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Moxon SG, B SS, Penn-Kekana L, Sharma S, Talbott J, Campbell OMR, Freedman L. Evolving narratives on signal functions for monitoring maternal and newborn health services: A meta-narrative inspired review. Soc Sci Med 2024; 352:116980. [PMID: 38820693 DOI: 10.1016/j.socscimed.2024.116980] [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: 10/24/2023] [Revised: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
Emergency obstetric care (EmOC) signal functions are a shortlist of key clinical interventions capable of averting deaths from the five main direct causes of maternal mortality; they have been used since 1997 as a part of an EmOC monitoring framework to track the availability of EmOC services in low- and middle-income settings. Their widespread use and proposed adaptation to include other types of care, such as care for newborns, is testimony to their legacy as part of the measurement architecture within reproductive health. Yet, much has changed in the landscape of maternal and newborn health (MNH) since the initial introduction of EmOC signal functions. As part of a project to revise the EmOC monitoring framework, we carried out a meta-narrative inspired review to reflect on how signal functions have been developed and conceptualised over the past two decades, and how different narratives, which have emerged alongside the evolving MNH landscape, have played a role in the conceptualisation of the signal function measurement. We identified three overarching narrative traditions: 1) clinical 2) health systems and 3) human rights, that dominated the discourse and critique around the use of signal functions. Through an iterative synthesis process including 19 final articles selected for the review, we explored patterns of conciliation and areas of contradiction between the three narrative traditions. We summarised five meta-themes around the use of signal functions: i) framing the boundaries; ii) moving beyond clinical capability; iii) capturing the woods versus the trees; iv) grouping signal functions and v) measurement challenges. We intend for this review to contribute to a better understanding of the discourses around signal functions, and to provide insight for the future roles of this monitoring approach for emergency obstetric and newborn care.
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Affiliation(s)
- Sarah G Moxon
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | | | - Loveday Penn-Kekana
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | - Sudha Sharma
- CIWEC Hospital and Travel Medicine Center, GPO Box, 12895, Kapurdhara Marg, Kathmandu, Nepal.
| | - Jennifer Talbott
- Averting Maternal Death and Disability (AMDD), Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite B3, New York, NY, 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 3HT, UK.
| | - Lynn Freedman
- Averting Maternal Death and Disability (AMDD), Columbia University Mailman School of Public Health, 60 Haven Avenue, Suite B3, New York, NY, 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
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Sáenz R, Nigenda G, Gómez-Duarte I, Rojas K, Castro A, Serván-Mori E. Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019. Int J Equity Health 2024; 23:96. [PMID: 38730305 PMCID: PMC11088099 DOI: 10.1186/s12939-024-02100-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: 06/01/2023] [Accepted: 01/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.
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Affiliation(s)
- Rocío Sáenz
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ingrid Gómez-Duarte
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Karol Rojas
- Center for Research in Nursing and Health Care (CICES), University of Costa Rica, San Pedro Montes de Oca, San Jose, Costa Rica
| | - Arachu Castro
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, State of Louisiana, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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Nigenda G, Serván-Mori E. Human resources for health and maternal mortality in Latin America and the Caribbean over the last three decades: a systemic-perspective reflections. Int J Equity Health 2024; 23:67. [PMID: 38561759 PMCID: PMC10983735 DOI: 10.1186/s12939-024-02154-y] [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: 12/08/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The role of human resources for health in the operation of health systems is crucial. However, training and incorporating them into institutions is a complex process due to the continuous misalignment between the supply and demand of health personnel. Taking the case of the Latin American and Caribbean region countries, this comment discusses the relationship between the availability of human resources for health and the maternal mortality ratio for the period 1990-2021. It proposes the need to resume planning exercises from a systemic perspective that involves all areas of government and the private sector linked to the training and employment of health workers. MAIN TEXT We used secondary data from a global source to show patterns in the relationship between these two aspects and identify gaps in the Latin American and Caribbean regions. The results show enormous heterogeneity in the response of regional health systems to the challenge of maternal mortality in the region. Although most countries articulated specific programs to achieve the reduction committed by all countries through the Millennium Development Goals, not all had the same capacity to reduce it, and practically none met the target. In addition, in the English Caribbean countries, we found significant increases in the number of health personnel that do not explain the increases in the maternal mortality rate during the period. CONCLUSIONS The great lesson from the data shown is that some countries could articulate responses to the problem using available resources through effective strategies, considering the specific needs of their populations. Although variations in maternal mortality rate cannot be explained solely through the provision of health personnel, it is important to consider that it is critical to find new modalities on how human resources for health could integrate and create synergies with other resources to increase systems capacity to deliver care according to conditions in each country.
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Affiliation(s)
- Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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Handing G, Straneo M, Agossou C, Wanduru P, Kandeya B, Abeid MS, Annerstedt KS, Hanson C. Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda. Acta Obstet Gynecol Scand 2024; 103:590-601. [PMID: 38183308 PMCID: PMC10867390 DOI: 10.1111/aogs.14754] [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: 08/31/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. MATERIAL AND METHODS This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. CLINICAL TRIAL Pan African Clinical Trial Registry 202006793783148. RESULTS Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). CONCLUSIONS There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.
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Affiliation(s)
- Greta Handing
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Manuela Straneo
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Christian Agossou
- Department of StatisticsCenter for Research in Human Reproduction and DemographyCotonouBenin
| | - Phillip Wanduru
- School of Public HealthMakerere University College of Health SciencesMulago KampalaUganda
| | - Bianca Kandeya
- Center for Reproductive HealthKamuzu University of Health SciencesChichiriMalawi
| | - Muzdalifat S. Abeid
- Department of Obstetrics and GynecologyAga Khan UniversityDar es SalaamTanzania
| | | | - Claudia Hanson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonEngland
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Muriithi FG, Banke-Thomas A, Forbes G, Gakuo RW, Thomas E, Gallos ID, Devall A, Coomarasamy A, Lorencatto F. A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002950. [PMID: 38377077 PMCID: PMC10878526 DOI: 10.1371/journal.pgph.0002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
The rate of decline in the global burden of avoidable maternal deaths has stagnated and remains an issue of concern in many sub-Saharan Africa countries. As per the most recent evidence, an average maternal mortality ratio (MMR) of 223 deaths per 100,000 live births has been estimated globally, with sub-Saharan Africa's average MMR at 536 per 100,000 live births-more than twice the global average. Despite the high MMR, there is variation in MMR between and within sub-Saharan Africa countries. Differences in the behaviour of those accessing and/or delivering maternal healthcare may explain variations in outcomes and provide a basis for quality improvement in health systems. There is a gap in describing the landscape of interventions aimed at modifying the behaviours of those accessing and delivering maternal healthcare for improving maternal health outcomes in sub-Saharan Africa. Our objective was to extract and synthesise the target behaviours, component behaviour change strategies and outcomes of behaviour change interventions for improving maternal health outcomes in sub-Saharan Africa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our protocol was published a priori on PROSPERO (registration number CRD42022315130). We searched ten electronic databases (PsycINFO, Cochrane Database of Systematic Reviews, International Bibliography of Social Sciences, EMBASE, MEDLINE, Scopus, CINAHL PLUS, African Index Medicus, African Journals Online, and Web of Science) and included randomised trials and quasi-experimental studies. We extracted target behaviours and specified the behavioural interventions using the Action, Actor, Context, Time, and Target (AACTT) framework. We categorised the behaviour change strategies using the intervention functions described in the Behaviour Change Wheel (BCW). We reviewed 52 articles (26 randomized trials and 26 quasi-experimental studies). They had a mixed risk of bias. Out of these, 41 studies (78.8%) targeted behaviour change of those accessing maternal healthcare services, while seven studies (13.5%) focused on those delivering maternal healthcare. Four studies (7.7%) targeted mixed stakeholder groups. The studies employed a range of behaviour change strategies, including education 37 (33.3%), persuasion 20 (18%), training 19 (17.1%), enablement 16 (14.4%), environmental restructuring 8 (7.2%), modelling 6 (5.4%) and incentivisation 5 (4.5%). No studies used restriction or coercion strategies. Education was the most common strategy for changing the behaviour of those accessing maternal healthcare, while training was the most common strategy in studies targeting the behaviour of those delivering maternal healthcare. Of the 52 studies, 40 reported effective interventions, 7 were ineffective, and 5 were equivocal. A meta-analysis was not feasible due to methodological and clinical heterogeneity across the studies. In conclusion, there is evidence of effective behaviour change interventions targeted at those accessing and/or delivering maternal healthcare in sub-Saharan Africa. However, more focus should be placed on behaviour change by those delivering maternal healthcare within the health facilities to fast-track the reduction of the huge burden of avoidable maternal deaths in sub-Saharan Africa.
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Affiliation(s)
- Francis G. Muriithi
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aduragbemi Banke-Thomas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, London, United Kingdom
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Ruth W. Gakuo
- Department of Nursing, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Lenton, Nottingham, United Kingdom
| | - Eleanor Thomas
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ioannis D. Gallos
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adam Devall
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
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Nogueira-Pileggi V, Oladapo OT, Souza JP, Cavenague de Souza HC, Pileggi-Castro C, Oyeneyin LO, Oliveira-Ciabati L, Barbosa F, Camelo JS. Unveiling the strong positive relationship: Maternal characteristics and neonatal outcomes in the Better Outcomes in Labour Difficulty (BOLD) study - a secondary analysis validating neonatal near miss classification. J Glob Health 2024; 14:04024. [PMID: 38236696 PMCID: PMC10802829 DOI: 10.7189/jogh.14.04024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The near miss concept, denoting near collisions between aircraft, originated in aeronautics, but has recently been transferred to the neonatal context as a way of evaluating the quality of health services for newborns, especially in settings with reduced child mortality. However, there is yet no consensus regarding the underlying criteria. The most common indicators used to assess health care quality include mortality (maternal and neonatal) and life-threatening conditions. Using the World Health Organization (WHO) Better Outcomes in Labour Difficulty (BOLD) prospective cohort study data set, we conducted a secondary analysis to validate the near miss concept and explore the association between maternal and neonatal outcomes. Methods We studied 10 203 singleton mothers treated between December 2014 and November 2015 in nine Nigerian and four Ugandan hospitals. We validated the near miss concept by testing the diagnostic accuracy (sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and odds ratio (OR)) using death as the reference variable and calculating the maternal and neonatal case fatality rates. We performed ordinal and binomial logistic regression, with the independent variables being those that had P < 0.1 in the univariate analyses. We considered the significance level of 5%. Results We validated the neonatal near miss concept using the BOLD study data. We observed maternal and neonatal case fatality rates of 70.2% and 6.5%, with an increasing severity relationship between maternal and neonatal outcomes (P < 0.05). Ordinal logistic regression showed that gestational age <37 or >41 weeks and <8 antenatal consultations were related to a higher risk of neonatal severe outcomes, while maternal age between 30 and 34 years functioned as a protective factor against severe neonatal outcomes (SNO). Binomial logistic regression showed gestational age <37(OR = 1.46; 95% confidence interval (CI) = 1.07-1.94) or >41 weeks (OR = 2.26; 95% CI = 1.55-3.20), low educational level (OR = 1.76; 95% CI = 1.12-2.69), overweight/obesity (OR = 1.23; 95% CI = 1.02-1.47), one previous cesarean section (OR = 1.90; 95% CI = 1.36-2.61), one previous abortion (OR = 1.25; 95% CI = 1.00-1.56), and previous chronic condition (OR = 1.83; 95% CI = 1.37-2.41) were risk factors for SNO. Conclusions The neonatal near miss concept could be used as a parameter for analysis in different health systems, to ensure that measuring of neonatal severity is comparable across health care units. In this analysis, we observed a progressive association between maternal severity and the severity of the newborns' outcomes.
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Affiliation(s)
- Vicky Nogueira-Pileggi
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Olufemi T Oladapo
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Cynthia Pileggi-Castro
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lawal O Oyeneyin
- Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Ondo State, Nigeria
| | - Livia Oliveira-Ciabati
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - Francisco Barbosa
- UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, Geneva, Switzerland
| | - José Simon Camelo
- Department of Paediatrics – Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Solnes Miltenburg A, Kvernflaten B, Meguid T, Sundby J. Towards renewed commitment to prevent maternal mortality and morbidity: learning from 30 years of maternal health priorities. Sex Reprod Health Matters 2023; 31:2174245. [PMID: 36857112 PMCID: PMC9980022 DOI: 10.1080/26410397.2023.2174245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Andrea Solnes Miltenburg
- Associate Professor in Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Resident in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway
| | - Birgit Kvernflaten
- Researcher, Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tarek Meguid
- Associate Professor, Consultant Obstetrician & Gynaecologist, Department of Maternal and Child Health, University of Namibia, Windhoek, Namibia
| | - Johanne Sundby
- Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Beňová L, Semaan A, Portela A, Bonet M, van den Akker T, Pembe AB, Moran A, Duclos D. Facilitators and barriers of implementation of routine postnatal care guidelines for women: A systematic scoping review using critical interpretive synthesis. J Glob Health 2023; 13:04176. [PMID: 37997894 PMCID: PMC10668206 DOI: 10.7189/jogh.13.04176] [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: 11/25/2023] Open
Abstract
Background Postnatal care (PNC) has the potential to prevent a substantial burden of maternal and newborn morbidity and mortality. This scoping review aimed to identify and synthesise themes related to facilitators and barriers of implementation of guidelines on routine PNC for women (postpartum care) in all settings. Methods This is a scoping review guided by the standard principles of Arksey & O'Malley's framework. We used the critical interpretive synthesis method to synthesise the whole body of evidence. We searched four databases (Medline, Embase, Global Health, CINAHL Plus) using a combination of search terms comprising four key concepts: postnatal care, routine care, guidelines and implementation. No restrictions on country or language of publication were applied. We excluded studies not presenting findings about PNC for women. We thematically charted the themes of studies included based on title and abstract screening. All studies included after full text screening were described and their results synthesised using the socio-ecological model framework. We did not conduct a risk of bias analysis or quality assessment of included studies. Results We identified a total of 8692 unique records and included 43 studies which identified facilitators and barriers to implementing routine guidelines in provision of PNC to women. Three quarters of studies pertained to PNC provision in high-income countries. Specific facilitators and barriers were identified and thematically presented based on whether they affect the provision of PNC or the intersection between provision of PNC and its use by women and families. We applied a critical global health lens to synthesise three constructs in the literature: finding a balance between standardisation and individualisation of PNC, the fragmented PNC provision landscape complicating the experiences of women with intersecting vulnerabilities, and the heavy reliance on the short postpartum period as an opportunity to educate and retain women and newborns in the health system. Conclusions This interpretive synthesis of evidence shows that the fragmented and narrow nature of PNC provision presents specific challenges to developing, adapting and implementing routine PNC guidelines. This results in a lack of linkages to social support and services, fails to address intersecting vulnerabilities and inequities among women, and negatively influences care seeking. There is a lack of evidence on how processes of individualising PNC provision can be applied in practice to support health workers in providing woman-centered PNC in various global settings. Registration https://www.protocols.io/private/C99DA688881F11EBB4690A58A9FEAC02.
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Affiliation(s)
- Lenka Beňová
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene and Tropical Medicine, London, UK
| | - Aline Semaan
- Institute of Tropical Medicine, Antwerp, Belgium
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anayda Portela
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Thomas van den Akker
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania (s)
| | - Allisyn Moran
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Diane Duclos
- London School of Hygiene and Tropical Medicine, London, UK
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. Int J Equity Health 2023; 22:239. [PMID: 37978385 PMCID: PMC10656898 DOI: 10.1186/s12939-023-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ensuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa. METHODS We analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care. RESULTS We included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care. CONCLUSIONS Persistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Health Systems and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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10
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Sandie AB, Mutua MK, Sidze E, Nyakangi V, Sylla EHM, Wanjoya A, Njom Nlend AE, Faye C. Epidemiology of emergency and elective caesarean section and its association with early neonatal mortality in sub-Saharan African countries. BMJ Open 2023; 13:e074995. [PMID: 37827732 PMCID: PMC10582852 DOI: 10.1136/bmjopen-2023-074995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA. METHODS SSA countries Demographic and Health Surveys data that had collected information on the CS' timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries' level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality. RESULTS The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4-4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3-3.6). Private health facilities' elective CS prevalence was estimated at 10.2% (95% CI 9.3-11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0-8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8-4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6-2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64-3.41), while no association was found with elective CS. CONCLUSIONS Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.
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Affiliation(s)
- Arsène Brunelle Sandie
- West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
| | - Martin K Mutua
- West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
| | - Estelle Sidze
- Sexual Reproductive, Maternal, Newborn and Child health Research, African Population and Health Research Center, Nairobi, Senegal
| | | | - El Hadji Malick Sylla
- West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
| | - Anthony Wanjoya
- Department of Statistics and Acturial Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Anne Esther Njom Nlend
- Hopital de la Caisse Nationale de Prevoyance Sociale, Ministere de la Sante Publique, Yaoundé, Cameroon
| | - Cheikh Faye
- West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
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11
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Zhong X, Hu R, Afulani PA, Li X, Guo X, He T, Li D, Li Z. Cross-cultural adaptation and psychometric properties of the Chinese version of the Person-Centered Maternity Care Scale. BMC Pregnancy Childbirth 2023; 23:652. [PMID: 37689683 PMCID: PMC10492356 DOI: 10.1186/s12884-023-05959-x] [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: 03/21/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Increasing evidence show that women across the world face unacceptable mistreatment during childbirth. Person-centered maternity care is fundamental and essential to quality of healthcare services. The aim of this study was to translate and determine the psychometric properties of the Person-Centered Maternity Care (PCMC) Scale among Chinese postpartum women. METHODS A cross-sectional study was conducted among 1235 post-partum women in China. The cross-cultural adaptation process followed the Beaton intercultural debugging guidelines. A total of 1235 women were included to establish the psychometric properties of the PCMC. A demographic characteristics form and the PCMC were used for data collection. The psychometric properties of the PCMC were evaluated by examining item analysis, exploratory factor analysis, known-groups discriminant validity, and internal consistency. RESULTS The number of extracted common factors was limited to three (dignity & respect, communication & autonomy, supportive care), explaining a total variance of 40.8%. Regarding internal consistency, the Cronbach's alpha coefficient and split-half reliability of the full PCMC score were 0.989 and 0.852, respectively. CONCLUSIONS The Chinese version of the PCMC is a reliable and valid tool to assess person-centered care during childbirth in China.
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Affiliation(s)
- Xiaoying Zhong
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Rong Hu
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San San Francisco, California, USA
| | - Xixi Li
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China Philippines Women's University, Manila, Philippines.
| | - Xiujing Guo
- Department of Nursing, West China Second University Hospital, Sichuan University / Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Tingting He
- Nephrology department, The Third Hospital of Mianyang, Sichuan Mental Health Center/ The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, China
| | - Dehua Li
- Department of Nursing, West China Second University Hospital, Sichuan University / Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zuowei Li
- Department of Nursing, The Third Hospital of Mianyang, Sichuan Mental Health Center/ The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, China
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12
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Rebeiz MC, El-Kak F, van den Akker T, Hamadeh R, McCall SJ. Maternal mortality is preventable in Lebanon: A case series of maternal deaths to identify lessons learned using the "Three Delays" model. Int J Gynaecol Obstet 2023; 162:922-930. [PMID: 37102363 DOI: 10.1002/ijgo.14770] [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: 08/01/2022] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To identify the lessons learned from women who died during pregnancy or childbirth in Lebanon between 2018 and 2020. METHOD This is a case series and synthesis of maternal deaths between 2018 and 2020 that were reported by healthcare facilities to the Ministry of Public Health in Lebanon. The notes recorded from the maternal mortality review reports were analyzed using the "Three Delays" model to identify preventable causes and lessons learned. RESULTS A total of 49 women died before, during, or after childbirth, with hemorrhage being the most frequent cause (n = 16). The possible factors that would have prevented maternal deaths included a prompt recognition of clinical severity, availability of blood for transfusion and magnesium sulfate for eclampsia, adequate transfer to tertiary care hospitals comprising specialist care, and involvement of skilled medical staff in obstetric emergencies. CONCLUSION Many maternal deaths in Lebanon are preventable. Better risk assessment, use of an obstetric warning system, access to adequately skilled human resources and medications, and improved communication and transfer mechanisms between private and tertiary care hospitals may avoid future maternal deaths.
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Affiliation(s)
- Marie-Claire Rebeiz
- Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Faysal El-Kak
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Randa Hamadeh
- Primary Healthcare Department, Ministry of Public Health, Global Health Team of Experts, Beirut, Lebanon
| | - Stephen J McCall
- Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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13
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Salam SS, Ameen S, Balen J, Nahar Q, Jabeen S, Ahmed A, Gillespie B, Chauke L, Mannan A, Hoque M, Dey SK, Islam J, Ashrafee S, Alam HMS, Saberin A, Saha PK, Sarkar S, Alim A, Islam MS, Gray C, El Arifeen S, Rahman AE, Anumba DOC. Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method. J Glob Health 2023; 13:07004. [PMID: 37651640 PMCID: PMC10472017 DOI: 10.7189/jogh.13.07004] [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: 09/02/2023] Open
Abstract
Background Fifteen million babies are born preterm globally each year, with 81% occurring in low- and middle-income countries (LMICs). Preterm birth complications are the leading cause of newborn deaths and significantly impact health, quality of life, and costs of health services. Improving outcomes for newborns and their families requires prioritising research for developing practical, scalable solutions, especially in low-resource settings such as Bangladesh. We aimed to identify research priorities related to preventing and managing preterm birth in LMICs for 2021-2030, with a special focus on Bangladesh. Methods We adopted the Child Health and Nutrition Research Initiative (CHNRI) method to set research priorities for preventing and managing preterm birth. Seventy-six experts submitted 490 research questions online, which we collated into 95 unique questions and sent for scoring to all experts. A hundred and nine experts scored the questions using five pre-selected criteria: answerability, effectiveness, deliverability, maximum potential for burden reduction, and effect on equity. We calculated weighted and unweighted research priority scores and average expert agreement to generate a list of top-ranked research questions for LMICs and Bangladesh. Results Health systems and policy research dominated the top 20 identified priorities for LMICs, such as understanding and improving uptake of the facility and community-based Kangaroo Mother Care (KMC), promoting breastfeeding, improving referral and transport networks, evaluating the impact of the use of skilled attendants, quality improvement activities, and exploring barriers to antenatal steroid use. Several of the top 20 questions also focused on screening high-risk women or the general population of women, understanding the causes of preterm birth, or managing preterm babies with illnesses (jaundice, sepsis and retinopathy of prematurity). There was a high overlap between research priorities in LMICs and Bangladesh. Conclusions This exercise, aimed at identifying priorities for preterm birth prevention and management research in LMICs, especially in Bangladesh, found research on improving the care of preterm babies to be more important in reducing the burden of preterm birth and accelerating the attainment of Sustainable Development Goal 3 target of newborn deaths, by 2030.
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Affiliation(s)
| | - Shafiqul Ameen
- The University of Sheffield, Sheffield, UK
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julie Balen
- The University of Sheffield, Sheffield, UK
- Canterbury Christ Church University, Canterbury, UK
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Abdul Mannan
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Sanjoy Kumer Dey
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Husam Md Shah Alam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Palash Kumar Saha
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Supriya Sarkar
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Azizul Alim
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Clive Gray
- Stellenbosch University, Stellenbosch, South Africa
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Boerma T, Campbell OMR, Amouzou A, Blumenberg C, Blencowe H, Moran A, Lawn JE, Ikilezi G. Maternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries. Lancet Glob Health 2023; 11:e1024-e1031. [PMID: 37349032 PMCID: PMC10299966 DOI: 10.1016/s2214-109x(23)00195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/11/2023] [Accepted: 04/14/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Maternal mortality, stillbirths, and neonatal mortality account for almost 5 million deaths a year and are often analysed separately, despite having overlapping causes and interventions. We propose a comprehensive five-phase mortality transition model to improve analyses of progress and inform strategic planning. METHODS In this empirical data-driven study to develop a model transition, we used UN estimates for 151 countries to assess changes in maternal mortality, stillbirths, and neonatal deaths. On the basis of ratios of maternal to stillbirth and neonatal mortality, we identified five phases of transition, in which phase 1 has the highest mortality and phase 5 has the lowest. We used global databases to examine phase-specific characteristics during 2000-20 for causes of death, fertility rates, abortion policies, health workforce and financing, and socioeconomic indicators. We analysed 326 national surveys to assess service coverage and inequalities by transition phase. FINDINGS Among 116 countries in phases 1 to 4 in 2000, 73 (63%) progressed at least one phase by 2020, six advanced two phases, and three regressed. The ratio of stillbirth and neonatal deaths to maternal deaths increased from less than 10 in phase 1 to well over 50 in phase 4 and phase 5. Progression was associated with a declining proportion of deaths caused by infectious diseases and peripartum complications, declining total and adolescent fertility rates, changes in health-workforce densities and skills mix (ie, ratio of nurses or midwives to physicians) from phase 3 onwards, increasing per-capita health spending, and reducing shares of out-of-pocket health expenditures. From phase 1 to 5, the median coverage of first antenatal care visits increased from 66% to 98%, four or more antenatal care visits from 44% to 94%, institutional births from 36% to 99%, and caesarean section rates from 2% to 25%. The transition out of high-mortality phases involved a major increase in institutional births, primarily in lower-level health facilities, whereas subsequent progress was characterised by rapid increases in hospital births. Wealth-related inequalities reduced strongly for institutional birth coverage from phase 3 onwards. INTERPRETATION The five-phase maternal mortality, stillbirth, and neonatal mortality transition model can be used to benchmark the current indicators in comparison to typical patterns in the transition at national or sub-national level, identify outliers to better assess drivers of progress, and inform strategic planning and investments towards Sustainable Development Goal targets. It can also facilitate programming for integrated strategies to end preventable maternal mortality and neonatal mortality and stillbirths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ties Boerma
- Institute for Global Public Health and Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins University, Baltimore, MA, USA
| | - Cauane Blumenberg
- Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Gloria Ikilezi
- Exemplars in Global Health, Gates Ventures, Seattle, WA, USA
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15
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Gebeyehu NA, Adella GA, Tegegne KD. Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1117116. [PMID: 37153101 PMCID: PMC10157168 DOI: 10.3389/fmed.2023.1117116] [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: 12/06/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Disrespectful and abusive maternity care is a sign of poor treatment that influences women's choice to deliver their babies in institutions. Such malpractices continue to go unreported and are rarely exposed in developing countries, despite their serious burden. Therefore, this meta-analysis study aimed to estimate disrespect and abuse of women during childbirth in East Africa. Methods PubMed, Google Scholar, Scopus, and Science Direct databases were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed. Results Out of 654 articles assessed, 18 met the criteria and were included in this study. There were a total of 12,434 study participants. The pooled prevalence of disrespect and abuse of women during childbirth in East Africa was 46.85% (95% CI: 45.26.72-66.98), I2 = 81.9%. It was lower in studies with sample size greater than 5000 (33%). The disrespect and abuse rates between community-based studies (44.96%) and institutional-based studies (47.35%) did not differ significantly, though. Instrumental delivery (AOR = 2.70; 95%CI: 1.79-4.08), presence of complications (AOR = 6.41; 95% CI: 1.36-30.14), receiving care at government hospitals (AOR = 3.66; 95% CI: 1.09-12.23), and poor wealth index (AOR = 2.16; 95% CI: 1.26-3.70) were associated factors. Conclusion In East Africa, disrespect and abuse of women during childbirth was high. Instrumental delivery, presence of complications during childbirth, receiving care at government hospitals and poor wealth index were predictors of maternal disrespect and abuse. Safe delivery practice should be promoted. Training in compassionate and respectful maternity care, particularly in public hospitals, has also been recommended.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gtachew Asmare Adella
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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16
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Reinders S, Blas MM, Neuman M, Huicho L, Ronsmans C. Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region. LANCET REGIONAL HEALTH. AMERICAS 2023; 18:100404. [PMID: 36844009 PMCID: PMC9950545 DOI: 10.1016/j.lana.2022.100404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/16/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. Methods We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. Findings All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]). Interpretation Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Funding Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.
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Affiliation(s)
- Stefan Reinders
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Magaly M. Blas
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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17
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Mohan S, Chaudhry M, McCarthy O, Jarhyan P, Calvert C, Jindal D, Shakya R, Radovich E, Kondal D, Penn-Kekana L, Basany K, Roy A, Tandon N, Shrestha A, Shrestha A, Karmacharya B, Cairns J, Perel P, Campbell OMR, Prabhakaran D. A cluster randomized controlled trial of an electronic decision-support system to enhance antenatal care services in pregnancy at primary healthcare level in Telangana, India: trial protocol. BMC Pregnancy Childbirth 2023; 23:72. [PMID: 36703109 PMCID: PMC9878774 DOI: 10.1186/s12884-022-05249-y] [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: 10/03/2022] [Accepted: 11/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers - Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers). METHODS This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities-one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist. DISCUSSION To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries. TRIAL REGISTRATION CLINICALTRIALS gov, NCT03700034, registered 9 Oct 2018, https://www. CLINICALTRIALS gov/ct2/show/NCT03700034 CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27.
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Affiliation(s)
- Sailesh Mohan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Monica Chaudhry
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Ona McCarthy
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Prashant Jarhyan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Clara Calvert
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK ,grid.4305.20000 0004 1936 7988Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Devraj Jindal
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India
| | - Rajani Shakya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Emma Radovich
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dimple Kondal
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India
| | - Loveday Penn-Kekana
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Kalpana Basany
- grid.501907.a0000 0004 1792 1113SHARE (Sci Health Allied Res Education), MediCiti Institute of Medical Sciences Campus, Medchal-Malkajgiri, Hyderabad, Telangana 501401 India
| | - Ambuj Roy
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Nikhil Tandon
- grid.413618.90000 0004 1767 6103All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, Delhi, 110029 India
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Abha Shrestha
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - Biraj Karmacharya
- grid.429382.60000 0001 0680 7778Dhulikhel Hospital, Kathmandu University, JG8X+P54, Dhulikhel, 45200 Nepal
| | - John Cairns
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Pablo Perel
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Oona M. R. Campbell
- grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Dorairaj Prabhakaran
- grid.415361.40000 0004 1761 0198Public Health Foundation of India (PHFI), Plot 47, Sector 44, Gurugram, Haryana 122002 India ,grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control (CCDC), Safdarjung Development Area, C-1/52, Second Floor, Delhi, 110016 India ,grid.8991.90000 0004 0425 469X London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
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18
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Solnes Miltenburg A, van Pelt S, Lindskog B, Sundby J, Meguid T. Understanding women's decision-making process for birth location in Tanzania based on individual women's reproductive pathways: a life-course perspective. Glob Health Action 2022; 15:2040149. [PMID: 35322765 PMCID: PMC8956304 DOI: 10.1080/16549716.2022.2040149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Determinants for women’s care seeking for birth in low-income setting are multifactorial and remain poorly understood. A life course approach can assist to structure the interplay of the different factors that lead to women seeking care or not. Objective In this study we aimed to explore individual women’s reproductive pathways, and increase understanding of how important life events including previous pregnancy and birth experiences can help us to understand individual choices made for care seeking during childbirth. Methods The study took place in Tanzania between 2015 and 2017. 14 women were followed throughout their pregnancy, birth and postpartum period through participant observation and in-depth interviews. In total 94 in-depth interviews were held (between 5–7 interviews per woman). Analysis occurred continuous throughout the data collection period resulting in detailed narratives of crucial events across women’s life course, with specific attention to their current pregnancy. Results Of the 14 women, seven had a facility birth, six a home birth and one woman gave birth at the home of a local birth attendant. Four different story plots were identified: expected home birth, expected facility birth, unexpected facility birth and unexpected home birth. Birth narratives of four women representative of the different story plots are presented. Narratives illustrate women’s individual reproductive pathways including the various factors influencing women’s expectations and justifications for their actions during their pregnancy and birth. Conclusion Women’s agency, including women’s perception of self, the self in relation to the social environment and reflection on risks associated with the range of options, influences the final decision made for birth. Women’s narratives suggest that quality of care can function as a primary pull factor for facility birth. As long as home birth is by some perceived to be a better alternative, achieving skilled care for all will be difficult to achieve.
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Affiliation(s)
- Andrea Solnes Miltenburg
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sandra van Pelt
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Benedikte Lindskog
- Section for Diversity Studies Department of International Studies and Interpreting OsloMet, Oslo Metropolitan University, Oslo, Norway
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tarek Meguid
- Child Health Unit. University of Cape Town, South Africa
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19
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Egal JA, Essa A, Yusuf R, Osman F, Ereg D, Klingberg-Allvin M, Erlandsson K. A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs-a qualitative study among multiparous women in Somaliland. Glob Health Action 2022; 15:2054110. [PMID: 35389334 PMCID: PMC9004503 DOI: 10.1080/16549716.2022.2054110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women’s choice of place of birth. Objective In this study, we explore multipara women’s needs and preferences when choosing the place of birth. Method An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. Results The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. Conclusion To meet women’s needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.
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Affiliation(s)
- Jama Ali Egal
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Amina Essa
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Rahma Yusuf
- Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland
| | - Fatumo Osman
- Institution for Health and Welfare, Dalarna University, Falun, Sweden
| | - Derie Ereg
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
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20
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Maaløe N, Housseine N, Sørensen JB, Obel J, Sequeira DMello B, Kujabi ML, Osaki H, John TW, Khamis RS, Muniro ZSS, Nkungu DJ, Pinkowski Tersbøl B, Konradsen F, Mookherji S, Mbekenga C, Meguid T, van Roosmalen J, Bygbjerg IC, van den Akker T, Jensen AK, Skovdal M, L. Kidanto H, Wolf Meyrowitsch D. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study). Glob Health Action 2022; 15:2034135. [PMID: 35410590 PMCID: PMC9009913 DOI: 10.1080/16549716.2022.2034135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Natasha Housseine
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Obel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira DMello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
- Comprehensive Community Based Rehabilitation in Tanzania, Dar Es Salaam, Tanzania
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Columba Mbekenga
- School of Nursing and Midwifery East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Kryger Jensen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L. Kidanto
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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21
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Kukka AJ, Waheddoost S, Brown N, Litorp H, Wrammert J, KC A. Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2022-010294. [PMID: 36581333 PMCID: PMC9806096 DOI: 10.1136/bmjgh-2022-010294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/23/2022] [Indexed: 12/30/2022] Open
Abstract
AIM To examine the incidence of intrapartum-related neonatal encephalopathy, and neonatal mortality and neurodevelopmental outcomes associated with it in low-income and middle-income countries. METHODS Reports were included when neonatal encephalopathy diagnosed clinically within 24 hours of birth in term or near-term infants born after intrapartum hypoxia-ischaemia defined as any of the following: (1) pH≤7.1 or base excess ≤-12 or lactate ≥6, (2) Apgar score ≤5 at 5 or 10 min, (3) continuing resuscitation at 5 or 10 min or (4) no cry from baby at 5 or 10 min. Peer-reviewed articles were searched from Ovid MEDLINE, Cochrane, Web of Science and WHO Global Index Medicus with date limits 1 November 2009 to 17 November 2021. Risk of bias was assessed using modified Newcastle Ottawa Scale. Inverse variance of heterogenicity was used for meta-analyses. RESULTS There were 53 reports from 51 studies presenting data on 4181 children with intrapartum-related neonatal encephalopathy included in the review. Only five studies had data on incidence, which ranged from 1.5 to 20.3 per 1000 live births. Neonatal mortality was examined in 45 studies and in total 636 of the 3307 (19.2%) infants died. Combined outcome of death or moderate to severe neurodevelopmental disability was reported in 19 studies and occurred in 712 out of 1595 children (44.6%) with follow-up 1 to 3.5 years. CONCLUSION Though there has been progress in some regions, incidence, case mortality and morbidity in intrapartum-related neonatal encephalopathy has been static in the last 10 years. PROSPERO REGISTRATION NUMBER CRD42020177928.
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Affiliation(s)
- Antti Juhani Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .,Department of Pediatrics, Region Gävleborg, Gävle, Sweden
| | | | - Nick Brown
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Department of Pediatrics, Region Gävleborg, Gävle, Sweden
| | - Helena Litorp
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Wrammert
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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22
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Esan OT, Maswime S, Blaauw D. Organisational and individual readiness for change to respectful maternity care practice and associated factors in Ibadan, Nigeria: a cross-sectional survey. BMJ Open 2022; 12:e065517. [PMID: 36414287 PMCID: PMC9685001 DOI: 10.1136/bmjopen-2022-065517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study assessed health providers' organisational and individual readiness for change to respectful maternity care (RMC) practice and their associated factors in Ibadan Metropolis, Nigeria. DESIGN A cross-sectional survey using standardised structured instruments adapted from the literature. SETTING Nine public health facilities in Ibadan Metropolis, Nigeria, 1 December 2019-31 May 2020. PARTICIPANTS 212 health providers selected via a two-stage cluster sampling. OUTCOMES Organisational readiness for change to RMC (ORCRMC) and individual readiness for change to RMC (IRCRMC) scales had a maximum score of 5. Multiple linear regression was used to identify factors influencing IRCRMC and ORCRMC. We evaluated previously identified predictors of readiness for change (change valence, informational assessments on resource adequacy, core self-evaluation and job satisfaction) and proposed others (workplace characteristics, awareness of mistreatment during childbirth, perceptions of women's rights and resource availability to implement RMC). Data were adjusted for clustering and analysed using Stata V.15. RESULTS The providers' mean age was 44.0±9.9 years with 15.4±9.9 years of work experience. They scored high on awareness of women's mistreatment (3.9±0.5) and women's perceived rights during childbirth (3.9±0.5). They had high ORCRMC (4.1±0.9) and IRCRMC (4.2±0.6), both weakly but positively correlated (r=0.407, 95% CI: 0.288 to 0.514, p<0.001). Providers also had high change valence (4.5±0.8) but lower perceptions of resource availability (2.7±0.7) and adequacy for implementation (3.3±0.7). Higher provider change valence and informational assessments were associated with significantly increased IRCRMC (β=0.40, 95% CI: 0.11 to 0.70, p=0.015 and β=0.07, 95% CI: 0.01 to 0.13, p=0.032, respectively), and also with significantly increased ORCRMC (β=0.47, 95% CI: 0.21 to 0.74, p=0.004 and β=0.43, 95% CI: 0.22 to 0.63, p=0.002, respectively). Longer years of work experience (β=0.08, 95% CI: 0.01 to 0.2, p=0.024), providers' monthly income (β=0.08, 95% CI: 0.02 to 0.15, p=0.021) and the health facility of practice were associated with significantly increased ORCRMC. CONCLUSION The health providers studied valued a change to RMC and believed that both they and their facilities were ready for the change to RMC practice.
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Affiliation(s)
- Oluwaseun Taiwo Esan
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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23
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Roro M, Deressa W, Lindtjørn B. Antenatal care utilization and compliance with national and WHO guidelines in rural Ethiopia: a cohort study. BMC Pregnancy Childbirth 2022; 22:849. [DOI: 10.1186/s12884-022-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Antenatal health care utilization has the potential to influence maternal and new-born health. In this study, we assessed compliance of antenatal care utilization with national and World Health Organization (WHO) guidelines. We also examined association of antenatal care utilization with adverse pregnancy outcomes as secondary outcome.
Methods
This was a community-based cross sectional study conducted from July 2016 to November 2017 in rural south-central Ethiopia. We described antenatal care received by pregnant women, whom we followed at three prescheduled visits during pregnancy and collected birth data at time of delivery. Extent of antenatal care content received, timing of antenatal care, place of antenatal care and place and mode of delivery were obtained and computed in accordance with national and WHO guidelines. For adverse pregnancy outcomes, computed as sum of low birth weight, preterm birth, intrauterine foetal death, and stillbirth, the exposure variable used was antenatal care utilization.
Results
Seven hundred and four (704) women participated in the study, and 536 (76.1%) had attended at least one antenatal care visit. Among women who attended antenatal care visit, majority, 421 (79.3%), had done so at health centres and hospitals, while 110 (20.7%) attended at health post. Average number of antenatal care visits was 2.5, which is less than that recommended in national and WHO guidelines. Only 18 (2.6%) women had attended antenatal care in their first trimester, which is low in contrast to the expected 100% specified in the guidelines. Less than half (47%) of the women delivered in a health facility. This is in contrast to the 100% expected health institution deliveries. Low birth weight was 7.9% (n = 48), and preterm birth was 4.9% (n = 31). There were 12 twin pregnancies, three stillbirths, 11 spontaneous abortions, and two intrauterine foetal deaths. We did not find significant association between adverse pregnancy outcomes and antenatal care utilization (COR = 1.07, 95% CI 0.62, 1.86).
Conclusion
This study showed that antenatal care service utilization in the study area was markedly low compared to that recommended in national and WHO guidelines. The obtained antenatal health care utilization was not associated with the registered adverse pregnancy outcomes.
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24
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Syed U, Kinney MV, Pestvenidze E, Vandy AO, Slowing K, Kayita J, Lewis AF, Kenneh S, Moses FL, Aabroo A, Thom E, Uzma Q, Zaka N, Rattana K, Cheang K, Kanke RM, Kini B, Epondo JBE, Moran AC. Advancing maternal and perinatal health in low- and middle-income countries: A multi-country review of policies and programmes. Front Glob Womens Health 2022; 3:909991. [PMID: 36299801 PMCID: PMC9589433 DOI: 10.3389/fgwh.2022.909991] [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: 03/31/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The Sustainable Development Goals prioritize maternal mortality reduction, with a global average target of < 70 per 100,000 live births by 2030. Current pace of reduction is far short of what is needed to achieve the global target. It is estimated that globally there are 300,000 maternal deaths, 2.4 million newborn deaths and 2 million stillbirths annually. Majority of these deaths occur in low-and-middle-income countries. Global initiatives like, Ending Preventable Maternal Mortality (EPMM) and Every Newborn Action Plan (ENAP), have outlined the broad strategies for maternal and newborn health programmes. A set of coverage targets and ten milestones were launched to support low-and-middle-income countries in accelerating progress in improving maternal, perinatal and newborn health and wellbeing. WHO, UNICEF and UNFPA, undertook a scoping review to understand how country strategies evolved in different contexts over the past two decades to improve maternal survival and wellbeing, and how countries in similar settings could accelerate progress considering the changing epidemiology and demography. Case studies were conducted to inform countries in similar settings and various global initiatives. Six countries were selected based on standard criteria-Cambodia, Democratic Republic of the Congo, Georgia, Guatemala, Pakistan and Sierra Leone representing different stages of the obstetric transition. A conceptual framework, encapsulating the interrelated factors impacting maternal health outcomes, was used to organize data collection and analysis. While all six countries made remarkable progress in improving maternal and perinatal health, the pace of progress and the factors influencing the successes and challenges varied across the countries. The context, opportunities and challenges varied from country to country. Two strategic directions were identified for next steps including the need to implement and evaluate innovative service delivery models using an updated obstetric transition as an organizing framework and expanding our vision to address equity and well-being.
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Affiliation(s)
- Uzma Syed
- World Health Organization, Geneva, Switzerland
| | - Mary V. Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | | | | | - Karin Slowing
- Pan American Health Organization, Guatemala City, Guatemala
| | - Janet Kayita
- World Health Organization, Freetown, Sierra Leone
| | | | - Sartie Kenneh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ellen Thom
- World Health Organization, Islamabad, Pakistan
| | - Qudsia Uzma
- World Health Organization, Islamabad, Pakistan
| | - Nabila Zaka
- World Health Organization, Islamabad, Pakistan
| | - Kim Rattana
- National Maternal and Child Health Centre, Phnom Penh, Cambodia
| | | | - Robert M. Kanke
- World Health Organization, Kinshasa, Democratic Republic of Congo
| | - Brigitte Kini
- World Health Organization, Kinshasa, Democratic Republic of Congo
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Ghulaxe Y, Tayade S, Huse S, Chavada J. Advancement in Partograph: WHO's Labor Care Guide. Cureus 2022; 14:e30238. [PMID: 36381845 PMCID: PMC9652267 DOI: 10.7759/cureus.30238] [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: 08/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
Worldwide, the partograph, also known as a partogram, is used as a labor monitoring tool to detect difficulties early, allowing for referral, intervention, or closer observations to follow. Despite widespread support from health experts, there are worries that the partograph has not yet fully realized its potential for enhancing therapeutic results. As a result, the instrument has undergone several changes, and numerous studies have been conducted to examine the obstacles and enablers to its use. Nevertheless, the partograph was widely embraced and has been a component of evaluating labor progress. Earlier it was also used as a standard method for monitoring labor progress. Even though it is widely used, there have been reports of usage and accurate execution rates. The WHO Labor Care Guide (LCG) was created so that medical professionals could keep an eye on the health of pregnant women and their unborn children during labor by conducting routine evaluations to spot any abnormalities. The tool intends to enhance women-centered care and encourage collaborative decision-making between women and healthcare professionals. The LCG is designed to be a tool for ensuring high-quality research centered on health, reducing pointless measures, and offering comfort measures.
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Affiliation(s)
- Yash Ghulaxe
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Surekha Tayade
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shreyash Huse
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Jay Chavada
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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26
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Exploring Women's Experiences of Maternity Service Delivery in Regional Tasmania: A Descriptive Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10101883. [PMID: 36292330 PMCID: PMC9602368 DOI: 10.3390/healthcare10101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to explore and understand the experiences of women who receive antenatal, birthing, and postnatal care from an integrated maternity services model in a regional area in Tasmania, Australia. This descriptive qualitative study included semi-structured, one-on-one interviews with 14 mothers aged >18 years, who were living in a regional area of Tasmania and had accessed maternity health services. Thematic analysis revealed three key themes: (i) talking about me, (ii) is this normal? and (iii) care practices. Overall, women cited mostly negative experiences from a poorly implemented fragmented service. These experiences included feelings of isolation, frustration over receiving conflicting advice, feeling ignored, and minimal to no continuity of care. In contrast, women also experienced the euphoric feelings of birth, immense support, guidance, and encouragement. Regional women’s experiences of maternity care may be improved if health services work towards place-based continuity of care models. These models should be informed by the local women’s experiences and needs in order to achieve better communication, reduce feelings of isolation, and promote positive breastfeeding experiences.
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Croke K, Gage A, Fulcher I, Opondo K, Nzinga J, Tsofa B, Haneuse S, Kruk M. Service delivery reform for maternal and newborn health in Kakamega County, Kenya: study protocol for a prospective impact evaluation and implementation science study. BMC Public Health 2022; 22:1727. [PMID: 36096770 PMCID: PMC9465958 DOI: 10.1186/s12889-022-13578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternal and neonatal mortality remain elevated in low and middle income countries, and progress is slower than needed to achieve the Sustainable Development Goals. Existing strategies appear to be insufficient. One proposed alternative strategy, Service Delivery Redesign for Maternal and Neonatal Health (SDR), centers on strengthening higher level health facilities to provide rapid, definitive care in case of delivery and post-natal complications, and then promoting delivery in these hospitals, rather than in primary care facilities. However to date, SDR has not been piloted or evaluated. Methods We will use a prospective, non-randomized stepped-wedge design to evaluate the effectiveness and implementation of Service Delivery Redesign for Maternal and Neonatal Health in Kakamega County, Kenya. Discussion This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation (“effectiveness”) study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13578-y.
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Affiliation(s)
- Kevin Croke
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Anna Gage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Kennedy Opondo
- Harvard T.H. Chan School of Public Health, Kisumu, Kenya
| | - Jacinta Nzinga
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Margaret Kruk
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Brundell K, Vasilevski V, Sweet L. Australian maternity care, considering risk and supporting safety: A scoping review. Midwifery 2022; 112:103408. [DOI: 10.1016/j.midw.2022.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/31/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022]
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Emergency Medical Services (EMS) Utilization in Zimbabwe: Retrospective Review of Harare Ambulance System Reports. Ann Glob Health 2022; 88:70. [PMID: 36043040 PMCID: PMC9374015 DOI: 10.5334/aogh.3649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Emergency medical services (EMS) are a critical but often overlooked component of essential public health care delivery in low- and middle-income countries (LMICs). Few countries in Africa have established EMS and there is scant literature to provide guidance for EMS growth. Objective: This study aimed to characterize EMS utilization in Harare, Zimbabwe in order to guide system strengthening efforts. Methods: We performed a retrospective chart review of patient care reports (PCR) generated by the City of Harare ambulance system for patients transported and/or treated in the prehospital setting over a 14-month period (February 2018 – March 2019). Findings: A total of 875 PCRs were reviewed representing approximately 8% of the calls to EMS. The majority of patients were age 15 to 49 (76%) and 61% were female patients. In general, trauma and pregnancy were the most common chief complaints, comprising 56% of all transports. More than half (51%) of transports were for inter-facility transfers (IFTs) and 52% of these IFTs were maternity-related. Transports for trauma were mostly for male patients (63%), and 75% of the trauma patients were age 15–49. EMTs assessed and documented pulse and blood pressure for 72% of patients. Conclusion: In this study, EMS cared primarily for obstetric and trauma emergencies, which mirrors the leading causes of premature death in LMICs. The predominance of requests for maternity-related IFTs emphasizes the role for EMS as an integral player in peripartum maternal health care. Targeted public health efforts and chief complaint-specific training for EMTs in these priority areas could improve quality of care and patient outcomes. Moreover, a focus on strengthening prehospital data collection and research is critical to advancing EMS development in Zimbabwe and the region through quality improvement and epidemiologic surveillance.
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Grépin KA, Chukwuma A, Holmlund M, Vera-Hernandez M, Wang Q, Rosa-Dias P. Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design. BMJ Open 2022; 12:e053792. [PMID: 35613794 PMCID: PMC9125714 DOI: 10.1136/bmjopen-2021-053792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Studies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Programme Maternal and Child Health Project (SURE-P MCH) on rates of institutional delivery and antenatal care. DESIGN, SETTING AND PARTICIPANTS We used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-P MCH programme relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey. RESULTS We found that the programme significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10% relative to the baseline after 9 months of implementation. The programme, however, did not significantly increase the use of antenatal care. CONCLUSION The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions.
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Affiliation(s)
- Karen Ann Grépin
- School of Public Health, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Adanna Chukwuma
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Marcus Holmlund
- Development Impact Evaluation (DIME), World Bank, Washington, District of Columbia, USA
| | | | - Qiao Wang
- Water Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Pedro Rosa-Dias
- Department of Economics and Public Policy and CHEPI, Imperial College Business School, Imperial College London, London, UK
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Singh NS, Blanchard AK, Blencowe H, Koon AD, Boerma T, Sharma S, Campbell OMR. Zooming in and out: a holistic framework for research on maternal, late foetal and newborn survival and health. Health Policy Plan 2022; 37:565-574. [PMID: 34888635 PMCID: PMC9113153 DOI: 10.1093/heapol/czab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022] Open
Abstract
Research is needed to understand why some countries succeed in greater improvements in maternal, late foetal and newborn health (MNH) and reducing mortality than others. Pathways towards these health outcomes operate at many levels, making it difficult to understand which factors contribute most to these health improvements. Conceptual frameworks provide a cognitive means of rendering order to these factors and how they interrelate to positively influence MNH. We developed a conceptual framework by integrating theories and frameworks from different disciplines to encapsulate the range of factors that explain reductions in maternal, late foetal and neonatal mortality and improvements in health. We developed our framework iteratively, combining our interdisciplinary research team's knowledge, experience and review of the literature. We present a framework that includes health policy and system levers (or intentional actions that policy-makers can implement) to improve MNH; service delivery and coverage of interventions across the continuum of care; and epidemiological and behavioural risk factors. The framework also considers the role of context in influencing for whom and where health and non-health efforts have the most impact, to recognize 'the causes of the causes' at play at the individual/household, community, national and transnational levels. Our framework holistically reflects the range of interrelated factors influencing improved MNH and survival. The framework lends itself to studying how different factors work together to influence these outcomes using an array of methods. Such research should inform future efforts to improve MNH and survival in different contexts. By re-orienting research in this way, we hope to equip policy-makers and practitioners alike with the insight necessary to make the world a safer and fairer place for mothers and their babies.
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Affiliation(s)
- Neha S Singh
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Andrea K Blanchard
- Department of Community Health Sciences, University of Manitoba, R070-771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada
| | - Hannah Blencowe
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Ties Boerma
- Department of Community Health Sciences, University of Manitoba, R070-771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada
| | - Sudha Sharma
- CIWEC Hospital and Travel Medical Center, G.P.O. Box 12895, Kapurdhara Marg, Kathmandu 44600, Nepal
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Carvalho EMPD, Göttems LBD, Guilhem DB. The teaching of good obstetric practices from the Residency preceptors’ perspective. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022275.23872021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors’ perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.
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Carvalho EMPD, Göttems LBD, Guilhem DB. The teaching of good obstetric practices from the Residency preceptors' perspective. CIENCIA & SAUDE COLETIVA 2022; 27:1763-1772. [PMID: 35544806 DOI: 10.1590/1413-81232022275.23872021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.
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Affiliation(s)
| | | | - Dirce Bellezi Guilhem
- Departamento de Enfermagem, Faculdade de Ciências da Saúde, Universidade de Brasília. Brasília DF Brasil
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Dominico S, Serbanescu F, Mwakatundu N, Kasanga MG, Chaote P, Subi L, Maro G, Prasad N, Ruiz A, Mongo W, Schmidt K, Lobis S. A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00485. [PMID: 35487553 PMCID: PMC9053146 DOI: 10.9745/ghsp-d-21-00485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Efforts to increase the availability and utilization of high-quality emergency obstetric and newborn care and routine delivery care services in Kigoma were successful and subsequently contributed to significant reductions in maternal and perinatal mortality in the region. Introduction: To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand. Methods: Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities. Results: Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status. Conclusion: Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.
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Affiliation(s)
| | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA.
| | | | | | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | | | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA
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Prasad N, Mwakatundu N, Dominico S, Masako P, Mongo W, Mwanshemele Y, Maro G, Subi L, Chaote P, Rusibamayila N, Ruiz A, Schmidt K, Kasanga MG, Lobis S, Serbanescu F. Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00484. [PMID: 35487559 PMCID: PMC9053157 DOI: 10.9745/ghsp-d-21-00484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
The 13-year Program to Reduce Maternal Deaths in Tanzania employed multifaceted maternal, newborn, and reproductive health interventions that contributed to increasing the availability and utilization of high-quality obstetric and family planning services and reducing maternal and perinatal mortality in Kigoma. The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006–2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.
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Affiliation(s)
| | | | | | | | | | | | | | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Neema Rusibamayila
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | | | | | | | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
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Bixby H, Bennett JE, Bawah AA, Arku RE, Annim SK, Anum JD, Mintah SE, Schmidt AM, Agyei-Asabere C, Robinson BE, Cavanaugh A, Agyei-Mensah S, Owusu G, Ezzati M, Baumgartner J. Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis. BMJ Open 2022; 12:e054030. [PMID: 35027422 PMCID: PMC8762100 DOI: 10.1136/bmjopen-2021-054030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Countries in sub-Saharan Africa suffer the highest rates of child mortality worldwide. Urban areas tend to have lower mortality than rural areas, but these comparisons likely mask large within-city inequalities. We aimed to estimate rates of under-five mortality (U5M) at the neighbourhood level for Ghana's Greater Accra Metropolitan Area (GAMA) and measure the extent of intraurban inequalities. METHODS We accessed data on >700 000 women aged 25-49 years living in GAMA using the most recent Ghana census (2010). We summarised counts of child births and deaths by five-year age group of women and neighbourhood (n=406) and applied indirect demographic methods to convert the summaries to yearly probabilities of death before age five years. We fitted a Bayesian spatiotemporal model to the neighbourhood U5M probabilities to obtain estimates for the year 2010 and examined their correlations with indicators of neighbourhood living and socioeconomic conditions. RESULTS U5M varied almost five-fold across neighbourhoods in GAMA in 2010, ranging from 28 (95% credible interval (CrI) 8 to 63) to 138 (95% CrI 111 to 167) deaths per 1000 live births. U5M was highest in neighbourhoods of the central urban core and industrial areas, with an average of 95 deaths per 1000 live births across these neighbourhoods. Peri-urban neighbourhoods performed better, on average, but rates varied more across neighbourhoods compared with neighbourhoods in the central urban areas. U5M was negatively correlated with multiple indicators of improved living and socioeconomic conditions among peri-urban neighbourhoods. Among urban neighbourhoods, correlations with these factors were weaker or, in some cases, reversed, including with median household consumption and women's schooling. CONCLUSION Reducing child mortality in high-burden urban neighbourhoods in GAMA, where a substantial portion of the urban population resides, should be prioritised as part of continued efforts to meet the Sustainable Development Goal national target of less than 25 deaths per 1000 live births.
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Affiliation(s)
- Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Samuel K Annim
- Ghana Statistical Service, Accra, Ghana
- University of Cape Coast, Cape Coast, Ghana
| | | | | | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Brian E Robinson
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Alicia Cavanaugh
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Legon, Greater Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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Avoka CKO, Banke-Thomas A, Beňová L, Radovich E, Campbell OMR. Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000868. [PMID: 36962594 PMCID: PMC10021361 DOI: 10.1371/journal.pgph.0000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15-49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women's socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90-41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55-3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.
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Affiliation(s)
- Cephas Ke-On Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nimako K, Gage A, Benski C, Roder-DeWan S, Ali K, Kandie C, Mohamed A, Odeny H, Oloo M, Otieno JTB, Wanzala M, Okumu R, Kruk ME. Health System Redesign to Shift to Hospital Delivery for Maternal and Newborn Survival: Feasibility Assessment in Kakamega County, Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:1000-1010. [PMID: 34933993 PMCID: PMC8691889 DOI: 10.9745/ghsp-d-20-00684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Maternal and newborn health (MNH) service delivery redesign aims to improve maternal and newborn survival by shifting deliveries from poorly equipped primary care facilities to adequately prepared designated delivery hospitals. We assess the feasibility of such a model in Kakamega County, Kenya, by determining the capacity of hospitals to provide services under the redesigned model and the acceptability of the concept to providers and users. We find many existing system assets to implement redesign, including political will to improve MNH outcomes, a strong base of support among providers and users, and a good geographic spread of facilities to support implementation. There are nonetheless health workforce gaps, infrastructure deficits, and transportation challenges that would need to be addressed ahead of policy rollout. Implementing MNH redesign would require careful planning to limit unintended consequences and rigorous evaluation to assess impact and inform scale-up.
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Affiliation(s)
- Kojo Nimako
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Caroline Benski
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Khatra Ali
- Kenya Council of Governors, Nairobi, Kenya
| | | | | | - Hellen Odeny
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Micky Oloo
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | | | - Maximilla Wanzala
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | - Rachel Okumu
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Moyo I, Mgolozeli SE, Risenga PR, Mboweni SH, Tshivhase L, Mudau TS, Ndou ND, Mavhandu-Mudzusi AH. Experiences of Nurse Managers during the COVID-19 Outbreak in a Selected District Hospital in Limpopo Province, South Africa. Healthcare (Basel) 2021; 10:healthcare10010076. [PMID: 35052240 PMCID: PMC8775488 DOI: 10.3390/healthcare10010076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
The South African health care system was hard hit by the second wave of Coronavirus disease (COVID-19), which affected nurse managers as healthcare facilities became overwhelmed due to an increased workload emanating from the overflow of admissions. Therefore, this study sought to explore and describe the nurse managers’ experiences during COVID-19 in order to identify gaps and lessons learnt. A descriptive phenomenological research approach was used to explore the experiences of ten nurse managers who were purposively selected from different units of a selected district hospital. Data was collected through telephonic unstructured individual interviews and analysed using Colaizzi’s seven steps method. The study revealed that nurse managers experienced human resource related challenges during COVID-19, worsened by the fact that vacant posts were frozen. It also emerged that there was a shortage of material resources that affected patient care. Nurse managers also indicated that COVID-19 brought a lot of administrative duties plus an additional duty of patient care. Also, nurse managers who had previously contracted COVID-19 experienced stigma and discrimination. The government needs to address resource related challenges in rural public hospitals and provide continuous support to nurse managers, particularly during a pandemic like COVID-19.
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Affiliation(s)
- Idah Moyo
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa; (S.E.M.); (P.R.R.); (S.H.M.); (A.H.M.-M.)
- HIV Services, Population Services International Zimbabwe, Emerald Office Park, 30 The Chase, Harare, Zimbabwe
- Correspondence: ; Tel.: +263-776-306-719
| | - Siyabulela Eric Mgolozeli
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa; (S.E.M.); (P.R.R.); (S.H.M.); (A.H.M.-M.)
| | - Patrone Rebecca Risenga
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa; (S.E.M.); (P.R.R.); (S.H.M.); (A.H.M.-M.)
| | - Sheilla Hlamalani Mboweni
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa; (S.E.M.); (P.R.R.); (S.H.M.); (A.H.M.-M.)
| | - Livhuwani Tshivhase
- Department of Nursing Science, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0204, South Africa; (L.T.); (T.S.M.)
| | - Tshimangadzo Selina Mudau
- Department of Nursing Science, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0204, South Africa; (L.T.); (T.S.M.)
| | - Nthomeni Dorah Ndou
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, University Road, Thohoyandou 0950, South Africa;
| | - Azwihangwisi Helen Mavhandu-Mudzusi
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa; (S.E.M.); (P.R.R.); (S.H.M.); (A.H.M.-M.)
- Office of Graduate Studies and Research, College of Human Sciences, University of South Africa, Preller Street, Muckleneuk Ridge, Pretoria 0002, South Africa
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Millogo T, Kourouma RK, Méda BI, Agbre-Yace ML, Dosso A, Yaméogo MWE, Kouanda S. Determinants of childbirth care quality along the care continuum in limited resource settings: A structural equation modeling analysis of cross-sectional data from Burkina Faso and Côte d'Ivoire. BMC Pregnancy Childbirth 2021; 21:848. [PMID: 34965869 PMCID: PMC8715591 DOI: 10.1186/s12884-021-04328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. Methods A health facility-based cross-sectional study with a direct observation of health care workers’ practices while caring for mother–newborn pairs was carried out in Burkina Faso and Côte d’Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. Results A total of 532 and 627 mother–newborn pairs were evaluated in Burkina Faso and Côte d’Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d’Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (β = 0.48, p < 0.001, and β = 0.29, p < 0.001, respectively). Conclusion Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.
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Affiliation(s)
- Tieba Millogo
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso. .,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.
| | - Raïssa Kadidiatou Kourouma
- Institut National de Santé Publique (INSP-Côte d'Ivoire), Abidjan, Côte d'Ivoire.,Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Bertrand Ivlabéhiré Méda
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Marie Laurette Agbre-Yace
- Institut National de Santé Publique (INSP-Côte d'Ivoire), Abidjan, Côte d'Ivoire.,Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Abdul Dosso
- Cellule de Recherche en Santé de la Reproduction, Abidjan, Côte d'Ivoire
| | - Maurice W E Yaméogo
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- African Institute of Public Health (AIPH), 12 BP 199, Ouagadougou, Burkina Faso.,Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
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Scott NA, Kaiser JL, Ngoma T, McGlasson KL, Henry EG, Munro-Kramer ML, Biemba G, Bwalya M, Sakanga VR, Musonda G, Hamer DH, Boyd CJ, Bonawitz R, Vian T, Kruk ME, Fong RM, Chastain PS, Mataka K, Ahmed Mdluli E, Veliz P, Lori JR, Rockers PC. If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia. BMJ Glob Health 2021; 6:e006385. [PMID: 34876457 PMCID: PMC8655557 DOI: 10.1136/bmjgh-2021-006385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia. METHODS We conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs. RESULTS We interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery. CONCLUSION MWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely. TRIAL REGISTRATION NUMBER NCT02620436.
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Affiliation(s)
- Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Kathleen L McGlasson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle L Munro-Kramer
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Godfrey Biemba
- National Health Research Authority Zambia, Lusaka, Zambia
| | - Misheck Bwalya
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | | | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taryn Vian
- University of San Francisco - School of Nursing and Health Professions, San Francisco, California, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Parker S Chastain
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Philip Veliz
- Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jody R Lori
- Center for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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42
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Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study. PLoS Med 2021; 18:e1003843. [PMID: 34851947 PMCID: PMC8635398 DOI: 10.1371/journal.pmed.1003843] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. METHODS AND FINDINGS We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths (p-value < 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study's limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. CONCLUSIONS Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality.
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Straneo M, Benova L, Hanson C, Fogliati P, Pembe AB, Smekens T, van den Akker T. Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015-16 Tanzania Demographic and Health Survey. Health Policy Plan 2021; 36:1428-1440. [PMID: 34279643 PMCID: PMC8505858 DOI: 10.1093/heapol/czab079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015-16 Tanzania Demographic and Health Survey with a live birth in the preceding 5 years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (≥5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30-51%). The poorest women utilized it at intermediate parity, but at parity ≥5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women.
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Affiliation(s)
- Manuela Straneo
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Lenka Benova
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London WC1E 7HT, UK
| | - Claudia Hanson
- Karolinska Institutet, 171 77 Stockholm, Sweden
- Faculty of Infectious and Tropical Diseases, LSHTM, Keppel Street, London WC1E 7HT, UK
| | - Piera Fogliati
- Doctors with Africa-CUAMM, Av. Mártires da Machava n.º 859 R/C, Cidade de Maputo, Moçambique
| | - Andrea B Pembe
- Department of Obstetrics and Gynecology, Muhimbili University of Helath and Allied Sciences, PO Box 65001, Dar es Salaam, United Republic of Tanzania
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Thomas van den Akker
- Athena Institute, VU Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of obstetrics and Gynecology, Leiden University Medical Center, Rapenburg 70, 2311 EZ Leiden, The Netherlands
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Maaløe N, van Roosmalen J, Dmello B, Kwast B, van den Akker T, Housseine N, Kujabi M, Meguid T, Kidanto H. WHO next-generation partograph: revolutionary steps towards individualised labour care? BJOG 2021; 129:682-684. [PMID: 34520112 DOI: 10.1111/1471-0528.16914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- N Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - J van Roosmalen
- Athena Institute, VU University, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - B Dmello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Maternal and Newborn Health, Comprehensive Community Based Rehabilitation in Tanzania, Dar es salaam, United Republic of Tanzania.,Medical College East Africa, Aga Khan University, Dar es Salaam, United Republic of Tanzania
| | - B Kwast
- International Consultant Maternal Health and Safe Motherhood, Leusden, the Netherlands
| | - T van den Akker
- Athena Institute, VU University, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - N Housseine
- Medical College East Africa, Aga Khan University, Dar es Salaam, United Republic of Tanzania
| | - M Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T Meguid
- Kivunge Hospital, Zanzibar, United Republic of Tanzania
| | - H Kidanto
- Medical College East Africa, Aga Khan University, Dar es Salaam, United Republic of Tanzania
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Radovich E, Banke-Thomas A, Campbell OMR, Ezeanochie M, Gwacham-Anisiobi U, Ande ABA, Benova L. Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria. BMC Health Serv Res 2021; 21:927. [PMID: 34488752 PMCID: PMC8420846 DOI: 10.1186/s12913-021-06945-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems. METHODS The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis. RESULTS We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources. CONCLUSIONS Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.
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Affiliation(s)
- Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Ezeanochie
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adedapo B A Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Baumgartner JN, Headley J, Kirya J, Guenther J, Kaggwa J, Kim MK, Aldridge L, Weiland S, Egger J. Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities. Health Policy Plan 2021; 36:1103-1115. [PMID: 34184060 PMCID: PMC8359744 DOI: 10.1093/heapol/czab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/20/2021] [Accepted: 06/26/2021] [Indexed: 11/14/2022] Open
Abstract
Global and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017-18. Direct clinical observations of obstetric deliveries were conducted at baseline (n = 263 pre-intervention) and endline (n = 321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and/or a closer examination of the barriers to adherence.
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Affiliation(s)
- Joy Noel Baumgartner
- School of Social Work, University of North Carolina, 325 Pittsboro Street, Chapel Hill, NC 27599-3550, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Julius Kirya
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Josh Guenther
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - James Kaggwa
- LifeNet International, 64-25 Ring Road, Muyenga PO Box 21189, Kampala, Uganda
| | - Min Kyung Kim
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Luke Aldridge
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | | | - Joseph Egger
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
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Marx Delaney M, Kalita T, Hawrusik B, Neal BJ, Miller K, Ketchum R, Molina RL, Singh S, Kumar V, Semrau K. Modification of oxytocin use through a coaching-based intervention based on the WHO Safe Childbirth Checklist in Uttar Pradesh, India: a secondary analysis of a cluster randomised controlled trial. BJOG 2021; 128:2013-2021. [PMID: 34363293 DOI: 10.1111/1471-0528.16856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To understand the prevalence of intrapartum oxytocin use, assess associated perinatal and maternal outcomes, and evaluate the impact of a WHO Safe Childbirth Checklist intervention on oxytocin use at primary-level facilities in Uttar Pradesh, India. DESIGN Secondary analysis of a cluster-randomised controlled trial. SETTING Thirty Primary and Community public health facilities in Uttar Pradesh, India from 2014 to 2017. POPULATION Women admitted to a study facility for childbirth at baseline, 2, 6 or 12 months after intervention initiation. METHODS The BetterBirth intervention aimed to increase adherence to the WHO Safe Childbirth Checklist. We used Rao-Scott Chi-square tests to compare (1) timing of oxytocin use between study arms and (2) perinatal mortality and resuscitation of infants whose mothers received intrapartum oxytocin versus who did not. MAIN OUTCOME MEASURES Intrapartum and postpartum oxytocin administration, perinatal mortality, use of neonatal bag and mask. RESULTS We observed 5484 deliveries. At baseline, intrapartum oxytocin was administered to 78.2% of women. Two months after intervention initiation, intrapartum oxytocin (I) was administered to 32.1% of women compared with 70.6% in the control (C) (P < 0.01); this difference diminished after the end of the intervention (I = 48.2%, C = 74.7%, P = 0.03). Partograph use remained at <1% at all facilities. Resuscitation was performed on 7.5% of infants whose mother received intrapartum oxytocin versus 2.0% who did not (P < 0.0001). CONCLUSIONS In this setting, intrapartum oxytocin use was high despite limited maternal/fetal monitoring or caesarean capability, and was associated with increased neonatal resuscitation. The BetterBirth intervention was successful at decreasing intrapartum oxytocin use. Ongoing support is needed to sustain these practices. TWEETABLE ABSTRACT Coaching + WHO Safe Childbirth Checklist reduces intrapartum oxytocin use and need for newborn resuscitation.
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Affiliation(s)
- M Marx Delaney
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - T Kalita
- Population Services International, Guwahati, Assam, India
| | - B Hawrusik
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - B J Neal
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - K Miller
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - R Ketchum
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R L Molina
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Singh
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - V Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Kea Semrau
- Ariadne Labs at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Carvajal L, Wilson E, Harris Requejo J, Newby H, de Carvalho Eriksson C, Liang M, Dennis M, Gohar F, Simen-Kapeu A, Idele P, Amouzou A. Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate. J Glob Health 2021; 10:021401. [PMID: 33312517 PMCID: PMC7719354 DOI: 10.7189/jogh.10.021401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background In the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region. Methods We used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman’s socio-demographic and socio-economic characteristics. Results The median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18. Conclusion Coverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.
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Affiliation(s)
- Liliana Carvajal
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Harris Requejo
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | | | | | - Mengjia Liang
- Population and Development Branch, Technical Division, United Nations Population Fund (UNFPA), New York, New York, USA
| | - Mardieh Dennis
- London School of Hygiene and Tropical Medicine LSHTM, London, UK
| | - Fatima Gohar
- Regional Office for Eastern and Southern Africa ESARO, UNICEF, Nairobi, Kenya
| | - Aline Simen-Kapeu
- Regional Office for West and Central Africa, WCARO, UNICEF, Dakar, Senegal
| | | | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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49
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Mwansisya T, Mbekenga C, Isangula K, Mwasha L, Pallangyo E, Edwards G, Orwa J, Mantel M, Mugerwa M, Subi L, Mrema S, Siso D, Selestine E, Temmerman M. Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania. BMC Health Serv Res 2021; 21:735. [PMID: 34303368 PMCID: PMC8310585 DOI: 10.1186/s12913-021-06686-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.
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Affiliation(s)
- Tumbwene Mwansisya
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Grace Edwards
- School of Nursing and Midwifery, the Aga Khan University, Kampala, Uganda
| | - James Orwa
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | - Michaela Mantel
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | | | - Leonard Subi
- Community Development, Ministry of Health, Gender, Elderly and Children, Dodoma, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Coordinator, Mwanza, Tanzania
| | - David Siso
- Aga Khan Foundation, Dar es Salaam, Tanzania
| | | | - Marleen Temmerman
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
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50
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Woodd SL, Kabanywanyi AM, Rehman AM, Campbell OMR, Kagambo A, Martiasi W, TinaDay LM, Aiken AM, Graham WJ. Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study. PLoS One 2021; 16:e0254131. [PMID: 34197559 PMCID: PMC8248639 DOI: 10.1371/journal.pone.0254131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam. METHODS We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection. RESULTS We recruited 879 women and interviewed 791 (90%). From day 0-7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11-3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10-9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care. CONCLUSIONS Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.
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Affiliation(s)
- Susannah L. Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abdunoor M. Kabanywanyi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Andrea M. Rehman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oona M. R. Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Asila Kagambo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Warda Martiasi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise M. TinaDay
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexander M. Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy J. Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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