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Factors Associated with Caesarean and Peripartum Complications at Southern Mozambique’s Rural Hospitals: A Cross-Sectional Analytical Study. Healthcare (Basel) 2022; 10:healthcare10061013. [PMID: 35742065 PMCID: PMC9223089 DOI: 10.3390/healthcare10061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Information about factors underlying peripartum complications is needed to inform health programs in Mozambique. This retrospective study covered the period from January 2013 to December 2018 and was performed at three rural-district hospitals in southern Mozambique, aiming at assessing factors associated with caesarean and peripartum complications. Data were extracted by clinical criteria-based audits on randomly select clients’ files. Logistical regression was used to identify factors associated with peripartum complications. Amongst 5068 audited files, women mean age was 25 years (Standard Deviation (SD) = 7), gestational age was 38 weeks (SD = 2), 25% had “high obstetric-risk” and 19% delivered by caesarean. Factors significantly associated with caesarean included being transferred [Adjusted Odds Ratio (aOR) =1.8; 95% Confidence Interval (95%CI) = 1.3–2.6], preeclampsia [aOR (95%CI) = 2.0 (1.2–3.3)], age [aOR (95%CI) = 0.96 (0.93–0.99)] and “high obstetric-risk” [aOR (95%CI) = 0.54 (0.37–0.78)]. Factors significantly associated with neonatal complication included mother being transferred [aOR (95%CI) = 2.1 (1.8–2.6)], “high obstetric-risk” [aOR (95%CI) = 1.6 (1.3–1.96)], preeclampsia [aOR (95%CI) = 1.5 (1.2–1.8), mother’s age [aOR (95%CI) = −2% (−3%, −0.1%)] and gestational age [aOR (95%CI) = −8% (−13%, −6%)] increment. This study identified amendable factors associated with peripartum complications in rural referral health settings. Strengthening hospitals’ performance assurance is critical to address the identified factors and improve peripartum outcomes for mothers-neonate dyads.
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Sevene E, Boene H, Vidler M, Valá A, Macuacua S, Augusto O, Fernandes Q, Bique C, Macete E, Sidat M, von Dadelszen P, Munguambe K. Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique. Reprod Health 2021; 18:145. [PMID: 34229709 PMCID: PMC8259411 DOI: 10.1186/s12978-021-01192-x] [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: 03/16/2020] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Maternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals. Method The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals. Results Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility. Conclusions This study showed that task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level. Maternal mortality is an important public health problem in Mozambique. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. We conducted a study to describe the feasibility of task-sharing the screening and initiation of management for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and to document healthcare facility preparedness to respond to referrals. The study was done to inform a future intervention trial known as the Community-Level Interventions for Pre-eclampsia (CLIP) study. We interviewed community health workers, women, various community groups, health care providers, and policymakers and assessed health facilities in Maputo and Gaza provinces, Mozambique. Our results showed that community health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they were not trained or equipped to provide obstetric emergencies care prior to referral. Nurses at primary health facilities were supportive of task-sharing with community health workers; however, some barriers mentioned include a lack of equipment, shortage of supervisors, and irregular drug availability. Local stakeholders emphasized the need for comprehensive training and supervision of community health workers to take on new tasks. Task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia was deemed feasible at the community level in southern Mozambique, but still, to be addressed some health system level barriers to the management of pregnancies complications.
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Affiliation(s)
- Esperança Sevene
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique. .,Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
| | - Helena Boene
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and The Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada
| | - Anifa Valá
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Salésio Macuacua
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Orvalho Augusto
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Cassimo Bique
- Ministério da Saúde, Maputo, Mozambique.,Hospital Central de Maputo, Maputo, Mozambique
| | - Eusébio Macete
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Ministério da Saúde, Maputo, Mozambique
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Khátia Munguambe
- Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique
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Desta M, Amha H, Anteneh Bishaw K, Adane F, Assemie MA, Kibret GD, Yimer NB. Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis. PLoS One 2020; 15:e0240675. [PMID: 33137135 PMCID: PMC7605683 DOI: 10.1371/journal.pone.0240675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia. Methods This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I2 statistic and Egger’s tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval. Results Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture. Conclusion Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Haile Amha
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Keralem Anteneh Bishaw
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fentahun Adane
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Moges Agazhe Assemie
- Department of Public health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Department of Public health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nigus Bililign Yimer
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Loquiha O, Hens N, Chavane L, Temmerman M, Osman N, Faes C, Aerts M. Mapping maternal mortality rate via spatial zero-inflated models for count data: A case study of facility-based maternal deaths from Mozambique. PLoS One 2018; 13:e0202186. [PMID: 30412633 PMCID: PMC6226154 DOI: 10.1371/journal.pone.0202186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/30/2018] [Indexed: 12/02/2022] Open
Abstract
Maternal mortality remains very high in Mozambique, with estimates from 2015 showing a maternal mortality ratio of 489 deaths per 100,000 live births, even though the rates tend to decrease since 1990. Pregnancy related hemorrhage, gestational hypertension and diseases such as malaria and HIV/AIDS are amongst the leading causes of maternal death in Mozambique, and a significant number of these deaths occur within health facilities. Often, the analysis of data on maternal mortality involves the use of counts of maternal deaths as outcome variable. Previously we showed that a class of hierarchical zero-inflated models were very successful in dealing with overdispersion and clustered counts when analyzing data on maternal deaths and related risk factors within health facilities in Mozambique. This paper aims at providing additional insights over previous analyses and presents an extension of such models to account for spatial variation in a disease mapping framework of facility-based maternal mortality in Mozambique.
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Affiliation(s)
- Osvaldo Loquiha
- Department of Mathematics and Informatics, Faculty of Sciences, Universidade Eduardo Mondlane, Maputo, Mozambique
- I-BioStat, Hasselt University, Diepenbeek, Belgium
| | - Niel Hens
- I-BioStat, Hasselt University, Diepenbeek, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Centre of Excellence Women and Child Health, Aga Kan University, Nairobi, Kenya
| | - Nafissa Osman
- Department of Obstetrics and Gynaecology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Marc Aerts
- I-BioStat, Hasselt University, Diepenbeek, Belgium
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Augusto O, Keyes EE, Madede T, Abacassamo F, de la Corte P, Chilundo B, Bailey PE. Progress in Mozambique: Changes in the availability, use, and quality of emergency obstetric and newborn care between 2007 and 2012. PLoS One 2018; 13:e0199883. [PMID: 30020958 PMCID: PMC6051588 DOI: 10.1371/journal.pone.0199883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/17/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal mortality in Mozambique has not declined significantly in the last 10-15 years, plateauing around 480 maternal deaths per 100,000 live births. Good quality antenatal care and routine and emergency intrapartum care are critical to reducing preventable maternal and newborn deaths. MATERIALS AND METHODS We compare the findings from two national cross-sectional facility-based assessments conducted in 2007 and 2012. Both were designed to measure the availability, use and quality of emergency obstetric and neonatal care. Indicators for monitoring emergency obstetric care were used as were descriptive statistics. RESULTS The availability of facilities providing the full range of obstetric life-saving procedures (signal functions) decreased. However, an expansion in the provision of individual signal functions was highly visible in health centers and health posts, but in hospitals, performance was less satisfactory, with proportionally fewer hospitals providing assisted vaginal delivery, obstetric surgery and blood transfusions. All other key indicators showed signs of improvements: the institutional delivery rate, the cesarean delivery rate, met need for emergency obstetric care (EmOC), institutional stillbirth and early neonatal death rates, and cause-specific case fatality rates (CFRs). CFRs for most major obstetric complications declined between 17% and 69%. The contribution of direct causes to maternal deaths decreased while the proportion of indirect causes doubled during the five-year interval. CONCLUSIONS The indicator of EmOC service availability, often used for planning and developing EmONC networks, requires close examination. The standard definition can mask programmatic weaknesses and thus, fails to inform decision makers of what to target. In this case, the decline in the use of assisted vaginal delivery explained much of the difference in this indicator between the two surveys, as did faltering hospital performance. Despite this backsliding, many signs of improvement were also observed in this 5-year period, but indicator levels continue below recommended thresholds. The quality of intrapartum care and the adverse consequences from infectious diseases during pregnancy point to priority areas for programmatic improvement.
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Affiliation(s)
- Orvalho Augusto
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
- * E-mail:
| | - Emily E. Keyes
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
| | - Tavares Madede
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Fátima Abacassamo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Moçambique
| | - Patricia E. Bailey
- FHI 360, Durham, North Carolina, United States of America
- Averting Maternal Death & Disability, Columbia University, New York, NY, United States of America
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Geelhoed D, de Deus V, Sitoe M, Matsinhe O, Lampião Cardoso MI, Manjate CV, Pinto Matsena PI, Mosse Lazaro C. Improving emergency obstetric care and reversing the underutilisation of vacuum extraction: a qualitative study of implementation in Tete Province, Mozambique. BMC Pregnancy Childbirth 2018; 18:266. [PMID: 29945551 PMCID: PMC6020342 DOI: 10.1186/s12884-018-1901-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/17/2018] [Indexed: 01/29/2023] Open
Abstract
Background Maternal and perinatal mortality in Mozambique were declining at a slow pace, despite progress in coverage of institutional childbirth. Implementation of quality emergency obstetric care including vacuum extraction remained inadequate. In 2015–2017, Tete Province achieved remarkable progress in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, with encouraging results for maternal and perinatal outcomes, despite severe resource constraints. This paper presents the experience of Tete Province, generating a rich, contextualised understanding, which might provide generalizable insights and lessons. Methods This qualitative study design is used to present Tete’s experience in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, drawing on principles from implementation science and applying a systems thinking approach. Sources include routine data, documents, social media messages, and the lived experience of the authors, all intimately involved in the implementation process during 2014–2017. Iterative learning and analysis, involving all authors, led to the final interpretations. Results Within a context of severe resource constraints, Tete applied 4 interventions (training, accreditation, audit, monitoring and evaluation with feedback) to improve the implementation of emergency obstetric care. Considerable progress was achieved in vacuum extraction and other signal functions of emergency obstetric care and in the decision-making process for caesarean sections, contributing to important reductions in the provincial institutional maternal mortality and stillbirth rates. Facilitating factors include attributes of the vacuum extraction itself, of the structural and organisational environments in which it was introduced, of the people involved in implementation, and of the process through which the implementation was rolled-out. Conclusions The lessons from implementation science and systems thinking can contribute to surprising results in the improvement of emergency obstetric care including the use of vacuum extraction, even in a severely resource-constrained setting. The creation of conditions for real change, with empowerment of the staff and managers at the front-line of day-to-day practice in Tete may inspire others in similar conditions and circumstances. The underutilisation of vacuum extraction in middle- and low-income countries is indeed a missed opportunity. Its reversion is possible and provides a good chance to make considerable difference in maternal and perinatal outcomes.
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Affiliation(s)
- D Geelhoed
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique.
| | - V de Deus
- Tete Provincial Hospital, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M Sitoe
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - O Matsinhe
- Rural Hospital of Mutarara, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M I Lampião Cardoso
- Rural Hospital of Ulongue, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C V Manjate
- District Services of Health, Women and Social Action of Chifunde, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - P I Pinto Matsena
- District Services of Health, Women and Social Action of Cidade de Tete, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C Mosse Lazaro
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
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