumatera, 30662, Indonesia.
| | - Zhafirah Yanzli Anisah
- Department of Health Policy and Administration, Faculty of Public Health, Sriwijaya University, Indralaya, Ogan Ilir, South Sumatera, 30662, Indonesia
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Benedetto C, Borella F, Divakar H, O'Riordan SL, Mazzoli M, Hanson M, O'Reilly S, Jacobsson B, Conry JA, McAuliffe FM. FIGO Preconception Checklist: Preconception care for mother and baby. Int J Gynaecol Obstet 2024; 165:1-8. [PMID: 38426290 DOI: 10.1002/ijgo.15446] [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] [Indexed: 03/02/2024]
Abstract
The preconception period is a unique and opportunistic time in a woman's life when she is motivated to adopt healthy behaviors that will benefit her and her child, making this time period a critical "window of opportunity" to improve short- and long-term health. Improving preconception health can ultimately improve both fetal and maternal outcomes. Promoting health before conception has several beneficial effects, including an increase in seeking antenatal care and a reduction in neonatal mortality. Preconception health is a broad concept that encompasses the management of chronic diseases, including optimal nutrition, adequate consumption of folic acid, control of body weight, adoption of healthy lifestyles, and receipt of appropriate vaccinations. Use of the FIGO Preconception Checklist, which includes the key elements of optimal preconception care, will empower women and their healthcare providers to better prepare women and their families for pregnancy.
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Affiliation(s)
- Chiara Benedetto
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
- FIGO Committee on Well Woman Health Care, London, UK
| | - Fulvio Borella
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Hema Divakar
- FIGO Committee on Well Woman Health Care, London, UK
| | - Sarah L O'Riordan
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
| | - Martina Mazzoli
- Department of Obstetrics and Gynecology, Sant'Anna University Hospital, Torino, Italy
| | - Mark Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - Sharleen O'Reilly
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Bo Jacobsson
- FIGO Division of Maternal and Newborn Health, London, UK
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Jeanne A Conry
- The Environmental Health Leadership Foundation, California, USA
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Dublin, Ireland
- FIGO Committee on the Impact of Pregnancy on Long-Term Health, London, UK
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Wudu MA, Bekalu YE, Birehanu TA, Gebrye DB, Hailu MK. Level of knowledge about neonatal danger signs and associated factors among postpartum mothers in public hospitals, northeastern Ethiopia. Pediatr Neonatol 2024:S1875-9572(24)00041-X. [PMID: 38594168 DOI: 10.1016/j.pedneo.2023.10.010] [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: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Knowing and seeking medical attention for neonatal danger signs has many benefits for reducing neonatal morbidity and death. Despite numerous interventions that have been made to raise mothers' awareness about neonatal danger signs, the desired level of knowledge has not yet been reached in Ethiopia. OBJECTIVE To assess the level of knowledge of neonatal danger signs and associated factors among postpartum mothers in public hospitals in the Eastern Amhara region, northeastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted in four government hospitals between January 10, 2023, and February 10, 2023.421 participants in the study were selected using a systematic random sampling technique. Face-to-face interviews, observation, and chart reviews were used to collect the data. The association was discovered through multivariate logistic regression analysis. RESULT Only 36.6% (154) of mothers were knowledgeable about newborn danger signs in this study. Mothers who had higher institution status [(adjusted odds ratio) AOR = 3.355, 95% CI (1.751, 6.428)]; who were civil servants or a private employer [AOR = 2.986, 95% CI (1.822, 4.892)] and [AOR = 2.544, 95% CI (1.269, 5.138)]; and who had counseling about breastfeeding [AOR = 2.614, 95% CI (1.695, 4.029)] were positive predictors of awareness of neonatal danger signs. CONCLUSION In this study, the level of mothers' awareness of newborn danger signs was low and required more effort. Moreover, mothers who were educated, worked as civil servants or private employers, had a family size of 4-6, and received breastfeeding counseling were linked to mothers' good awareness of newborn danger signs. As a result, intensive community and facility-based health promotion activities on newborn danger signs should be strengthened, with special emphasis on uneducated and housewife mothers and breastfeeding counseling sessions.
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Affiliation(s)
- Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia.
| | - Yemane Eshetu Bekalu
- Department of Public Health, ALKAN Health Sciences Business and Technology College, 1492, Dessie, Ethiopia
| | - Tarikua Afework Birehanu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia
| | - Dagne Belete Gebrye
- Department of Maternity and Reproductive Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia
| | - Molla Kassa Hailu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia
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Alhassan Y, Otiso L, Okoth L, Murray L, Hemingway C, Lewis JM, Oguche M, Doyle V, Muturi N, Ogwang E, Barsosio HC, Taegtmeyer M. Four antenatal care visits by four months of pregnancy and four vital tests for pregnant mothers: impact of a community-facility health systems strengthening intervention in Migori County, Kenya. BMC Pregnancy Childbirth 2024; 24:224. [PMID: 38539129 PMCID: PMC10967157 DOI: 10.1186/s12884-024-06386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Early attendance at antenatal care (ANC), coupled with good-quality care, is essential for improving maternal and child health outcomes. However, achieving these outcomes in sub-Saharan Africa remains a challenge. This study examines the effects of a community-facility health system strengthening model (known as 4byFour) on early ANC attendance, testing for four conditions by four months of pregnancy, and four ANC clinic visits in Migori county, western Kenya. METHODS We conducted a mixed methods quasi-experimental study with a before-after interventional design to assess the impact of the 4byFour model on ANC attendance. Data were collected between August 2019 and December 2020 from two ANC hospitals. Using quantitative data obtained from facility ANC registers, we analysed 707 baseline and 894 endline unique ANC numbers (attendances) based on negative binomial regression. Logistic regression models were used to determine the impact of patient factors on outcomes with Akaike Information Criterion (AIC) and likelihood ratio testing used to compare models. Regular facility stock checks were undertaken at the study sites to assess the availability of ANC profile tests. Analysis of the quantitative data was conducted in R v4.1.1 software. Additionally, qualitative in-depth interviews were conducted with 37 purposively sampled participants, including pregnant mothers, community health volunteers, facility staff, and senior county health officials to explore outcomes of the intervention. The interview data were audio-recorded, transcribed, and coded; and thematic analysis was conducted in NVivo. RESULTS There was a significant 26% increase in overall ANC uptake in both facilities following the intervention. Early ANC attendance improved for all age groups, including adolescents, from 22% (baseline) to 33% (endline, p = 0.002). Logistic regression models predicting early booking were a better fit to data when patient factors were included (age, parity, and distance to clinic, p = 0.004 on likelihood ratio testing), suggesting that patient factors were associated with early booking.The proportion of women receiving all four tests by four months increased to 3% (27/894), with haemoglobin and malaria testing rates rising to 8% and 4%, respectively. Despite statistical significance (p < 0.001), the rates of testing remained low. Testing uptake in ANC was hampered by frequent shortage of profile commodities not covered by buffer stock and low ANC attendance during the first trimester. Qualitative data highlighted how community health volunteer-enhanced health education improved understanding and motivated early ANC-seeking. Community pregnancy testing facilitated early detection and referral, particularly for adolescent mothers. Challenges to optimal ANC attendance included insufficient knowledge about the ideal timing for ANC initiation, financial constraints, and long distances to facilities. CONCLUSION The 4byFour model of community-facility health system strengthening has the potential to improve early uptake of ANC and testing in pregnancy. Sustained improvement in ANC attendance requires concerted efforts to improve care quality, consistent availability of ANC commodities, understand motivating factors, and addressing barriers to ANC. Research involving randomised control trials is needed to strengthen the evidence on the model's effectiveness and inform potential scale up.
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Affiliation(s)
- Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Lilian Otiso
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Linet Okoth
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Lois Murray
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joseph M Lewis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mandela Oguche
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Vicki Doyle
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nelly Muturi
- Airbel Impact Lab- International Rescue Committee, Nairobi, Kenya
| | - Emily Ogwang
- LVCT Health, The Key Place, Along Homa Bay-Rongo Road, P.O Box 352-40300, Homabay, Kenya
| | | | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
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Namuhani N, Wanyenze RK, Kiwanuka SN, Matovu JKB, Makumbi FE. Equity in family planning policies and programs in Uganda: conceptualization, dimensions and implementation constraints. Int J Equity Health 2024; 23:50. [PMID: 38468272 DOI: 10.1186/s12939-024-02143-1] [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: 07/02/2022] [Accepted: 03/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Equity is at the core and a fundamental principle of achieving the family planning (FP) 2030 Agenda. However, the conceptualization, definition, and measurement of equity remain inconsistent and unclear in many FP programs and policies. This paper aims to document the conceptualization, dimensions and implementation constraints of equity in FP policies and programs in Uganda. METHODS A review of Ugandan literature and key informant interviews with 25 key stakeholders on equity in FP was undertaken between April and July 2020. We searched Google, Google Scholar and PubMed for published and grey literature from Uganda on equity in FP. A total of 112 documents were identified, 25 met the inclusion criteria and were reviewed. Data from the selected documents were extracted into a Google master matrix in MS Excel. Data analysis was done across the thematic areas by collating similar information. Data were analyzed using thematic content analysis approach. RESULTS A limited number of documents had an explicit definition of equity, which varied across documents and stakeholders. The definitions revolved around universal access to FP information and services. There was a limited focus on equity in FP programs in Uganda. The dimensions most commonly used to assess equity were either geographical location, or socio-demographics, or wealth quintile. Almost all the key informants noted that equity is a very important element, which needs to be part of FP programming. However, implementation constraints (e.g. lack of quality comprehensive FP services, duplicated FP programs and a generic design of FP programs with limited targeting of the underserved populations) continue to hinder effective implementation of equitable FP programs in Uganda. Clients' constraints (e.g. limited contraceptive information) and policy constraints (inadequate focus on equity in policy documents) also remain key challenges. CONCLUSIONS There is lack of a common understanding and definition of equity in FP programs in Uganda. There is need to build consensus on the definitions and measurements of equity with a multidimensional lens to inform clear policy and programming focus on equity in FP programs and outcomes. To improve equitable access to and use of FP services, attention must be paid to addressing implementation, client and policy constraints.
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Affiliation(s)
- Noel Namuhani
- Department of Health Policy Planning and Management , Makerere University School of Public Health, P. BOX 7072, Kampala, Uganda.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy Planning and Management , Makerere University School of Public Health, P. BOX 7072, Kampala, Uganda
| | - Joseph K B Matovu
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Olakkengil M, Said S, Abdalla O, Hofmann R, Hedt-Gauthier B, Fulcher I. Are populations of postpartum women differentially served by community health worker programs: an observational cohort study from Zanzibar, Tanzania. BMC Pregnancy Childbirth 2024; 24:183. [PMID: 38454323 PMCID: PMC10921749 DOI: 10.1186/s12884-024-06356-8] [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: 03/19/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Although community health worker (CHW) programs focus on improving access to healthcare, some individuals may not receive the intended quality or quantity of an intervention. The objective of this research was to examine if certain populations of pregnant women differentially experience the implementation of a community health worker-led maternal health intervention in Zanzibar. METHODS We included pregnant women enrolled in the Safer Deliveries (Uzazi Salama) program, which operated in 10 of 11 districts in Zanzibar, Tanzania between January 1, 2017, and June 19, 2019 (N = 33,914). The outcomes of interest were receipt of the entire postpartum intervention (three CHW visits) and time to first postpartum CHW visit (days). Visits by CHWs were done at the women's home, however, a telehealth option existed for women who were unable to be reached in-person. We conducted statistical tests to investigate the bivariate associations between our outcomes and each demographic and health characteristic. We used multivariate logistic regression to estimate the relationships between covariates and the outcomes and multivariate linear regression to estimate the association between covariates and the average time until first postpartum visit. RESULTS Higher parity (OR = 0.85; P = 0.014; 95%CI: 0.75-0.97), unknown or unreported HIV status (OR = 0.64; p < 0.001; 95%CI: 0.53-0.78), and receipt of phone consultations (OR = 0.77; p < 0.001; 95%CI: 0.69-0.87) were associated with a lower odds of receiving all postpartum visits. Similarly, women with an unknown or unreported HIV status (estimated mean difference of 1.81 days; p < 0.001; 95%CI: 1.03-2.59) and those who received a phone consultation (estimated mean difference of 0.83 days; p < 0.001; 95%CI: 0.43-1.23), on average, experienced delays to first visit. In addition, current delivery at a referral hospital was associated with lower odds of receiving a postpartum visit and longer time to first visit compared to delivery at home, cottage hospital, PHCU + , or district hospital. Women from all other districts received their first visit earlier than women from Kaskazini B. There were no differences in the odds of receiving the entire postpartum intervention by sociodemographic variables, including age, education, and poverty assessment indicators. CONCLUSION The results indicate no differences in intervention contact across wealth and education levels, suggesting that the program is effectively reaching women regardless of SES. However, women with other characteristics (e.g., higher parity, unknown or unreported HIV status) had lower odds of receiving the complete intervention. Overall, this work generates knowledge on existing disparities in intervention coverage and enables future programs to develop approaches to achieve equity in health care utilization and outcomes.
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Affiliation(s)
- Michelle Olakkengil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Samira Said
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Omar Abdalla
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Rachel Hofmann
- D-Tree International, IRCH Building, Kidongo Chekundu, Zanzibar, Tanzania
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Okai E, Fair F, Soltani H. Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis. Health Sci Rep 2024; 7:e1938. [PMID: 38455643 PMCID: PMC10918979 DOI: 10.1002/hsr2.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 02/04/2024] [Indexed: 03/09/2024] Open
Abstract
Background and Aims Neonatal deaths contribute significantly to under-5 mortality worldwide with Sub-Saharan Africa (SSA) alone accounting for 43% of global newborn deaths. Significant challenges in the region's health systems evidenced by huge disparities in health facility deliveries and poor planning for preterm births are major contributors to the high neonatal mortality. Many neonates in the region are delivered in suboptimal conditions and require transportation to facilities equipped for specialized care. This review describes neonatal transport across the subregion, focusing on low-cost interventions employed. Methods We conducted a systematic review of studies on neonatal transport in SSA followed by a narrative synthesis. A search in the databases CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar was performed from inception to March 2023. Two authors reviewed the full texts of relevant studies to determine eligibility for inclusion which was subsequently cross-checked by a third reviewer using a random 30% overlay. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results A total of 20 studies were included in this review involving 11,895 neonates from 10 countries. All studies evaluated the transfer of neonates into referral centers from the peripheries. Most neonates were transferred by public transport (n = 12), mostly in the arms of caregivers with little communication between referring facilities. Studies reporting on ambulance transfers reported pervasive inadequacies in both human resources and transport equipment. No study reported on the use of Kangaroo mother care (KMC) in the transfer process. Conclusions The neonatal transport system across the SSA region is poorly planned, poorly resourced, and executed with little communication between facilities. Using cost-effective measures like KMC and improved training of community health workers may be key to improving the outcomes of transported neonates.
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Affiliation(s)
- Emmanuel Okai
- Department of Paediatrics, School of Medical Sciences, College of Health and Allied SciencesUniversity of Cape CoastCape CoastGhana
| | - Frankie Fair
- Department of Nursing and Midwifery, College of Health, Wellbeing and Life SciencesSheffield Hallam UniversitySheffieldUK
| | - Hora Soltani
- Department of Nursing and Midwifery, College of Health, Wellbeing and Life SciencesSheffield Hallam UniversitySheffieldUK
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Vasconcelos A, Sousa S, Bandeira N, Alves M, Papoila AL, Pereira F, Machado MC. Factors associated with perinatal and neonatal deaths in Sao Tome & Principe: a prospective cohort study. Front Pediatr 2024; 12:1335926. [PMID: 38434731 PMCID: PMC10904650 DOI: 10.3389/fped.2024.1335926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Background Neonatal mortality reduction is a global goal, but its factors are seldom studied in most resource-constrained settings. This is the first study conducted to identify the factors affecting perinatal and neonatal deaths in Sao Tome & Principe (STP), the smallest Central Africa country. Methods Institution-based prospective cohort study conducted at Hospital Dr. Ayres Menezes. Maternal-neonate dyads enrolled were followed up after the 28th day of life (n = 194) for identification of neonatal death-outcome (n = 22) and alive-outcome groups (n = 172). Data were collected from pregnancy cards, hospital records and face-to-face interviews. After the 28th day of birth, a phone call was made to evaluate the newborn's health status. Crude odds ratios and corresponding 95% confidence intervals were obtained. A p value <0.05 was considered statistically significant. Results The mean gestational age of the death-outcome and alive-outcome groups was 36 (SD = 4.8) and 39 (SD = 1.4) weeks, respectively. Death-outcome group (n = 22) included sixteen stillbirths, four early and two late neonatal deaths. High-risk pregnancy score [cOR 2.91, 95% CI: 1.18-7.22], meconium-stained fluid [cOR 4.38, 95% CI: 1.74-10.98], prolonged rupture of membranes [cOR 4.84, 95% CI: 1.47-15.93], transfer from another unit [cOR 6.08, 95% CI:1.95-18.90], and instrumental vaginal delivery [cOR 8.90, 95% CI: 1.68-47.21], were factors significantly associated with deaths. The odds of experiencing death were higher for newborns with infectious risk, IUGR, resuscitation maneuvers, fetal distress at birth, birth asphyxia, and unit care admission. Female newborn [cOR 0.37, 95% CI: 0.14-1.00] and birth weight of more than 2,500 g [cOR 0.017, 95% CI: 0.002-0.162] were found to be protective factors. Conclusion Factors such as having a high-risk pregnancy score, meconium-stained amniotic fluid, prolonged rupture of membranes, being transferred from another unit, and an instrumental-assisted vaginal delivery increased 4- to 9-fold the risk of stillbirth and neonatal deaths. Thus, avoiding delays in prompt intrapartum care is a key strategy to implement in Sao Tome & Principe.
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Affiliation(s)
- Alexandra Vasconcelos
- Unidade de Clínica Tropical-Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Swasilanne Sousa
- Department of Pediatrics, Hospital Dr. Ayres de Menezes, São Tomé, Sao Tome and Principe
| | - Nelson Bandeira
- Department of Obstetrics & Gynecology, Hospital Dr. Ayres de Menezes, São Tomé, Sao Tome and Principe
| | - Marta Alves
- CEAUL, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana Luísa Papoila
- CEAUL, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Filomena Pereira
- Unidade de Clínica Tropical-Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Maria Céu Machado
- Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
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Niehaus L, Sheffel A, Kalter HD, Amouzou A, Koffi AK, Munos MK. Delays in accessing high-quality care for newborns in East Africa: An analysis of survey data in Malawi, Mozambique, and Tanzania. J Glob Health 2024; 14:04022. [PMID: 38334468 PMCID: PMC10854463 DOI: 10.7189/jogh.14.04022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Despite the existence of evidence-based interventions, substantial progress in reducing neonatal mortality is lagging, indicating that small and sick newborns (SSNs) are likely not receiving the care they require to survive and thrive. The 'three delays model' provides a framework for understanding the challenges in accessing care for SSNs. However, the extent to which each delay impacts access to care for SSNs is not well understood. To fill this evidence gap, we explored the impact of each of the three delays on access to care for SSNs in Malawi, Mozambique, and Tanzania. Methods Secondary analyses of data from three different surveys served as the foundation of this study. To understand the impact of delays in the decision to seek care (delay 1) and the ability to reach an appropriate point of care (delay 2), we investigated time trends in place of birth disaggregated by facility type. We also explored care-seeking behaviours for newborns who died. To understand the impact of delays in accessing high-quality care after reaching a facility (delay 3), we measured facility readiness to manage care for SSNs. We used this measure to adjust institutional delivery coverage for SSN care readiness. Results Coverage of institutional deliveries was substantially lower after adjusting for facility readiness to manage SSN care, with decreases of 30 percentage points (pp) in Malawi, 14 pp in Mozambique, and 24 pp in Tanzania. While trends suggest more SSNs are born in facilities, substantial gaps remain in facilities' capacities to provide lifesaving interventions. In addition, exploration of care-seeking pathways revealed that a substantial proportion of newborn deaths occurred outside of health facilities, indicating barriers in the decision to seek care or the ability to reach an appropriate source of care may also prevent SSNs from receiving these interventions. Conclusions Investments are needed to overcome delays in accessing high-quality care for the most vulnerable newborns, those who are born small or sick. As more mothers and newborns access health services in low- and middle-income countries, ensuring that life-saving interventions for SSNs are available at the locations where newborns are born and seek care after birth is critical.
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Nankabirwa V, Mukunya D, Ndeezi G, Odongkara B, Arach AA, Achora V, Mugenyi L, Sebit MB, Wandabwa JN, Waako P, Tylleskär T, Tumwine JK. Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda. BMJ Open 2024; 14:e070798. [PMID: 38326267 PMCID: PMC10860059 DOI: 10.1136/bmjopen-2022-070798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births. SETTING Three subcounties of Lira district in Northern Uganda. DESIGN A cluster randomised controlled trial where a total of 30 clusters were randomised in a ratio of 1:1 to intervention or standard of care. PARTICIPANTS Pregnant women at ≥28 weeks of gestation. INTERVENTIONS Participants in the intervention arm received an integrated intervention package of peer support, mobile phone messaging and birthing kits during pregnancy while those in the control arm received routine government health services ('standard of care'). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of women giving birth at a health facility in the intervention arm compared with the control arm. Secondary outcomes were perinatal and neonatal deaths. RESULTS In 2018-2019, 995 pregnant women were included in 15 intervention clusters and 882 in 15 control clusters. The primary outcome was ascertained for all except one participant who died before childbirth. In the intervention arm, 754/994 participants (76%) gave birth at a health facility compared with 500/882 (57%) in the control arm. Participants in the intervention arm were 35% more likely to give birth at a health facility compared with participants in the control arm, (risk ratio 1.35 (95% CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI 0.13 to 0.27)). Adjusting for baseline differences generated similar results. There was no difference in secondary outcomes (perinatal or neonatal mortality or number of postnatal visits) between arms. CONCLUSION The intervention was successful in increasing the proportion of facility-based births but did not reduce perinatal or neonatal mortality. TRIAL REGISTRATION NUMBER NCT02605369.
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Affiliation(s)
- Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Agnes A Arach
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Vicentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Levi Mugenyi
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | | | - Thorkild Tylleskär
- Centre for International health, Universitetet i Bergen, Bergen, Norway
- University of Bergen Centre for Intervention Science for Maternal and Child Health, Bergen, Norway
| | - James K Tumwine
- Paediatrics and Child Health, Makerere University CHS, Kampala, Uganda
- Kabale University, Kabale, Uganda
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Muwema M, Nankabirwa JI, Edwards G, Nalwadda G, Nangendo J, Okiring J, Obeng-Amoako GO, Mwanja W, Ekong EN, Kalyango JN, Kaye DK. Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda. BMC Pregnancy Childbirth 2024; 24:113. [PMID: 38321398 PMCID: PMC10845583 DOI: 10.1186/s12884-024-06305-5] [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: 02/11/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. METHODS A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. RESULTS The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. CONCLUSION Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.
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Affiliation(s)
- Mercy Muwema
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Gorrette Nalwadda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gloria Odei Obeng-Amoako
- Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | | | - Elizabeth N Ekong
- Department of Nursing and Midwifery, Faculty of Public Health, Nursing and Midwifery, Uganda Christian University, Mukono, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Dinis A, Fernandes Q, Wagenaar BH, Gimbel S, Weiner BJ, John-Stewart G, Birru E, Gloyd S, Etzioni R, Uetela D, Ramiro I, Gremu A, Augusto O, Tembe S, Mário JL, Chinai JE, Covele AF, Sáide CM, Manaca N, Sherr K. Implementation outcomes of the integrated district evidence to action (IDEAs) program to reduce neonatal mortality in central Mozambique: an application of the RE-AIM evaluation framework. BMC Health Serv Res 2024; 24:164. [PMID: 38308300 PMCID: PMC10835896 DOI: 10.1186/s12913-024-10638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Scarce evidence exists on audit and feedback implementation processes in low-resource health systems. The Integrated District Evidence to Action (IDEAs) is a multi-component audit and feedback strategy designed to improve the implementation of maternal and child guidelines in Mozambique. We report IDEAs implementation outcomes. METHODS IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces between 2016 and 2020 and evaluated using a quasi-experimental design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Reach is the proportion of pregnant women attending IDEAs facilities. Adoption is the proportion of facilities initiating audit and feedback meetings. Implementation is the fidelity to the strategy components, including readiness assessments, meetings (frequency, participation, action plan development), and targeted financial support and supervision. Maintenance is the sustainment at 12, 24, and 54 months. RESULTS Across both provinces, 56% of facilities were exposed to IDEAs (target 57%). Sixty-nine and 73% of pregnant women attended those facilities' first and fourth antenatal consultations (target 70%). All facilities adopted the intervention. 99% of the expected meetings occurred with an average interval of 5.9 out of 6 months. Participation of maternal and child managers was high, with 3076 attending meetings, of which 64% were from the facility, 29% from the district, and 7% from the province level. 97% of expected action plans were created, and 41 specific problems were identified. "Weak diagnosis or management of obstetric complications" was identified as the main problem, and "actions to reinforce norms and protocols" was the dominant subcategory of micro-interventions selected. Fidelity to semiannual readiness assessments was low (52% of expected facilities), and in completing micro-interventions (17% were completed). Ninety-six and 95% of facilities sustained the intervention at 12 and 24 months, respectively, and 71% had completed nine cycles at 54 months. CONCLUSION Maternal and child managers can lead audit and feedback processes in primary health care in Mozambique with high reach, adoption, and maintenance. The IDEAs strategy should be adapted to promote higher fidelity around implementing action plans and conducting readiness assessments. Adding effectiveness to these findings will help to inform strategy scale-up.
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Affiliation(s)
- Aneth Dinis
- National Department of Public Health, Ministry of Health, Maputo City, Mozambique.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Quinhas Fernandes
- National Department of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Child, Family & Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ermyas Birru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | | | | | - Artur Gremu
- Comité para Saúde de Moçambique, Maputo, Mozambique
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, USA
- Eduardo Mondlane University, Maputo, Mozambique
| | - Stélio Tembe
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Nélia Manaca
- Comité para Saúde de Moçambique, Maputo, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, USA
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Fernandez-Turienzo C, Sandall J. Delivering high-quality childbirth care. Nat Med 2024; 30:348-349. [PMID: 38336834 DOI: 10.1038/s41591-024-02812-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Cristina Fernandez-Turienzo
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
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Holm-Hansen CC, Lund S, Skytte TB, Molenaar J, Steensgaard CN, Mohd UA, Mzee S, Ali SM, Kjærgaard J, Greisen G, Sorensen JL, Poulsen A. Neonatal mortality and video assessment of resuscitation in four district hospitals in Pemba, Tanzania. Pediatr Res 2024; 95:712-721. [PMID: 37770540 PMCID: PMC10899108 DOI: 10.1038/s41390-023-02824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/17/2023] [Accepted: 06/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND We aimed to assess risk factors for neonatal mortality, quality of neonatal resuscitation (NR) on videos and identify potential areas for improvement. METHODS This prospective cohort study included women in childbirth and their newborns at four district hospitals in Pemba, Tanzania. Videos were analysed for quality-of-care. Questionnaires on quality-of-care indicators were answered by health workers (HW) and women. Risk factors for neonatal mortality were analysed in a binomial logistic regression model. RESULTS 1440 newborns were enrolled. 34 newborns died within the neonatal period (23.6 per 1000 live births). Ninety neonatal resuscitations were performed, 20 cases on video. Positive pressure ventilation (PPV) was inadequate in 15 cases (75%). Half (10/20) did not have PPV initiated within the first minute, and in one case (5.0%), no PPV was performed. PPV was not sustained in 16/20 (80%) newborns. Of the 20 videos analysed, death occurred in 10 newborns: 8 after resuscitation attempts and two within the first 24 h. Most of HW 49/56 (87.5%) had received training in NR. CONCLUSIONS Video analysis of NR revealed significant deviations from guidelines despite 87.5% of HW being trained in NR. Videos provided direct evidence of gaps in the quality of care and areas for future education, particularly effective PPV. IMPACT Neonatal mortality in Pemba is 23.6 per 1000 livebirths, with more than 90% occurring in the first 24 h of life. Video assessment of neonatal resuscitation revealed deviations from guidelines and can add to understanding challenges and aid intervention design. The present study using video assessment of neonatal resuscitation is the first one performed at secondary-level hospitals where many of the world's births are conducted. Almost 90% of the health workers had received training in neonatal resuscitation, and the paper can aid intervention design by understanding the actual challenges in neonatal resuscitation.
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Affiliation(s)
- Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, The Juliane Marie Centre for Children, Copenhagen University Hospital Rigshospitalet, København, Denmark
| | - Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health, Faculty of Medical and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Christina Nadia Steensgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulfat Amour Mohd
- Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Tanzania
| | - Said Mzee
- Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Tanzania
| | | | - Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, The Juliane Marie Centre for Children, Copenhagen University Hospital Rigshospitalet, København, Denmark
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Tanzania
- The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen University Hospital Rigshospitalet, København, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Gannon H, Larsson L, Chimhuya S, Mangiza M, Wilson E, Kesler E, Chimhini G, Fitzgerald F, Zailani G, Crehan C, Khan N, Hull-Bailey T, Sassoon Y, Baradza M, Heys M, Chiume M. Development and Implementation of Digital Diagnostic Algorithms for Neonatal Units in Zimbabwe and Malawi: Development and Usability Study. JMIR Form Res 2024; 8:e54274. [PMID: 38277198 PMCID: PMC10858425 DOI: 10.2196/54274] [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: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite an increase in hospital-based deliveries, neonatal mortality remains high in low-resource settings. Due to limited laboratory diagnostics, there is significant reliance on clinical findings to inform diagnoses. Accurate, evidence-based identification and management of neonatal conditions could improve outcomes by standardizing care. This could be achieved through digital clinical decision support (CDS) tools. Neotree is a digital, quality improvement platform that incorporates CDS, aiming to improve neonatal care in low-resource health care facilities. Before this study, first-phase CDS development included developing and implementing neonatal resuscitation algorithms, creating initial versions of CDS to address a range of neonatal conditions, and a Delphi study to review key algorithms. OBJECTIVE This second-phase study aims to codevelop and implement neonatal digital CDS algorithms in Malawi and Zimbabwe. METHODS Overall, 11 diagnosis-specific web-based workshops with Zimbabwean, Malawian, and UK neonatal experts were conducted (August 2021 to April 2022) encompassing the following: (1) review of available evidence, (2) review of country-specific guidelines (Essential Medicines List and Standard Treatment Guidelinesfor Zimbabwe and Care of the Infant and Newborn, Malawi), and (3) identification of uncertainties within the literature for future studies. After agreement of clinical content, the algorithms were programmed into a test script, tested with the respective hospital's health care professionals (HCPs), and refined according to their feedback. Once finalized, the algorithms were programmed into the Neotree software and implemented at the tertiary-level implementation sites: Sally Mugabe Central Hospital in Zimbabwe and Kamuzu Central Hospital in Malawi, in December 2021 and May 2022, respectively. In Zimbabwe, usability was evaluated through 2 usability workshops and usability questionnaires: Post-Study System Usability Questionnaire (PSSUQ) and System Usability Scale (SUS). RESULTS Overall, 11 evidence-based diagnostic and management algorithms were tailored to local resource availability. These refined algorithms were then integrated into Neotree. Where national management guidelines differed, country-specific guidelines were created. In total, 9 HCPs attended the usability workshops and completed the SUS, among whom 8 (89%) completed the PSSUQ. Both usability scores (SUS mean score 75.8 out of 100 [higher score is better]; PSSUQ overall score 2.28 out of 7 [lower score is better]) demonstrated high usability of the CDS function but highlighted issues around technical complexity, which continue to be addressed iteratively. CONCLUSIONS This study describes the successful development and implementation of the only known neonatal CDS system, incorporated within a bedside data capture system with the ability to deliver up-to-date management guidelines, tailored to local resource availability. This study highlighted the importance of collaborative participatory design. Further implementation evaluation is planned to guide and inform the development of health system and program strategies to support newborn HCPs, with the ultimate goal of reducing preventable neonatal morbidity and mortality in low-resource settings.
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Affiliation(s)
- Hannah Gannon
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Leyla Larsson
- Institute of Computational Biology, Computational Health Centre, Helmholtz, Munich, Germany
| | - Simbarashe Chimhuya
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | | | - Emma Wilson
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Erin Kesler
- Children's Hospital of Philadelphia, Philidephia, PA, United States
| | - Gwendoline Chimhini
- Department of Child, Adolescent and Women's Health, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Felicity Fitzgerald
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Caroline Crehan
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Nushrat Khan
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | - Tim Hull-Bailey
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Michelle Heys
- Population, Policy and Practice, Institute of Child Health, University College London, London, United Kingdom
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Bellad MB, Patted A, Derman RJ. Is It Time to Alter the Standard of Care for Iron Deficiency/Iron Deficiency Anemia in Reproductive-Age Women? Biomedicines 2024; 12:278. [PMID: 38397880 PMCID: PMC10886917 DOI: 10.3390/biomedicines12020278] [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: 12/21/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Two billion people worldwide suffer from anemia, with reproductive-age women being disproportionately affected. Iron plays a crucial role in cellular function and impacts cognition, physical function, and quality of life. Iron deficiency (ID) and iron deficiency anemia (IDA) are associated with adverse effects on pregnancy and fetal development. Oral iron supplementation has been the standard treatment for decades, often producing sub-optimal outcomes. Many babies are still being born with ID and suffer adverse sequelae due to inadequate iron levels in the mothers. Is it time to consider a broad scale-up of parenteral iron as a new standard of care?
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Affiliation(s)
- Mrutyunjaya B. Bellad
- Department of Obstetrics and Gynecology, KAHER’s Jawaharlal Nehru Medical College, Belagavi 590010, Karnataka, India;
| | - Anmol Patted
- Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Richard J. Derman
- Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA 19107, USA;
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Tuladhar S, Paudel D, Rehfuess E, Siebeck M, Oberhauser C, Delius M. Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021. BMC Pregnancy Childbirth 2024; 24:79. [PMID: 38267966 PMCID: PMC10807104 DOI: 10.1186/s12884-023-06138-8] [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: 04/15/2023] [Accepted: 11/18/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Nepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved. METHODS Cross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs. RESULTS Despite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent. CONCLUSIONS The slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.
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Affiliation(s)
- Sabita Tuladhar
- Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.
- Center for International Health, LMU, Munich, Germany.
| | | | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Matthias Siebeck
- Institute of Medical Education, LMU, University Hospital, LMU, Munich, Germany
| | - Cornelia Oberhauser
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
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Shen H, Zhao H, Wang B, Jiang Y. Women's status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling. Front Public Health 2024; 11:1192966. [PMID: 38269389 PMCID: PMC10807043 DOI: 10.3389/fpubh.2023.1192966] [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: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Skilled birth attendants (SBA) facilitate identifying and overcoming labor problems and saving lives. With one of the highest maternal death rates in the Asia-Pacific area, SBA utilization during childbirth among Papua New Guinea (PNG) women remains low. Women's status and empowerment are important factors in maternal and child health services and critical to maternal and child health development. This study is intended to apply structural equation modeling based on data from the Demographic and Health Survey (DHS) to evaluate the causal relationship between women's status, empowerment, and SBA utilization in PNG and the mechanisms of their influence. Methods This study employed data from the 2016-2018 Papua New Guinea Demographic Health Survey (PNG DHS), which recruited 18,175 women aged 15-49 years. A multi-stage sample and a structured questionnaire were used to collect information on maternal health, women's empowerment, and related topics. STATA 17.0 was used to describe the data, while MPLUS 8.2 was employed for structural equation modeling and pathway analysis. Results The two empowerment dimensions of household decision-making (standardized path coefficient, β = 0.049, p < 0.05) and access to health services (β = 0.069, p < 0.01) were positively associated with SBA utilization, while the association between attitudes toward partner violence and SBA utilization was not statistically significant. In addition, mediation analysis revealed that education indirectly influenced SBA utilization through access to health services (β = 0.011, 95% CI: 0.002, 0.022). Conclusion The findings confirmed the direct and indirect effects of women's status and empowerment on SBA utilization in PNG. Therefore, a call for further evidence-based interventions in PNG and possibly Pacific Small Island Developing States (PSIDS) is needed to improve women's educational attainment, household decision-making, and access to health services to enhance maternal and newborn health and well-being.
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Affiliation(s)
- Hao Shen
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hang Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Baoqin Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
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Endehabtu BF, Gelaye KA, Mengiste SA, Tilahun B. Mapping the Role of Digital Health Interventions to Enhance Effective Coverage of Antenatal Care: A Scoping Review. J Multidiscip Healthc 2024; 17:71-82. [PMID: 38196936 PMCID: PMC10775799 DOI: 10.2147/jmdh.s438097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
Background Antenatal care (ANC) is a core component of maternal health services. However, only half of the pregnant women in LMICs obtain WHO recommended minimum of four antenatal contacts. In addition, ANC 4+ is a commonly used indicator in monitoring ANC utilization. However, contact coverage alone provides no indications of service quality. In recent years, digital health interventions bring opportunities to provide quality maternal health care. Yet, there are few reviews on how digital health interventions contribute to improving effective coverage of antenatal care. A rigorous review that examines the role of digital health interventions in improving effective coverage of antenatal care is needed to examine how digital health solutions were rapidly deployed to support quality antenatal care service delivery. Objective This review aimed to map evidence on the role of digital health solutions on quality of antenatal care service to enhance effective ANC coverage. Methods A scoping review approach was used and four Databases (PubMed, Cochrane Library, Scopus and Embase) as well as search engines like Advanced Google Search and Google Scholar were searched from September 1 to 8, 2022. Thematic content analysis was used to present the findings. Results A total of 1701 articles were searched. A total of 27 full-text studies were included in the final analysis. The most reported use of digital health was for client education and behavior change communication. Most studies showed that digital health interventions have proven effective in improving antenatal care. However, most of the studies did not address to assess the quality of ANC services. Conclusion In this review, we found out that digital health solutions targeted at pregnant women can improve antenatal care services. There is body of evidence showing the effectiveness of digital health interventions on a range of maternal health outcomes. Few pieces of literature exist on the use of digital health interventions on the quality of antenatal care services. There is a need for more trial and program evaluation studies that examine the role of digital health interventions on the quality of ANC.
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Affiliation(s)
- Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Center for Digital Health and Implementation Science, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Center for Digital Health and Implementation Science, University of Gondar, Gondar, Ethiopia
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48
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Panigrahi P. The neonatal gut microbiome and global health. Gut Microbes 2024; 16:2352175. [PMID: 38743045 PMCID: PMC11095572 DOI: 10.1080/19490976.2024.2352175] [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: 10/12/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
The role of gut microbiome in health, a century-old concept, has been on the center stage of medical research recently. While different body sites, disease conditions, and populations have been targeted, neonatal and early infancy appear to be the most suitable period for such interventions. It is intriguing to note that, unlike traditional use in diarrhea and maintenance of gastrointestinal health, microbiome-mediating therapies have now addressed the most serious medical conditions in young infants such as necrotizing enterocolitis and neonatal sepsis. Unfortunately, almost all new endeavors in this space have been carried out in the Western world leaving behind millions of neonates that can benefit from such manipulations while serving as a large resource for further learning. In this review, an attempt has been made to quantify the global burden of neonatal morbidity and mortality, examples presented on interventions that have failed as a result of drawing from studies conducted in the West, and a case made for manipulating the neonatal gut microbiome to address the biggest killers in early life. A brief comparative analysis has been made to demonstrate the differences in the gut microbiota of North and South and a large clinical trial of synbiotics conducted by our group in a South Asian setting has been presented. Although challenging, the value of conducting such global health research is introduced with an intent to invite medical scientists to engage in well-planned, scientifically robust research endeavors. This can bring about innovation while saving and serving the most vulnerable citizens now and protecting them from the negative health consequences in the later part of their lives, ultimately shaping a resilient and equitable world as pledged by 193 United Nations member countries in 2015.
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Affiliation(s)
- Pinaki Panigrahi
- Department of Pediatrics, Division of Neonatal Perinatal Medicine, International Microbiome Research, Georgetown University Medical Center, Georgetown, WA, USA
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49
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Flores-Quispe MDP, Duro SMS, Facchini LA, Barros NBR, Tomasi E. Trends in the quality of child health care in the first week of life in primary care services in Brazil. CIENCIA & SAUDE COLETIVA 2024; 29:e09192022. [PMID: 38198324 DOI: 10.1590/1413-81232024291.09192022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/21/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study was to assess temporal trends in the quality of health care during the first-week child check-up in primary care services stratified by municipal, health team and maternal characteristics. We conducted a cross-sectional study using data from the three cycles of the National Program for the Improvement of Access and Quality (PMAQ) (2012, 2014 and 2018). Adult service users with children aged up to 2 were interviewed. The outcome was "good quality health care in the first week of life". Descriptive and time trend analyses were performed using variance-weighted least squares regression. The frequency of good quality care during the first-week check-up was 47.9% (95%CI 46.6-49.3) in 2012, 52.5% (95%CI 51.3-53.7) in 2014 and 53.3% (95%CI 52.2-54.4) in 2018, with an annual increase of 0.73 pp (p<0.001). The annual increase was greater in the Northeast (2.06 pp) and in municipalities with very low/low HDI (1.48 pp) and 100% family health strategy coverage (0.98 pp). Trends in the frequency of good quality health care during the first-week child check-up were favorable.
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Affiliation(s)
- María Del Pilar Flores-Quispe
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | | | - Luiz Augusto Facchini
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
- Departamento de Medicina Social, Faculdade de Medicina, UFPel. Pelotas RS Brasil
| | | | - Elaine Tomasi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas (UFPel). Rua Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
- Departamento de Medicina Social, Faculdade de Medicina, UFPel. Pelotas RS Brasil
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50
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Kea AZ, Lindtjørn B, Tekle AG, Hinderaker SG. Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002466. [PMID: 38150438 PMCID: PMC10752526 DOI: 10.1371/journal.pgph.0002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.
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Affiliation(s)
- Aschenaki Zerihun Kea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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