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Chen L, Qian Q, Zhu Y, Zhang X, Zhang Y, Jiang F, Chu G, Shi J, Pu L. Experiences and needs of Chinese women after a stillbirth: a qualitative phenomenological study. BMJ Open 2024; 14:e088079. [PMID: 39231550 DOI: 10.1136/bmjopen-2024-088079] [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: 09/06/2024] Open
Abstract
OBJECTIVES We aimed to explore the lived experiences and needs of women after a recent stillbirth event. DESIGN Qualitative phenomenological study. SETTING The current study was conducted in a tertiary obstetric hospital in East China between 25 January 2024 and 29 March 2024. PARTICIPANTS 14 women having experienced a stillbirth within the last 6 months. RESULTS Researchers agreed on four key themes including individual variations in emotional reaction and recovery, physical recovery and concerns about future pregnancies, the critical role of social support systems and variations in perceptions of stillbirth as the death of a fetus versus a human being, along with related mourning rituals. These themes collectively highlight the multifaceted nature of the stillbirth experience, underscoring the complex interplay between personal, cultural and medical factors that shape women's emotional and physical responses. CONCLUSIONS Post-stillbirth experiences among Chinese women are deeply individualised and influenced by a complex interplay of personal emotions, cultural contexts and medical interactions. It is imperative for healthcare systems to implement tailored care strategies beyond standard protocols to proactively address their varied emotional landscapes and physical concerns with an enhanced awareness of cultural sensitivities. Specialised training for healthcare providers should be devised to recognise and respond to the unique grief processes. Comprehensive support systems should be established to significantly enhance the recovery journey by providing essential resources and community connections.
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Affiliation(s)
- Li Chen
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiyu Qian
- Department of Women's Health, Suzhou Gusu District Maternal and Child Health Care Institute, Suzhou, Jiangsu, China
| | - Yan Zhu
- Center for Health Statistics and Information, National Health Commission of People's Republic of China, Beijing, China
| | - Xu Zhang
- Department of Women's Health, Suzhou Gusu District Maternal and Child Health Care Institute, Suzhou, Jiangsu, China
| | - Yueming Zhang
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feizhou Jiang
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guangping Chu
- Department of Women's Health, Suzhou Gusu District Maternal and Child Health Care Institute, Suzhou, Jiangsu, China
| | - Jia Shi
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li Pu
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Riaz M, Waris N, Saadat A, Fawwad A, Basit A. Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan. Pak J Med Sci 2024; 40:851-856. [PMID: 38827883 PMCID: PMC11140359 DOI: 10.12669/pjms.40.5.7507] [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: 01/03/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital. Methods This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent. Results A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years. Conclusion Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.
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Affiliation(s)
- Musarrat Riaz
- Musarrat Riaz, FCPS. Associate Professor, Department of Medicine, Consultant Endocrinologist, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Nazish Waris
- Nazish Waris, Ph.D. Senior Lecturer, Department of Biochemistry, Research Associate, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Akifa Saadat
- Akifa Saadat, B.S. Research Officer, Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Asher Fawwad
- Asher Fawwad, Ph.D. Professor & Head of the Biochemistry Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Abdul Basit
- Abdul Basit, FRCP. Professor of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Goldenberg RL, Hwang K, Saleem S, Tikmani SS, Yogeshkumar S, Kulkani V, Ghanchi N, Harakuni S, Ahmed I, Uddin Z, Goudar SS, Guruprasad G, Dhaded S, Goco N, Silver RM, McClure EM. Data usefulness in determining cause of stillbirth in South Asia. BJOG 2023; 130 Suppl 3:61-67. [PMID: 37470078 DOI: 10.1111/1471-0528.17592] [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: 04/16/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To evaluate the usefulness of data to determine cause of stillbirth in India and Pakistan. DESIGN Prospective, observational study. SETTINGS Study hospitals in India and Pakistan. POPULATION 200 fetal deaths with placental evaluation and minimally invasive tissue sampling (MITS) of internal organs and polymerase chain reaction (PCR) test for 75 pathogens. MAIN OUTCOME MEASURES Data defined as useful to determine stillbirth causes. RESULTS Placental pathology was the most useful to determine cause of stillbirth. Comparing placental and fetal weight with standard weights was useful in 44.5% and 48.5%, respectively. Lung histology was useful in 42.5%. Most of the other findings of internal organ histology were only occasionally useful. Signs of abruption, by maternal history or placental evaluation, were always deemed useful. Placenta, brain and cord blood PCR were also useful, but less often than histology. CONCLUSION Based on this analysis, maternal clinical history, placental histology and fetal examination were most informative. Comparing the placental and fetal weights with recognised standards was useful in nearly half the cases. Fetal tissue histology and PCR were also informative. Of all the potential tests of MITS-obtained specimens, we would first recommend histological evaluation of the lungs, and using a multiplex PCR platform would determine pathogens in blood and brain/CSF. We recognise that this approach will not identify some causes, including some genetic and internal organ anomalies, but will confirm most common causes of stillbirth and most of the preventable causes of stillbirth in low- and middle-income countries.
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Affiliation(s)
| | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | | | | | - S Yogeshkumar
- KLE Academy of Higher Education's JN Medical College, Belagavi, India
| | | | | | - Sheetal Harakuni
- KLE Academy of Higher Education's JN Medical College, Belagavi, India
| | - Imran Ahmed
- RTI International, Durham, North Carolina, USA
| | | | | | | | - Sangappa Dhaded
- KLE Academy of Higher Education's JN Medical College, Belagavi, India
| | - Norman Goco
- RTI International, Durham, North Carolina, USA
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De Silva MS, Panisi L, Manubuasa L, Honimae C, Taragwanu S, Burggraaf S, Ogaoga D, Lindquist AC, Walker SP, Tong S, Hastie R. Incidence and causes of stillbirth in the only tertiary referral hospital in the Solomon Islands: a hospital-based retrospective cohort study. BMJ Open 2022; 12:e066237. [PMID: 36585152 PMCID: PMC9809253 DOI: 10.1136/bmjopen-2022-066237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Stillbirth is a major global health issue, which disproportionately affects families living in low-income and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes, however research investigating stillbirth is lacking. Thus, we aimed to investigate the incidence and cause of stillbirth occurring at the National Referral Hospital, Solomon Islands. DESIGN We conducted a retrospective cohort study from January 2017 to December 2018. SETTING At the only tertiary referral hospital in the Solomon Islands, on the main island of Guadalcanal. PARTICIPANTS All births occurring in the hospital during the study period. OUTCOME MEASURES Number of, causes and risk factors for stillbirths (fetal deaths before birth at ≥20 estimated gestational weeks, or ≥500 g in birth weight). RESULTS Over 2 years 341 stillbirths and 11 056 total births were recorded, giving an institutional incidence of 31 stillbirths per 1000 births. Of the cases with a recorded cause of death, 72% were deemed preventable. Most stillbirths occurred antenatally and 62% at preterm gestations (<37 weeks). 59% had a birth weight below 2500 g and preventable maternal conditions were present in 42% of the cases. 46% of the cases were caused by an acute intrapartum event, and among these 92% did not receive intrapartum monitoring. CONCLUSIONS Stillbirth affects 31 in every 1000 births at the National Referral Hospital in the Solomon Islands and many cases are preventable. Our findings highlight the urgent need for increased focus on perinatal deaths in the Solomon Islands with universal classification and targeted training, improved quality of obstetrical care and community awareness.
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Affiliation(s)
- Manarangi Sajini De Silva
- Obstetrics and Gynaecology, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Leeanne Panisi
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Lenin Manubuasa
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Catherine Honimae
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Susan Taragwanu
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Simon Burggraaf
- Department of Maternal and Child Health, Office of the WHO Representative in Solomon Islands, Honiara, Solomon Islands
| | - Divinal Ogaoga
- Ministry of Health of Solomon Islands, Honiara, Solomon Islands
| | - Anthea Clare Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
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Milton R, Modibbo F, Gillespie D, Alkali FI, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Khalid RY, Muhammad MY, Bello M, Edwin CP, Ogudo E, Iregbu KC, Jones L, Hood K, Ghazal P, Sanders J, Hassan B, Belga FJ, Walsh TR. Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria. BMC Pregnancy Childbirth 2022; 22:692. [PMID: 36076161 PMCID: PMC9454147 DOI: 10.1186/s12884-022-04971-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: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Almost two million stillbirths occur annually, most occurring in low- and middle-income countries. Nigeria is reported to have one of the highest stillbirth rates on the African continent. The aim was to identify sociodemographic, living environment, and health status factors associated with stillbirth and determine the associations between pregnancy and birth factors and stillbirth in the Murtala Mohammed Specialist Hospital, Kano, Nigeria. Methods A three-month single-site prospective observational feasibility study. Demographic and clinical data were collected. We fitted bivariable and multivariable models for stillbirth (yes/no) and three-category livebirth/macerated stillbirth/non-macerated stillbirth outcomes to explore their association with demographic and clinical factors. Findings 1,998 neonates and 1,926 mothers were enrolled. Higher odds of stillbirth were associated with low-levels of maternal education, a further distance to travel to the hospital, living in a shack, maternal hypertension, previous stillbirth, birthing complications, increased duration of labour, antepartum haemorrhage, prolonged or obstructed labour, vaginal breech delivery, emergency caesarean-section, and signs of trauma to the neonate following birth. Interpretation This work has obtained data on some factors influencing stillbirth. This in turn will facilitate the development of improved public health interventions to reduce preventable deaths and to progress maternal health within this site. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04971-x.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Modibbo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - D Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - R Y Khalid
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Y Muhammad
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Bello
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - C P Edwin
- Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - E Ogudo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - L Jones
- Department of Medical Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Belga
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - T R Walsh
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, UK
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Prüst ZD, Kodan LR, van den Akker T, Bloemenkamp KWM, Rijken MJ, Verschueren KJC. The global use of the International Classification of Diseases to Perinatal Mortality (ICD-PM): A systematic review. J Glob Health 2022; 12:04069. [PMID: 35972943 PMCID: PMC9380964 DOI: 10.7189/jogh.12.04069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The World Health Organization launched the International Classification of Diseases for Perinatal Mortality (ICD-PM) in 2016 to uniformly report on the causes of perinatal deaths. In this systematic review, we aim to describe the global use of the ICD-PM by reporting causes of perinatal mortality and summarizing challenges and suggested amendments. Methods We systematically searched MEDLINE, Embase, Global Health, and CINAHL databases using key terms related to perinatal mortality and the classification for causes of death. We included studies that applied the ICD-PM and were published between January 2016 and June 2021. The ICD-PM data were extracted and a qualitative analysis was performed to summarize the challenges of the ICD-PM. We applied the PRISMA guidelines, registered our protocol at PROSPERO [CRD42020203466], and used the Appraisal tool for Cross-Sectional Studies (AXIS) as a framework to evaluate the quality of evidence. Results The search retrieved 6599 reports. Of these, we included 15 studies that applied the ICD-PM to 44 900 perinatal deaths. Most causes varied widely; for example, "antepartum hypoxia" was the cause of stillbirths in 0% to 46% (median = 12%, n = 95) in low-income settings, 0% to 62% (median = 6%, n = 1159) in middle-income settings and 0% to 55% (median = 5%, n = 249) in high-income settings. Five studies reported challenges and suggested amendments to the ICD-PM. The most frequently reported challenges included the high proportion of antepartum deaths of unspecified cause (five studies), the inability to determine the cause of death when the timing of death is unknown (three studies), and the challenge of assigning one cause in case of multiple contributing conditions (three studies). Conclusions The ICD-PM is increasingly being used across the globe and gives health care providers insight into the causes of perinatal death in different settings. However, there is wide variation in reported causes of perinatal death across comparable settings, which suggests that the ICD-PM is applied inconsistently. We summarized the suggested amendments and made additional recommendations to improve the use of the ICD-PM and help strengthen its consistency. Registration PROSPERO [CRD42020203466].
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Affiliation(s)
- Zita D Prüst
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Academic Hospital Paramaribo (AZP), Paramaribo, Suriname
| | - Lachmi R Kodan
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Academic Hospital Paramaribo (AZP), Paramaribo, Suriname
- Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kitty WM Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kim JC Verschueren
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
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Mohammed-Ahmed A, Abdullahi A, Beshir F. Magnitude and associated factors of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Harar, eastern Ethiopia. Eur J Midwifery 2022; 6:49. [PMID: 35974716 PMCID: PMC9340818 DOI: 10.18332/ejm/150354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION According to WHO, there are nearly 2 million stillbirths every year, one every 16 seconds. The objective of our study was to assess the frequency and associated factors of stillbirth among women who gave birth at Hiwot Fana Specialized University Hospital, Harar, eastern Ethiopia, 2021. METHODS An institution-based retrospective cross-sectional study of medical records was conducted among 336 women who gave birth from 1 January 2020 to 31 December 2020. Maternal medical records were selected by systematic random sampling technique and a pre-tested checklist was used to collect data. Data entry and analysis were done using SPSS-version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with stillbirth. Adjusted odds ratios with 95% confidence intervals are reported. RESULTS The frequency of stillbirth was 12.5% (95% CI: 8.1–14.6). Preterm delivery (AOR=8.10; 95% CI: 3.01–21.79), non-booking for antenatal care (AOR=2.8; 95% CI: 1.14–6.88), antepartum hemorrhage (AOR=3.16; 95% CI: 1.10–9.04), obstructed labor (AOR=2.56; 95% CI: 1.85–7.93) and eclampsia (AOR=2.84; 95% CI: 1.45–6.98) were found to be statistically significantly associated with stillbirth. CONCLUSIONS The frequency of stillbirth in this study was high. Prematurity, non-booking for antenatal care, ante-partum hemorrhage, obstructed labor and eclampsia were independently associated for stillbirth. Therefore, we recommend that the health professionals should better work on prevention of preterm birth, active emergency obstetrical and neonatal care by boosting focused antenatal care follow-up with health education on danger signs.
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Affiliation(s)
| | - Aisha Abdullahi
- Department of Nursing and Midwifery, Harar Health Sciences College, Harar, Ethiopia
| | - Furo Beshir
- Department of Medical Laboratory Science, Harar Health Sciences College, Harar, Ethiopia
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Marques LJP, da Silva ZP, Moura BLA, Francisco RPV, de Almeida MF. Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil. Sci Rep 2021; 11:24256. [PMID: 34930961 PMCID: PMC8688466 DOI: 10.1038/s41598-021-03646-5] [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: 07/24/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007-2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.
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Affiliation(s)
- Lays Janaina Prazeres Marques
- Department of Epidemiology, School of Public Health of the University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil.
| | - Zilda Pereira da Silva
- Department of Epidemiology, School of Public Health of the University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - Bárbara Laisa Alves Moura
- Department of Epidemiology, School of Public Health of the University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | | | - Marcia Furquim de Almeida
- Department of Epidemiology, School of Public Health of the University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.2] [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] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands.,Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK.,Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 04/30/2024] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J. Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands
- Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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The unheard parental cry of a stillbirth: fathers and mothers. Arch Gynecol Obstet 2021; 305:313-322. [PMID: 34117899 DOI: 10.1007/s00404-021-06120-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Our objective was to compare the prevalence of depression, anxiety, stress, and domestic violence among parents after a stillbirth vs. livebirths and assessing of the need for psychological and pharmacological interventions for the affected individuals. METHODS This was a prospective cohort study conducted in a tertiary care public sector hospital Northern India. 150 consecutive couples with a recent stillbirth (group 1) and 150 couples with a recent live birth (group 2) were enrolled. They were screened for depression (EPDS scale), anxiety (GAD-7), stress (PSS). Apriori sample size was calculated. Screen positive mothers and fathers were compared for the presence of depression, anxiety and stress, domestic violence, and need for treatment interventions. RESULTS Depression was higher in group 1 mothers (39.3 vs 14.0%, p < 0.001) as well as fathers (18.1 vs 6.7%, p value = 0.022). Anxiety and moderate to severe stress were also significantly higher in stillborn than liveborn groups respectively. Characteristics associated with higher risk are analyzed. Domestic violence was found in 6.7% in group 1 and 2.7% in group 2 mothers (p value 0.169). Pharmacotherapy and counselling were required by 11.3 and 18.0% in stillbirth versus 3.3 and 18.7% in livebirth group, respectively. CONCLUSION Couples suffering stillbirths are at higher risk of depression, anxiety, and stress. We highlight this obstetrical public health issue, especially for the low middle income countries (LMIC) and advocate development of health policies for mental health screening of couples suffering stillbirths.
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Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. PLoS One 2021; 16:e0249865. [PMID: 33939713 PMCID: PMC8092801 DOI: 10.1371/journal.pone.0249865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although the rate of stillbirth has decreased globally, it remains unacceptably high in low- and middle-income countries. Only ten countries including Ethiopia attribute more than 65% of global burden of still birth. Ethiopia has the 7th highest still birth rate in the world. Identifying the predictors of stillbirth is critical for developing successful interventions and monitoring public health programs. Although certain studies have assessed the predictors of stillbirth, they failed in identify the proximate predictors of stillbirth. In addition, the inconsistent findings in identify the predictors of stillbirth, and the methodological limitations in previously published works are some of the gaps. Therefore, this study aimed to identify the predictors of stillbirth among mothers who gave birth in six referral hospitals in Southern, Ethiopia. Methods A hospital-based unmatched case-control study was conducted in six referral hospitals in Southern, Ethiopia from October 2019 to June 2020. Consecutive sampling techniques and simple random techniques were used to recruit cases and controls respectively. A structured standard tool was used to identify the predictors of stillbirth. Data were entered into Epi Info 7 and exported to SPSS 23 for analysis. A multivariable logistic regression model was used to identify the independent predictors of stillbirth. The goodness of fit was tested using the Hosmer and Lemeshow goodness-of-fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 138 stillbirth cases and 269 controls were included. Women with multiple pregnancy [AOR = 2.98, 95%CI: 1.39–6.36], having preterm birth [AOR = 2.83, 95%CI: 1.58–508], having cesarean mode of delivery [AOR = 3.19, 95%CI: 1.87–5.44], having no ANC visit [AOR = 4.17, 95%CI: 2.38–7.33], and being hypertensive during pregnancy [AOR = 3.43, 95%CI: 1.93–6.06] were significantly associated with stillbirth. Conclusions The predictors of stillbirth identified are manageable and can be amenable to interventions. Therefore, strengthening maternal antenatal care utilization should be encouraged by providing appropriate information to the mothers. There is a need to identify, screen, and critically follow high-risk mothers: those who have different complications during pregnancy, and those undergoing cesarean section due to different indications.
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Affiliation(s)
- Haimanot Abebe
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Solomon Shitu
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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13
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Marques LJP, Silva ZPD, Alencar GP, Almeida MFD. [Contributions by the investigation of fetal deaths for improving the definition of underlying cause of death in the city of São Paulo, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00079120. [PMID: 33729304 DOI: 10.1590/0102-311x00079120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the time trend in stillbirth rate (SBR) and the contribution by investigation to improving the definition of underlying cause of stillbirth in the city of São Paulo, Brazil, according to the place where the death certificate was issued. An ecological approach was used to analyze the trend in SBR by weight stratum (< 2,500g and ≥ 2,500g) and total deaths in the city in 2007-2017. Prais-Winsten generalized linear regression was used. The study of cases analyzed the underlying causes of stillbirth from 2012 to 2014, before and after the investigation, time of conclusion of the investigation, and redefinition of the underlying cause of stillbirths by type of issuer. In deaths with < 2,500g, there was an upward trend in SBR of 1.5% per year and a reduction (-1.3% per year) in stillbirths ≥ 2,500g. Total deaths presented a stable trend. In 2012-2014, 90% of deaths with ≥ 2,500g were investigated. After investigation, the underlying cause of death was redefined in 15% of the deaths, and not otherwise specified stillbirth (P95) represented 25% of the causes of death. The highest proportion of changes in the underlying cause of death occurred in deaths for which the death certificate was issued by the death certification review service (17%), while in health services the proportion was 10.6%. In conclusion, the SBR in deaths with ≥ 2,500g showed a downward trend. There was a significant redefinition of underlying causes, especially in those attested by the death certification review service. However, the redefinition was insufficient to expand the proportion of causes of death that would allow a better understanding of the mortality conditions.
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Choummanivong M, Karimi S, Durham J, Sychareun V, Flenady V, Horey D, Boyle F. Stillbirth in Lao PDR: a healthcare provider perspective. Glob Health Action 2021; 13:1786975. [PMID: 32741353 PMCID: PMC7480497 DOI: 10.1080/16549716.2020.1786975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Stillbirth is a major global concern. However, most research has been conducted in high-income countries. Understanding of the experience and management of stillbirth in low-middle income countries is needed. Objective This qualitative study explored health professionals’ experiences of providing stillbirth care in the Lao People’s Democratic Republic, a lower-middle-income country in South-East Asia. Methods In-depth interviews were conducted with 33 health professionals (doctors, midwives and nurses) and thematic analysis was undertaken. Results All participants acknowledged stillbirth as a concern, but its incidence and causes were largely undocumented and unknown. A lack of training in managing stillbirth left health professionals often ill-equipped to support mothers and provide responsive care. Social stigma surrounds stillbirth, meaning mothers found limited support or opportunities to openly express their grief. Conclusions Better awareness of stillbirth causes could promote more positive experiences for healthcare providers and parents and more responsive healthcare. This requires improved training for healthcare professionals and awareness raising in the wider community.
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Affiliation(s)
- Molina Choummanivong
- Faculty of Public Health Department, University of Health Sciences , Vientiane, Lao People's Democratic Republic
| | - Sediqa Karimi
- School of Public Health, The University of Queensland , Brisbane, Australia.,Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Joanne Durham
- School of Public Health and Social Work, Queensland University of Technology , Brisbane, Australia
| | - Vanphanom Sychareun
- Faculty of Public Health Department, University of Health Sciences , Vientiane, Lao People's Democratic Republic
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Dell Horey
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia.,Public Health, School of Psychology and Public Health, La Trobe University , Melbourne, Australia
| | - Fran Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland , Brisbane, Australia.,Institute for Social Science Research, The University of Queensland , Brisbane, Australia
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15
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Rossiter SK, Aziz S, Wilson AN, Comrie-Thomson L, Stacey T, Homer CSE, Vogel JP. Women's sleep position during pregnancy in low- and middle-income countries: a systematic review. Reprod Health 2021; 18:53. [PMID: 33648551 PMCID: PMC7923448 DOI: 10.1186/s12978-021-01106-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: 09/08/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 2.6 million babies are stillborn each year globally, of which 98% occur in low- and middle-income countries (LMICs). A 2019 individual participant data meta-analysis of 6 studies from high-income countries found that maternal supine going-to-sleep position increased the risk of stillbirth. It is not clear whether this impact would be the same in LMICs, and the normal sleep behaviour of pregnant women in LMICs is not well understood. Objective Determine the prevalence of different sleeping positions among pregnant women in LMICs, and what (if any) positions were associated with stillbirth using a systematic review. Search strategy We systematically searched the databases Medline, Embase, Emcare, CINAHL and Global Index Medicus for relevant studies, with no date or language restrictions on 4 April 2020. Reference lists of included studies were also screened. Selection criteria Observational studies of maternal sleep position during pregnancy in LMICs Data collection and analysis Recovered citations were screened and eligible studies were included for extraction. These steps were performed by two independent reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale. Main results A total of 3480 citations were screened but only two studies met the inclusion criteria. The studies were conducted in Ghana and India and reported on different maternal sleep positions: supine and left lateral. In Ghana, a prevalence of 9.7% for supine sleeping position amongst 220 women was found. The primary outcome could not be extracted from the Indian study as sleep position information was only reported for women who had a stillbirth (100 of the 300 participants). Conclusion There is limited information on maternal sleeping position in LMICs. Since sleep position may be a modifiable risk factor for stillbirth, there is a need for further research to understand the sleep practices and behaviours of pregnant women in LMICs. PROSPERO registration: CRD42020173314
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Affiliation(s)
- Shania K Rossiter
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - Samia Aziz
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - Tomasina Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3000, Australia.
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Di Stefano L, Bottecchia M, Yargawa J, Akuze J, Haider MM, Galiwango E, Dzabeng F, Fisker AB, Geremew BM, Cousens S, Lawn JE, Blencowe H, Waiswa P. Stillbirth maternity care measurement and associated factors in population-based surveys: EN-INDEPTH study. Popul Health Metr 2021; 19:11. [PMID: 33557874 PMCID: PMC7869205 DOI: 10.1186/s12963-020-00240-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Household surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually. METHODS The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies' characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group. RESULTS A total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth. CONCLUSIONS Women who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.
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Affiliation(s)
- Lydia Di Stefano
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Matteo Bottecchia
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph Akuze
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda
| | | | - Edward Galiwango
- IgangaMayuge Health and Demographic Surveillance System, Makerere University Centre for Health and Population Research, Makerere, Uganda
| | | | - Ane B. Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Open Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Bisrat Misganaw Geremew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Simon Cousens
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Luk HM, Allanson E, Ming WK, Leung WC. Improving Diagnostic Classification of Stillbirths and Neonatal Deaths Using ICD-PM (International Classification of Diseases for Perinatal Mortality) Codes: Validation Study. JMIR Med Inform 2020; 8:e20071. [PMID: 32744510 PMCID: PMC7432142 DOI: 10.2196/20071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Stillbirths and neonatal deaths have long been imperfectly classified and recorded worldwide. In Hong Kong, the current code system is deficient (>90% cases with unknown causes) in providing the diagnoses of perinatal mortality cases. OBJECTIVE The objective of this study was to apply the International Classification of Diseases for Perinatal Mortality (ICD-PM) system to existing perinatal death data. Further, the aim was to assess whether there was any change in the classifications of perinatal deaths compared with the existing classification system and identify any areas in which future interventions can be made. METHODS We applied the ICD-PM (with International Statistical Classification of Diseases and Related Health Problems, 10th Revision) code system to existing perinatal death data in Kwong Wah Hospital, Hong Kong, to improve diagnostic classification. The study included stillbirths (after 24 weeks gestation) and neonatal deaths (from birth to 28 days). The retrospective data (5 years) from May 1, 2012, to April 30, 2017, were recoded by the principal investigator (HML) applying the ICD-PM, then validated by an overseas expert (EA) after she reviewed the detailed case summaries. The prospective application of ICD-PM from May 1, 2017, to April 30, 2019, was performed during the monthly multidisciplinary perinatal meetings and then also validated by EA for agreement. RESULTS We analyzed the data of 34,920 deliveries, and 119 cases were included for analysis (92 stillbirths and 27 neonatal deaths). The overall agreement with EA of our codes using the ICD-PM was 93.2% (111/119); 92% (78/85) for the 5 years of retrospective codes and 97% (33/34) for the 2 years of prospective codes (P=.44). After the application of the ICD-PM, the overall proportion of unknown causes of perinatal mortality dropped from 34.5% (41/119) to 10.1% (12/119) of cases (P<.001). CONCLUSIONS Using the ICD-PM would lead to a better classification of perinatal deaths, reduce the proportion of unknown diagnoses, and clearly link the maternal conditions with these perinatal deaths.
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Affiliation(s)
- Hiu Mei Luk
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China (Hong Kong)
| | - Emma Allanson
- Institute of Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Wing Cheong Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China (Hong Kong)
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