Early postnatal discharge during COVID-19: A cross-sectional study

Postnatal care services availability and utilization during the COVID-19 era in sub-Saharan Africa: A rapid review

BACKGROUND

Considerable progress has been made globally in improving maternal and newborn babies' health. The COVID-19 pandemic has posed considerable challenges for countries to maintain the provision of high-quality, essential maternal and newborn healthcare services.

METHODS

A rapid review was carried out on 20 March 2022 on postnatal care (PNC) services availability and utilization during the COVID-19 era in sub-Saharan Africa. PubMed, Google Scholar, and Africa Journals Online (AJOL) databases were searched for relevant studies. Studies included in the review utilized both primary data and secondary data.

FINDINGS

Nineteen studies met the inclusion criteria. The review revealed that there were significant declines in the availability and utilization of PNC services during and after the COVID-19 lockdown. Several reasons were found to contribute to the decline.

DISCUSSION

New, innovative strategies are therefore required to ensure that mothers and their newborn babies receive essential PNC to reduce maternal and neonatal morbidity and mortality in sub-Saharan Africa. Some of the strategies that can be used include home-based PNC visits, the use of telemedicine, phone-based referral networks, social media, and community radios.

Complication experience during pregnancy and place of delivery among pregnant women: a cross-sectional study

BACKGROUND

Unlike other causes such as abortion, obstetric complications like hemorrhage, and hypertensive disorders of pregnancy, which are difficult to resolve for women who give birth out of health facilities are persisted or increased to be the cause of maternal mortality in Ethiopia. Direct obstetric complications resulted in the crude direct obstetric case fatality rate in this country. This study aimed to assess the relationship between Complication Experience during Pregnancy and Place of Delivery among Pregnant Women.

METHOD

A community-based cross-sectional study was conducted to assess the baseline information as a part of a randomized control trial study. The sample size that was calculated for the cohort study with the assumptions to detect an increase in a minimum acceptable diet from 11 to 31%, with 95% CIs and 80% power, an intra-cluster correlation coefficient of 0·2 for a cluster size of 10 was used for this study. Statistical analysis was done using SPSS version 22.

RESULT

The prevalence of self-reported pregnancy-related complications and home delivery were 79(15.9%, CI; 12.7-19.1) and 46.90% (95%CI; 42.5-51.1) respectively. Women who did not face vaginal bleeding were five times AOR 5.28(95% CI: 1.79-15.56) more like to give birth at home than those who faced this problem. Women who did not face severe headache were nearly three AOR 2.45(95%CI:1.01-5.97) times more like to give birth at home.

CONCLUSION

This study concluded that home delivery was high among the study participants whereas pregnancy-related complications such as vaginal bleeding and severe headache were identified as protective factors for facility delivery. Hence, the researchers recommended the incorporation of "storytelling" into the existing health extension program packages to improve facility delivery which shall be applied after the approval of its effectiveness by further research.

Early discharge from maternity ward in response to the COVID-19 pandemic: Impact on emergency attendance

BACKGROUND

In response to the coronavirus disease 2019 (COVID-19) epidemic, our maternity department had to rapidly implement a protocol for early postpartum discharge. We evaluated the benefits and risks of early postpartum discharge.

METHODS

We performed an observational, single-center case-control study over a 3 month-period during the COVID-19 outbreak (from June 1 to August 31, 2020), following implementation of the early discharge policy. Newborns were classified into an early discharge group (within 48-72 h of a vaginal delivery and within 72-96 h of a cesarean delivery) or a standard discharge group (more than 72 h after a vaginal delivery and more than 96 h after a cesarean delivery). The primary outcome measure was inappropriate pediatric emergency department visits within 28 days of delivery.

RESULTS

A total of 546 newborns were included. A total of 22 (8.9%) of the 246 newborns in the early discharge group attended the pediatric emergency department vs. 30 (10.0%) of the 300 newborns in the standard discharge group (p = 0.65). Nine visits (40.9%) were considered inappropriate in the early discharge group vs. 13 (43.3%) in the standard discharge group (p = 0.83). Likewise, the intergroup difference in the hospital readmission rate was not statistically significant.

DISCUSSION

The implementation of early discharge and early follow-up did not result in a significantly greater need (vs. standard discharge) for inappropriate emergency visit or hospital readmission during the first 28 days postpartum, regardless of the parity and breastfeeding status.

Length of Hospital Stay After Cesarean Delivery and Its Determinants Among Women in Eastern Sudan

Background

There is an increasing caesarean delivery (CD) rate globally. Length of hospital stay (LoS) is longer in CD compared with vaginal delivery. There are few published data on LoS following CD in Africa, including Sudan. We aimed to investigate LoS after CD in eastern Sudan and its associated risk factors.

Methods

A cross-sectional study was conducted at Gadarif hospital in eastern Sudan from May to December 2020. Sociodemographic, clinical and obstetrical data were gathered through questionnaires. Poisson regressions were used to model the LoS and provide relative risk (RR) and a 95.0% confidence interval (CI).

Results

We enrolled 544 women with CD. The median (interquartile range, IQR) of their age and parity was 28.0 (24.0 ‒32.0) years and 3(2‒3), respectively. The LoS range was 1.0-9.0 days (mean = 2.7 days) and its median (IRQ) was 3.0 (2.0‒3.0) days. The median (IQR) of the LoS was significantly higher in women who had emergency CD vs elective CD, [3 (3.0‒3.0) vs 3 (2.0‒3.0) days, P < 0.001] and in women with maternal complications vs women who had no maternal complications [3 (2.0‒3.0) vs 3 (2.0‒3.0) days, P < 0.001]. Poisson regression showed that women with emergency CD stayed for 13.0% longer than women with elective CD (RR=1.13, 95% CI=1.01‒1.29). Women with maternal complications stayed 24.0% longer than women who had no maternal complications (RR=1.24, 95% CI=1.07‒1.43). Women who had neonatal complications stayed for 21.0% longer than women who had no neonatal complications (RR=1.21, 95% CI=1.05‒1.40). Age, parity, residence, education, occupation and postoperative haemoglobin were not associated with LoS.

Conclusion

The mean LoS in this study was 2.7 days, and women with emergency CD and maternal and neonatal complications had longer LoS.