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KC A, Rönnbäck M, Humgain U, Basnet O, Bhattarai P, Axelin A. Implementation barriers and facilitators of Moyo foetal heart rate monitor during labour in public hospitals in Nepal. Glob Health Action 2024; 17:2328894. [PMID: 38577869 PMCID: PMC11000597 DOI: 10.1080/16549716.2024.2328894] [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: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths. OBJECTIVE This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM. METHODS The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied. RESULTS Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership. CONCLUSION The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.
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Affiliation(s)
- Ashish KC
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mikaela Rönnbäck
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Urja Humgain
- Research Division, Golden Community, Lalitpur, Nepal
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | | | - Anna Axelin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
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Garabedian C, Sibiude J, Anselem O, Attie-Bittach T, Bertholdt C, Blanc J, Dap M, de Mézerac I, Fischer C, Girault A, Guerby P, Le Gouez A, Madar H, Quibel T, Tardy V, Stirnemann J, Vialard F, Vivanti A, Sananès N, Verspyck E. [Fetal death: Expert consensus from the College of French Gynecologists and Obstetricians]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:549-611. [PMID: 39153884 DOI: 10.1016/j.gofs.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
Fetal death is defined as the spontaneous cessation of cardiac activity after fourteen weeks of amenorrhea. In France, the prevalence of fetal death after 22 weeks is between 3.2 and 4.4/1000 births. Regarding the prevention of fetal death in the general population, it is not recommended to counsel for rest and not to prescribe vitamin A, vitamin D nor micronutrient supplementation for the sole purpose of reducing the risk of fetal death (Weak recommendations; Low quality of evidence). It is not recommended to prescribe aspirin (Weak recommendation; Very low quality of evidence). It is recommended to offer vaccination against influenza in epidemic periods and against SARS-CoV-2 (Strong recommendations; Low quality of evidence). It is not recommended to systematically look for nuchal cord encirclements during prenatal screening ultrasounds (Strong Recommendation; Low Quality of Evidence) and not to perform systematic antepartum monitoring by cardiotocography (Weak Recommendation; Very Low Quality of Evidence). It is not recommended to ask women to perform an active fetal movement count to reduce the risk of fetal death (Strong Recommendation; High Quality of Evidence). Regarding evaluation in the event of fetal death, it is suggested that an external fetal examination be systematically offered (Expert opinion). It is recommended that a fetopathological and anatomopathological examination of the placenta be carried out to participate in cause identification (Strong Recommendation. Moderate quality of evidence). It is recommended that chromosomal analysis by microarray testing be performed rather than conventional karyotype, in order to be able to identify a potentially causal anomaly more frequently (Strong Recommendation, moderate quality of evidence); to this end, it is suggested that postnatal sampling of the placental fetal surface for genetic purposes be preferred (Expert Opinion). It is suggested to test for antiphospholipid antibodies and systematically perform a Kleihauer test and a test for irregular agglutinins (Expert opinion). It is suggested to offer a summary consultation, with the aim of assessing the physical and psychological status of the parents, reporting the results, discussing the cause and providing information on monitoring for a subsequent pregnancy (Expert opinion). Regarding announcement and support, it is suggested to announce fetal death without ambiguity, using simple words and adapting to each situation, and then to support couples with empathy in the various stages of their care (Expert opinion). Regarding management, it is suggested that, in the absence of a situation at risk of disseminated intravascular coagulation or maternal vitality, the patient's wishes should be taken into account when determining the time between the diagnosis of fetal death and induction of birth. Returning home is possible if it's the patient wish (Expert opinion). In all situations excluding maternal life-threatening emergencies, the preferred mode of delivery is vaginal delivery, regardless the history of cesarean section(s) history (Expert opinion). In the event of fetal death, it is recommended that mifepristone 200mg be prescribed at least 24hours before induction, to reduce the delay between induction and delivery (Low recommendation. Low quality of evidence). There are insufficient data in the literature to make a recommendation regarding the route of administration (vaginal or oral) of misoprostol, neither the type of prostaglandin to reduce induction-delivery time or maternal morbidity. It is suggested that perimedullary analgesia be introduced at the start of induction if the patient asks, regardless of gestational age. It is suggested to prescribe cabergoline immediately in the postpartum period in order to avoid lactation, whatever the gestational age, after discussing the side effects of the treatment with the patient (Expert opinion). The risk of recurrence of fetal death after unexplained fetal death does not appear to be increased in subsequent pregnancies, and data from the literature are insufficient to make a recommendation on the prescription of aspirin. In the event of a history of fetal death due to vascular issues, low-dose aspirin is recommended to reduce perinatal morbidity, and should not be combined with heparin therapy (Low recommendation, very low quality of evidence). It is suggested not to recommend an optimal delay before initiating another pregnancy just because of the history of fetal death. It is suggested that the woman and co-parent be informed of the possibility of psychological support. Fetal heart rate monitoring is not indicated solely because of a history of fetal death. It is suggested that delivery not be systematically induced. However, induction can be considered depending on the context and parental request. The gestational age will be discussed, taking into account the benefits and risks, especially before 39 weeks. If a cause of fetal death is identified, management will be adapted on a case-by-case basis (expert opinion). In the event of fetal death occurring in a twin pregnancy, it is suggested that the surviving twin be evaluated as soon as the diagnosis of fetal death is made. In the case of dichorionic pregnancy, it is suggested to offer ultrasound monitoring on a monthly basis. It is suggested not to deliver prematurely following fetal death of a twin. If fetal death occurs in a monochorionic twin pregnancy, it is suggested to contact the referral competence center, in order to urgently look for signs of acute fetal anemia on ultrasound in the surviving twin, and to carry out weekly ultrasound monitoring for the first month. It is suggested not to induce birth immediately.
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Affiliation(s)
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, 75014 Paris, France
| | | | - Charline Bertholdt
- Pôle de gynécologie-obstétrique, pôle laboratoires, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | - Julie Blanc
- Service de gynécologie-obstétrique, hôpital Nord, hôpitaux universitaires de Marseille, AP-HM, Marseille, France
| | - Matthieu Dap
- Pôle de gynécologie-obstétrique, pôle laboratoires, CHRU de Nancy, université de Lorraine, 54000 Nancy, France
| | | | - Catherine Fischer
- Service d'anesthésie, maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, Paris, France
| | - Aude Girault
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, 75014 Paris, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, CHU de Toulouse, Toulouse, France
| | - Agnès Le Gouez
- Service d'anesthésie, hôpital Antoine-Béclère, AP-HP, université Paris Saclay, Clamart, France
| | - Hugo Madar
- Service de gynécologie-obstétrique, CHU de Bordeaux, 33000 Bordeaux, France
| | - Thibaud Quibel
- Service de gynécologie-obstétrique, CHI de Poissy Saint-Germain-en-Laye, Poissy, France
| | - Véronique Tardy
- Direction des plateaux médicotechniques, hospices civils de Lyon, Lyon, France; Département de biochimie biologie moléculaire, université Claude-Bernard Lyon, Lyon, France
| | - Julien Stirnemann
- Service de gynécologie-obstétrique, hôpital Necker, AP-HP, Paris, France
| | - François Vialard
- Département de génétique, CHI de Poissy Saint-Germain-en-Laye, Poissy, France
| | - Alexandre Vivanti
- Service de gynécologie-obstétrique, DMU santé des femmes et des nouveau-nés, hôpital Antoine-Béclère, AP-HP, université Paris Saclay, Clamart, France
| | - Nicolas Sananès
- Service de gynécologie-obstétrique, hôpital américain, Neuilly-sur-Seine, France
| | - Eric Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, Rouen, France
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Kumar S, Tarnow-Mordi W, Mol BW, Flenady V, Liley H, Badawi N, Walker SP, Hyett J, Seidler L, Callander E, O'Connell R. The iSEARCH randomised controlled trial protocol: a pragmatic Australian phase III clinical trial of intrapartum sildenafil citrate to improve outcomes potentially related to intrapartum hypoxia. BMJ Open 2024; 14:e082943. [PMID: 39343454 DOI: 10.1136/bmjopen-2023-082943] [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] [Indexed: 10/01/2024] Open
Abstract
INTRODUCTION We showed in a phase II randomised controlled trial (RCT) that oral sildenafil citrate in term labour halved operative birth for fetal distress. We outline the protocol for a phase III RCT (can intrapartum SildEnafil safely Avert the Risks of Contraction-induced Hypoxia? (iSEARCH)) of 3200 women in Australia to assess if sildenafil citrate reduces adverse perinatal outcomes related to intrapartum hypoxia. METHODS AND ANALYSIS iSEARCH will enrol 3200 Australian women in term labour to determine whether up to three 50 mg oral doses of sildenafil citrate versus placebo reduce the relative risk of a primary composite end point of 10 perinatal outcomes potentially related to intrapartum hypoxia by 35% (from 7% to 4.55%). Secondary aims are to evaluate reductions in the relative risk of emergency caesarean section or instrumental vaginal birth for fetal distress by 25% (from 20% to 15%) and in healthcare costs. To detect a 35% reduction in the primary outcome for an alpha of 0.05 and power of 80% with 10% dropout in each arm requires 3200 women (1600 in each arm). This sample size will also yield >90% power to detect a 25% reduction for the secondary outcome of any operative birth (caesarean section or instrumental vaginal birth) for fetal distress. ETHICS AND DISSEMINATION Ethical approval for the iSEARCH RCT was granted by the Hunter New England Human Research Ethics Committee (ref no: 2020/ETH02791). Results will be disseminated through websites, peer-reviewed publications, scientific meetings and social media, news outlets, television and radio. TRIAL REGISTRATION NUMBER ACTRN12621000231842.
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Affiliation(s)
- Sailesh Kumar
- Maternal & Fetal Medicine, Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben W Mol
- OB/GYN, Monash Medical School, Clayton, Victoria, Australia
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen Liley
- Mater Research Institute, The University of Queensland, Saint Lucia, Queensland, Australia
- Neonatal Critical Care Unit, Brisbane, Queensland, Australia
| | - Nadia Badawi
- Neonatology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Susan P Walker
- Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jonathan Hyett
- Western Sydney University School of Medicine, Penrith South DC, New South Wales, Australia
| | - Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, UK
| | - R O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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Joyce CM, Sharma D, Mukherji A, Nandi A. Socioeconomic inequalities in adverse pregnancy outcomes in India: 2004-2019. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003701. [PMID: 39292712 PMCID: PMC11410185 DOI: 10.1371/journal.pgph.0003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/16/2024] [Indexed: 09/20/2024]
Abstract
Although India has made substantial improvements in public health, it accounted for one-fifth of global maternal and neonatal deaths in 2015. Stillbirth, abortion, and miscarriage contribute to maternal and infant morbidity and mortality. There are known socioeconomic inequalities in adverse pregnancy outcomes. This study estimated changes in socioeconomic inequalities in rates of stillbirth, abortion, and miscarriage in India across 15 years. We combined data from three nationally representative health surveys. Absolute inequalities were estimated using the slope index of inequality and risk differences, and relative inequalities were estimated using the relative index of inequalities and risk ratios. We used household wealth, maternal education, and Scheduled Caste and Scheduled Tribe membership as socioeconomic indicators. We observed persistent socioeconomic inequalities in abortion and stillbirth from rates of 2004-2019. Women at the top of the wealth distribution reported between 2 and 5 fewer stillbirths per 1,000 pregnancies over the study time period compared to women at the bottom of the wealth distribution. Women who completed primary school, and those at the top of the household wealth distribution, had, over the study period, 5 and 20 additional abortions per 1,000 pregnancies respectively compared to women who did not complete primary school and those at the bottom of the wealth distribution. Women belonging to a Scheduled Caste or Scheduled Tribe had 5 fewer abortions per 1,000 pregnancies compared to other women, although these inequalities diminished by the end of the study period. There was less consistent evidence for socioeconomic inequalities in miscarriage, which increased for all groups over the study period. Despite targeted investments by the Government of India to improve access to health services for socioeconomically disadvantaged groups, disparities in pregnancy outcomes persist.
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Affiliation(s)
- Caroline M Joyce
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Deepti Sharma
- Center for Public Policy, Indian Institute of Management Bangalore, Bengaluru, Karnataka, India
| | - Arnab Mukherji
- Center for Public Policy, Indian Institute of Management Bangalore, Bengaluru, Karnataka, India
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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Israel E, Abraham A, Tesfaw M, Geta T, Kercho MW, Dubale S, Yakob T, Jambo E, Elfios E. Epidemiology of intrapartum stillbirth and associated factors among women who gave childbirth in Ethiopia: systematic review and meta-analysis. Front Glob Womens Health 2024; 5:1432729. [PMID: 39329084 PMCID: PMC11424998 DOI: 10.3389/fgwh.2024.1432729] [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: 05/14/2024] [Accepted: 08/21/2024] [Indexed: 09/28/2024] Open
Abstract
Background Stillbirth always resulted in a multi-dimensional impact from the individual level to the country level at large. It causes psychological depression, social stigmatization, and decreased quality of life for women. Despite several studies conducted in Ethiopia, no national pooled estimates were done. Therefore, this systematic review and meta-analysis sought to assess intrapartum stillbirth and associated factors among women who had childbirth in Ethiopia using the available published evidence. Methods The current review included studies conducted in Ethiopia. The databases used primarily were Medline/PubMed, Google Scholar, Scopus, Web of Science, Ethiopian University Repository Online, CINAHL, African Journals Online and Cochrane Library. All cross-sectional studies conducted in English and met eligibility criteria were included in the final review. A random-effects meta-analysis was performed. Data extraction and analysis were also performed using Microsoft Excel and STATA version 14 software respectively. Results In the current review, eleven studies were included, and their quality was assessed before being chosen for the final review. The pooled prevalence of intrapartum stillbirth among women who had childbirth in Ethiopia was 9.21% [95% CI (7.03%, 11.39%); I 2 = 90.2, P = 0.000]. Women with a previous history of stillbirth [OR = 5.14, 95% CI (3.53-6.75), I 2 = 60.0%, p = 0.04] and had no use of antenatal care {[OR = 0.43, 95% CI (0.18-0.68) I 2 = 85.3%, p = 0.001]} were significantly associated with intrapartum stillbirth among women who gave childbirth. Conclusions Nearly one-tenth of women who had childbirth in Ethiopia had an intrapartum SB. Revitalizing the existing health extension package particularly family health services with emphasis on focused antenatal care and counselling as well as with prompt referral system would reduce intrapartum SB. This review calls for the need to assess the quality of ANC provision and tailor targeted interventions to best improve the service quality.
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Affiliation(s)
- Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Awoke Abraham
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Mihiret Tesfaw
- Department of Public Health, Marie-stopes International (MSI) Ethiopia Reproductive Choices, Hawassa, Ethiopia
| | - Temesgen Geta
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Melkamu Worku Kercho
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Samson Dubale
- Department of Public Health, Marie-stopes International (MSI) Ethiopia Reproductive Choices, Hawassa, Ethiopia
| | - Tagese Yakob
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Endale Jambo
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Eshetu Elfios
- Department of Public Health, Marie-stopes International (MSI) Ethiopia Reproductive Choices, Hawassa, Ethiopia
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Özer E, Güvenç G. Developing the quality of life in pregnancy scale (PREG-QOL). BMC Pregnancy Childbirth 2024; 24:587. [PMID: 39244534 PMCID: PMC11380417 DOI: 10.1186/s12884-024-06771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024] Open
Abstract
AIM This study aims to develop the Quality of Life in Pregnancy Scale (PREG-QOL) as a new instrument to evaluate the quality of life during pregnancy and test its psychometric properties. DESIGN An instrument development study and psychometric testing of the content and construct validity, factor structure and reliability. METHODS The study was conducted in three stages: (1) creating an item pool, (2) preliminary evaluation of items, and (3) refining the scale and evaluating psychometric properties. Instrument development guidelines were used to evaluate content validity, construct validity, internal consistency and stability of the instrument over time. Data to evaluate psychometric properties of the PREG-QOL were collected between April and August 2021. RESULTS Items were developed using in-depth interviews with pregnant women and extensive literature review. Scale-content validity index was 0.98. Exploratory factor analysis revealed a 26-item instrument with 6 factors, which explained % 56.2 of variance. Confirmatory factor analysis (CFA) showed that factors 3 and 5 should be combined into the factor of physical domain since they included items about the same theme. Fit indices obtained by CFA were at sufficient levels. Parallel test method was employed to evaluate the correlation of the PREG-QOL with the SF-36. The findings indicated that the PREG-QOL had high internal inconsistency and stability over time. CONCLUSION The PREG-QOL is a valid and reliable instrument in terms of its psychometric characteristics. The 26-item instrument was composed of the five factors of perception of general satisfaction, emotional domain, physical domain, health support systems and social domain. IMPACT Displaying good psychometric properties, the PREG-QOL may be used to evaluate multiple dimensions of the quality of life during pregnancy.
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Affiliation(s)
- Esra Özer
- Faculty of Health Sciences, Midwifery Department, Ankara Medipol University, Ankara, Turkey.
| | - Gülten Güvenç
- Gulhane Faculty of Nursing, Department of Obstetrics and Gynecology Nursing, University of Health Sciences, Ankara, Turkey
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Tantengco OAG, Diwa MH, Millagrosa PMM, Velayo CL. Epidemiology and placental pathology of intrauterine fetal demise in a tertiary hospital in the Philippines. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100338. [PMID: 39286338 PMCID: PMC11404223 DOI: 10.1016/j.eurox.2024.100338] [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: 06/27/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024] Open
Abstract
Objectives The Philippines has at least 25,000 stillbirth or intrauterine fetal demise (IUFD) cases every year. Despite its burden, there is scarce information on IUFD epidemiology in the Philippines. Hence, this study reported the epidemiology and placental pathology of IUFD in a tertiary hospital in the Philippines. Study design This cross-sectional study analyzed second- and third-trimester IUFD cases at the Philippine General Hospital from 2012 to 2021. We reviewed maternal sociodemographic and clinical characteristics and evaluated placental pathology. All statistical tests were done with GraphPad Prism software version 8.0. Results We recorded 947 (2.28 %) cases of IUFD out of 41,562 obstetric deliveries from 2012 to 2021. Out of 947 IUFD cases, 532 had placental pathology reports. Second-trimester IUFD cases showed higher rates of no antenatal care (42.86 %) compared to third-trimester cases (10.61 %). Hypertensive disorders were more common in third-trimester IUFD. Infarcts (23.34 %), calcifications (4.12 %), and hemorrhages/hematomas (3.00 %) were the most prevalent placental abnormalities. While these abnormalities were more common in third-trimester IUFD, placental and fetal membrane infections like chorioamnionitis were more frequent in second-trimester IUFD. Conclusion The results highlighted the differences in maternal sociodemographic and clinical characteristics, and placental pathology between second- and third-trimester cases of IUFD. These observations revealed distinct pathological processes and potential etiologies contributing to IUFD in the Philippines.
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Affiliation(s)
- Ourlad Alzeus G Tantengco
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Michele H Diwa
- Department of Pathology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Laboratories, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | | | - Clarissa L Velayo
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
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8
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Aragaw FM, Atlie G, Tesfaye AH, Belay DG. Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis. Front Glob Womens Health 2024; 5:1082670. [PMID: 39188539 PMCID: PMC11345201 DOI: 10.3389/fgwh.2024.1082670] [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: 10/28/2022] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
Background The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Methods Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. Results The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Conclusion Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gela Atlie
- Department of Internal Medicine, College of Medicine and Health Sciences, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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9
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Zheng Q, Yin X, Liu L, Jevitt C, Fu D, Sun Y, Yu X. The influence of culture and spirituality on maternal grief following stillbirth in China: A qualitative study. Int J Nurs Stud 2024; 160:104863. [PMID: 39244949 DOI: 10.1016/j.ijnurstu.2024.104863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Stillbirth is a unique phenomenon with various manifestations influenced by cultural contexts and spiritual beliefs. Chinese cultural and spiritual practices produce different post-stillbirth grief experiences for bereaved mothers in China. However, the majority of research on perinatal loss and grief has been conducted in Western cultures. In the Chinese cultural context, the post-stillbirth grief experience of bereaved mothers may differ from the types of Western bereavement examined in the dominant research. OBJECTIVE This study investigated the influence of culture and spirituality on grieving mothers who had experienced a stillbirth in China. METHODS This qualitative study was grounded in an interpretivist constructionist epistemology. In-depth interviews were conducted with mothers who had experienced a stillbirth within the previous year. Thematic analysis was used to analyse the data. FINDINGS A total of 28 women were interviewed by trained interviewers. Three key themes were identified: 1) The influence of culture on grief expression, with four subthemes: restrained expressions of grief, unattainable mourning ceremonies, hospital policy as a barrier to grieving, and others-oriented self; 2) Cultural characteristics of post-stillbirth experiences, with four subthemes: paternalistic medical culture, "Kong yuezi", embarrassment during postpartum visits, and cultural taboos on dealing with deceased babies' possessions; and 3) Finding significance in spiritual healing process, with four subthemes: seeking meaning in the event, accepting and reconciling with the event, reshaping beliefs and views about life and death, and achieving personal growth. CONCLUSION Chinese culture and spirituality have different influences on bereaved mothers' expressions of grief and post-stillbirth healing. This research demonstrates specific aspects of spirituality that contribute to or hinder the grieving process and the different roles of Chinese culture and spirituality for individuals. The findings suggest the need for the development of culturally sensitive interventions and support systems to assist mothers in navigating grief and healing. Future studies could explore the roles of Chinese culture and spirituality over time in the different stages of grief and healing after stillbirth.
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Affiliation(s)
- Qiong Zheng
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
| | - Xiuxiu Yin
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
| | - Lu Liu
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
| | - Cecilia Jevitt
- The University of British Columbia, Faculty of Medicine, Midwifery Program, Apt 505, 5988 Gray Ave, Vancouver, British Columbia V6S 0K4, Canada.
| | - Dongmei Fu
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yaping Sun
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
| | - Xiaoyan Yu
- Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China; XinChang Branch of the Women's Hospital School of Medicine Zhejiang University, Xinchang, Zhejiang, China.
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10
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Brasileiro M, Metelus S, Griggio TB, Vieira MC, Dias MAB, Leite DF, da Cunha Filho EV, Schreiner L, Ramos JGL, Haddad SM, Osanan G, Mayrink J, de Jesús GR, Fernandes KG, Pasupathy D, Cecatti JG, Souza RT. Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals. Int J Gynaecol Obstet 2024. [PMID: 39087442 DOI: 10.1002/ijgo.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. METHODS A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. RESULTS Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. CONCLUSION The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.
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Affiliation(s)
- Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
| | - Sherly Metelus
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Débora F Leite
- Department of Obstetrics and Gynaecology, Federal University of Pernambuco, Recife, Brazil
| | - Edson V da Cunha Filho
- Department of Obstetrics and Gynaecology, São Lucas Hospital, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Lucas Schreiner
- Department of Obstetrics and Gynaecology, São Lucas Hospital, School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Samira M Haddad
- Jorge Rossmann Regional Hospital-Sócrates Guanaes Institute, Itanhaém, Brazil
| | - Gabriel Osanan
- Federal University of Minas Gerais-HC/UFMG, Belo Horizonte, Brazil
| | - Jussara Mayrink
- Federal University of Minas Gerais-HC/UFMG, Belo Horizonte, Brazil
| | - Guilherme R de Jesús
- Department of Obstetrics, University Hospital Pedro Ernesto-Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, Brazil
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11
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Silver RM, Reddy U. Stillbirth: we can do better. Am J Obstet Gynecol 2024; 231:152-165. [PMID: 38789073 DOI: 10.1016/j.ajog.2024.05.042] [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: 12/27/2023] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
Stillbirth is far too common, occurring in millions of pregnancies per year globally. The rate of stillbirth (defined as death of a fetus prior to birth at 20 weeks' gestation or more) in the United States is 5.73 per 1000. This is approximately 1 in 175 pregnancies accounting for about 21,000 stillbirths per year. Although rates are much higher in low-income countries, the stillbirth rate in the United States is much higher than most high resource countries. Moreover, there are substantial disparities in stillbirth, with rates twice as high for non-Hispanic Black and Native Hawaiian or Other Pacific Islanders compared to non-Hispanic Whites. There is considerable opportunity for reduction in stillbirths, even in high resource countries such as the United States. In this article, we review the epidemiology, risk factors, causes, evaluation, medical and emotional management, and prevention of stillbirth. We focus on novel data regarding genetic etiologies, placental assessment, risk stratification, and prevention.
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Affiliation(s)
- Robert M Silver
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, University of Utah, Salt Lake City, UT.
| | - Uma Reddy
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, Columbia University, New York, NY
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12
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Tebeje TM, Seifu BL, Seboka BT, Mare KU, Chekol YM, Tesfie TK, Gelaw NB, Abebe M. Trends, spatiotemporal variation and decomposition analysis of pregnancy termination among women of reproductive age in Ethiopia: Evidence from the Ethiopian demographic and health survey, from 2000 to 2016. Heliyon 2024; 10:e34633. [PMID: 39130402 PMCID: PMC11315203 DOI: 10.1016/j.heliyon.2024.e34633] [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: 04/15/2024] [Revised: 06/08/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background Pregnancy termination is a major public health problem, and complications of unsafe abortion are among the proximate and major causes of maternal mortality. Mapping the trend and spatiotemporal variation and identifying factors that are responsible for the changes in pregnancy termination help achieve the sustainable development goal of reducing maternal mortality in Ethiopia by understanding the epidemiology and regional variations. Methods Data from the 2000-2016 Ethiopian Demographic and Health Survey were analyzed with a total weighted sample of 40,983 women of reproductive age. Variables with a p-value <0.05 in a logit multivariable decomposition analysis were considered significant predictors of the decline in pregnancy termination over time. Spatial analysis was used separately for each survey to show the changes in regional disparities in pregnancy termination in Ethiopia. Results The magnitude of pregnancy termination among women of reproductive age decreased by 39.5 %, from 17.7 % in 2000 to 10.7 % in 2016. The difference in the effects of literacy, working status, marital status, age at first intercourse, age at first cohabitation, knowledge about contraceptives, and knowledge of the ovulatory cycle were the significant predictors that contributed to the change in pregnancy termination over time. Significant clusters of pregnancy terminations were observed in central and northern Ethiopia (Addis Ababa, eastern Amhara, and Tigray regions). Conclusions Despite the substantial decrease in terminated pregnancies over time in Ethiopia, the magnitude is still high. The government should focus on promoting education for girls and women, providing reproductive health education, including access to contraceptives, and raising the minimum age for girls to engage in sexual activities or marriage by implementing policies.
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Affiliation(s)
- Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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13
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Al-Fattah AN, Mahindra MP, Yusrika MU, Mapindra MP, Marizni S, Putri VP, Besar SP, Widjaja FF, Kusuma RA, Siassakos D. A prediction model for stillbirth based on first trimester pre-eclampsia combined screening. Int J Gynaecol Obstet 2024. [PMID: 38961831 DOI: 10.1002/ijgo.15755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To evaluate the accuracy of combined models of maternal biophysical factors, ultrasound, and biochemical markers for predicting stillbirths. METHODS A retrospective cohort study of pregnant women undergoing first-trimester pre-eclampsia screening at 11-13 gestational weeks was conducted. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified as placental dysfunction-related when it occurred with pre-eclampsia or birth weight <10th percentile. Combined prediction models were developed from significant variables in stillbirths, placental dysfunction-related, and controls. We used the area under the receiver-operating-characteristics curve (AUC), sensitivity, and specificity based on a specific cutoff to evaluate the model's predictive performance by measuring the capacity to distinguish between stillbirths and live births. RESULTS There were 13 (0.79%) cases of stillbirth in 1643 women included in the analysis. The combination of maternal factors, MAP, UtA-PI, and PlGF, significantly contributed to the prediction of stillbirth. This model was a good predictor for all (including controls) types of stillbirth (AUC 0.879, 95% CI: 0.799-0.959, sensitivity of 99.3%, specificity of 38.5%), and an excellent predictor for placental dysfunction-related stillbirth (AUC 0.984, 95% CI: 0.960-1.000, sensitivity of 98.5, specificity of 85.7). CONCLUSION Screening at 11-13 weeks' gestation by combining maternal factors, MAP, UtA-PI, and PlGF, can predict a high proportion of stillbirths. Our model has good accuracy for predicting stillbirths, predominantly placental dysfunction-related stillbirths.
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Affiliation(s)
- Adly Nanda Al-Fattah
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Kosambi Maternal and Child Center, Jakarta, Indonesia
| | - Muhammad Pradhiki Mahindra
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | | | - Muhammad Pradhika Mapindra
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | | | - Vania Permata Putri
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Kosambi Maternal and Child Center, Jakarta, Indonesia
| | | | | | - Raden Aditya Kusuma
- Indonesian Prenatal Institute, Jakarta, Indonesia
- Harapan Kita National Women and Children's Hospital, Jakarta, Indonesia
| | - Dimitrios Siassakos
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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14
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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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15
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Roberts LR, Nick JM, Sarpy NL, Peters J, Tamares S. Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review. JBI Evid Synth 2024:02174543-990000000-00324. [PMID: 38932508 DOI: 10.11124/jbies-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. INTRODUCTION Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. INCLUSION CRITERIA Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. METHODS The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. RESULTS The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. CONCLUSIONS Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.
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Affiliation(s)
- Lisa R Roberts
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
| | - Nancy L Sarpy
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Judith Peters
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Shanalee Tamares
- LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA
- Del Webb Library, Loma Linda University, Loma Linda, CA, USA
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16
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Al-Nuaimi AMA. Role of hematological indices in predicting preeclampsia and its severity: retrospective case-control study. Medicine (Baltimore) 2024; 103:e38557. [PMID: 38905404 PMCID: PMC11192010 DOI: 10.1097/md.0000000000038557] [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: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024] Open
Abstract
Preeclampsia (PE) is a serious condition that threatens pregnancy with severe sequelae on both the mother and infant. Early detection of PE will lead to favorable outcomes, and using readily available markers like hematological indices is an attractive choice. Examine the diagnostic utility of hematological indices in pregnant women to predict preeclampsia and its severity. In a retrospective case-control study that included 252 women, all had their complete blood picture evaluated during their first and third trimesters as part of their outpatient antenatal care during their pregnancy. They were also divided into 3 groups: healthy pregnant women (control), non-severe PE, and severe PE, each involving 84 women. The changes in platelet to lymphocyte ratio (PLR) between 1st and 3rd trimesters showed an excellent ability to differentiate between severe PE and control (area under the curve = 0.954, cutoff ≤ -5.45%) and a good ability to differentiate between severe PE and non-severe PE (area under the curve = 0.841, cutoff ≤ -7.89%). Neutrophil to lymphocyte ratio showed a good to excellent ability to differentiate between severe PE and non-severe PE compared to control in the first and third trimesters and the percentage change between them. Changes in neutrophil to lymphocyte ratio and PLR strongly predict preeclampsia and its severity since they offer more predictive values than measuring NLP and PLR at different stages of pregnancy individually.
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17
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Nikbakht HA, Farajpour F, Farhadi Z, Hashemi SN, Jahani MA. Analyzing the trend of mortality due to traffic and nontraffic accidents: a study in the north of Iran. Ann Med Surg (Lond) 2024; 86:3242-3248. [PMID: 38846822 PMCID: PMC11152805 DOI: 10.1097/ms9.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
Background Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them. Objectives This study examined the trend of mortalities due to traffic and nontraffic accidents. Methods This cross-sectional study examines the registered mortalities during the years 2016-2022 in the form of a census in the health department's death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population. Results Out of 18 265 deaths during 2016-2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend<0.001). Conclusion In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality.
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Affiliation(s)
| | - Fatemeh Farajpour
- Student Research Committee, Babol University of Medical Sciences, Babol
| | - Zeynab Farhadi
- Social Determinants of Health Research Center, Health Research Institute
| | - Seyedeh N. Hashemi
- Doctorate of Medicine Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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18
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Abdul-Mumin A, Bimpong KA, Cotache-Condor C, Oppong J, Charadan AMS, Munkaila A, Perez de Souza JV, Smith ER. Impact of the COVID-19 pandemic on perinatal care and outcomes: A retrospective study in a tertiary hospital in Northern Ghana. PLoS One 2024; 19:e0301081. [PMID: 38820360 PMCID: PMC11142585 DOI: 10.1371/journal.pone.0301081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Perinatal mortality remains a global challenge. This challenge may be worsened by the negative effects of the COVID-19 pandemic on maternal and child health. OBJECTIVES Examine the impact of the COVID-19 pandemic on perinatal care and outcomes in the Tamale Teaching Hospital in northern Ghana. METHODS A hospital-based retrospective study was conducted in the Tamale Teaching Hospital. We compared antenatal care attendance, total deliveries, cesarean sections, and perinatal mortality before the COVID-19 pandemic (March 1, 2019 to February 28, 2020) and during the COVID-19 pandemic (March 1, 2020 to February 28, 2021). Interrupted time series analyses was performed to evaluate the impact of the COVID-19 pandemic on perinatal care and outcomes at TTH. RESULTS A total number of 35,350 antenatal visits and 16,786 deliveries were registered at TTH from March 2019 to February 2021. Antenatal care, early neonatal death, and emergency cesarean section showed a rapid decline after the onset of the pandemic, with a progressive recovery over the following months. The total number of deliveries and fresh stillbirths showed a step change with a marked decrease during the pandemic, while the macerated stillbirths showed a pulse change, a temporary marked decrease with a quick recovery over time. CONCLUSION The COVID-19 pandemic had a negative impact on perinatal care and outcomes in our facility. Pregnancy monitoring through antenatal care should be encouraged and continued even as countries tackle the pandemic.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
- Department of Pediatrics and Child Health, School of Medicine, University for Development Studies, Tamale, Ghana
| | | | - Cesia Cotache-Condor
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Global Surgery and Health Equity, Duke University, Durham, North Carolina, United States of America
| | - Jonathan Oppong
- Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Tamale, Ghana
| | - Ana Maria Simono Charadan
- Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Tamale, Ghana
- Department of Obstetrics and Gynecology, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Adam Munkaila
- Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Tamale, Ghana
- Department of Obstetrics and Gynecology, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Joao Vitor Perez de Souza
- Division of Translational Health Sciences, Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Emily R. Smith
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Global Surgery and Health Equity, Duke University, Durham, North Carolina, United States of America
- Division of Translational Health Sciences, Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, North Carolina, United States of America
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Yusrika MU, Al Fattah AN, Kusuma RA, Widjaja FF, Marizni S, Putri VP. Incidence and first trimester risk factors of stillbirth in Indonesia. J Perinat Med 2024; 52:392-398. [PMID: 38407221 DOI: 10.1515/jpm-2023-0348] [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: 08/23/2023] [Accepted: 01/28/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To determine the incidence and the risk factors of stillbirth from maternal biophysical, ultrasound, and biochemical markers at 11-13 weeks of gestation in the Indonesian population. METHODS This was a retrospective cohort study of pregnant women for first-trimester preeclampsia screening at 11-13 weeks of gestation in some clinics and hospital in Jakarta. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio (Oph-PR) Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified into placental dysfunction-related when it occurred with preeclampsia or birth weight <10th percentile and non-placental dysfunction-related. Bivariate and multivariate logistic regression analyses were employed to determine the risk factors associated with stillbirth. RESULTS Of 1,643 eligible participants, 13 (0.79 %) stillbirth cases were reported. More than half of the stillbirths (7) were placental dysfunction-related. After adjusted with maternal age, body mass index (BMI), and parity status, chronic hypertension (aOR (adjusted odds ratio)) 24.41, 95 % CI {confidence interval} 5.93-100.43), previous pregnancy with preeclampsia (aOR 15.79, 95 % CI 4.42-56.41), MAP >101.85 (aOR 26.67, 95 % CI 8.26-86.06), UtA-PI >1.90 (aOR 10.68, 95 % CI 2.34-48.58, and PlGF <28.77 pg/mL (aOR 18.60, 95 % CI 5.59-61.92) were associated with stillbirth. CONCLUSIONS The incidence of stillbirth in the population is comparable to studies conducted in developed countries. Most routine variables assessed at the 11-13 weeks combined screening for preeclampsia are associated with the risk of stillbirth.
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Affiliation(s)
| | - Adly Nanda Al Fattah
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
| | - Raden Aditya Kusuma
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Harapan Kita National Women and Children Hospital, Jakarta, Indonesia
| | | | - Shinda Marizni
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
| | - Vania Permata Putri
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
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Bekele Y, Gallagher C, Batra M, Buultjens M, Eren S, Erbas B. Does oral iron and folate supplementation during pregnancy protect against adverse birth outcomes and reduced neonatal and infant mortality in Africa: A protocol for a systematic review and meta-analysis? Nutr Health 2024:2601060241256200. [PMID: 38778781 DOI: 10.1177/02601060241256200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. METHODS AND ANALYSIS MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. ETHICS AND DISSEMINATION This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. PROSPERO REGISTRATION NUMBER CRD42023452588.
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Affiliation(s)
- Yibeltal Bekele
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Claire Gallagher
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Senem Eren
- School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Rauf N, Park S, Zaidi A, Malik A, Atif N, Surkan PJ. Self-reported problems and functional difficulties in anxious pregnant women in Pakistan: The use of a patient-generated mental health outcome measure. Transcult Psychiatry 2024:13634615241250206. [PMID: 38766864 DOI: 10.1177/13634615241250206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.
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Affiliation(s)
- Nida Rauf
- Human Development Research Foundation, Islamabad, Pakistan
| | - Soim Park
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Abid Malik
- Human Development Research Foundation, Islamabad, Pakistan
- Department of Public Mental Health, Health Services Academy, Islamabad, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rent S, Gaffur R, Nkini G, Sengoka EG, Mlay P, Moyer CA, Lemmon M, Docherty SL, Mmbaga BT, Staton CA, Shayo A. Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003227. [PMID: 38768103 PMCID: PMC11104680 DOI: 10.1371/journal.pgph.0003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024]
Abstract
Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Raziya Gaffur
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Getrude Nkini
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Enna Geofrey Sengoka
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Pendo Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Cheryl A. Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Monica Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
| | - Sharron L. Docherty
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Aisa Shayo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Daniels-Donkor SS, Afaya A, Daliri DB, Laari TT, Salia SM, Avane MA, Afaya RA, Yakong VN, Ayanore MA, Alhassan RK. Factors associated with timely initiation of antenatal care among reproductive age women in The Gambia: a multilevel fixed effects analysis. Arch Public Health 2024; 82:73. [PMID: 38760806 PMCID: PMC11100154 DOI: 10.1186/s13690-024-01247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. METHODS A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019-2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05. RESULTS The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30-34 [aOR = 1.79, 95% CI = 1.30-2.47], those who were married [aOR = 2.69, 95% CI = 1.85-3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas. CONCLUSION Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia.
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Affiliation(s)
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
| | - Dennis Bomansang Daliri
- Department of Global Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Solomon Mohammed Salia
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Mabel Apaanye Avane
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Richard Adongo Afaya
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Vida Nyagre Yakong
- Department of Midwifery and Women's Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- University of Dundee, Scotland United Kingdom, Dundee, Scotland, UK
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Melesse DY, Tadele A, Mulu S, Spicer N, Tadelle T, Wado YD, Gajaa M, Arja A, Blumenberg C, Manaye T, Gonfa G, du Plessis E, Hamilton E, Mihretu A, Usamael A, Mengesha M, Kassahun Gelaw S, Worku A, Woldie M, Abate B, Getachew T, Wondirad N, Zelalem M, Tollera G, Boerma T. Learning from Ethiopia's success in reducing maternal and neonatal mortality through a health systems lens. BMJ Glob Health 2024; 9:e011911. [PMID: 38770809 PMCID: PMC11085893 DOI: 10.1136/bmjgh-2023-011911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/29/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND This study aimed to enhance insights into the key characteristics of maternal and neonatal mortality declines in Ethiopia, conducted as part of a seven-country study on Maternal and Newborn Health (MNH) Exemplars. METHODS We synthesised key indicators for 2000, 2010 and 2020 and contextualised those with typical country values in a global five-phase model for a maternal, stillbirth and neonatal mortality transition. We reviewed health system changes relevant to MNH over the period 2000-2020, focusing on governance, financing, workforce and infrastructure, and assessed trends in mortality, service coverage and systems by region. We analysed data from five national surveys, health facility assessments, global estimates and government databases and reports on health policies, infrastructure and workforce. RESULTS Ethiopia progressed from the highest mortality phase to the third phase, accompanied by typical changes in terms of fertility decline and health system strengthening, especially health infrastructure and workforce. For health coverage and financing indicators, Ethiopia progressed but remained lower than typical in the transition model. Maternal and neonatal mortality declines and intervention coverage increases were greater after 2010 than during 2000-2010. Similar patterns were observed in most regions of Ethiopia, though regional gaps persisted for many indicators. Ethiopia's progress is characterised by a well-coordinated and government-led system prioritising first maternal and later neonatal health, resulting major increases in access to services by improving infrastructure and workforce from 2008, combined with widespread community actions to generate service demand. CONCLUSION Ethiopia has achieved one of the fastest declines in mortality in sub-Saharan Africa, with major intervention coverage increases, especially from 2010. Starting from a weak health infrastructure and low coverage, Ethiopia's comprehensive approach provides valuable lessons for other low-income countries. Major increases towards universal coverage of interventions, including emergency care, are critical to further reduce mortality and advance the mortality transition.
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Affiliation(s)
- Dessalegn Y Melesse
- Countdown to 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Biostatistics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenif Tadele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shegaw Mulu
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Neil Spicer
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Tefera Tadelle
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yohannes D Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Mulugeta Gajaa
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Asrat Arja
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- causale consultoria, Pelotas, Brazil
| | - Tewabe Manaye
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Geremew Gonfa
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elsabe du Plessis
- Countdown to 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elisabeth Hamilton
- Countdown to 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Awoke Mihretu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abdurehman Usamael
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Magdelawit Mengesha
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Solomon Kassahun Gelaw
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Aschale Worku
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mirkuzie Woldie
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Biruk Abate
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Naod Wondirad
- Policy, Planning, Monitoring & Evaluation Directorate, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Meseret Zelalem
- Maternal, Child and Adolescent Health Lead Executive, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Getachew Tollera
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ties Boerma
- Countdown to 2030 for Women's, Children's and Adolescents' Health, Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Mekonnen W, Mariam DH, Meh C, Yigezu B, Assalif AT, Aimone A, Atnafu S, Ahmed H, Asnake W, Jha P. Child, maternal, and adult mortality in rural Ethiopia in 2019: a cross-sectional mortality survey using electronic verbal autopsies. EClinicalMedicine 2024; 71:102573. [PMID: 38618200 PMCID: PMC11015337 DOI: 10.1016/j.eclinm.2024.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
Background Ethiopia, with about 10% of Africa's population, has little direct information on causes of death, particularly in rural areas where 80% of Ethiopians live. In 2019-2020, we conducted electronic verbal autopsies (e-VA) to examine causes of death and quantify cause-specific mortality rates in rural Ethiopia. Methods We examined deaths under 70 years in the three years prior to the survey dates (November 25, 2019-February 29, 2020) among 2% of East Gojjam Zone (Amhara Region) using registered deaths and adding random sampling in this cross-sectional study. Trained surveyors interviewed relatives of the deceased with central dual-physician assignment of causes as the main outcome. We documented details on age, sex and location of death, and derived overall rural death rates using 2007 Census data and the United Nations national estimates for 2019. To these, we applied our sample-weighted causes to derive cause-specific mortality rates. We calculated death risks for the leading causes for major age groups. Findings We studied 3516 deaths: 55% male, 97% rural, and 68% occurring at home. At ages 5 and older, injuries were notable, accounting for over a third of deaths at 5-14 years, half of the deaths at ages 15-29 years, and a quarter of deaths at ages 30-69 years. Neonatal mortality was high, mostly from prematurity/low birthweight and infections. Among children under 5 (excluding neonates), infections caused nearly two-thirds of deaths. Most maternal deaths (84%) arose from direct causes. After injuries, especially suicide, assaults, and road traffic accidents, vascular disease (15%) and cancer (13%) were the leading causes among adults at 30-69 years. HIV/AIDS and tuberculosis deaths were also important causes among adults. Interpretation Rural Ethiopia has a high burden of avoidable mortality, particularly injury, including suicide, assaults, and road traffic accidents. Funding International Development Research Centre, and the Canadian Institutes of Health Research.
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Affiliation(s)
- Wubegzier Mekonnen
- School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Catherine Meh
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Anteneh T. Assalif
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Aimone
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Solomon Atnafu
- Department of Computer Science, College of Natural and Computational Sciences, Addis Ababa University, Ethiopia
| | - Hayat Ahmed
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Wubetsh Asnake
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Alsolami AM, Alamri AG, Khodari AH, Tayeb RK. Adequacy of Antenatal Care at Ministry of Health Facilities in Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus 2024; 16:e61113. [PMID: 38919229 PMCID: PMC11198215 DOI: 10.7759/cureus.61113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
Background Most pregnancy-related complications and undesirable outcomes are preventable by effective interventions at a reasonable cost. These interventions are mainly deployed during the antenatal phase and are included under the umbrella of antenatal care (ANC). To our knowledge, no studies have been conducted to assess the adequacy of ANC in Saudi Arabia. This study aimed to measure and quantify the adequacy of ANC provided by the Ministry of Health (MoH) facilities in Jeddah and to determine potential factors influencing ANC. Methodology In this cross-sectional study, we used the Adequacy of Perinatal Care Utilization index to measure the adequacy of ANC. Data were collected from September 2023 to March 2024 in two randomly selected MoH hospitals by interviewing mothers and collecting data from medical records. Results A total of 303 mothers participated in this study. Mothers' mean age was 31 years, and 50% of them had received higher school education. Prevalence of adequate ANC was 64.7%. There was a significant association between the adequacy of ANC and mothers' level of education (p < 0.001), time taken to reach the nearest primary care center (p < 0.001), number of total pregnancies (p < 0.034), and the total number prenatal visits (p < 0.001). Conclusions This is the first study to shed light on the prevalence of adequacy of ANC in Saudi Arabia and its associated factors. This study would pave the way to investigate the adequacy of ANC on a national level and will aid policymakers in developing and implementing effective ANC preventive measures, hence helping improve women's health and their babies.
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Affiliation(s)
- Ali M Alsolami
- Public Health Administration, Ministry of Health, Jeddah, SAU
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Madina, SAU
| | - Abdulmajeed G Alamri
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Madina, SAU
| | - Ali H Khodari
- Obstetrics and Gynaecology, King Abdulaziz Hospital and Oncology Center, Jeddah, SAU
| | - Raghda K Tayeb
- Obstetrics and Gynaecology, King Abdulaziz Hospital and Oncology Center, Jeddah, SAU
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Kedar Sade E, Lantsberg D, Tagar Sar-El M, Gefen S, Gafner M, Katorza E. Identifying causes and associated factors of stillbirths using autopsy of the fetus and placenta. Arch Gynecol Obstet 2024:10.1007/s00404-024-07522-1. [PMID: 38691157 DOI: 10.1007/s00404-024-07522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The study aimed to evaluate the causes of death and associated factors in cases of stillbirth, using post-mortem examination and applying a rigorous, evidence-based holistic approach. METHODS Our retrospective observational study included cases of autopsy following stillbirth that occurred at our tertiary medical center during a period of 8 years. Detailed up-to-date criteria that incorporate clinical reports, medical history, prenatal imaging, and histopathological findings were used to evaluate the cause of death and associated factors. RESULTS After applying our proposed methodology, 138 cases of stillbirth were classified into eight categories based on the causes of death. A definitive cause of death was observed in 100 (72%) cases, while 38 (28%) cases were considered unexplained. The leading cause of death was placental lesions (n = 39, 28%) with maternal vascular malperfusion (MVM) lesions being the most common (54%). Ascending infection was the second most common cause of fetal death (n = 24, 17%) and was often seen in the setting of preterm labor and cervical insufficiency. CONCLUSION The largest category of cause of death was attributed to placental pathology. Using rigorous detailed up-to-date criteria that incorporate pathological and clinical factors may help in objectively classifying the cause of death.
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Affiliation(s)
- Eliel Kedar Sade
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated With the Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
| | - Daniel Lantsberg
- Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Australia
| | | | - Sheizaf Gefen
- Department of Internal Medicine 'E', Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
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Alem AZ, Tegegne BA, Aragaw FM, Teklu RE, Baykeda TA. Multilevel negative binomial analysis of factors associated with numbers of antenatal care contacts in low and middle income countries: Findings from 59 nationally representative datasets. PLoS One 2024; 19:e0301542. [PMID: 38635815 PMCID: PMC11025891 DOI: 10.1371/journal.pone.0301542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is one of the recommended interventions to reduce stillbirth, maternal, neonatal, and child mortality through early identification and management of pregnancy complications or pre-existing conditions. Although increasing number of ANC is a key priority of the 2016 WHO recommendations, ANC uptake in Low and Middle Income Countries (LMICs) is insufficient. Therefore, this study aimed to investigate factors associated with the number of ANC contacts in LMICs. METHODS Data for the study were drawn from 59 recent Demographic and Health Surveys (DHS) conducted in LMICS. We included a total sample of 520,377 mothers who gave birth in the five years preceding the survey. A multilevel negative binomial regression model was applied to identify factors that may affect number of ANC. Adjusted incidence rate ratios (AIRR) with 95% Confidence Interval (CI) were reported to show association. RESULTS This study found that mothers and their partner with higher educational attainment, mothers aged >35 years, mothers who had decision making autonomy, mothers from female headed household, mothers from richer and richest household, mothers exposed to media, and residing in urban areas had significantly more ANC contacts. However, number of ANC contacts were significantly lower among mothers who initiated ANC after 12 weeks of gestation and perceived healthcare access to be a big problem. CONCLUSION Our results suggest that individual, household, and community-level factors were associated with number of ANC contacts among pregnant mothers in LMICs. Hence, local and international policymakers, and programmers should focus on improving community awareness about maternal health care services through mass media and outreach programs with especial emphasis on women's and their partners educational attainment, rural mothers, women's empowerment, and household socioeconomic status.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, Australia
| | - Biresaw Ayen Tegegne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare Baykeda
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, Australia
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Mforteh AAA, Pisoh DW, Boten M, Andoh NEL, Tameh TY, Mbi-Kobenge AFE, Ombaku KS, Takang WA, Mbu RE. Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study. BMC Pregnancy Childbirth 2024; 24:270. [PMID: 38609848 PMCID: PMC11010432 DOI: 10.1186/s12884-024-06486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Stillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon. MATERIALS AND METHODS A Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05. RESULTS A total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19-12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17-3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4-84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4-98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0-89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06-149.7;p = 0.045). CONCLUSION The stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.
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Affiliation(s)
- Achuo Ascensius Ambe Mforteh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon.
- Bamenda Regional Hospital, Bamenda, Cameroon.
| | - Dobgima Walter Pisoh
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Merlin Boten
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | | | | | | | | | - William Ako Takang
- Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bamenda, Cameroon
| | - Robinson Enow Mbu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
- Yaoundé Gyneco-Obstetric and Paediatric Hospital, Yaounde, Cameroon
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Ghosh R, Gutierrez JP, de Jesús Ascencio-Montiel I, Juárez-Flores A, Bertozzi SM. SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study. BMJ Open 2024; 14:e075928. [PMID: 38604636 PMCID: PMC11015228 DOI: 10.1136/bmjopen-2023-075928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Arturo Juárez-Flores
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Stefano M Bertozzi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
- University of Washington - Seattle Campus, Seattle, Washington, USA
- National Institute of Public Health, Cuernavaca, Mexico
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Muhammad A, Rizvee MSH, Khan U, Khan H, Bachlany A, Baloch B, Shafiq Y. Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi. PLoS One 2024; 19:e0298120. [PMID: 38578771 PMCID: PMC10997060 DOI: 10.1371/journal.pone.0298120] [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] [Received: 08/08/2023] [Accepted: 01/16/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. METHODS A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis. RESULTS Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors. CONCLUSION The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.
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Affiliation(s)
| | | | - Uzma Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | - Hina Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | | | - Benazir Baloch
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Yasir Shafiq
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan
- CRIMEDIM–Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Alene AA, Mengesha EW, Dagnew GW. Adverse fetal birth outcomes and its associated factors among mothers with premature rupture of membrane in Amhara region, Ethiopia. PLoS One 2024; 19:e0298319. [PMID: 38558073 PMCID: PMC10984396 DOI: 10.1371/journal.pone.0298319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Adverse birth outcomes are the leading cause of neonatal mortality worldwide. Ethiopia is one of the countries struggling to reduce neonatal mortality through different strategies, but neonatal mortality remains high for many reasons. Despite adverse birth outcomes being a public health problem in Ethiopia, the contribution of Premature rupture of the membrane to the adverse fetal birth outcome is neglected and not well explained in our country. This study aims to assess fetal birth outcomes and associated factors among mothers with all types of PROM at Specialized Hospitals in Amhara Region, Ethiopia. METHODS A facility-based cross-sectional study design was applied among 538 mothers with premature rapture of the membrane at Amhara region specialized hospitals. A simple random sampling technique was employed to select the medical charts diagnosed with all types of PROM and giving birth in the hospital within the period from July 8, 2019, to July 7, 2021. The data was collected using a checklist, entered into EPI Data version 3.1, and analyzed using SPSS version 23. A binary logistic regression model was used to see the association between independent and dependent variables. A P-value <0.05 was used to declare the statistical significance. The AOR with 95% CI was used to measure the strength of the association. RESULT Adverse birth outcome among all types of Premature rupture of membrane mothers was 33.1% [95% CI 29.2-37.2]. Rural residents [AOR = 2.94, 95% CI:1.73-4.97], have a history of urinary tract infection [AOR = 6.87, 95% CI: 2.77-17.01], anemia [AOR = 7.51, 95% CI: 2.88-19.62], previous history of adverse birth outcome [AOR = 3.54, 95% CI: 1.32-9.47] and less than two years interpregnancy interval [AOR = 6.07, 95% CI: 2.49-14.77] were positively associated with adverse birth outcome compared to their counterparts. CONCLUSION The adverse birth outcome was high in the Amhara region as compared to the World Health Organization's estimated figure and target; the target is less than 15%. History of the previous adverse birth outcome, residence, urinary tract infection, Anemia, and interpregnancy interval had an association with adverse birth outcomes. Therefore, strengthening close follow-up for mothers who had previous adverse birth outcomes, screening and treatment of urinary tract infection, anemia prevention, and maximizing birth interval are recommended for reducing adverse birth outcomes.
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Affiliation(s)
- Abebe Abrha Alene
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Worku Mengesha
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Oluwasomidoyin OB, Emmanuel AU, Folasade AB. Admission Cardiotocography and Neonatal Outcomes at a Tertiary Health Facility in Southwestern Nigeria. Ann Afr Med 2024; 23:154-159. [PMID: 39028163 PMCID: PMC11210730 DOI: 10.4103/aam.aam_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/21/2023] [Accepted: 12/19/2023] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. OBJECTIVE This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility. MATERIALS AND METHODS A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P < 0.05. RESULTS The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P < 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery. CONCLUSION Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological.
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Affiliation(s)
- O Bello Oluwasomidoyin
- Department of Obstetrics and Gynecology, University of Ibadan, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A Unwaha Emmanuel
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A Bello Folasade
- Department of Obstetrics and Gynecology, University of Ibadan, University College Hospital, Ibadan, Oyo State, Nigeria
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Feng CS, Li SF, Ju HH. The application of the ICD-10 for antepartum stillbirth patients in a referral centre of Eastern China: a retrospective study from 2015 to 2022. BMC Pregnancy Childbirth 2024; 24:164. [PMID: 38408955 PMCID: PMC10895843 DOI: 10.1186/s12884-024-06313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The causes of some stillbirths are unclear, and additional work must be done to investigate the risk factors for stillbirths. OBJECTIVE To apply the International Classification of Disease-10 (ICD-10) for antepartum stillbirth at a referral center in eastern China. METHODS Antepartum stillbirths were grouped according to the cause of death according to the International Classification of Disease-10 (ICD-10) criteria. The main maternal condition at the time of antepartum stillbirth was assigned to each patient. RESULTS Antepartum stillbirths were mostly classified as fetal deaths of unspecified cause, antepartum hypoxia. Although more than half of the mothers were without an identified condition at the time of the antepartum stillbirth, where there was a maternal condition associated with perinatal death, maternal medical and surgical conditions and maternal complications during pregnancy were most common. Of all the stillbirths, 51.2% occurred between 28 and 37 weeks of gestation, the main causes of stillbirth at different gestational ages also differed. Autopsy and chromosomal microarray analysis (CMA) were recommended in all stillbirths, but only 3.6% received autopsy and 10.5% underwent chromosomal microarray analysis. CONCLUSIONS The ICD-10 is helpful in classifying the causes of stillbirths, but more than half of the stillbirths in our study were unexplained; therefore, additional work must be done. And the ICD-10 score may need to be improved, such as by classifying stillbirths according to gestational age. Autopsy and CMA could help determine the cause of stillbirth, but the acceptance of these methods is currently low.
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Affiliation(s)
- Chuan-Shou Feng
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China.
| | - Shu-Fen Li
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hui-Hui Ju
- Obstetrical department, Changzhou Women and Children Health Hospital, Nanjing Medical University, Changzhou, Jiangsu, China
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Bayrı Bingöl F, Karaçam Yılmaz ZD, Topaloğlu S. Partners in Pain, Two Sides of a Zipper - Midwives' Experiences With Stillbirth: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241235429. [PMID: 38404056 DOI: 10.1177/00302228241235429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This study was conducted to explore and understand the experiences of midwives who care for women experiencing stillbirth and the challenges they face in this process. A qualitative study was conducted with 11 midwives using the phenomenological method. Descriptive analysis of the data revealed four main themes: 1) Silent screams in the face of despair (women's reactions to stillbirth), 2) Being a partner in pain, "two sides of a zipper" (midwives' experience of stillbirth), 3) Efforts to cope with the pain, and 4) Just two words: "if only." The impact of stillbirths on midwives should not be disregarded. Emotions such as shock, horror, fear, guilt, and anger experienced by midwives following a stillbirth can adversely affect their mental health. The guilt experienced by midwives can also negatively impact their health and quality of life, as well as cause burnout and distancing from the profession.
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Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Health Sciences Faculty, Marmara University, Istanbul, Türkiye
| | - Zeynep Dilşah Karaçam Yılmaz
- Midwifery Department, Health Sciences Faculty, Marmara University, Istanbul, Türkiye
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Türkiye
| | - Seçil Topaloğlu
- Midwifery Department, Health Sciences Faculty, Istanbul Medipol University, Istanbul, Türkiye
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Arega BN, Feleke LA, Tilahun HA, Ahmed DM, Hailu FG. Proportion of stillbirth and associated factors among women who deliver at public hospitals in Bahir Dar city, north-West Ethiopia. BMC Womens Health 2024; 24:122. [PMID: 38365779 PMCID: PMC10870528 DOI: 10.1186/s12905-024-02920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/21/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The annual global burden of stillbirths is estimated to be 3.2 million, of which 98% occur in low and middle-income countries (LMICs). In the Amhara region of Ethiopia, the prevalence of stillbirth outcomes was 85 per 1000. Ethiopia is experiencing an increase in the number of health professionals attending deliveries, however, stillbirth rates are not decreasing as anticipated. However, there are limited numbers of studies done related to the proportion of stillbirths and associated factors in the study area. This study aimed to assess the proportion of stillbirths and associated factors among women who attended deliveries at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital. METHODS An institutional-based cross-sectional study was conducted on 366 women who delivered at two referral hospitals in Bahir Dar from April 1, 2020, to August 30, 2020. Study participants were selected using systematic random sampling techniques. A checklist and structured questionnaire were used to retrieve information from the clients and their attendants. The collected data were cleaned, coded, and entered into Epi-data version 3.1 and then exported into SPSS 23 for analysis. Bivariate and multivariable logistic regression analysis was computed to identify statistically significant associated factors with a P value < 0.05. The results were presented in tables and charts. RESULT The proportion of stillbirths was 3.8% in this study area. This study showed that level of education, who completed primary school (AOR = 0.12; 95% CI (0.01, 0.98)), not using partograph (AOR = 3.77, 95%; CI (1.02; 13.93)), and obstetric complication (AOR = 6.7; 95% CI (1.54, 29.79) were the major factors affecting the stillbirth. CONCLUSION Our study found that stillbirth rate remains a major public health problem. Illiteracy, not using a partograph, and having obstetric complications were major associated factors for stillbirth. The risk factors identified in this study can be prevented and managed by providing appropriate care during preconception, antepartum, and intrapartum periods.
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Affiliation(s)
- Bantayehu Nega Arega
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Lakachew Asrade Feleke
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hiwotemariam Alemu Tilahun
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dawud Muhammed Ahmed
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fekadie Getachew Hailu
- Department of obstetrics and gynecology, college of medicine and health sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Li Q, Li D, Lu J, Zou K, Wang L, Jiao Y, Wang M, Gao R, Song J, Li Y, Li F, Ji J, Wang J, Li L, Ye T, He E, Chen H, Wang Y, Ren J, Bai C, Yang S, Zhang Y. Interface-Stabilized Fiber Sensor for Real-Time Monitoring of Amniotic Fluid During Pregnancy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307726. [PMID: 37775103 DOI: 10.1002/adma.202307726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 10/01/2023]
Abstract
Diseases in pregnancy endanger millions of fetuses worldwide every year. The onset of these diseases can be early warned by the dynamic abnormalities of biochemicals in amniotic fluid, thus requiring real-time monitoring. However, when continuously penetrated by detection devices, the amnion is prone to loss of robustness and rupture, which is difficult to regenerate. Here, an interface-stabilized fiber sensor is presented for real-time monitoring of biochemical dynamics in amniotic fluid during pregnancy. The sensor is seamlessly integrated into the amnion through tissue adhesion, amniotic regeneration, and uniform stress distribution, posing no risk to the amniotic fluid environment. The sensor demonstrates a response performance of less than 0.3% fluctuation under complex dynamic conditions and an accuracy of more than 98% from the second to the third trimester. By applying it to early warning of diseases such as intrauterine hypoxia, intrauterine infection, and fetal growth restriction, fetal survival increases to 95% with timely intervention.
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Affiliation(s)
- Qianming Li
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Dan Li
- Key Laboratory of Inflammation and Immunoregulation, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jiang Lu
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Kuangyi Zou
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Lie Wang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Yiding Jiao
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Maosen Wang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Rui Gao
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Jie Song
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Yiran Li
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Fangyan Li
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Jianjian Ji
- Key Laboratory of Inflammation and Immunoregulation, School of Medicine and Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jiacheng Wang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Luhe Li
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Tingting Ye
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Er He
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Hao Chen
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Yuanzhen Wang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Junye Ren
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Chenyu Bai
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Shuo Yang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
| | - Ye Zhang
- College of Engineering and Applied Sciences, National Laboratory of Solid State Microstructures, Jiangsu Key Laboratory of Artificial Functional Materials, Chemistry and Biomedicine Innovation Centre, Collaborative Innovation Centre of Advanced Microstructures, Nanjing University, Nanjing, 210023, China
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Shi T, Ma H, Li D, Pan L, Wang T, Li R, Ren X. Prenatal exposure to fine particulate matter chemical constituents and the risk of stillbirth and the mediating role of pregnancy complications: A cohort study. CHEMOSPHERE 2024; 349:140858. [PMID: 38048830 DOI: 10.1016/j.chemosphere.2023.140858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
Evidence on the association of fine particulate matter (PM2.5) exposure with stillbirth is limited and inconsistent, which is largely attributed to differences in PM2.5 constituents. Studies have found that the hazards of certain PM2.5 constituents to the fetus are comparable to or even higher than total PM2.5 mass. However, few studies have linked PM2.5 constituents to stillbirth. Moreover, the mediating role of pregnancy complications in PM2.5-related stillbirth remains unclear. To our knowledge, this study was the first to explore the individual and mixed associations of PM2.5 and its constituents with stillbirth in China. After matching the concentrations of PM2.5 and its constituents (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+], organic matter [OM], and black carbon [BC]) for participants according to their geographical location, there were 170,507 participants included in this study. We found that stillbirth was associated with exposure to PM2.5 and its constituents in the year before pregnancy and during the entire pregnancy, and the associations in trimester 1 were strongest. The risk of stillbirth increased sharply when PM2.5 and its constituents during pregnancy exceeded the median concentrations. Moreover, stillbirth was associated with exposure to the mixtures of SO42-, NO3-, NH4+, OM, and BC before and during pregnancy (trimesters 1 and 2). Meanwhile, two-pollutant models also suggested stillbirth was associated with PM2.5 and its constituents in the year before and during pregnancy. The associations of PM2.5 and its constituents with stillbirth were stronger in mothers with advanced age and without cesarean delivery history. Additionally, hypertensive disorders in pregnancy, gestational diabetes, and placental abruption mediated the association of PM2.5 with stillbirth. Therefore, enhanced protection against PM2.5 for pregnant women before and during pregnancy and targeted interventions for pregnancy complications and anthropogenic sources of PM2.5 constituents are important to reduce stillbirth risk.
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Affiliation(s)
- Tianshan Shi
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Hanping Ma
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, 730000, China
| | - Donghua Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Li Pan
- Lanzhou Maternal and Child Health Hospital, Lanzhou, Gansu, 730000, China
| | - Tingrong Wang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Rui Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China
| | - Xiaowei Ren
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China.
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Goldenberg RL, Saleem S, Aziz A, McClure EM. International progress on stillbirth reduction: Changes in Stillbirth Rates in Selected Low and Middle-Income Countries from 2000 to 2021. Semin Perinatol 2024; 48:151868. [PMID: 38281882 DOI: 10.1016/j.semperi.2023.151868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this paper, we attempted to determine if there were reductions in low and middle - income country stillbirth rates since 2000 - focusing on sub-Saharan Africa, Asia and Latin America and the Caribbean. We used data made available by the United Nations Inter-agency Group for Child Mortality Estimation and the World Health Organization as well as the National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research.. Overall, nearly every country evaluated had at least a small reduction in stillbirth rate from the year 2000 to 2021, but the reductions varied substantially between regions. Asia and Latin America/Caribbean had similar levels of reductions with a number of countries in each of those regions having rates in 2021 that were 40 % or more lower than those documented in 2000. No country in Africa documented a reduction in stillbirths of 40 % and many had stillbirth reductions of less than 15 %.
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O'Connor E, Leitao S, Fogarty AP, Greene R, O'Donoghue K. A systematic review of standardised tools used in perinatal death review programmes. Women Birth 2024; 37:88-97. [PMID: 37793961 DOI: 10.1016/j.wombi.2023.09.006] [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: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Reducing preventable perinatal deaths is the focus of perinatal death surveillance and response programmes. Standardised review tools can help identify modifiable factors in perinatal deaths. AIM This systematic review aimed to identify, compare, and appraise perinatal mortality review tools (PMRTs) in upper-middle to high-income countries. METHODS Four major scientific databases were searched for publications relating to perinatal death reviews. There were no restrictions on date, study, or publication type. Professional websites for each country were searched for relevant material. The Appraisal of Guidelines Research and Evaluation Health Systems (AGREE-HS) checklist was used for quality appraisal of each tool. A narrative synthesis was used to describe and compare tools. FINDINGS Ten PMRTs were included. Five PMRTs were from high-income countries, four from upper-middle income countries and one was designed for use in a global context. The structure, content, and quality of each PMRT varied. Each tool collected information about the antepartum, intrapartum, and neonatal periods and a section to classify perinatal deaths using a standardised classification system. All tools reviewed the care provided. Five tools included recommendation development for changes to clinical care. Four tools mentioned parent involvement in the review process. For quality appraisal, one review tool scored "high quality", six scored "moderate quality" and two scored "poor quality". CONCLUSION There is little standardisation when it comes to PMRTs. Guidance on structuring PMRTs in a standardised way is needed. Recommendation development from a review is important to highlight changes to care required to reduce preventable perinatal deaths.
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Affiliation(s)
- Emily O'Connor
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland.
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Amy P Fogarty
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Keelin O'Donoghue
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Mensah Abrampah NA, Okwaraji YB, Oteng KF, Asiedu EK, Larsen-Reindorf R, Blencowe H, Jackson D. District health management and stillbirth recording and reporting: a qualitative study in the Ashanti Region of Ghana. BMC Pregnancy Childbirth 2024; 24:91. [PMID: 38287283 PMCID: PMC10826143 DOI: 10.1186/s12884-024-06272-x] [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: 09/29/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Despite global efforts to reduce maternal and neonatal mortality, stillbirths remain a significant public health challenge in many low- and middle-income countries. District health systems, largely seen as the backbone of health systems, are pivotal in addressing the data gaps reported for stillbirths. Available, accurate and complete data is essential for District Health Management Teams (DHMTs) to understand the burden of stillbirths, evaluate interventions and tailor health facility support to address the complex challenges that contribute to stillbirths. This study aims to understand stillbirth recording and reporting in the Ashanti Region of Ghana from the perspective of DHMTs. METHODS The study was conducted in the Ashanti Region of Ghana. 15 members of the regional and district health directorates (RHD/DHD) participated in semi-structured interviews. Sampling was purposive, focusing on RHD/DHD members who interact with maternity services or stillbirth data. Thematic analyses were informed by an a priori framework, including theme 1) experiences, perceptions and attitudes; theme 2) stillbirth data use; and theme 3) leadership and support mechanisms, for stillbirth recording and reporting. RESULTS Under theme 1, stillbirth definitions varied among respondents, with 20 and 28 weeks commonly used. Fresh and macerated skin appearance was used to classify timing with limited knowledge of antepartum and intrapartum stillbirths. For theme 2, data quality checks, audits, and the district health information management system (DHIMS-2) data entry and review are functions played by the DHD. Midwives were blamed for data quality issues on omissions and misclassifications. Manual entry of data, data transfer from the facility to the DHD, limited knowledge of stillbirth terminology and periodic closure of the DHIMS-2 were seen to proliferate gaps in stillbirth recording and reporting. Under theme 3, perinatal audits were acknowledged as an enabler for stillbirth recording and reporting by the DHD, though audits are mandated for only late-gestational stillbirths (> 28 weeks). Engagement of other sectors, e.g., civil/vital registration and private health facilities, was seen as key in understanding the true population-level burden of stillbirths. CONCLUSION Effective district health management ensures that every stillbirth is accurately recorded, reported, and acted upon to drive improvements. A large need exists for capacity building on stillbirth definitions and data use. Recommendations are made, for example, terminology standardization and private sector engagement, aimed at reducing stillbirth rates in high-mortality settings such as Ghana.
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Affiliation(s)
- Nana A Mensah Abrampah
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Kenneth Fosu Oteng
- Ashanti Regional Health Directorate, Ghana Health Service, Kumasi, Ghana
| | - Ernest Konadu Asiedu
- National Centre for Coordination for Early Warning and Response Mechanisms, Accra, Ghana
| | | | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Hennessy M, O'Donoghue K. Bridging the gap between pregnancy loss research and policy and practice: insights from a qualitative survey with knowledge users. Health Res Policy Syst 2024; 22:15. [PMID: 38273374 PMCID: PMC10809434 DOI: 10.1186/s12961-024-01103-z] [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: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The loss of a pregnancy or the death of baby around the time of their birth can have profound impacts on parents, families and staff involved. There is much opportunity to enhance the systematic uptake of evidence-based interventions to enhance service provision, lived experiences and outcomes. Challenges exist to translating pregnancy loss research evidence into policy and practice, however. Pregnancy loss remains a neglected area of research and resourcing and is steeped in stigma. While barriers and facilitators to the use of research evidence by decision-makers in public health and health services are well documented, we aimed to better understand the factors that influence the translation of pregnancy loss research into practice and policy. METHODS We conducted a qualitative online survey of pregnancy loss research knowledge users in Ireland, identified through our clinical and academic networks, between January and March 2022. The survey comprised ten questions, with three closed questions, informed by the Knowledge Translation Planning Template©. Questions included who could benefit from pregnancy loss research, perceived barriers and facilitators to the use of research evidence and preferred knowledge translation strategies. We analysed data using reflexive thematic analysis. RESULTS We included data from 46 participants in our analysis, from which we generated two central themes. The first-'End the silence; stigma and inequality around pregnancy loss to enhance awareness and understanding, public health and services and supports'-addresses issues related to the stigma, sensitivities and silence, lack of awareness and understanding, and lack of relevance or priority afforded to pregnancy loss. The second theme-'Use a range of tailored, accessible approaches to engage a large, diverse range of knowledge users'-highlights the need to use relevant, accessible, and engaging information, resources or materials in knowledge translation efforts, and a variety of tailored approaches to suit different audiences, including materials, workshops/webinars, media, knowledge brokers and champions or opinion leaders. CONCLUSIONS Our analysis provides rich insights into the barriers and facilitators to knowledge translation in the field of pregnancy loss research. We identified key strategies that can be used to inform knowledge translation planning in Ireland, and which have international applicability.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, T12 YE02, Ireland.
- INFANT Research Centre, University College Cork, Cork, T12 YE02, Ireland.
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, T12 YE02, Ireland
- INFANT Research Centre, University College Cork, Cork, T12 YE02, Ireland
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Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG 2024; 131:140-150. [PMID: 37272228 DOI: 10.1111/1471-0528.17562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. OBJECTIVES To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. SEARCH STRATEGY CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. SELECTION CRITERIA Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. DATA COLLECTION AND ANALYSIS A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. MAIN RESULTS Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. CONCLUSIONS The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.
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Affiliation(s)
- Ankita Mukherjee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Monitoring, Evaluation and Research, New Delhi, India
| | | | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Mee
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
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de Mucio B, Sosa C, Colomar M, Mainero L, Cruz CM, Chévez LM, Lopez R, Carrillo G, Rizo U, Saint Hillaire EE, Arriaga WE, Guadalupe Flores RM, Ochoa C, Gonzalez F, Castro R, Stefan A, Moreno A, Metelus S, Souza RT, Costa ML, Luz AG, Sousa MH, Cecatti JG, Serruya SJ. The burden of stillbirths in low resource settings in Latin America: Evidence from a network using an electronic surveillance system. PLoS One 2023; 18:e0296002. [PMID: 38134193 PMCID: PMC10745214 DOI: 10.1371/journal.pone.0296002] [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] [Received: 02/22/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To determine stillbirth ratio and its association with maternal, perinatal, and delivery characteristics, as well as geographic differences in Latin American countries (LAC). METHODS We analysed data from the Perinatal Information System of the Latin American Center for Perinatology and Human Development (CLAP) between January 2018 and June 2021 in 8 health facilities from five LAC countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic). Maternal, pregnancy, and delivery characteristics, in addition to pregnancy outcomes were reported. Estimates of association were tested using chi-square tests, and P < 0.05 was regarded as significant. Bivariate analysis was conducted to estimate stillbirth risk. Prevalence ratios (PR) with their 95% confidence intervals (CI) for each predictor were reported. RESULTS In total, 101,852 childbirths comprised the SIP database. For this analysis, we included 99,712 childbirths. There were 762 stillbirths during the study period; the Stillbirth ratio of 7.7/1,000 live births (ranged from 3.8 to 18.2/1,000 live births across the different maternities); 586 (76.9%) were antepartum stillbirths, 150 (19.7%) were intrapartum stillbirths and 26 (3.4%) with an ignored time of death. Stillbirth was significantly associated with women with diabetes (PRadj 2.36; 95%CI [1.25-4.46]), preeclampsia (PRadj 2.01; 95%CI [1.26-3.19]), maternal age (PRadj 1.04; 95%CI [1.02-1.05]), any medical condition (PRadj 1.48; 95%CI [1.24-1.76, and severe maternal outcome (PRadj 3.27; 95%CI [3.27-11.66]). CONCLUSIONS Pregnancy complications and maternal morbidity were significantly associated with stillbirths. The stillbirth ratios varied across the maternity hospitals, which highlights the importance for individual surveillance. Specialized antenatal and intrapartum care remains a priority, particularly for women who are at a higher risk of stillbirth.
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Affiliation(s)
- Bremen de Mucio
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | - Luis Mainero
- Latin American Center of Perinatology (CLAP-PAHO), Montevideo, Uruguay
| | | | | | - Rita Lopez
- Hospital Berta Calderon Roque, Managua, Nicaragua
| | | | | | | | | | | | | | | | | | - Allan Stefan
- Hospital Leonardo Martinez Valenzuela, San Pedro Sula, Honduras
| | | | - Sherly Metelus
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Adriana G. Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | | | - José G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Dah AK, Osarfo J, Ampofo GD, Appiah-Kubi A, Mbroh H, Azanu WK, Sakyi AT, Abradu L, Morhe ESK. Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana. PLoS One 2023; 18:e0296076. [PMID: 38128029 PMCID: PMC10734929 DOI: 10.1371/journal.pone.0296076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa. METHOD This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant. RESULTS A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths. CONCLUSION Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.
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Affiliation(s)
- Anthony Kwame Dah
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Joseph Osarfo
- Department of Community Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Gifty Dufie Ampofo
- Department of Community Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Adu Appiah-Kubi
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Hintermann Mbroh
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Wisdom Klutse Azanu
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Afia Tabuaa Sakyi
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Lydia Abradu
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Emmanuel Senanu Komla Morhe
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Directorate of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
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Aggarwal N, Lahariya C, Sharma B, Khan T, Sood B, Singh VV, Verma S, Upadhyay A, Dhaliwal LK. Stillbirths in India: Current Status, Challenges, and the Way Forward. Indian J Pediatr 2023; 90:63-70. [PMID: 37605065 DOI: 10.1007/s12098-023-04807-2] [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: 05/28/2023] [Accepted: 06/23/2023] [Indexed: 08/23/2023]
Abstract
Stillbirth is a major public health challenge and a multifaceted issue that leads to significant financial, physical, mental, financial, and psychosocial implications. India has made substantial progress in stillbirth reduction. Yet, many challenges continue and the absolute number of stillbirths remain high. This paper presents the national and state level burden of stillbirths and discusses about the magnitude, risk factors, causes and inequities in stillbirths. A few additional approaches for reduction of preventable stillbirths have been suggested. The authors argue that the institutional mechanisms need to be developed to ensure all stillbirths are registered in a timely manner. There is a need for standard definition for classification of stillbirths and document the cause, to roll-out suitable interventions. There is a need for state specific interventions to address different causes, as Indian states have variable stillbirth rates. The stillbirth audits should be institutionalised as a continuous quality improvement exercise to bring local accountability and reduce stillbirth rate. The healthcare system and providers must be trained to offer bereavement support to the affected mothers and families. These approaches should be implemented through primary healthcare system as well.
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Affiliation(s)
- Neelam Aggarwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - Chandrakant Lahariya
- Foundation for People-Centric Health Systems, New Delhi, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, India
| | - Bharti Sharma
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Tamkin Khan
- Department of Obstetrics & Gynecology, Aligarh Muslim University, Aligarh, U.P, India
| | - Bulbul Sood
- Former Senior Strategic Advisor, Jhpiego India, New Delhi, India
| | | | - Shruti Verma
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-Centric Health Systems, New Delhi, India
| | - Anita Upadhyay
- Human Capital Lighthouse Consulting Pvt Ltd, New Delhi, India
| | - L K Dhaliwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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Mouseli A, Sharafi M, Mastaneh Z, Shiri MS. Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study. Health Sci Rep 2023; 6:e1682. [PMID: 37936619 PMCID: PMC10625898 DOI: 10.1002/hsr2.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI). Methods This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant. Results Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES. Conclusions The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.
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Affiliation(s)
- Ali Mouseli
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
| | - Mehdi Sharafi
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
| | - Zahra Mastaneh
- Department of Health Information Management and Technology, School of Allied Medical SciencesHormozgan University of Medical SciencesBandar AbbasIran
| | - Maryam Shiravani Shiri
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
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Chacko M, George LS, Retnakumar C. Role of male partners in birth preparedness and complication readiness: A qualitative study. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:330-333. [PMID: 37167525 DOI: 10.25259/nmji_35_6_330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background In familial and societal matters, men are the decision-makers and economic resource providers in many patriarchal societies. It is important to assess the involvement of men in birth preparedness and complication readiness (BPCR), as men act as gatekeepers to women's health. We examined the role, motivators and barriers for participation of male partners of pregnant women in BPCR. Methods This qualitative study was based on the grounded theory approach. Data were collected through 29 in-depth interviews conducted among husbands (n=8), mothers (n=8), mothers-in-law (n=8), health professionals (n=5) and focus group discussions (FGDs) with pregnant women (FGD, n=3). Interviews and FGDs were transcribed; themes and sub-themes were generated and conclusions were drawn by triangulation of the data. Results Men were found to have a major role in BPCR. They supported their pregnant wives by maintaining their health, providing financial support and helping them in the decision-making process regarding treatment. They also provided complication readiness support by arranging transportation and facilitating the process of hospital admission. Conclusions Our study emphasizes how changes have occurred in the attitudes and practices over generations regarding men's role in BPCR and their participation during delivery. However, there is a long way to go for which transference of knowledge and cultural transformation have become necessities.
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Affiliation(s)
- Maya Chacko
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Ponekkara, Kochi 682031, Kerala, India
| | - Leyanna Susan George
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Ponekkara, Kochi 682031, Kerala, India
| | - Charutha Retnakumar
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Ponekkara, Kochi 682031, Kerala, India
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Rent S, Rocha T, Silva L, Souza JVP, Guinsburg R, Filho AC, Staton C, Vissoci JRN. The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality in Brazil, 2000-2019. J Pediatr 2023; 262:113613. [PMID: 37459908 DOI: 10.1016/j.jpeds.2023.113613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To describe trends in perinatal loss across Brazil, a country that transitioned in 2006 from a lower-middle income to an upper-middle income country, from 2000 to 2019 and analyze the effect of municipal wealth status on perinatal outcomes. STUDY DESIGN We conducted an ecological cohort study, based on publicly available data from the Brazilian Ministry of Health's data repository on live births and deaths. The Atlas of Human Development in Brazil was used to associate each region with a World Bank income classification. RESULTS The national neonatal mortality rate (NMR) for infants born at ≥22 weeks of gestation decreased from 21.2 in 2000 to 12.4 in 2019. The stillbirth rate (SBR) decreased from 12.0 to 10.2 during this period. For infants born between 22 and 27 weeks of gestation, worsening perinatal outcomes were seen after 2012. In 2019, the median rates of neonatal mortality and stillbirth were both 4 points higher in lower- to middle-income municipalities compared with high-income municipalities (P < .01). CONCLUSION Brazil has made significant progress in neonatal mortality and stillbirth from 2000 to 2019, yet inequity in perinatal outcomes remains and is correlated with municipal economic status. Nationally, ongoing improvement is needed for infants <28 weeks of gestation, and closer exploration is needed into why there are increasing rates of negative perinatal outcomes among infants born at 22-27 weeks of gestation after 2012.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Durham, NC.
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | - Lincoln Silva
- Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Catherine Staton
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
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Copaja-Corzo C, Gomez-Colque S, Vilchez-Cornejo J, Hueda-Zavaleta M, Taype-Rondan A. Fetal death and its association with indicators of social inequality: 20-year analysis in Tacna, Peru. PLoS One 2023; 18:e0292183. [PMID: 37797056 PMCID: PMC10553794 DOI: 10.1371/journal.pone.0292183] [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] [Received: 02/05/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the rates of fetal mortality in a Peruvian hospital between 2001 and 2020 and to investigate the association of indicators of social inequality (such as access to prenatal care and education) with fetal mortality. METHODOLOGY We conducted a retrospective cohort study, including all pregnant women who attended a Peruvian hospital between 2001 and 2020. We collected data from the hospital's perinatal computer system. We used Poisson regression models with robust variance to assess the associations of interest, estimating adjusted relative risks (aRR) and their 95% confidence intervals (95% CI). RESULTS We analyzed data from 67,908 pregnant women (median age: 26, range: 21 to 31 years). Of these, 58.3% had one or more comorbidities; the most frequent comorbidities were anemia (33.3%) and urinary tract infection (26.3%). The fetal mortality ratio during the study period was 0.96%, with the highest rate in 2003 (13.7 per 1,000 births) and the lowest in 2016 (6.1 per 1,000 births), without showing a marked trend. Having less than six (aRR: 4.87; 95% CI: 3.99-5.93) or no (aRR: 7.79; 6.31-9.61) prenatal care was associated with higher fetal mortality compared to having six or more check-ups. On the other hand, higher levels of education, such as secondary education (aRR: 0.73; 0.59-0.91), technical college (aRR: 0.63; 0.46-0.85), or university education (aRR: 0.38; 0.25-0.57) were associated with a lower risk of fetal death compared to having primary education or no education. In addition, a more recent year of delivery was associated with lower fetal mortality. CONCLUSION Our study presents findings of fetal mortality rates that are comparable to those observed in Peru in 2015, but higher than the estimated rates for other Latin American countries. A more recent year of delivery was associated with lower fetal mortality, probably due to reduced illiteracy and increased access to health care between 2000 and 2015. The findings suggest a significant association between indicators of social inequality (such as access to prenatal care and education) with fetal mortality. These results emphasize the critical need to address the social and structural determinants of health, as well as to mitigate health inequities, to effectively reduce fetal mortality.
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Affiliation(s)
| | | | - Jennifer Vilchez-Cornejo
- Facultad de Salud Pública y Administración, Unidad de Investigación de Enfermedades Emergentes y Cambio Climático, Universidad Peruana Cayetano Heredia, Lima, Perú
- Facultad de Medicina Humana, Universidad Nacional de Ucayali, Ucayali, Perú
| | - Miguel Hueda-Zavaleta
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna, Perú
- Hospital Daniel Alcides Carrión, EsSalud, Tacna, Perú
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú
- EviSalud—Evidencias en Salud, Lima, Perú
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