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Lewnard JA, Charani E, Gleason A, Hsu LY, Khan WA, Karkey A, Chandler CIR, Mashe T, Khan EA, Bulabula ANH, Donado-Godoy P, Laxminarayan R. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 2024; 403:2439-2454. [PMID: 38797180 DOI: 10.1016/s0140-6736(24)00862-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alec Gleason
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe; Health System Strengthening Unit, WHO, Harare, Zimbabwe
| | - Ejaz Ahmed Khan
- Department of Pediatrics, Shifa Tameer-e-Millat University, Shifa International Hospital, Islamabad, Pakistan
| | - Andre N H Bulabula
- Division of Disease Control and Prevention, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Pilar Donado-Godoy
- AMR Global Health Research Unit, Colombian Integrated Program of Antimicrobial Resistance Surveillance, Corporación Colombiana de Investigación Agropecuaria, Cundinamarca, Colombia
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Johns NE, Blumenberg C, Kirkby K, Allorant A, Costa FDS, Danovaro-Holliday MC, Lyons C, Yusuf N, Barros AJD, Hosseinpoor AR. Comparison of Wealth-Related Inequality in Tetanus Vaccination Coverage before and during Pregnancy: A Cross-Sectional Analysis of 72 Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:431. [PMID: 38675813 PMCID: PMC11054082 DOI: 10.3390/vaccines12040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant's tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.
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Affiliation(s)
- Nicole E. Johns
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
- Causale Consulting, Avenida Adolfo Fetter 4331, Pelotas 96090-840, Brazil
| | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Adrien Allorant
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Francine Dos Santos Costa
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Carrie Lyons
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
| | - Nasir Yusuf
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.E.J.)
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Arowosegbe AO, Dedeke IO, Shittu OB, Ojo DA, Amusan JS, Iwaloye O, Ekpo UF. Can Clean Delivery Kits Prevent Infections? Lessons from Traditional Birth Attendants in Nigeria. Ann Glob Health 2023; 89:85. [PMID: 38077261 PMCID: PMC10705026 DOI: 10.5334/aogh.4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Background In resource-poor settings, perinatal infections contribute significantly to maternal and neonatal deaths, and the use of clean delivery kits (CDKs) has been proposed as a tool to reduce the risk of infection-related deaths. This study aims to assess the acceptability and effectiveness of CDKs in preventing infections in deliveries attended by traditional birth attendants (TBAs) in Abeokuta, Nigeria. Methods The study was a cluster-randomized trial with 67 birth centres/clusters, 453 births/mothers, and 457 babies randomized to intervention or control arms; intervention involved supplementation of delivery with JANMA CDKs. Interviews were conducted at the birth homes, and the primary outcomes were neonatal infection and puerperal fever. The association between infection and perinatal risk factors was tested using the Chi-square and Fisher's exact tests. Results CDKs were well accepted by TBAs. The incidence of puerperal fever and neonatal infection was 1.1% and 11.2%, respectively. Concurrent infection was found in 1 (0.22%) of the mother-neonate pair. There was no significant association between any of the sociodemographic factors and infection for both mothers and neonates. PROM and prolonged labour were significantly associated with puerperal infection. All mothers with puerperal fever were from the control group. Compared to the control group, the relative risk of puerperal infection and neonatal infection in the intervention group was 0.08 (0.004 -1.35, p = 0.079) and 0.64 (0.37 to 1.1, p = 0.10), respectively. Conclusion CDKs hold promising results in attenuating maternal infections in resource-poor settings. Larger studies with greater statistical power are required to establish statistically reliable information.
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Affiliation(s)
| | | | - Olufunke Bolatito Shittu
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - David Ajiboye Ojo
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Joy Stephen Amusan
- Department of Public Health, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Opeoluwa Iwaloye
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Uwemedimo Friday Ekpo
- Department of Pure and Applied Zoology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
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Dektar B, Beckford AN, Kemba J, Crayson B. Mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district, Uganda- a qualitative study. Front Public Health 2023; 11:1180945. [PMID: 37920578 PMCID: PMC10619897 DOI: 10.3389/fpubh.2023.1180945] [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: 03/06/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction In Uganda 27% of deliveries take place outside a health facility. The existing gaps in quality of maternal and newborn health care must be addressed for Uganda to attain its health targets and consequently its economic targets. Some of the gaps include but are not limited to; ill-equipped healthcare facilities in rural settings, inadequate client/customer care skills by healthcare providers, and health worker absenteeism especially in the night hours. In Kaberamaido District, only 38.3% of the deliveries in Alwa sub county took place at a health facility. Despite the district local government and stakeholder efforts to promote health facility-based deliveries, sadly, a very low proportion of women use the health facilities for delivery. We sought to explore mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district. Methods The study adopted a cross-sectional descriptive qualitative design. We purposively included 115 mothers who delivered outside the health facility and consented to participate and those who lost their babies within the last 24 months preceding the study. Other participants included in the study were village health team (VHT), traditional birth attendants (TBA) and older women. The main instruments used to collect data were focus group discussion (FGD) and in-depth interview (IDI) guides. All voice recordings from FGDs and interviews were transcribed and translated from the local language (Kumam) into English. Thematic content analysis was used to synthesize data by applying codes to segments of the transcripts upon which major domains were derived. Key findings were synthesized and quotes were carefully selected based on their relevance and representativeness to the analysis and study objective. Results Our findings indicated general satisfaction with the care provided during and after home delivery by TBAs as expressed by mothers. Motivation to seek services from TBAs was attributable to their vast experience spanning decades with history of safe delivery. Few mothers expressed discontent with TBA services citing abuse and rudeness. Discussion Our study underscored the common view that TBAs effectively managed home deliveries, providing satisfactory care to mothers. However, concerns emerged on TBAs' capacity to manage complications, emphasizing a need for their reintegration into formal healthcare systems, alongside further training, and standardization in maternal care practices.
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Affiliation(s)
- Benbella Dektar
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Africa Centres for Disease Control and Prevention, Lusaka, Zambia
| | | | - Jonny Kemba
- Global Quest Consulting Limited, Kampala, Uganda
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Kyololo OM, Kipkoech MJ. Mothers' cord care practices in an academic hospital in Kenya. Afr Health Sci 2023; 23:429-437. [PMID: 37545945 PMCID: PMC10398470 DOI: 10.4314/ahs.v23i1.45] [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] [Indexed: 08/08/2023] Open
Abstract
Background Nearly 99% of neonatal deaths globally occur in low- and middle-income countries with about three-quarters of the neonatal deaths resulting from sepsis including those arising from cord infections. Thus, good cord care practices have the potential to reduce the neonatal deaths in low and middle-income countries such as Kenya. Objective Describe cord care practices of mothers in an academic hospital in Kenya. Methods A questionnaire was administered to 114 mothers attending child welfare clinic at 6 weeks in an academic hospital in Western Kenya. Descriptive statistics were computed for continuous variables while frequencies were computed for categorical variables. Parametric and non-parametric tests were used to check for association between maternal variables and cord care practices. Results Most mothers applied chlorhexidine (n =73, 64%) or practiced dry cord care (n = 17, 14.9%). Some mothers (12.9%) applied potentially harmful substances including saliva, ash and soil. Mothers who attended at least three antenatal clinic visits practiced the recommended cord care (χ2 =16.02, p. = 0.03). Conclusions Although mothers predominantly practiced the recommended cord care, some potentially deleterious practices were reported. There is need to encourage attendance to antenatal clinic in order to optimize umbilical cord care practices.
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Reinders S, Blas MM, Neuman M, Huicho L, Ronsmans C. Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region. LANCET REGIONAL HEALTH. AMERICAS 2023; 18:100404. [PMID: 36844009 PMCID: PMC9950545 DOI: 10.1016/j.lana.2022.100404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/16/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. Methods We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. Findings All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to -7]). Interpretation Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Funding Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.
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Affiliation(s)
- Stefan Reinders
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Magaly M. Blas
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Stewart CL, Hall JA. Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi. PLoS One 2022; 17:e0279613. [PMID: 36584165 PMCID: PMC9803273 DOI: 10.1371/journal.pone.0279613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care-the integrated delivery of antenatal, delivery and postnatal care-has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi. METHODS 4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable-continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare. RESULTS Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04-0.96), having at least one live child (OR = 0.87, 95%CI = 0.84-0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50-0.82) or abuse (OR = 0.81, 95%CI = 0.69-0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08-1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11-1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80-1.49) increased utilisation. CONCLUSION Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.
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Affiliation(s)
- Catherine Louise Stewart
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
| | - Jennifer Anne Hall
- Reproductive Health Research Department, UCL Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom
- * E-mail:
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Nalule Y, Pors P, Samol C, Ret S, Leang S, Ir P, Macintyre A, Dreibelbis R. A controlled before-and-after study of a multi-modal intervention to improve hand hygiene during the peri-natal period in Cambodia. Sci Rep 2022; 12:19646. [PMID: 36385113 PMCID: PMC9666993 DOI: 10.1038/s41598-022-23937-9] [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: 10/15/2021] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.
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Affiliation(s)
- Yolisa Nalule
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | | | | | | | - Supheap Leang
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | - Por Ir
- grid.436334.5National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Robert Dreibelbis
- grid.8991.90000 0004 0425 469XDisease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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Meshi EB, Nakamura K, Seino K, Alemi S. Equity in water, sanitation, hygiene, and waste management services in healthcare facilities in Tanzania. PUBLIC HEALTH IN PRACTICE 2022; 4:100323. [PMID: 36304419 PMCID: PMC9593710 DOI: 10.1016/j.puhip.2022.100323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives To determine coverage and the reliability of water, sanitation, hygiene (WASH) and healthcare waste management (HCWM) services in healthcare facilities (HCFs) in Tanzania. Study design Cross-sectional study design. Methods Data of 1066 HCFs in Tanzania from the 2014-15 Tanzania Service Provision Assessment (TSPA) survey were analyzed. The availability of WASH and HCWM services was examined across facility locations, types, and managing authorities. Descriptive statistics, and bivariate and multivariate logistic regression analyses were performed. Results HCFs with improved water sources, with functional improved latrines for patients, and using the incineration method to treat sharps waste before final disposal were 81.2%, 70.6%, and 41.3%, respectively. Among the HCFs with improved water sources and with functional improved latrines for patients, 50.9% and 50.6% respectively experienced water outages. Rural HCFs were less likely to have water sources on-site within 500 m (AOR 0.41; 95%CI 0.24-0.68), and soap, running water or alcohol-based hand rub (AOR 0.54; 95%CI 0.37-0.80). Rural HCFs were 0.25 times less likely to have functioning improved latrines for patients than urban HCFs (p < 0.001). Public HCFs were 0.5 times less likely to have an incineration method for sharps waste treatment than private HCFs (p < 0.001). Conclusion Access inequity in WASH and HCWM was observed in HCFs in rural areas and those under public management. To attain equity and sustainability, investing in improving WASH and HCWM services for both new and renovations projects, must consider the circumstance status of the marginalized society.
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Affiliation(s)
- Eugene Benjamin Meshi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Department of Public Health, School of Nursing and Public Health, The University of Dodoma, P.O. BOX 259, Dodoma, United Republic of Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Corresponding author.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Sharifullah Alemi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Handwashing Practice among Elementary Schoolchildren in Urban Setting, Mongolia: A School-Based Cross-Sectional Survey. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:3103241. [PMID: 36159758 PMCID: PMC9507677 DOI: 10.1155/2022/3103241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/24/2022]
Abstract
Objectives Handwashing with soap is the simplest, most affordable, and cost-effective preventative intervention for reducing the burden of communicable diseases, including the COVID-19. This study was aimed at investigating elementary schoolchildren's handwashing practice at two critical moments, namely, before eating and after using the toilet and its associated factors. Methods The cross-sectional study was conducted at ten public secondary schools in Ulaanbaatar, Mongolia, between February and March 2019. Data were collected from all fifth-grade children's parents at the selected schools by using a self-reported questionnaire. Descriptive and multiple regression analyses were conducted using STATA/MP version 13.0. Results A total of 1507 parents/guardians of 5th-grade school children participated. Reported schoolchildren's handwashing practice for both critical moments was 50.1%. It was significantly associated with female gender (adjusted odds ratio [AOR] = 0.56 (95%CI = 0.45, 0.70)), number of siblings (AOR = 0.72 (95%CI = 0.61, 0.80)), and availability of handwashing amenity at school (AOR = 1.1595%CI = 0.86, 1.42)). Only 34% of children wash their hands with soap at school, and the most common reasons for skipping handwashing were an absence of soap (23.9%), lack of sink (14.5%), and the use of hand sanitizer (19.7%). Conclusions The school children's handwashing practice at two critical moments is considerably low. The main disabling factors of regular handwashing at school included insufficient handwashing facility and soap. Therefore, promoting HW facilities and innovative and participatory education for elementary schoolchildren should be prioritized.
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Matta G, Kumar P, Uniyal DP, Joshi DU. Communicating Water, Sanitation, and Hygiene under Sustainable Development Goals 3, 4, and 6 as the Panacea for Epidemics and Pandemics Referencing the Succession of COVID-19 Surges. ACS ES&T WATER 2022; 2:667-689. [PMID: 35603040 PMCID: PMC9113005 DOI: 10.1021/acsestwater.1c00366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 05/25/2023]
Abstract
WASH (water, sanitation, and hygiene) has become the most crucial amenity in the past decade for every individual on the planet. In the UN agenda for 2030, which created 17 Sustainable Development Goals (SDGs), SDGs 3, 4, and 6 directly correlate with WASH practices and management for creating a good health hygiene environment for all. The dearth of WASH facilities has created barriers for averting the transmission of COVID-19, motivating the concept of WASH as the primary step of precaution and prevention, which includes WASH practices, communication for literacy, and positive behavioral changes primarily in developing and low-income countries. This Review deals with the complex concept of correlation of WASH and SDGs 3, 4, and 6 while defining elaborate WASH practices, including the prominence of clean water, the need for sanitation facilities, and health hygiene for good health and immunity for preparedness for and during epidemics and pandemics. Certain risk factors explain the sectors in which the gaps exist, creating a gap for implementation of WASH practices in epidemics and pandemics across the globe. Further, COVID-19 surge succession is presented along with data of different variants that have occurred. The need of WASH understanding is required using different tools (audio-visual, social media, print media, and mass media) and strategies (communication, advocacy, and positive behavioral changes) for every individual as an act to counter consequences during and after the COVID-19 pandemic and as a routine practice for future preparedness. This Review gives a detailed concept of WASH understanding for every sector from community to government agencies and research professionals to act immediately for the sustainable future of humanity.
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Affiliation(s)
- Gagan Matta
- Hydrological
Research Laboratory, Department of Zoology and Environmental Science, Gurukula Kangri (Deemed to be University), Haridwar 249404, India
| | - Pamposh Kumar
- National
Council for Science and Technology Communication, Department of Science
and Technology, Government of India, New Delhi 110016, India
| | - D. P. Uniyal
- Uttarakhand
State Council for Science and Technology, Dehradun 248007, India
| | - Divya U. Joshi
- Human
Resource Development Center, Kumaon University, Nainital 263002, India
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12
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Sebayang SK, Has EMM, Hadisuyatmana S, Efendi F, Astutik E, Kuswanto H. Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data. Matern Child Health J 2022; 26:545-555. [PMID: 35013886 PMCID: PMC8747864 DOI: 10.1007/s10995-021-03324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Objective The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women’s empowerment indicators to provide evidence for the need for policy change. Methods Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women’s empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women’s empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design. Results The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women’s knowledge level were associated with any PNC, but the association between women’s knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women’s knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant’s gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant’s size at birth. Conclusions for Practice PNC coverage after discharge in Indonesia needs improvement. Women’s empowerment indicators need to be addressed in improving PNC coverage. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03324-y.
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Affiliation(s)
- Susy K Sebayang
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia. .,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Jl. Wijaya Kusuma No. 113, Banyuwangi, East Java, 68425, Indonesia.
| | - Eka M M Has
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group of Community Health, Surabaya, Indonesia
| | - Erni Astutik
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia.,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember (ITS), Kampus ITS Sukolilo, Surabaya, Indonesia
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13
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Kebede SA, Weldesenbet AB, Tusa BS. Determinants of Postnatal Care and Timing of the First Postnatal Care for Newborns in Ethiopia: Further Analysis of 2019 Ethiopian Demographic and Health Survey. Front Pediatr 2022; 10:809643. [PMID: 35402352 PMCID: PMC8987711 DOI: 10.3389/fped.2022.809643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a persisting public health challenge in Ethiopia. Most of the factors that lead to neonatal deaths could be prevented through postnatal checkups. However, in Ethiopia, the provision of postnatal care (PNC) continues to be low. This study aims to assess the socioeconomic and demographic factors associated with PNC visits and the timing of PNC among newborns in Ethiopia. METHODS Using the Ethiopia Mini Demographic and Health Survey (EMDHS) 2019, a total weighted sample of 2,105 women aged 15-49 giving birth in the 2 years preceding the survey were included in the study. The generalized linear mixed models were separately fitted to identify factors associated with any PNC for newborns delivered at home and health facilities. Multinomial logistic regression was used to assess the timing of PNC with their associated factors. RESULTS Overall, only 13% (95% CI: 11.2, 14.0) of the newborns received PNC in Ethiopia. Among newborns delivered at home, utilization of any PNC was determined by region, maternal educational status, and birth order. On the other hand, among newborns delivered in a health facility, region, number of antenatal care (ANC) visits, and religion were determinants of any PNC. Furthermore, utilization of the first PNC within 48 h after the delivery was determined by region and religion. On the other hand, utilization of the first PNC after 48 h after the delivery was determined by region number of ANC visits, maternal educational status, and religion. CONCLUSION The finding of the current study revealed low coverage of PNC among newborns regardless of the place of delivery in Ethiopia. The study makes the following recommendation: increase community health education on PNC, encourage delivery at health facilities, and link community home birth with PNC. It will be more valuable if there is sharing good practice.
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Affiliation(s)
- Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
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Mallick LM, Amo-Adjei J. A Call to Action: Reinvigorating Interest and Investments in Health Infrastructure. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:711-715. [PMID: 34933968 PMCID: PMC8691883 DOI: 10.9745/ghsp-d-21-00674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
Infrastructure investments can contribute substantially to alleviating burdens of morbidity and mortality while also providing a positive return on investment in the long term.
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Affiliation(s)
- Lindsay M Mallick
- Department of Family Science, Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA.
- Maryland Population Research Center, College Park, MD, USA
- Avenir Health, Glastonbury, CT, USA
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Ogundare EO, Ajite AB, Adeniyi AT, Babatola AO, Taiwo AB, Fatunla OA, Airemionkhale A, Odeyemi OA, Olatunya OS, Oyelami OA. A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome. PLoS Negl Trop Dis 2021; 15:e0010010. [PMID: 34874950 PMCID: PMC8683026 DOI: 10.1371/journal.pntd.0010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/17/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. MATERIALS AND METHODS This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. RESULTS During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant's place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. CONCLUSION This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.
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Affiliation(s)
- Ezra Olatunde Ogundare
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Adebukola Bidemi Ajite
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Adewuyi Temidayo Adeniyi
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Adefunke Olarinre Babatola
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Adekunle Bamidele Taiwo
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | | | - Alfred Airemionkhale
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | | | - Oladele Simeon Olatunya
- Department of Paediatrics and Child Health, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Oyeku Akibu Oyelami
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Dhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med 2021; 12:247-261. [PMID: 34849046 PMCID: PMC8627318 DOI: 10.2147/rrtm.s201989] [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: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
The maternal and neonatal tetanus elimination (MNTE) program was envisaged by the World Health Organization to overcome the mortality and morbidity caused by maternal and neonatal tetanus (MNT). Although preventable by simple cost-effective practices like universal immunization, clean delivery practices, and healthy umbilical cord care, as of date MNT is still prevalent in 12 developing countries of Asia and Africa. Definitive approaches need to be microplanned by these countries to successfully accomplish the three stages of MNTE, ie, achieving, validating, and sustaining. Once a country achieves MNTE, this status is required to be validated and sustained according to the high-risk and low-risk categorization of the districts. The three-pronged strategies for achieving and sustaining MNTE include (a) rigorous immunization of women of reproductive age with tetanus toxoid-containing vaccines, (b) strengthening of clean delivery services for pregnant women, and (c) effective surveillance for MNT. Although the deadlines for achieving MNTE globally have been missed many times, yet there has been a significant progress to date as evident by 80% reduction in countries requiring validation for MNTE (59 countries in 1999 to 12 countries in 2020). Huge strides have been made in the overall coverage of two doses of tetanus toxoid (13.79% to 65.27%), neonates being protected at birth (12% to 88%), global coverage of third-dose DPT (more than doubled), and reduction of 88% estimated deaths due to NT in the last four decades. Identification of the most vulnerable populations, systematic planning at all levels of health care, involvement of local community support, tackling the implementation gap, strong political will, good financial support, and continued robust surveillance will go a long way in achieving MNTE.
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Affiliation(s)
- Shashi Kant Dhir
- Department of Pediatrics, Guru Gobind Singh Medical College, Punjab, India
| | - Pooja Dewan
- Department of Pediatrics, University College of Medical Sciences, Delhi, India
| | - Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences, Delhi, India
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Pullattayil S AK, Cavallin F, Roehr CC, Trevisanuto D. Delivery room CPAP in improving outcomes of preterm neonates in low-and middle-income countries: A systematic review and network meta-analysis. Resuscitation 2021; 170:250-263. [PMID: 34757058 DOI: 10.1016/j.resuscitation.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To study the impact of delivery room continuous positive airway pressure (DRCPAP) on outcomes of preterm neonates in low- and middle- income countries (LMICs) by comparing with interventions: oxygen supplementation, late DRCPAP, DRCPAP with sustained inflation, DRCPAP with surfactant and invasive mechanical ventilation (IMV). METHODS Medline, Embase, CENTRAL, WOS and CINAHL searched. Observational studies and randomized controlled trials (RCTs) were included. Pair-wise meta-analysis and Bayesian network meta-analysis (NMA) were utilized. Primary outcome was receipt of IMV. RESULTS Data from 11 of the 18 included studies (4 observational studies, 7 RCTs) enrolling 4210 preterm infants was synthesized. Moderate certainty of evidence (CoE) from NMA of RCTs comparing DRCPAP with surfactant administration versus DRCPAP alone suggested no decrease in subsequent receipt of IMV [Risk ratio (RR); 95% Credible Interval (CrI): 0.73; (0.34, 1.40)]. Very low CoE from observational studies comparing use of DRCPAP versus oxygen supplementation indicated a trend towards decreased IMV [RR; 95% Confidence Interval (CI): 0.75; (0.56-1.00)]. Although moderate CoE from NMA evaluating DRCPAP versus oxygen supplementation showed a trend towards decreased receipt of surfactant, it did not reach statistical significance [RR; 95% CrI: 0.69; (0.44, 1.06)]. Moderate CoE from NMA indicated that none of the interventions, when compared with use of supplemental oxygen alone or with each other decreased mortality or bronchopulmonary dysplasia. LIMITATIONS CoE was very low for primary outcome. CONCLUSIONS Present evidence is not sufficient for use of DRCPAP, but also did not show harm. Since it seems unlikely that there are marked variations in patient physiology to explain the difference in efficacy between high income countries and LMICs, we suggest future research evaluating other barriers in improving the effectiveness of DRCPAP in LMICs.
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | | | | | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom; Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom; University of Bristol, Women's and Children Division, Bristol, United Kingdom
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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18
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Arowosegbe AO, Ojo DA, Shittu OB, Iwaloye O, Ekpo UF. Water, sanitation, and hygiene (WASH) facilities and infection control/prevention practices in traditional birth homes in Southwest Nigeria. BMC Health Serv Res 2021; 21:912. [PMID: 34479549 PMCID: PMC8417956 DOI: 10.1186/s12913-021-06911-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Poor environmental conditions and hygiene practices at the time of childbirth is linked to life-threatening infections and death in mothers and babies. Improvements in water, sanitation, and hygiene (WASH) have been identified as a means through which the lives of mothers and babies could be saved. This study was carried out to explore WASH conditions and infection prevention and control (IPC) practices in traditional birth homes/centers in Abeokuta, Southwest Nigeria. A total of 50 traditional birth centers and attendants (TBAs) were enrolled in the study. Sociodemographic characteristics of the TBAs and features of the birth centers were obtained using a semi-structured questionnaire. Assessment of WASH conditions and IPC practices was based on established protocols. Results Findings revealed that majority of the centers operated under poor WASH conditions and IPC practices; none met with the WHO minimum standards for environmental health. Conclusions Adequate WASH facilities and IPC practices remain a critical component of maternal and child health even in non-facility birth. As the transition to facility births continues in many countries, the large number of non-facility births demands their inclusion in WASH-related strategies, if global goals of reducing deaths of newborns and women deaths will be achieved.
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Affiliation(s)
| | - David Ajiboye Ojo
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Olufunke Bolatito Shittu
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Opeoluwa Iwaloye
- Department of Microbiology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
| | - Uwem Friday Ekpo
- Department of Zoology, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria
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19
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Kanyangarara M, Allen S, Jiwani SS, Fuente D. Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013-2018: Results of health facility surveys and implications for COVID-19 transmission. BMC Health Serv Res 2021; 21:601. [PMID: 34172045 PMCID: PMC8231746 DOI: 10.1186/s12913-021-06515-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services. RESULT Overall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households. CONCLUSIONS Availability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.
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Affiliation(s)
- Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, SC 29201 Columbia, USA
| | - Savannah Allen
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, SC 29201 Columbia, USA
| | - Safia S Jiwani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - David Fuente
- School of Earth, Ocean and the Environment, University of South Carolina, Columbia, SC USA
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20
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Mahapatra B, Walia M, Avis WR, Saggurti N. Effect of exposure to PM 10 on child health: evidence based on a large-scale survey from 184 cities in India. BMJ Glob Health 2021; 5:bmjgh-2020-002597. [PMID: 32816954 PMCID: PMC7437942 DOI: 10.1136/bmjgh-2020-002597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/22/2020] [Accepted: 07/12/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Air pollution is increasingly becoming a serious global public health concern. Prior studies examining the effect of air pollution on health have ignored the role of households’ hygienic practices and socioeconomic condition, which are key determinants of the health status of a country like India. This study examines the effects of air pollution, measured in levels of particulate matters of size below 10 µg/m3 (PM10), on child-health outcomes after adjusting for hygiene practices. Methods Health data from the National Family Health Survey-4 (NFHS-4) and PM10 levels provided by the Central Pollution Control Board were matched for 184 Indian towns/cities. Child health outcomes included neonatal mortality, post-neonatal mortality, premature births, children with symptoms of acute respiratory infections (ARI) and low birth weight. Multilevel mixed-effects models were used to estimate the risk associated with exposure to PM10. Result Analyses based on 23 954 births found that every 10-unit increase in PM10 level, increased the risk of neonatal mortality by 6% (adjusted RR (95% CI): 1.02 (1.02 to 1.09)), and the odds of symptoms of ARI among children by 7% (adjusted OR (95% CI): 1.07 (1.03 to 1.12)), and premature births by 8% (adjusted OR (95% CI): 1.08 (1.03 to 1.12)). There was no statistically significant difference in the effect of PM10 on child health regardless of household’s hygienic practices. Effects of PM10 on child health outcomes remained similar for cities whether or not they were part of the National Clean Air Program (NCAP). Conclusion Exposure to PM10, regardless of hygienic practices, increases the risk of adverse child health outcomes. Study findings suggest that the focus of mitigating the effects of air pollution should be beyond the towns/cities identified under NCAP. Given the increasing industrialisation and urbanisation, a systemic, coherent approach is required to address the issue of air pollution in India.
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Affiliation(s)
| | | | - Wiliam Robert Avis
- International Development Department, University of Birmingham, Birmingham, UK
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21
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Nalule Y, Buxton H, Ir P, Leang S, Macintyre A, Pors P, Samol C, Dreibelbis R. Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study. BMC Pregnancy Childbirth 2021; 21:429. [PMID: 34139995 PMCID: PMC8212449 DOI: 10.1186/s12884-021-03901-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03901-7.
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Affiliation(s)
- Yolisa Nalule
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Helen Buxton
- Division of Psychiatry, University College London, London, W1T 7BN, UK
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Supheap Leang
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | | | | | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Bulto GA, Fekene DB, Woldeyes BS, Debelo BT. Determinants of Neonatal Sepsis among Neonates Admitted to Public Hospitals in Central Ethiopia: Unmatched Case-control Study. Glob Pediatr Health 2021; 8:2333794X211026186. [PMID: 34212071 PMCID: PMC8216335 DOI: 10.1177/2333794x211026186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background. Neonatal sepsis is the cause of substantial morbidity and mortality, mostly affecting the developing countries including Ethiopia. Previously conducted studies also highlighted the high prevalence of neonatal sepsis in Ethiopia. Therefore, this study was aimed at assessing the determinants of neonatal sepsis in the central Ethiopia. Method. Institution based un-matched case control study was conducted among 192 cases (neonates with sepsis) and 384 controls (without sepsis) in public hospitals in Central Ethiopia. The data were collected through face-to-face interview using structured questionnaire and extraction from maternal and neonatal charts. Binary logistic regression (bi-variable and multi-variable) model was fitted. Adjusted odds ratio with respect to 95% confidence interval was employed for the strength and directions of the association. Results. Younger maternal-age; 30 to 34 years (AOR = 0.41, 95%CI: 0.19-0.85) and 25 to 29 years (AOR = 0.38, 95%CI: 0.17-0.84), not having antenatal care (ANC) follow-ups (AOR = 1.89, 95%CI: 1.02-3.49), place of delivery; home (AOR = 12.6, 95%CI: 5.32-29.82) and health center (AOR = 2.74, 95%CI: 1.7, 4.41), prolonged duration of labor (AOR = 1.90, 95%CI: 1.22, 2.96), prolonged rupture of membrane 12 to 17 hours (AOR = 3.26, 95%CI: 1.46, 7.26) and ≥18 hours (AOR = 5.18, 95%CI: 1.98, 13.55) were maternal related determinants of neonatal sepsis. Whereas, prematurity (AOR = 2.74, 95%CI: 1.73, 4.36), being resuscitated (AOR = 1.93, 95%CI: 1.22, 3.06) and not having meconium aspiration syndrome (AOR = 2.55, 95%CI: 1.34, 4.83) were identified as neonatal related determinants of neonatal sepsis. Conclusion. Younger maternal age, not having antenatal care follow-up, home, and health center delivery, prolonged duration of labor, prolonged duration of rupture of membrane, prematurity, had resuscitation, and neonates without meconium aspiration syndrome were found to be determinants of neonatal sepsis. Therefore, the concerned stakeholders should consider those identified determinants during an intervention for improvement of neonatal health.
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Liyew AM, Ayalew HG. Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis. ACTA ACUST UNITED AC 2021; 79:92. [PMID: 34088345 PMCID: PMC8176679 DOI: 10.1186/s13690-021-00622-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/24/2021] [Indexed: 11/21/2022]
Abstract
Background Tetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates. Besides, only 49% of mothers get vaccinated with adequate tetanus toxoid in Ethiopia which is below the world health organization recommendation. To date, there is limited evidence on the individual and community level determinants of poor tetanus toxoid (TT) immunization. Therefore, this study aimed to assess individual and community-level factors associated with poor TT immunization coverage in Ethiopia. Method Secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey. A total of 7043 pregnant women were included in the current study. A multilevel logistic regression model was used to identify individual and community level determinants of poor tetanus toxoid immunization. Finally, the adjusted odds ratio with a 95% confidence interval was reported. Results In the multilevel logistic regression model adjustment, having no Antenatal care visit (AOR = 5.64; 95% CI:2.48,7.30) and having one to three antenatal care visit (AOR = 1.50; 95% CI: 1.19–1.82); poor wealth index (AOR = 1.26; 95% CI: 1.03, 1.54); not being exposed to media (AOR = 1.29; 95% CI: 1.10, 1.51); maternal unemployment (AOR = 1.15; 95% CI: 1.10, 1.31); rural residence (AOR = 1.13; 95% CI: 1.08, 1.72); and high community illiteracy (AOR = 1.28; 95% CI: 1.03, 1.58) were associated with higher odds of poor tetanus toxoid immunization. Whereas, iron uptake during pregnancy (AOR = 0.59; 95% CI: 0.51, 0.68), was associated with lower odds of poor tetanus toxoid immunization. Conclusion In this study tetanus toxoid (TT) vaccine utilization was affected by both community and individual-level factors. Therefore, focusing on antenatal care services especially encouraging pregnant women to have at least four visits, consulting women to be exposed to media, improving community literacy and maternal employment will help to minimize TT underutilization.
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Affiliation(s)
- Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia.
| | - Hiwotie Getaneh Ayalew
- Department of midwifery, school of nursing and midwifery, college of medicine and health sciences, Wollo University, Dessie, Ethiopia
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Kim EJ, Lee HJ. Relationship between the Toothbrushing Behavior and Hand Hygiene Practices of Korean Adolescents: A Study Focused on the 15th Korea Youth Risk Behavior Survey Conducted in 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115913. [PMID: 34072944 PMCID: PMC8198789 DOI: 10.3390/ijerph18115913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/04/2022]
Abstract
Hand hygiene is one of the most important measures available to prevent infectious diseases such as COVID-19, and it is recommended that individuals wash their hands periodically before and after meals, after using toilets, before preparing food at home, at schools, and in public places. The aim of this study was to investigate the relationship between oral hygiene and hand hygiene in Korean adolescents. Data from 57,303 adolescents who participated in the 2019 Korea Youth Risk Behavior web-based survey were analyzed to determine the relationship between oral hygiene and hand hygiene. A complex sample logistic regression analysis was performed to determine association between toothbrushing behavior and handwashing practices. According to the results of this study, adolescents who brushed their teeth after lunch were 1.48 times more likely to practice handwashing before lunch than were those who did not brush their teeth after lunch (p < 0.001). In addition, the odds ratios adjusted for gender, grade, school type, and residence were found to be 1.87 (p < 0.001). Moreover, these adjusted odds ratios were higher in students who received personal hygiene education (OR: 1.98, p < 0.001). Oral hygiene practices were found to be related to personal hygiene, as assessed by handwashing, in Korean adolescents. Additional studies are needed to develop ways of improving the hygiene and health of adolescents.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Dental hygiene, Gangdong University, Eumseong-gun 27600, Chungcheongbuk-do, Korea;
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Gwanak-gu, Korea
| | - Hye-Ju Lee
- Department of Dental Hygiene, College of Health Science, Sun Moon University, Asan-si 31460, Chungcheongnam-do, Korea
- Correspondence: ; Tel.: +82-41-530-2761
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Del Mastro N. I, Tejada-Llacsa PJ, Reinders S, Pérez R, Solís Y, Alva I, Blas MM. Home birth preference, childbirth, and newborn care practices in rural Peruvian Amazon. PLoS One 2021; 16:e0250702. [PMID: 33945560 PMCID: PMC8096074 DOI: 10.1371/journal.pone.0250702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at home constantly. This study aims to understand the preference for home births as well as childbirth and newborn care practices among Kukama-Kukamiria women in rural Loreto. Following a case study approach, sixty semi-structured, face-to-face interviews were conducted with recent mothers who experienced childbirth within one year prior to the interview, female relatives of recent mothers who had a role in childbirth, male relatives of recent mothers, community health workers, and traditional healers. We found that for women from these communities, home birth is a courageous act and an intimate (i.e. members of the community and relatives participate in it) and inexpensive practice in comparison with institutional birth. These preferences are also linked to experiences of mistreatment at health facilities, lack of cultural adaptation of birthing services, and access barriers to them. Preparations for home births included handwashing and cleaning delivery surfaces. After birth, waiting for the godparent to arrive to cut the cord can delay drying of the newborn. Discarding of colostrum, lack of skin-to-skin contact as well as a range of responses regarding immediate breastfeeding and immediate drying of the baby were also found. These findings were used to tailor the educational content of the Mamas del Rio program, where community health workers are trained to identify pregnancy early, perform home visits to pregnant women and newborns, and promote essential newborn care practices in case institutional birth is not desired or feasible. We make recommendations to improve Peru's cultural adaptation of birthing services.
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Affiliation(s)
- Irene Del Mastro N.
- Department of Sociology, University of California, Los Angeles, California, United States of America
| | - Paul J. Tejada-Llacsa
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stefan Reinders
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Raquel Pérez
- Ages of Life and Education Research Group–EVE, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Yliana Solís
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Isaac Alva
- Intercultural Citizenship and Indigenous Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Magaly M. Blas
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Nalule Y, Buxton H, Macintyre A, Ir P, Pors P, Samol C, Leang S, Dreibelbis R. Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4416. [PMID: 33919264 PMCID: PMC8122667 DOI: 10.3390/ijerph18094416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To inform the design of a hand hygiene behavioural change intervention in rural Cambodia, a formative mixed-methods observational study was conducted to investigate the context-specific behaviours and determinants of handwashing among healthcare workers, and maternal and non-maternal caregivers along the early newborn care continuum. METHODS Direct observations of hygiene practices of all individuals providing care to 46 newborns across eight facilities and the associated communities were completed and hand hygiene compliance was assessed. Semi-structured interactive interviews were subsequently conducted with 35 midwives and household members to explore the corresponding cognitive, emotional and environmental factors influencing the observed key hand hygiene behaviours. RESULTS Hand hygiene opportunities during newborn care were frequent in both settings (n = 1319) and predominantly performed by mothers, fathers and non-parental caregivers. Compliance with hand hygiene protocol across all caregivers, including midwives, was inadequate (0%). Practices were influenced by the lack of accessible physical infrastructure, time, increased workload, low infection risk perception, nurture-related motives, norms and inadequate knowledge. CONCLUSIONS Our findings indicate that an effective intervention in this context should be multi-modal to address the different key behaviour determinants and target a wide range of caregivers.
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Affiliation(s)
- Yolisa Nalule
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Helen Buxton
- Division of Psychiatry, University College London, London W1T 7BN, UK;
| | - Alison Macintyre
- Policy and Programs Division, WaterAid Australia, Melbourne 3002, Australia;
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia; (P.I.); (S.L.)
| | - Ponnary Pors
- WASH and Health Division, WaterAid Cambodia, Phnom Penh, Cambodia; (P.P.); (C.S.)
| | - Channa Samol
- WASH and Health Division, WaterAid Cambodia, Phnom Penh, Cambodia; (P.P.); (C.S.)
| | - Supheap Leang
- National Institute of Public Health, Phnom Penh, Cambodia; (P.I.); (S.L.)
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Tahsina T, Hossain AT, Ruysen H, Rahman AE, Day LT, Peven K, Rahman QSU, Khan J, Shabani J, Kc A, Mazumder T, Zaman SB, Ameen S, Kong S, Amouzou A, Lincetto O, El Arifeen S, Lawn JE. Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:237. [PMID: 33765946 PMCID: PMC7995709 DOI: 10.1186/s12884-020-03421-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. METHODS The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. RESULTS Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. CONCLUSIONS Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.
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Affiliation(s)
- Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Ashish Kc
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Chauhan BG, Verma RK, Alagarajan M, Chauhan SK. Effect of Maternal Healthcare Utilization on Early Neonatal, Neonatal and Post-Neonatal Mortality in India. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:31-43. [PMID: 33745398 DOI: 10.1177/0272684x211004925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy.
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Affiliation(s)
- Bal Govind Chauhan
- Population Research Centre, Gokhale Institute of Politics and Economics, Pune, India
| | | | - Manoj Alagarajan
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
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Ghalavand M, Saadati M, Salimian J, Abbasi E, Hosseinzadeh G, Gouvarchin Ghaleh HE, Ahmadi A. Biological properties the novel application of N-trimethyl chitosan nanospheres as a stabilizer and preservative in tetanus vaccine. Clin Exp Vaccine Res 2021; 10:24-34. [PMID: 33628751 PMCID: PMC7892940 DOI: 10.7774/cevr.2021.10.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Chitosan is a natural polymer that has excellent properties include biocompatibility, biodegradability, no cytotoxicity, high charge density, low cost, mucoadhesive, permeation enhancing (ability to cross tight junction), and immunomodulating ability that makes the spectrum of its applicability much broader. This study was conducted to investigate the stabilizing, preservative and immunogenicity properties of N-trimethyl chitosan nanospheres (N-TMCNS). Materials and Methods The tetanus toxoid (TT) was encapsulated into N-TMCNS and then characterized by scanning electron microscope, atomic force microscope, and dynamic light scattering. For stabilizer assay of N-TMCNS after storage of TT-N-TMCNS at different temperatures for 3 weeks, they were used for immunization of mice and different temperatures groups' anti-TT-N-TMCNS production compared with other groups. Finally, the immunized mice were challenged with tetanus toxin. The preservation activity of TT-N-TMCNS against Escherichia coli was compared with thimerosal formulated TT. Results Our results revealed that heat-treated TT-N-TMCNS could induce higher titer of neutralizing immunoglobulin G in compared to TT vaccine and was able to protect the mice better than TT vaccine in challenge test. Furthermore, N-TMCNS as a preservative inhibited the growth of E. coli more effective than thimerosal. Conclusion Overall, the obtained results indicated that the N-TMCNS is one of the best stabilizer and preservative agent that can be used in the formulation of TT vaccine.
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Affiliation(s)
- Majdedin Ghalavand
- Student Research Committee, Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Applied Virology Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Mojtaba Saadati
- Biology Research Center, Faculty of Basic Sciences, Imam Hossein University, Tehran, Iran
| | - Jafar Salimian
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Science, Tehran, Iran
| | | | - Ghader Hosseinzadeh
- Department of Polymer Science and Engineering, University of Bonab, Bonab, Iran
| | | | - Ali Ahmadi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Science, Tehran, Iran
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Ugwu-Dike P, Nambudiri VE. A review of ethnomedicinal uses of shea butter for dermatoses in Sub-Saharan Africa. Dermatol Ther 2021; 35:e14786. [PMID: 33480103 DOI: 10.1111/dth.14786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/23/2020] [Accepted: 01/17/2021] [Indexed: 12/01/2022]
Abstract
Indigenous therapies, or traditional medicines (TMs), constitute a highly accessible and continuously growing health system in many parts of the world, including Sub-Saharan Africa (SSA). Shea butter, a fat produced from the kernels of the shea tree, has historically been used as an indigenous therapy for dermatologic ailments in SSA. Characterizing traditional therapeutic applications for shea butter is important to inform the continued development of TM in SSA. We conducted a literature review aimed at identifying all available publications on the use of shea butter to treat dermatoses within SSA and evaluating patterns of use. We found 24 dermatologic uses across 30 references. The most common study design was descriptive cross-sectional analysis (46.7%), often relying on the use of in-depth interviews, focus groups, and surveys. Eight SSA countries were represented and there were disparities in availability of information across SSA with the eastern and southern regions less likely to be represented. The most frequently investigated conditions were scabies, wound healing, and umbilical cord care. Shea butter was most commonly used in combination with other ingredients to produce a medical treatment with the most frequent adjuvant being Elaeis guineensis, African oil palm. Broad use of TM to treat varied skin diseases throughout SSA warrants increased investigations into this field in order to further develop the capacity of TM as a source of healthcare.
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Affiliation(s)
- Pearl Ugwu-Dike
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cronk R, Guo A, Folz C, Hynes P, Labat A, Liang K, Bartram J. Environmental conditions in maternity wards: Evidence from rural healthcare facilities in 14 low- and middle-income countries. Int J Hyg Environ Health 2020; 232:113681. [PMID: 33360501 DOI: 10.1016/j.ijheh.2020.113681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
Adequate environmental conditions, comprising sufficient environmental hygiene items (e.g. gloves, soap, and disinfectant), adequate infrastructure (e.g. sanitation facilities, water supply), a clean environment, and hygienic behaviors in healthcare facilities (HCFs) are necessary for safe care in maternity wards. Few data are available describing environmental conditions in maternity wards in rural areas of low- and middle-income countries (LMICs). We collected data on these conditions from 1547 HCFs with maternity wards in 14 countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). We described patterns and availability of essential environmental conditions, and a regression model was developed to explore predictive factors. 73% of HCFs offering maternal and neonatal health (MNH) services did not meet the guidelines for the World Health Organization 'six cleans' (clean perineum, clean bed surface, clean hands, clean blade, clean cord tie, and clean towels to wrap the baby and mother). The items with the lowest availability were clean towels (40%). In a multivariable logistic regression model, HCFs that provided maternity services were more likely to have all 'six cleans' available if they: had at least an improved water source; had an infection prevention and control (IPC) protocol; had a budget considered sufficient that included funding for water, sanitation, hygiene, and IPC; and emphasized the importance of IPC within the nearby community. Our results demonstrate substantial differences between countries in the availability of environmental hygiene items, facility cleanliness, and quality of environmental health infrastructure in HCF maternity wards. There are several low-cost, high-impact, context-relevant opportunities to enhance essential environmental conditions that would improve the quality of neonatal and maternal care in maternity wards in HCFs in LMICs.
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Affiliation(s)
- Ryan Cronk
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA; ICF, 2635 Meridian Pkwy Suite 200, Durham, NC, 27713, USA.
| | - Amy Guo
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA
| | - Caroline Folz
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA
| | | | | | - Kaida Liang
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA
| | - Jamie Bartram
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA; School of Civil Engineering, University of Leeds, UK
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Gon G, Ali SM, Aunger R, Campbell OM, de Barra M, de Bruin M, Juma M, Nash S, Tajo A, Westbrook J, Woodd S, Graham WJ. A Practical Guide to Using Time-and-Motion Methods to Monitor Compliance With Hand Hygiene Guidelines: Experience From Tanzanian Labor Wards. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:827-837. [PMID: 33361245 PMCID: PMC7784080 DOI: 10.9745/ghsp-d-20-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/19/2020] [Indexed: 12/05/2022]
Abstract
Understanding hand hygiene behaviors is critical in hospitals. We developed the HANDS at birth tool—and provide information on its design and implementation–to capture the complex patterns of health care workers’ hand hygiene including hand rubbing/washing, glove use, and recontamination. Background: Good-quality evidence on hand hygiene compliance among birth attendants in low-resource labor wards is limited. The World Health Organization Hand Hygiene Observation Form is widely used for directly observing behaviors, but it does not support capturing complex patterns of behavior. We developed the HANDS at Birth tool for direct observational studies of complex patterns of hand rubbing/washing, glove use, recontamination, and their determinants among birth attendants. Understanding these behaviors is particularly critical in wards with variable patient volumes or unpredictable patient complications, such as emergency departments, operating wards, or triage and isolation wards during epidemics. Here we provide detailed information on the design and implementation of the HANDS at Birth tool, with a particular focus on low-resource settings. We developed the HANDS at Birth tool from available guidelines, unstructured observation, and iterative refinement based on consultation with collaborators and pilot results. We designed the tool with WOMBAT software, which supports collecting multidimensional time-and-motion data. Our analysis of the tool’s performance centered on interobserver agreement and convergent validity and the implications of the data structure for data analysis. The HANDS at Birth tool encompasses various hand actions and context-relevant information. Hand actions include procedures relevant during labor and delivery; hand hygiene or glove actions; and other types of touch. During field implementation, we used the tool for continuous observation of the birth attendant. Interobserver agreement was good (kappa range: 0.7–0.9), and the tool showed convergent validity. Using the HANDS at Birth tool is a feasible way to obtain useful information about compliance with hand hygiene procedures. The tool could be used after simple training and allows for collection of reliable information about the complex pattern of hygiene behaviors. Future studies should explore using this tool to observe behavior in labor wards in other settings and in other types of wards.
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Affiliation(s)
- Giorgia Gon
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Said M Ali
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Robert Aunger
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oona M Campbell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mícheál de Barra
- Brunel University London, Department of Life Sciences, Uxbridge, United Kingdom
| | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Mohammed Juma
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amour Tajo
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | | | - Susannah Woodd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy J Graham
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nalule Y, Buxton H, Flynn E, Oluyinka O, Sara S, Cumming O, Dreibelbis R. Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria. BMC Pregnancy Childbirth 2020; 20:589. [PMID: 33023531 PMCID: PMC7541299 DOI: 10.1186/s12884-020-03282-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. METHODS This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. RESULTS Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. CONCLUSIONS In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.
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Affiliation(s)
- Yolisa Nalule
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Buxton
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Erin Flynn
- Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
| | - Olutunde Oluyinka
- Maternal and Child Survival Program (MCSP)/Save the Children Nigeria, Abuja, Nigeria
| | - Stephen Sara
- Maternal and Child Survival Program (MCSP)/Save the Children US, Washington, DC, 20036, USA
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Bazzano AN, Stolow JA, Duggal R, Oberhelman RA, Sun Y, Var C. Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health. Healthcare (Basel) 2020; 8:healthcare8020187. [PMID: 32604756 PMCID: PMC7349223 DOI: 10.3390/healthcare8020187] [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: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022] Open
Abstract
Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming.
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Affiliation(s)
- Alessandra N. Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USA; (J.A.S.); (R.A.O.); (Y.S.)
- Correspondence: ; Tel.: +1-504-988-2338
| | - Jeni A. Stolow
- Department of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USA; (J.A.S.); (R.A.O.); (Y.S.)
| | - Ryan Duggal
- School of Medicine, Tulane University, New Orleans, 70112 LA, USA;
| | - Richard A. Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USA; (J.A.S.); (R.A.O.); (Y.S.)
| | - Yaoyao Sun
- Department of Global Community Health and Behavioral Sciences, Tulane School Public Health and Tropical Medicine, New Orleans, 70112 LA, USA; (J.A.S.); (R.A.O.); (Y.S.)
- School of Nursing, Shandong University, Shandong 250012, China
| | - Chivorn Var
- Reproductive Health Association of Cambodia, Phnom Penh 905, Cambodia;
- National Institute of Public Health, #2 Kim Y Sung Blvd, Tuol Kork, Phnom Penh 1300, Cambodia
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Tareke KG, Lemu YK, Feyissa GT. Exploration of facilitators of and barriers to the community-based service utilization for newborn possible serious bacterial infection management in Debre Libanos District, Ethiopia: descriptive qualitative study. BMC Pediatr 2020; 20:303. [PMID: 32563243 PMCID: PMC7305601 DOI: 10.1186/s12887-020-02211-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, possible serious bacterial infection [PSBI] is a cause for about 600,000 newborn deaths per year. To decrease the burden of this infection, a community-based management newborn PSBI when referral to hospital is not possible has been on implementation. Studies showed gaps in the service utilization and this study was aimed at exploring its barriers and facilitators. Methods A descriptive qualitative study was conducted from March 11– April 7, 2019, in Debre Libanos District, Ethiopia. Study participants were recruited purposively. Women who gave birth within 2 months before data collection, health extension workers [HEW], health workers, religious leader, kebele chairman, and other community members were involved in the study. Five in-depth interviews, seven key informant interviews, and four focused group discussions were conducted with a total of fifty-two participants. The data were audio-recorded, transcribed verbatim and translated, and inductive thematic analysis was done using Atlas ti.7.1 software. Result The availability of health workers trained on community-based newborn care [CBNC], Integrated Management of Newborn and Childhood Illness guidelines, availability of medical supplies and job aids, and performance review meetings were identified as facilitators. Communities perception that the newborn illness has no medical treatment, newborn illness is not severe and is self-resolution; the belief in healing power of traditional medicines, socio-cultural and religious beliefs, lack of awareness about service availability at the health post, poor supportive supervision or monitoring, shortage of HEW, the residency of HEWs outside the health post, a poor commitment of health workers and HEWs, and non-functionality of health developmental army were explored as barriers. Conclusions The findings provided insight into the facilitators of and barriers to community-based service utilization for newborn PSBI management. There is a need to develop strategies to address the barriers. Therefore, health care providers should have to develop strategies, and conduct a behavioral change communication to change the perception of community members towards newborn illnesses, promote the availability of the service at the health post, and the HEWs provide the service staying at the health post.
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Affiliation(s)
- Kasahun Girma Tareke
- Department of Health, Behavior and Society, Jimma University, P. O. Box 378, Jimma, Ethiopia.
| | - Yohannes Kebede Lemu
- Department of Health, Behavior and Society, Jimma University, P. O. Box 378, Jimma, Ethiopia
| | - Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, P. O. Box 378, Jimma, Ethiopia
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Esteves Mills J, Flynn E, Cumming O, Dreibelbis R. Determinants of clean birthing practices in low- and middle-income countries: a scoping review. BMC Public Health 2020; 20:602. [PMID: 32357872 PMCID: PMC7195776 DOI: 10.1186/s12889-020-8431-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. Methods We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants – capability, opportunity and motivation. Results Seventy-eight studies were included in the review: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours – commonly referred to as “the six cleans” – featured in 31 studies. Determinants of hand hygiene (n = 13) and clean cord care (n = 11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. Conclusions Efforts to combine clean birthing practices into a single suite of behaviours – such as the “six cleans”– may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.
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Affiliation(s)
- Joanna Esteves Mills
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Erin Flynn
- Infection & Immunity, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Lassi ZS, Fisher Z, Andraweera P, Cummins A, Roberts CT. Effectiveness of birthing kits for clean childbirth: a systematic review. Int Health 2020; 12:3-10. [PMID: 31340003 PMCID: PMC6964231 DOI: 10.1093/inthealth/ihz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 11/12/2022] Open
Abstract
Poor infection control practices during childbirth are recognised as a critical factor leading to life-threatening maternal and newborn sepsis. Therefore, this paper assesses the effectiveness of clean birth kits (CBKs) to ensure a safe birthing environment. We searched PubMed, Cochrane Library and CINAHL, as well as Google Scholar, to identify both qualitative and quantitative studies on CBKs published in English up to November 2018. Studies were included if the pregnant women or women giving birth intended to use or used a CBK. The methodological quality of included papers was assessed. A total of 37 studies, 26 quantitative and 11 qualitative studies, were included. Quantitative studies showed a positive impact of CBKs on reducing the incidence of puerperal sepsis and neonatal tetanus. The review also identified CBK use to be associated with a reduction in perinatal, neonatal and young infant mortality. Qualitative studies suggested that a lack of awareness of the importance of CBKs and clean delivery practices, unavailability of CBKs and financial constraints to purchase CBKs were the potential barriers. CBKs appear to be a promising strategy to reduce maternal and neonatal morbidity and mortality. However, the current evidence is limited and further large-scale trials are required.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Zeshi Fisher
- Birthing Kit Foundation Australia, PO Box 330 Belair South Australia, Australia
| | - Prabha Andraweera
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Alexandra Cummins
- Birthing Kit Foundation Australia, PO Box 330 Belair South Australia, Australia
| | - Claire T Roberts
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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Bowring AL, Schwartz S, Lyons C, Rao A, Olawore O, Njindam IM, Nzau J, Fouda G, Fako GH, Turpin G, Levitt D, Georges S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi AC, Baral S. Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:82-99. [PMID: 32234842 PMCID: PMC7108938 DOI: 10.9745/ghsp-d-19-00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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Affiliation(s)
- Anna L Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Burnet Institute, Melbourne, Australia
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Metabiota, Yaounde, Cameroon
| | | | | | | | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Serge C Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Anne-Cécile Zoung-Kanyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.,Division of Operations Research, Ministry of Health, Yaounde, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mannava P, Murray JC, Kim R, Sobel HL. Status of water, sanitation and hygiene services for childbirth and newborn care in eight countries in East Asia and the Pacific. J Glob Health 2020; 9:020430. [PMID: 31893033 PMCID: PMC6925970 DOI: 10.7189/jogh.09.020430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Water, sanitation and hygiene (WASH) services are critical to providing quality maternal and neonatal care in health facilities. This study aimed to investigate availability of WASH policies, standards, and services for childbirth and newborn care in hospitals in East Asia and the Pacific. Methods Descriptive analysis of survey data and observations of water, sanitation and hygiene services in maternity and neonatal care rooms and of deliveries in 147 hospitals in Cambodia, Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Philippines, Solomon Islands, and Viet Nam. The main outcome measures were availability of national policies and standards; availability of water, sanitation, and hygiene services in maternity rooms and neonatal care units; and practice of hygiene at childbirth. Results Three of seven countries had national WASH policies and three had standards for health facilities. Seventy-seven percent of hospitals had a sink with water and soap or alcohol hand rub in delivery rooms, 78% in neonatal care rooms and 42% in postnatal care rooms. Only 44% of hospitals had clean sinks with water, soap and hand drying methods in the delivery room, 40% in neonatal care units and 10% in postnatal care rooms. Flush toilets were available in or next to delivery rooms in 60% and neonatal care units in 50% of 10 hospitals with data. Countries with WASH standards had a higher proportion of hospitals with water and hand hygiene services. Appropriate hygiene was practiced by health workers in 65% of 371 deliveries observed, and more likely in delivery rooms with a sink, water and soap. Conclusions Coverage of WASH services for maternal and newborn care must be improved to reduce risks of maternal and newborn morbidity and mortality.
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Affiliation(s)
- Priya Mannava
- Maternal and Child Health, and Health Facility Quality and Safety, World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - John Cs Murray
- Maternal and Child Health, and Health Facility Quality and Safety, World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - Rokho Kim
- Health and the Environment, World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - Howard L Sobel
- Maternal and Child Health, and Health Facility Quality and Safety, World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
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Shukla VV, Carlo WA. Review of the evidence for interventions to reduce perinatal mortality in low- and middle-income countries. Int J Pediatr Adolesc Med 2020; 7:2-8. [PMID: 32373695 PMCID: PMC7193071 DOI: 10.1016/j.ijpam.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Low- and middle-income countries contribute to the overwhelming majority of the global perinatal and neonatal mortality. There is a growing amount of literature focused on interventions aimed at reducing the healthcare gaps and thereby reducing perinatal and neonatal mortality in low- and middle-income countries. The current review synthesizes available evidence for interventions that have shown to improve perinatal and neonatal outcomes. Reduction in important gaps in the availability and utilization of perinatal care practices is needed to end preventable deaths of newborns.
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Affiliation(s)
- Vivek V. Shukla
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
| | - Waldemar A. Carlo
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
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A Linked Community and Health Facility Intervention to Improve Newborn Health in Cambodia: the NICCI Stepped-Wedge Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051559. [PMID: 32121288 PMCID: PMC7084723 DOI: 10.3390/ijerph17051559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/14/2023]
Abstract
Background: Newborn mortality in Cambodia remains high, with sepsis and complications of delayed care-seeking important contributing factors. Intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns; increase recognition of danger signs, and prompt care-seeking at an appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants. Methods: The stepped-wedge cluster-randomized controlled trial took place in rural Cambodia from February 2015 to November 2016. Sixteen clusters consisted of public health center catchment areas serving the community. The intervention included health center staff training and home visits to mothers by community health volunteers within 24 h of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs and counselling mothers. The trial participants included women who had recently delivered a newborn who were visited in their homes in the first week, as well as health center staff and community volunteers who were trained in newborn care. Women in their last trimester of pregnancy greater than 18 years of age were recruited and were blinded to their group assignment. Mothers and caregivers (2494) received counseling on handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. Results: Health center staff in the intervention group had increased likelihood of hand washing at recommended key moments when compared with the control group, increased knowledge of danger signs, and higher recall of at least three hygiene messages. Of mother/caregiver participants at 14 days after delivery, women in the intervention group were much more likely to know at least three danger signs and to have received messages on care-seeking compared with controls. Conclusions: The intervention improved factors understood to be associated with newborn survival and health. Well-designed training, followed by regular supervision, enhanced the knowledge and self-reported behavior of health staff and health volunteers, as well as mothers’ own knowledge of newborn danger signs. However, further improvement in newborn care, including care-seeking for illness and handwashing among mothers and families, will require additional involvement from broader stakeholders in the community.
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Gon G, Virgo S, de Barra M, Ali SM, Campbell OM, Graham WJ, Nash S, Woodd SL, de Bruin M. Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041438. [PMID: 32102276 PMCID: PMC7068290 DOI: 10.3390/ijerph17041438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022]
Abstract
Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.
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Affiliation(s)
- Giorgia Gon
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
- Correspondence:
| | - Sandra Virgo
- University of Kent, Higher Education Access Tracker, Catenrbury CT2 7NZ, UK;
| | - Mícheál de Barra
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK;
| | - Said M. Ali
- Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Zanzibar 9820, Tanzania;
| | - Oona M. Campbell
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Wendy J. Graham
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Susannah L. Woodd
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, 6525 GA Nijmegen, The Netherlands
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Oza HH, Fisher MB, Abebe L, Cronk R, McCord R, Reuland F, Behnke N, Kafanikhale H, Mofolo I, Hoffman I, Bartram J. Application of tools to monitor environmental conditions, identify exposures, and inform decision-making to improve infection prevention and control practices in Malawian maternity wards. ENVIRONMENTAL MONITORING AND ASSESSMENT 2020; 192:134. [PMID: 31970501 DOI: 10.1007/s10661-020-8089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
Healthcare-acquired infections (HAIs) contribute to maternal and neonatal morbidity and mortality, especially in low- and middle-income countries (LMICs). Deficient environmental health (EH) conditions and infection prevention and control (IPC) practices in healthcare facilities (HCFs) contribute to the spread of HAIs, but microbial sampling of sources of contamination is rarely conducted nor reported in low-resource settings. The purpose of this study was to assess EH conditions and IPC practices in Malawian HCFs and evaluate how EH deficiencies contribute to pathogen exposures and HAIs, and to provide recommendations to inform improvements in EH conditions using a mixed-methods approach. Thirty-one maternity wards in government-run HCFs were surveyed in the three regions of Malawi. Questionnaires were administered in parallel with structured observations of EH conditions and IPC practices and microbial testing of water sources and facility surfaces. Results indicated significant associations between IPC practices and microbial contamination. Facilities where separate wards were not available for mothers and newborns with infections and where linens were not used for patients during healthcare services were more likely to have delivery tables with surface contamination (relative risk = 2.23; 1.49, 3.34). E. coli was detected in water samples from seven (23%) HCFs. Our results suggest that Malawian maternity wards could reduce microbial contamination, and potentially reduce the occurrence of HAIs, by improving EH conditions and IPC practices. HCF staff can use the simple, low-cost EH monitoring methods used in this study to incorporate microbial monitoring of EH conditions and IPC practices in HCFs in low-resource settings.
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Affiliation(s)
- Hemali Harish Oza
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Michael Benjamin Fisher
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA.
| | - Lydia Abebe
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
- United States Agency for International Development (USAID), Washington, DC, USA
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
| | - Ryan McCord
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Carolina Population Center, UNC-CH, Chapel Hill, NC, USA
| | - Frances Reuland
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Nikki Behnke
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
| | | | - Innocent Mofolo
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, UNC-CH, Chapel Hill, NC, USA
| | - Irving Hoffman
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, UNC-CH, Chapel Hill, NC, USA
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA.
- School of Civil Engineering, University of Leeds, Leeds, UK.
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Shukla V, Mwenechanya M, Carlo WA. Dealing with neonatal emergencies in low-resource settings. Semin Fetal Neonatal Med 2019; 24:101028. [PMID: 31744767 DOI: 10.1016/j.siny.2019.101028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe the development and delivery of neonatal care including trends and impacts of major interventions on neonatal mortality particularly in low-resource settings. Low- and middle-income countries continue to be major contributors to neonatal mortality. Although there has been progress in reducing neonatal mortality, neonatal deaths are contributing an increasing percentage of childhood mortality. Several interventions targeting neonatal care such as neonatal resuscitation and essential newborn care have contributed to improved outcomes. However, there are still many neonatal deaths that are preventable with known effective interventions. This review addresses interventions proven effective in reducing neonatal mortality, challenges to implement them, and future directions of implementing these interventions in low- and middle-income countries.
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Affiliation(s)
- Vivek Shukla
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA
| | - Musaku Mwenechanya
- University Teaching Hospital- Children's Hospital, Nationalist Road, Lusaka, Zambia
| | - Waldemar A Carlo
- University of Alabama at Birmingham, Division of Neonatology, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL, 35249, USA.
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Raza SA, Avan BI. Eliminating Maternal and Neonatal Tetanus and Promoting Clean Delivery Practices Through Disposable Clean Birth Kits. Front Public Health 2019; 7:339. [PMID: 31824909 PMCID: PMC6886002 DOI: 10.3389/fpubh.2019.00339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/29/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Syed Ahsan Raza
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Bilal Iqbal Avan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Klugman J, Li L, Barker KM, Parsons J, Dale K. How are the domains of women's inclusion, justice, and security associated with maternal and infant mortality across countries? Insights from the Women, Peace, and Security Index. SSM Popul Health 2019; 9:100486. [PMID: 31998827 PMCID: PMC6978497 DOI: 10.1016/j.ssmph.2019.100486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
Women's autonomy and empowerment in their homes, communities, and societies at large have been shown, through many direct and indirect pathways, to be associated with maternal and infant health. A novel global measure—the Women, Peace, and Security (WPS) Index—that bridges insights from gender and development indices with those from peace and security has recently been developed to capture the constructs of women's inclusion, justice, and security, using indicators and targets in the Sustainable Development Goals. This paper adds to the growing literature about the importance of gender inequality to key mortality outcomes for women and children by investigating the associations between nations' WPS Index scores and maternal mortality ratios and infant mortality rates. We use a range of international databases to obtain country-level data from 144 nations on health, demographic, income, and gender equality indicators. The aim is to highlight the role of women's inclusion, justice, and security in explaining national rates of maternal and infant mortality. Fully adjusted Poisson regression models indicate that a one point (0.01) increase on the WPS Index score is associated with a 2.0% reduction in the number of maternal deaths and a 2.3% reduction in the number of infant deaths. For a country such as Sierra Leone, with a maternal mortality ratio of 1360 maternal deaths per 100,000 live births, a one point improvement in the WPS Index would correspond to a maternal mortality ratio of 1,332, or 28 fewer deaths per 100,000 births. These associations are ecological and apply to the average level of mortality at the country level rather than the likelihood or risk faced at the individual level. Although we cannot claim causality for the observed relations in the cross-country regressions, the findings and recurring patterns are both suggestive and encouraging about the potential contributions of women's inclusion, justice, and security to maternal and infant mortality. The Women, Peace, and Security (WPS) Index is a novel composite index, developed in 2019. The index measures women’s inclusion (economic, political, social); justice; and security (at home and in society). Using data from 144 nations, we find a significant relationship between the WPS Index and maternal and infant mortality. The inclusion and security aspects of the WPS Index are especially significant.
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Affiliation(s)
- Jeni Klugman
- Institute for Women, Peace and Security, Georgetown University, 1412 36th Street, N.W., Washington, DC, 20057, United States
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchison Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA, 98109, United States
| | - Kathryn M Barker
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Jennifer Parsons
- Institute for Women, Peace and Security, Georgetown University, 1412 36th Street, N.W., Washington, DC, 20057, United States
| | - Kelly Dale
- Institute for Women, Peace and Security, Georgetown University, 1412 36th Street, N.W., Washington, DC, 20057, United States
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Johnson J, Milstone AM. Hospital-onset Neonatal Sepsis and Mortality in Low-resource Settings: Will Bundles Save the Day? Clin Infect Dis 2019; 69:1368-1369. [PMID: 30596982 DOI: 10.1093/cid/ciy1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023] Open
Affiliation(s)
- Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron M Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Burgoine K, Egiru E, Ikiror J, Acom L, Akol S, Olupot-Olupot P. Neonatal tetanus in eastern Uganda: improved outcome following the implementation of a neonatal tetanus protocol. Trop Doct 2019; 50:57-62. [PMID: 31474192 DOI: 10.1177/0049475519872860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal tetanus remains a significant, yet avoidable, cause of neonatal death. Despite the 34,000 deaths that occur globally from neonatal tetanus every year, there has been little research into the management of neonatal tetanus. Until worldwide elimination of neonatal tetanus is achieved, the case management of this devastating illness needs to be improved. We describe an improved outcome of neonatal tetanus following the introduction of a neonatal tetanus protocol including diazepam, magnesium sulphate, bubble continuous positive airway pressure and broad-spectrum antibiotics in a low-resource setting in eastern Uganda.
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Affiliation(s)
- Kathy Burgoine
- Neonatal Lead, Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda.,Medical Officer, Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Emma Egiru
- Medical Officer, Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Juliet Ikiror
- Neonatal Clinical Officer, Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Linda Acom
- Neonatal Clinical Officer, Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Sylivia Akol
- Nurse in charge, Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Peter Olupot-Olupot
- Medical Officer, Mbale Clinical Research Institute, Mbale Regional Referral Hospital, Mbale, Uganda.,Director Mbale Clinical Research Institute, Faculty of Health Sciences, Busitema University, Busitema, Uganda
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Watson J, D'Mello-Guyett L, Flynn E, Falconer J, Esteves-Mills J, Prual A, Hunter P, Allegranzi B, Montgomery M, Cumming O. Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review. BMJ Glob Health 2019; 4:e001632. [PMID: 31354976 PMCID: PMC6626521 DOI: 10.1136/bmjgh-2019-001632] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/10/2019] [Accepted: 06/15/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date. METHODS As per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps. RESULTS Only three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps. CONCLUSIONS Although there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs. PROSPERO REGISTRATION NUMBER CRD42017080943.
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Affiliation(s)
- Julie Watson
- Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
| | - Lauren D'Mello-Guyett
- Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
| | - Erin Flynn
- Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jane Falconer
- Library and Archives Service, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Esteves-Mills
- Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
| | - Alain Prual
- Regional Office for Western and Central Africa, UNICEF, Dakar, Senegal
| | - Paul Hunter
- School of Medicine Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Benedetta Allegranzi
- Global Infection Prevention and Control Unit, World Health Organization, Geneva, Switzerland
| | - Maggie Montgomery
- Water, Sanitation, Hygiene and Health, World Health Organization, Geneva, Switzerland
| | - Oliver Cumming
- Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
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50
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Alyahya MS, Khader YS, Batieha A, Asad M. The quality of maternal-fetal and newborn care services in Jordan: a qualitative focus group study. BMC Health Serv Res 2019; 19:425. [PMID: 31242940 PMCID: PMC6595569 DOI: 10.1186/s12913-019-4232-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/07/2019] [Indexed: 01/06/2023] Open
Abstract
Background The antenatal, intrapartum, and postnatal periods are considered high-risk periods for the health of mothers and their newborns. Although the current utilization rate of some maternal and child care services in Jordan is encouraging, detailed information about the quality of these services is limited. Therefore, this study aimed to explore the quality of maternal-fetal and newborn antenatal care (ANC), delivery, and postnatal care (PNC) services in Jordan. Methods We conducted 12 focus group discussions (FGDs) with pregnant and postpartum women who attended maternal-child care services in three major hospitals in Jordan. All FGDs were recorded and transcribed verbatim. An inductive thematic analysis approach was used to identify themes and subthemes. Results The content analysis of the FGDs revealed a consensus among the discussants regarding the importance of ANC and PNC services for the health of mothers and their newborns. However, the participating women viewed ANC to be much more important than PNC. With regards to the choice between public and private antenatal care services, some of the discussants were disposed towards the private sector. Reasons for this included longer consultation time, a higher quality of services, better interpersonal and communication skills of healthcare providers, better treatment, more advanced equipment and devices, availability of female obstetricians, and more flexible appointment times. These women only perceived public hospital services to be necessary in cases of pregnancy-related complications and labor, as the costs of private sector services in such cases are too high. The findings also revealed that mothers usually only seek PNC services to check up on their newborn’s health and not their own. Conclusion Visiting private ANC clinics throughout pregnancy while giving birth in public facilities leads to the discontinuity and fragmentation in maternal-fetal and child healthcare services. To address this fragmentation, healthcare systems are proposed to establish interprofessional teamwork that requires different healthcare providers with complementary skills and practices in both public and private settings to work co-operatively and collectively. Investment in new technologies and interventions which enhance coordination and collaboration between public and private healthcare settings is necessary for the provision of non-traditional maternal healthcare. Electronic supplementary material The online version of this article (10.1186/s12913-019-4232-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Majed Asad
- Jordan Ministry of Health, Directorate of non-communicable diseases, Amman, Jordan
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