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Pillay Y, Ngonzi J, Nguyen V, Payne BA, Komugisha C, Twinomujuni AH, Vidler M, Lavoie PM, Bebell LM, Christoffersen-Deb A, Kenya-Mugisha N, Kissoon N, Ansermino JM, Wiens MO. The epidemiology and risk factors for postnatal complications among postpartum women and newborns in southwestern Uganda: A prospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003458. [PMID: 39110697 PMCID: PMC11305527 DOI: 10.1371/journal.pgph.0003458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 06/13/2024] [Indexed: 08/10/2024]
Abstract
Sub-Saharan Africa accounts for two-thirds of the global burden of maternal and newborn deaths. Adverse outcomes among postpartum women and newborns occurring in the first six weeks of life are often related, though data co-examining patients are limited. This study is an exploratory analysis describing the epidemiology of postnatal complications among postpartum women and newborns following facility birth and discharge in Mbarara, Uganda. This single-site prospective cohort observational study enrolled postpartum women following facility-based delivery. To capture health information about both the postpartum women and newborns, data was collected and categorized according to domains within the continuum of care including (1) social and demographic, (2) pregnancy history and antenatal care, (3) delivery, (4) maternal discharge, and (5) newborn discharge. The primary outcomes were readmission and mortality within the six-week postnatal period as defined by the WHO. Multivariable logistic regression was used to identify risk factors. Among 2930 discharged dyads, 2.8% and 9.0% of women and newborns received three or more postnatal visits respectively. Readmission and deaths occurred among 108(3.6%) and 25(0.8%) newborns and in 80(2.7%) and 0(0%) women, respectively. Readmissions were related to sepsis/infection in 70(88%) women and 68(63%) newborns. Adjusted analysis found that caesarean delivery (OR:2.91; 95%CI:1.5-6.04), longer travel time to the facility (OR:1.54; 95%CI:1.24-1.91) and higher maternal heart rate at discharge (OR:1.02; 95%CI:1.00-1.01) were significantly associated with maternal readmission. Discharge taken on all patients including maternal haemoglobin (per g/dL) (OR:0.90; 95%CI:0.82-0.99), maternal symptoms (OR:1.76; 95%CI:1.02-2.91), newborn temperature (OR:1.66; 95%CI:1.28-2.13) and newborn heart rate at (OR:1.94; 95%CI:1.19-3.09) were risk factors among newborns. Readmission and death following delivery and discharge from healthcare facilities is still a problem in settings with low rates of postnatal care visits for both women and newborns. Strategies to identify vulnerable dyads and provide better access to follow-up care, are urgently required.
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Affiliation(s)
- Yashodani Pillay
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Global Health, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology and Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Vuong Nguyen
- Institute for Global Health, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Beth A. Payne
- Digital Health, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa M. Bebell
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - J. Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Global Health, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Matthew O. Wiens
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Global Health, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- WALIMU, Kololo, Kampala, Uganda
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Tolani H, Neogi SB, Pandey AK, Khan PK, Mishra SS. Contributing factors for reduction in maternal mortality ratio in India. Sci Rep 2024; 14:14883. [PMID: 38937489 PMCID: PMC11211505 DOI: 10.1038/s41598-024-65009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/15/2024] [Indexed: 06/29/2024] Open
Abstract
Maternal mortality ratio (MMR) estimates have been studied over time for understanding its variation across the country. However, it is never sufficient without accounting for presence of variability across in terms of space, time, maternal and system level factors. The study endeavours to estimate and quantify the effect of exposures encompassing all maternal health indicators and system level indicators along with space-time effects influencing MMR in India. Using the most recent level of possible -factors of MMR, maternal health indicators from the National Family Health Survey (NFHS: 2019-21) and system level indicators from government reports a heatmap compared the relative performance of all 19 SRS states. Facet plots with a regression line was utilised for studying patterns of MMR for different states in one frame. Using Bayesian Spatio-temporal random effects, evidence for different MMR patterns and quantification of spatial risks among individual states was produced using estimates of MMR from SRS reports (2014-2020). India has witnessed a decline in MMR, and for the majority of the states, this drop is linear. Few states exhibit cyclical trend such as increasing trends for Haryana and West Bengal which was evident from the two analytical models i.e., facet plots and Bayesian spatio- temporal model. Period of major transition in MMR levels which was common to all states is identified as 2009-2013. Bihar and Assam have estimated posterior probabilities for spatial risk that are relatively greater than other SRS states and are classified as hot spots. More than the individual level factors, health system factors account for a greater reduction in MMR. For more robust findings district level reliable estimates are required. As evident from our study the two most strong health system influencers for reducing MMR in India are Institutional delivery and Skilled birth attendance.
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Affiliation(s)
- Himanshu Tolani
- International Institute of Health Management Research, New Delhi, India
| | | | - Anuj Kumar Pandey
- International Institute of Health Management Research, New Delhi, India
| | - Pijush Kanti Khan
- International Institute of Health Management Research, New Delhi, India
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Gharacheh M, Khalili N, Ebrahimi Kalan M, Heidarzadeh M, Ranjbar F. Pregnancy-Related Complications During the COVID-19 Pandemic in Iran. ARCHIVES OF IRANIAN MEDICINE 2024; 27:30-35. [PMID: 38431958 PMCID: PMC10915933 DOI: 10.34172/aim.2024.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/24/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected healthcare systems worldwide, with significant collateral damage to vulnerable populations, including the perinatal population. This study sought to compare pregnancy-related complications before and during the COVID-19 pandemic in Iran. METHODS This retrospective data analysis was performed from February 20 to August 20, 2019 (prior to the onset of the COVID-19 pandemic) and from February 20 to August 20, 2020 (during the pandemic), encompassing the initial wave of the pandemic and the subsequent lockdown. To collect data, we utilized the medical records of 168,358 women obtained from the Iranian Maternal and Neonatal Network, which is a comprehensive electronic health record database management system specifically designed to store information pertaining to maternal and neonatal health. RESULTS A total of 168,358 medical records were analyzed, with 87388 (51.9%) and 80970 (48.1%) before and during the pandemic, respectively. The occurrence of pregnancy complications was found to be significantly more frequent during the pandemic compared to the pre-pandemic period. Notably, there was a higher likelihood of experiencing preeclampsia (odds ratio [OR]=1.14, 95% confidence interval [CI]: 1.07‒1.22, P=0.0001) and gestational diabetes (OR=1.14, 95% CI: 1.09‒1.19, P=0.0001) during the pandemic. Furthermore, cesarean section (CS) became more prevalent during the pandemic in comparison to vaginal delivery (OR=1.19, 95% CI: 1.17‒-1.22, P=0.0001). CONCLUSION Our findings demonstrated a significant association between the COVID-19 pandemic and an escalation in adverse pregnancy outcomes, notably preeclampsia, gestational diabetes, and CS deliveries. However, further research is warranted to gain a richer understanding of the intricate interplay between the COVID-19 pandemic and pregnancy complications. This is particularly crucial in light of the evolving landscape of new coronavirus variants.
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Affiliation(s)
- Maryam Gharacheh
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Heidarzadeh
- Department of Pediatrics, School of Medicine, Children Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahimeh Ranjbar
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Kawish AB, Umer MF, Arshed M, Khan SA, Hafeez A, Waqar S. Respectful Maternal Care Experience in Low- and Middle-Income Countries: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1842. [PMID: 37893560 PMCID: PMC10608623 DOI: 10.3390/medicina59101842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Respectful maternity care promotes practices that acknowledge women's preferences and women and newborns' needs. It is an individual-centered strategy founded on ethical and human rights principles. The objective of this systematic review is to identify the impact of income on maternal care and respectful maternity care in low- and middle-income countries. Materials and Methods: Data were searched from Google Scholar, PubMed, Web of Science, NCBI, CINAHL, National Library of Medicine, ResearchGate, MEDLINE, EMBASE database, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Maternity and Infant Care database. This review followed PRISMA guidelines. The initial search for publications comparing low- and middle-income countries with respectful maternity care yielded 6000 papers, from which 700 were selected. The review articles were further analyzed to ensure they were pertinent to the comparative impact of income on maternal care. A total of 24 articles were included, with preference given to those published from 2010 to 2023 during the last fourteen years. Results: Considering this study's findings, respectful maternity care is a crucial component of high-quality care and human rights. It can be estimated that there is a direct association between income and maternity care in LMICs, and maternity care is substandard compared to high-income countries. Moreover, it is determined that the evidence for medical tools that can enhance respectful maternity care is sparse. Conclusions: This review highlights the significance of improving maternal care experiences, emphasizing the importance of promoting respectful practices and addressing disparities in low- and middle-income countries.
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Affiliation(s)
- Ayesha Babar Kawish
- Alshifa School of Public Health, AlShifa Trust, Rawalpindi 46200, Pakistan; (A.B.K.); (S.W.)
| | - Muhammad Farooq Umer
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Hofuf 31982, Saudi Arabia
| | - Muhammad Arshed
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Near Bhuptian Chowk, Lahore 54590, Pakistan;
| | - Shahzad Ali Khan
- Office of the Vice Chancellor, Health Services Academy University, Chak Shahzad, Islamabad 44000, Pakistan;
| | - Assad Hafeez
- Country Representative World Health Organization (WHO), Salmiya 20001, Kuwait;
| | - Saman Waqar
- Alshifa School of Public Health, AlShifa Trust, Rawalpindi 46200, Pakistan; (A.B.K.); (S.W.)
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Dent M, VanOtterloo L, Brady M. Improving Nurse Management of the Second Stage of Labor. Nurs Womens Health 2023; 27:344-353. [PMID: 37524314 DOI: 10.1016/j.nwh.2023.03.005] [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: 11/19/2022] [Revised: 03/23/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To develop, implement, and evaluate an educational program to improve nurses' management of the second stage of labor. DESIGN Evidence-based practice project guided by the Iowa Model-Revised. SETTING Acute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery. PARTICIPANTS Eighteen registered nurses participated in the educational intervention. INTERVENTION An instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal-fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions. MEASUREMENTS Data collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing. RESULTS Second-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%. CONCLUSION Based on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.
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Maïga A, Ogyu A, Millogo RM, Lopez-Hernandez A, Labité MA, Labrique A, Agarwal S. Use of a digital job-aid in improving antenatal clinical protocols and quality of care in rural primary-level health facilities in Burkina Faso: a quasi-experimental evaluation. BMJ Open 2023; 13:e074770. [PMID: 37758675 PMCID: PMC10537835 DOI: 10.1136/bmjopen-2023-074770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE We assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in Burkina Faso. DESIGN A quasi-experimental evaluation based on a cross-sectional post-intervention assessment comparing the intervention district to a comparison group. SETTING AND PARTICIPANTS The study included 331 direct observations and exit interviews of pregnant women seeking antenatal care (ANC) across 48 rural primary-level health facilities in Burkina Faso in 2021. INTERVENTION Digital CDS tool to improve health providers adherence to recommended antenatal protocols. OUTCOME MEASURES We analysed the quality of care on both the supply and demand sides. Quality-of-care service scores were based on actual care provided and expected care according to standards. Pregnant women's knowledge of counselling and satisfaction score after receiving care were also calculated. Other outcomes included time of clinical encounter. RESULTS The overall quality of health service provision was comparable across intervention and comparison health facilities (52% vs 51%) despite there being a significantly higher proportion of lower skilled providers in the intervention arm (42.5% vs 17.8%). On average, ANC visits were longer in the intervention area (median 24 min, IQR 18) versus comparison area (median 12 min, IQR: 8). The intervention arm had a significantly higher score difference in women's knowledge of received counselling (16.4 points, 95% CI 10.37 to 22.49), and women's satisfaction (16.18 points, 95% CI: 9.95 to 22.40). CONCLUSION Digital CDS tools provide a valuable opportunity to achieve substantial improvements of the quality of ANC and broadly maternal and newborn health in settings with high burden mortality and less trained health cadres when adequately implemented.
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Affiliation(s)
- Abdoulaye Maïga
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anju Ogyu
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roch Modeste Millogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Centre, Burkina Faso
| | - Angelica Lopez-Hernandez
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matè Alonyenyo Labité
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Centre, Burkina Faso
| | - Alain Labrique
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Smisha Agarwal
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Singh T, Kaur R, Kant S, Mani K, Yadav K, Gupta SK. Maternal Healthcare Services in a Rural Area of Haryana during the COVID-19 Pandemic: A Community-Based Study. Indian J Community Med 2023; 48:715-720. [PMID: 37970159 PMCID: PMC10637588 DOI: 10.4103/ijcm.ijcm_43_23] [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: 01/24/2023] [Accepted: 06/30/2023] [Indexed: 11/17/2023] Open
Abstract
Background It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. Material and Methods In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Results Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002]. Conclusion Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future.
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Affiliation(s)
- Tejbeer Singh
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Njiro BJ, Ngowi JE, Mlunde L, Munishi C, Kapologwe N, Kengia JT, Deng L, Timbrell A, Kitinya WJ, Sunguya BF. Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002097. [PMID: 37343036 DOI: 10.1371/journal.pgph.0002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation.
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Affiliation(s)
- Belinda J Njiro
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jackline E Ngowi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Linda Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Castory Munishi
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ntuli Kapologwe
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | - James T Kengia
- President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | | | - Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Symonds NE, Vidler M, Wiens MO, Omar S, English LL, Ukah UV, Ansermino JM, Ngonzi J, Bebell LM, Hwang B, Christoffersen-Deb A, Kissoon N, Payne BA. Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth 2023; 23:303. [PMID: 37120529 PMCID: PMC10148415 DOI: 10.1186/s12884-023-05459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 02/20/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. METHODS A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. RESULTS Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. CONCLUSIONS Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. TRIAL REGISTRATION PROSPERO registration number: CRD42018103955.
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Affiliation(s)
- Nicola E Symonds
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Matthew O Wiens
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Walimu, Kampala, Uganda
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - L Lacey English
- Department of Internal Medicine and Pediatrics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - U Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Mark Ansermino
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lisa M Bebell
- Infectious Diseases Division, and Center for Global Health, Massachusetts General Hospital Medical Practice Evaluation Center, Boston, MA, USA
| | - Bella Hwang
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Niranjan Kissoon
- The Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Beth A Payne
- School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
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Dusingizimana T, Ramilan T, Weber JL, Iversen PO, Mugabowindekwe M, Ahishakiye J, Brough L. Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda. BMC Pregnancy Childbirth 2023; 23:69. [PMID: 36703102 PMCID: PMC9878946 DOI: 10.1186/s12884-023-05384-0] [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: 08/21/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.
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Affiliation(s)
- Theogene Dusingizimana
- grid.10818.300000 0004 0620 2260Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, Rwanda
| | - Thiagarajah Ramilan
- grid.148374.d0000 0001 0696 9806School of Agriculture and Environment, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
| | - Janet L. Weber
- grid.148374.d0000 0001 0696 9806School of Food and Advanced Technology, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
| | - Per Ole Iversen
- grid.5510.10000 0004 1936 8921Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0317 Norway ,grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital, Oslo, 0424 Norway ,grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505 South Africa
| | - Maurice Mugabowindekwe
- grid.5254.60000 0001 0674 042XDepartment of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark ,grid.10818.300000 0004 0620 2260Centre for Geographic Information Systems and Remote Sensing, College of Science and Technology, University of Rwanda, P.0. Box 3900, Kigali, Rwanda
| | - Jeannine Ahishakiye
- grid.10818.300000 0004 0620 2260Human Nutrition and Dietetics Department, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Louise Brough
- grid.148374.d0000 0001 0696 9806School of Food and Advanced Technology, Massey University, Tennent Drive, Palmerston North, 4442 New Zealand
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Anwar J, Torvaldsen S, Morrell S, Taylor R. Maternal Mortality in a Rural District of Pakistan and Contributing Factors. Matern Child Health J 2023; 27:902-915. [PMID: 36609798 DOI: 10.1007/s10995-022-03570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. MATERIAL AND METHODS A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. RESULTS The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. CONCLUSION The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.
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Affiliation(s)
- Jasim Anwar
- Department of Community Medicine, Women Medical and Dental College, Abbottabad, Pakistan.
- School of Population Health, UNSW Sydney, Sydney, Australia.
| | - Siranda Torvaldsen
- School of Population Health, UNSW Sydney, Sydney, Australia
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | | | - Richard Taylor
- School of Population Health, UNSW Sydney, Sydney, Australia
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Maharani M, Sutrisno S. Analysis of Causes of Maternal Death in East Java Province, Indonesia. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.9549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND: The maternal mortality rate is an indicator that reflects the mother’s health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR.
AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province.
METHODS: The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases.
RESULTS: The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders — cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases.
CONCLUSION: Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.
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Tajvar M, Hajizadeh A, Zalvand R. A systematic review of individual and ecological determinants of maternal mortality in the world based on the income level of countries. BMC Public Health 2022; 22:2354. [PMID: 36522731 PMCID: PMC9753301 DOI: 10.1186/s12889-022-14686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This systematic review was conducted to map the literature on all the existing evidence regarding individual and ecological determinants of maternal mortality in the world and to classify them based on the income level of countries. Such a systematic review had not been conducted before. METHODS We conducted an electronic search for primary and review articles using "Maternal Mortality" and "Determinant" as keywords or MeSH terms in their Title or Abstract, indexed in Scopus, PubMed, and Google with no time or geographical limitation and also hand searching was performed for most relevant journals. STROBE and Glasgow university critical appraisal checklists were used for quality assessment of the included studies. Data of the determinants were extracted and classified into individual or ecological categories based on income level of the countries according to World Bank classification. RESULTS In this review, 109 original studies and 12 review articles from 33 countries or at global level met the inclusion criteria. Most studies were published after 2013. Most literature studied determinants of low and lower-middle-income countries. The most important individual determinants in low and lower-middle-income countries were location of birth, maternal education, any delays in health services seeking, prenatal care and skilled birth attendance. Household-related determinants in low-income countries included improved water source and sanitation system, region of residence, house condition, wealth of household, and husband education. Additionally, ecological determinants including human resources, access to medical equipment and facilities, total fertility rate, health financing system, country income, poverty rate, governance, education, employment, social protection, gender inequality, and human development index were found to be important contributors in maternal mortality. A few factors were more important in higher-income countries than lower-income countries including parity, IVF births, older mothers, and type of delivery. CONCLUSION A comprehensive list of factors associated with maternal death was gathered through this systematic review, most of which were related to lower-income countries. It seems that the income level of the countries makes a significant difference in determinants of maternal mortality in the world.
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Affiliation(s)
- Maryam Tajvar
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Hajizadeh
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rostam Zalvand
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ma J, Grogan-Kaylor AC, Lee SJ, Ward KP, Pace GT. Gender Inequality in Low- and Middle-Income Countries: Associations with Parental Physical Abuse and Moderation by Child Gender. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11928. [PMID: 36231226 PMCID: PMC9565581 DOI: 10.3390/ijerph191911928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Gender inequality perpetuates women's economic insecurity and a culture of violence. Parental distress caused by economic pressure may increase violence against children. High levels of gender inequality and interpersonal violence may contribute to higher levels of physical abuse. Using an ecological perspective, this study examines the association of country-level gender inequality and household-level parental physical abuse, and the moderating role of child gender in this association in low- and middle-income countries. We used data on over 420,000 households from the UNICEF Multiple Indicator Cluster Surveys and country-level indicators from the United Nations Development Program Human Development data. We employed multilevel logistic regression to examine the association between gender inequality with the log-odds of physical abuse after accounting for country- and individual-level covariates. In order to more fully explore our results, we calculated predicted probabilities of abuse for several scenarios. The results indicated that higher levels of gender inequality were associated with higher probabilities of physical abuse. This association was stronger for female children than for male children. The probabilities of abuse by child gender were indistinguishable, although rates of physical abuse converged as gender inequality increased, at a statistically marginal level. These findings indicate that macro-level interventions that reduce gender inequality are necessary to prevent and reduce child physical abuse.
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Affiliation(s)
- Julie Ma
- Department of Social Work, University of Michigan-Flint, 303 E. Kearsley St., Flint, MI 48502, USA
| | - Andrew C. Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Shawna J. Lee
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Kaitlin P. Ward
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Garrett T. Pace
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
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Toja E, Abebe A, Mekonen N, Baza D. Why Home Delivery After Full Antenatal Care Follow-Up in Southern Ethiopia? An Exploratory-Descriptive Qualitative Study. Int J Womens Health 2022; 14:765-775. [PMID: 35719720 PMCID: PMC9200408 DOI: 10.2147/ijwh.s365244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pregnant women who had full antenatal care follow-up are expected to give birth in health facilities. However, in Ethiopia, after full antenatal care booking, many women still prefer to give birth at home. Thus, the purpose of this study was to explore and describe why women give childbirth at home after full antenatal care follow-up in the study setting. Methods Exploratory-descriptive qualitative design was conducted in Humbo and Abala Abaya districts, Southern Ethiopia, from June to September 2020. Nine in-depth interviews and four focus group discussions were held with purposively selected participants. Women who gave birth at home after attending equal to or more than four antenatal care appointments in the last year were included. The collected data were majorly analyzed by inductive thematic analysis technique, but deductive analysis was also applied whenever the potential themes needed further enrichment. A thick description of the findings is done in the respective heading and sub-heading using participants’ verbatim quotations. Results A total of 9 in-depth interviews and four focus group discussions comprising 35 participants was conducted. Three major themes and nine sub-themes emerged from the data. Socio-cultural and community influences, socio-economic obstacles, and health system-related barriers are the major themes identified. Traditional practices, personal beliefs, social norms, knowledge, and attitude about institutional delivery, household economic capability, decision-making capacity of the women, delivery service quality, and service providers related barriers are the sub-themes defining the home delivery experience of women after full antenatal care follow-up in the study setting. Conclusion In this study, socio-economic, cultural, and health system-related barriers are major reasons for home delivery. Improvement of public awareness on the risk of home delivery and elimination of its facilitative social norms, empowerment of women’s economic, educational, and decision-making capability and healthcare workers’ and health facilities’ capacity are recommended.
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Affiliation(s)
- Eshetu Toja
- Department of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amene Abebe
- Department of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Niguse Mekonen
- Department of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Daniel Baza
- Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Rahman M, Saha P, Uddin J. Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy. BMC Pregnancy Childbirth 2022; 22:255. [PMID: 35346100 PMCID: PMC8961925 DOI: 10.1186/s12884-022-04588-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant. Methods We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04588-0.
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Affiliation(s)
- Mostafizur Rahman
- Department of Science and Humanities, Bangabandhu Sheikh Mujibur Rahman Aviation and Aerospace University, Old Airport, Tejgaon, Dhaka, 1215, Bangladesh.
| | - Priom Saha
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Jalal Uddin
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Alobo G, Reverzani C, Sarno L, Giordani B, Greco L. Estimating the Risk of Maternal Death at Admission: A Predictive Model from a 5-Year Case Reference Study in Northern Uganda. Obstet Gynecol Int 2022; 2022:4419722. [PMID: 35342429 PMCID: PMC8947917 DOI: 10.1155/2022/4419722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods This was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results The average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (18.7%) and complications of abortion (2.1%), whereas malaria (23.5%) and HIV/AIDS (20.6%) were the leading indirect causes. The odds of dying were higher among women who were aged 30 years or more (OR 1.12; 95% CI, 1.04-1.19), did not attend antenatal care (OR 3.11; 95% CI, 1.36-7.09), were HIV positive (OR 3.13; 95% CI, 1.41-6.95), had a caesarean delivery (OR 2.22; 95% CI 1.13-4.37), and were referred from other facilities (OR 5.57; 95% CI 2.83-10.99). Conclusion Mortality is high among mothers referred late from other facilities who are HIV positive, aged more than 30 years, lack antenatal care attendance, and are delivered by caesarean section. This calls for prompt and better assessment of referred mothers and specific attention to antibiotic therapy before and after caesarean section, especially among HIV-positive women.
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Affiliation(s)
- Gasthony Alobo
- Department of Obstetrics and Gynaecology, Lira University, Lira, Uganda
| | - Cristina Reverzani
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
| | - Barbara Giordani
- Department of Obstetrics and Gynaecology, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Luigi Greco
- GULUNAP Project, Department of Paediatrics, University of Naples Federico II, Naples, Italy
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Maternal and fetal mortality in adolescent patients. GINECOLOGIA.RO 2022. [DOI: 10.26416/gine.38.4.2022.7387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tukay SM, Pasape L, Tani K, Manzi F. Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania. Int J Womens Health 2021; 13:1227-1242. [PMID: 34916854 PMCID: PMC8669272 DOI: 10.2147/ijwh.s333900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. METHODS This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. RESULTS Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders' engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. CONCLUSION Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.
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Affiliation(s)
- Samwel Marco Tukay
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Pangani District Council, Tanga, Tanzania
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Liliane Pasape
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Kassimu Tani
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
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Stefanovic V. Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle? J Perinat Med 2021; 49:1042-1047. [PMID: 34008379 DOI: 10.1515/jpm-2021-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
Despite substantial improvement in reducing maternal mortality during the recent decades, we constantly face tragic fact that maternal mortality (especially preventable deaths) is still unacceptably too high, particularly in the developing countries, where 99% of all maternal deaths worldwide occur. Poverty, lack of proper statistics, gender inequality, beliefs and corruption-associated poor governmental policies are just few of the reasons why decline in maternal mortality has not been as sharp as it was wished and expected. Education has not yet been fully recognized as the way out of poverty, improvement of women's role in the society and consequent better perinatal care and consequent lower maternal mortality. Education should be improved on all levels including girls, women and their partners, medical providers, religious and governmental authorities. Teaching the teachers should be also an essential part of global strategy to lower maternal mortality. This paper is mostly a commentary, not a systematic review nor a meta-analysis with the aim to rise attention (again) to the role of different aspects of education in lowering maternal mortality. The International Academy of Perinatal Medicine should play a crucial role in pushing the efforts on this issue as the influential instance that promotes reflection and dialog in perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of this specific problem of huge magnitude. The five concrete steps to achieve these goals are listed and discussed.
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Affiliation(s)
- Vedran Stefanovic
- IAPM Educational Committee, Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Factors affecting optimal antenatal care utilization in Indonesia: implications for policies and practices. J Public Health Policy 2021; 42:559-573. [PMID: 34728813 DOI: 10.1057/s41271-021-00307-9] [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] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
Most maternal deaths are preventable with good antenatal care. The study aimed to examine factors relevant to optimal frequency of Antenatal Care (ANC) visits in Indonesia using the Indonesian Demographic and Health Survey 2017 data. Our study outcome was optimal numbers of ANC visits (≥ 8 visits). Predictors include age, had pregnancy termination, number of children, education level, employment status, awareness of pregnancy problems, wealth index, residence, region, health insurance coverage, and barriers to reach healthcare facilities. Of 3738 participants, about 60.2% had optimal number of ANC visits. There was an association between optimal ANC utilization and: experiencing pregnancy complications, distance to the healthcare facility, health insurance coverage, residence, region, awareness of pregnancy problems, and the number of children. Policymakers should improve healthcare facilities' availability, expand health insurance coverage, and educate women about the importance of ANC. This finding might be relevant in developing countries with similar health infrastructure situation.
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Nadella P, Subramanian SV, Roman-Urrestarazu A. The impact of community health workers on antenatal and infant health in India: A cross-sectional study. SSM Popul Health 2021; 15:100872. [PMID: 34345646 PMCID: PMC8319567 DOI: 10.1016/j.ssmph.2021.100872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Community health workers (CHWs) are central to India's strategy for reaching the Sustainable Development Goals around maternal and child health. Despite India's significant investment in these programs, few studies have analyzed the effect of CHWs across India. Objective This study aims to analyze multiple types of CHWs and their impact on a broad range of antenatal and infant health outcomes across India. Methods In this population-based cross-sectional study, we analyzed data of women interviewed by the most recent 2015–2016 National Family Health Survey-4 (NFHS-4) in India. This study performed multiple variable regressions to examine the effect of receiving ANC during pregnancy from 1) any CHW and 2) by specific type of CHW - Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW), and Community/Village Health Worker (defined in Table 1) on antenatal and infant health outcomes. Results Of 166,498 women, 14.2% received ANC from any CHW with specifically 5.9% receiving from ASHAs, 10.2% receiving from AWWs, and 0.5% receiving from Community/Village Health Workers. Women who received ANC from an ASHA had increased ANC utilization (OR 1.77; 95% CI 1.65, 1.91) as well as quality (IRR 1.06; 95% CI 1.05, 1.08), increased early initiation of breast feeding (OR 1.20; 95% CI 1.12, 1.29), and decreased one-year mortality (OR 0.75; 95% CI 0.63, 0.88). Women who received ANC from an AWW had increased ANC utilization (OR 2.24; 95% CI 2.12, 2.37) as well as quality (IRR 1.07, 95% CI 1.06, 1.08) and increased early initiation of breast feeding (OR 1.30; 95% CI 1.26, 1.40). Conclusion Receiving ANC from ASHAs and AWWs is associated with improved ANC utilization, ANC quality, early initiation of breastfeeding and the key outcome of reduced infant mortality. 14% of women received antenatal care from any community health worker. ASHAs improve antenatal care utilization and quality, early initiation of breastfeeding, and infant mortality. Anganwadi workers improve antenatal care utilization and quality as well as early initiation of breastfeeding.
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Affiliation(s)
- Pranay Nadella
- Centre for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - S V Subramanian
- Department of Social and Behavioural Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA.,Harvard Centre for Population and Development Studies, Harvard University, Boston, USA
| | - Andres Roman-Urrestarazu
- Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
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Miller P, Afulani PA, Musange S, Sayingoza F, Walker D. Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data. BMC Pregnancy Childbirth 2021; 21:290. [PMID: 33838658 PMCID: PMC8037834 DOI: 10.1186/s12884-021-03747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that women's experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda. METHODS We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC. RESULTS PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC. CONCLUSIONS This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.
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Affiliation(s)
- Phoebe Miller
- University of California San Francisco, San Francisco, USA.
| | | | - Sabine Musange
- University of Rwanda School of Public Health, Kigali, Rwanda
| | | | - Dilys Walker
- University of California San Francisco, San Francisco, USA
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Singh P, Singh KK, Singh P. Maternal health care service utilization among young married women in India, 1992-2016: trends and determinants. BMC Pregnancy Childbirth 2021; 21:122. [PMID: 33568078 PMCID: PMC7877063 DOI: 10.1186/s12884-021-03607-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. METHODS The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992-93, 1998-99, 2005-06 and 2015-16. Young married women aged 15-24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05. RESULTS The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88 and 83% during 2015-16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. CONCLUSIONS In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.
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Affiliation(s)
- Pooja Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Kaushalendra Kumar Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Pragya Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
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Amini-Rarani M, Mansouri A, Nosratabadi M. Decomposing educational inequality in maternal mortality in Iran. Women Health 2021; 61:244-253. [PMID: 33390093 DOI: 10.1080/03630242.2020.1856294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Given the significance of educational equality as one of the key social determinants of health in maternal health outcomes, the present study aimed to assess maternal mortality inequality and its main contributors based on the level of education amongst mothers living in Isfahan, Iran. In this case-control study, all 171 maternal deaths in the Isfahan Province during 2001-2016 were taken from the national maternal mortality surveillance system (as a case group). For the control group, 523 mothers who were alive were selected from 22 health centers located in 21 cities in the province of Isfahan. Concentration index and curve were used to measure educational inequality in maternal mortality. The chi-square test was used to select explanatory social and health variables to enter the decomposition model. The analyses were performed with STATA 12. Social and healthcare factors accounted for 43.57% and 23.44% of educational inequality, respectively. The normalized maternal mortality concentration index was -0.13 (95% CI, -0.10 to -0.02). Among the social factors, the mother's education level (38.14%) and immigrant status (25.39%) contributed the most to educational inequality. Regarding healthcare factors, proximate medical causes (14.49%) and the number of pregnancies (9.72%) had the highest contribution. Maternal mortality has been distributed unequally among the less and more educated mothers in Iran, which suggests that promoting health literacy is imperative, especially for women with lower education levels.
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Affiliation(s)
- Mostafa Amini-Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nosratabadi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Prevention of iron deficiency anemia in infants and toddlers. Pediatr Res 2021; 89:63-73. [PMID: 32330927 DOI: 10.1038/s41390-020-0907-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/08/2022]
Abstract
Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem. Identification of anemia is crucial to public health interventions. It is estimated globally that 273 million children under 5 years of age were anemic in 2011, and about ~50% of those cases were attributable to iron deficiency (Lancet Global Health 1:e16-e25, 2013). Iron-deficiency anemia (IDA) in infants adversely impacts short-term hematological indices and long-term neuro-cognitive functions of learning and memory that result in both fatigue and low economic productivity. IDA contributes to death and disability and is an important risk factor for maternal and perinatal mortality, including the risks for stillbirths, prematurity, and low birth weight (Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Ch. 3 (World Health Organization, Geneva, 2004)). Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as delayed cord clamping (DCC). DCC until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. DCC, an effective anemia prevention strategy, requires cooperation among health providers involved in childbirth, and a participatory culture change in public health. Public intervention strategies must consider multiple factors associated with anemia listed in this review before designing intervention studies that aim to reduce anemia prevalence in infants and toddlers. IMPACT: Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem and identification of anemia is crucial to public health interventions. Delayed cord clamping (DCC) until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as DCC.
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Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB, Hibberd PL, Garces AL, Figueroa L, Krebs NF, Esamai F, Nyongesa P, Liechty EA, Carlo WA, Chomba E, Goudar SS, Kavi A, Derman RJ, Saleem S, Jessani S, Billah SM, Koso-Thomas M, McClure EM, Goldenberg RL, Bose C. Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reprod Health 2020; 17:173. [PMID: 33334343 PMCID: PMC7745363 DOI: 10.1186/s12978-020-00990-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION The MNHR is registered at NCT01073475 .
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Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | | | | | - Jackie Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India
- Adjunct Faculty Medical Research, Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | | | | | | | - Sk Masum Billah
- Maternal and Child Health Division (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
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Khankhell RMK, Ghotbi N, Hemat S. <Editors' Choice> Factors influencing utilization of postnatal care visits in Afghanistan. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:711-723. [PMID: 33311802 PMCID: PMC7719444 DOI: 10.18999/nagjms.82.4.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) defines the postnatal period as the first six weeks (42 days) after delivery and recommends four postnatal care (PNC) visits for women giving birth to a child to enable early detection and treatment of complications. However, a low utilization of PNC visits by Afghan women has contributed to a relatively high maternal mortality in Afghanistan. This study aimed to identify factors influencing the utilization of PNC visits among Afghan women by sampling nationally representative data from Afghanistan Demographic and Health Survey (AfDHS), 2015. The logistic model was used to measure the adjusted odds of utilizing PNC services among women, with a 95% confidence interval (95% CI) and a p-value of <0.05 for statistical significance. The study found that the utilization of PNC visits in Afghanistan is low; among 8,581 women (44%) who utilized PNC visits and 10,924 women (56%) who didn’t, the women’s age, place of residence, parity, education, occupation, number of antenatal care (ANC) visits, place of delivery, exposure to public media, the woman’s role in decision making and needing a permission to seek healthcare were found to be associated with the level of utilization of PNC visits. Based on the study results, health promotion interventions are recommended to increase the utilization of PNC visits.
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Affiliation(s)
| | - Nader Ghotbi
- Graduate School of Asia Pacific Studies, Ritsumeikan Asia Pacific University, Beppu, Japan
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Fadiloglu E, Unal C, Tanacan A, Ocal S, Kilicaslan B, Akinci SB, Topeli A, Beksac MS. Maternal Mortality: 10 Year Experience of a Tertiary Center in Turkey. Case Rep Med 2020; 2020:3595024. [PMID: 33061988 PMCID: PMC7545441 DOI: 10.1155/2020/3595024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
We retrospectively evaluated five maternal mortality cases that occurred in our institution within the last 10 years. Rate of maternal mortality was 24.5 per 100000 live births. Maternal mortality causes were cardiopulmonary failure secondary to veno-occlusive disease, septic shock secondary to osteosarcoma, pulmonary thromboembolism secondary to metastatic breast cancer, septic shock secondary to cholecystitis, and postpartum hemorrhage secondary to Niemann-Pick disease. Four out of five cases were evaluated as indirect maternal mortality cases. Three out of five cases ended up with a healthy newborn, while other cases ended up with abortus and postpartum exitus.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Serpil Ocal
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Banu Kilicaslan
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Seda Banu Akinci
- Division of Critical Care, Department of Anaesthesiology and Reanimation, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Arzu Topeli
- Division of Critical Care, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
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Horwood G, Opondo C, Choudhury SS, Rani A, Nair M. Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data. BMJ Open 2020; 10:e038910. [PMID: 32819952 PMCID: PMC7440828 DOI: 10.1136/bmjopen-2020-038910] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the risk factors for pregnancy-related death in India's nine Empowered Action Group (EAG) states. DESIGN Secondary data analysis of the Indian Annual Health Survey (2010-2013). SETTING Nine states: Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. PARTICIPANTS 1 989 396 pregnant women. METHODS Maternal mortality ratio (MMR), overall and for each state, with 95% CI was calculated. Stepwise multivariable logistic regression was used to investigate the association of risk factors with maternal mortality. Area under the receiver-operating characteristic (AUROC) curve was used to assess the prediction of the model. OUTCOME MEASURES MMR adjusted for survey design, adjusted OR (aOR)with 95% CI and C-statistic with 95% CI. RESULTS MMR calculated for the nine states was 383/100 000 live births (95% CI 346 to 423 per 100 000). Age exhibited a U-shaped association with maternal mortality. Not having a health scheme and belonging to a scheduled caste or scheduled tribe group were significant risk factors for maternal death with aOR of 2.72 (95% CI 2.41 to 3.07), 1.10 (95% CI 1.02 to 1.18) and 1.43 (95% CI 1.31 to 1.56), respectively. Socioeconomic status and rural residence were not associated with maternal mortality after adjusting for access to a healthcare facility. Complications of pregnancy and medical comorbidities were the strongest risk factors for maternal death (aOR 50.2, 95% CI 44.5 to 56.6). Together, the risk factors identified accounted for 89% (95% CI 0.887 to 0.894) of the AUROC. CONCLUSIONS Maternal mortality in India's EAG states greatly exceeds the national average. The identified risk factors demonstrate the importance of improving the quality of pregnancy care. Notably, the study showed that the risk conferred by poor socioeconomic status could be mitigated by universal access to healthcare during pregnancy and childbirth.
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Affiliation(s)
- Geneviève Horwood
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Charles Opondo
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Saswati Sanyal Choudhury
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Anjali Rani
- Department of Obstetrics and Gynaecology, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Manisha Nair
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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Brandt AJ, Pedroza J, Cassiani SHDB, Brown S, da Silva FAM. Maternal health training priorities for nursing and allied professions in Haiti. Rev Panam Salud Publica 2020; 44:e67. [PMID: 32684914 PMCID: PMC7363286 DOI: 10.26633/rpsp.2020.67] [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: 12/04/2019] [Accepted: 03/19/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives This study summarizes the findings of a training needs and priority assessment completed in Haiti. Its objective is to describe the characteristics of nursing and allied professions providing first level maternal health care and identify training needs and priorities to inform planning of Human Resources for Health interventions. Methods A cross-sectional survey was completed between October 2016 and March 2017 by the Pan American Health Organization/World Health Organization Haiti office in collaboration with national health authorities. Participants reached consensus to submit one finalized version of the survey. Data were collected on composition, capacities, and training needs and priorities of traditional birth attendants, community health workers, registered nurses, professional midwives, and auxiliary nurses. Results Haiti relies heavily on community level workers including community health workers, auxiliary nurses, and traditional birth attendants. Traditional birth attendants attend the majority of Haiti's births, despite having low education levels and not being regulated by the Ministry of Public Health and Population. All professional categories prioritize preventive capacities such as timely identification of complications, while none are trained to manage postpartum hemorrhage, preeclampsia, or eclampsia. Management of obstetric emergencies is a training priority for Haiti but is not part of the scope of work of the nursing and allied health professions included in this study. Conclusions Community level health workers are key in providing preventive care and referral of complicated pregnancies, but lack of access to providers qualified to treat obstetric complications remains a challenge to reducing maternal mortality.
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Affiliation(s)
- Amelia J Brandt
- Pan American Health Organization/World Health Organization Washington DC United States of America Pan American Health Organization/World Health Organization, Washington DC, United States of America
| | - Julio Pedroza
- Pan American Health Organization/World Health Organization Port-au-Prince Haiti Pan American Health Organization/World Health Organization, Port-au-Prince, Haiti
| | - Silvia H de Bortoli Cassiani
- Pan American Health Organization/World Health Organization Washington DC United States of America Pan American Health Organization/World Health Organization, Washington DC, United States of America
| | - Samantha Brown
- George Washington University Washington DC United States of America George Washington University, Washington DC, United States of America
| | - Fernando A Menezes da Silva
- Pan American Health Organization/World Health Organization Washington DC United States of America Pan American Health Organization/World Health Organization, Washington DC, United States of America
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Diana S, Wahyuni CU, Prasetyo B. Maternal complications and risk factors for mortality. J Public Health Res 2020; 9:1842. [PMID: 32728581 PMCID: PMC7376486 DOI: 10.4081/jphr.2020.1842] [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: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Maternal mortality could be prevented through early detection, including the period preceding pregnancy. Women of childbearing age are faced with extreme uncertainties, hence the purpose of this study was to analyse maternal complications and the possible high-risk factors connected to maternal mortality. Design and methods: A case-control study was used to study the causes of maternal mortalities amongst pregnant, delivering, and postpartum mothers between 2017 and 2018. A total sample size of 48 samples was selected through simple random sampling. Results: The result of logistic regression analysis showed nutritional status, prominence of anemia, history of illness, age, antenatal care ANC examination, method of delivery, late referral, occupational status, as well as postpartum complications, as the most influencing risk factors. This very high significance for maternal mortality was based on the chi-square value of 109.431 (p equal to 0.000), and R square (0.897). Conclusions: In conclusion, the potential risk factors of maternal mortality include nutritional status, state of anemia, history of illness, age, ANC examination, delivery method, late referral, occupational status, and pregnancy complications, which is specifically the most dominant factor.
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Affiliation(s)
| | | | - Budi Prasetyo
- Faculty of Medicine, Airlangga University, Mulyorejo, Surabaya, Indonesia
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Maternal health services utilization and maternal mortality in China: a longitudinal study from 2009 to 2016. BMC Pregnancy Childbirth 2020; 20:220. [PMID: 32295528 PMCID: PMC7161293 DOI: 10.1186/s12884-020-02900-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background The Chinese government introduced the maternal health services as part of the Basic Public Health Service (BPHS) project in 2009. While China has made progress in reducing maternal mortality, the longitudinal association between the utilization rate of the maternal health services of the BPHS project and such reduction was rarely evaluated with robust methods. Methods We conducted a longitudinal study on the maternal health service utilization rates of the BPHS project and the maternal mortality ratios (MMR) in mainland China and its 31 provincial regions. The data were extracted from the National Health Statistic Yearbooks (2009–2016). Panel data models were used to evaluate the association between the utilization rate and the MMR after adjusting for available covariates on healthcare resources. Stepwise regression models were used to gauge the direction and magnitude of omitted variable bias. Results It was found that the service utilization rate increased from 79.24% in 2009 to 91.67% in 2016, while MMR decreased from 30.90 to 17.88 per 100,000 livebirths at the national level. The results of the fixed effects panel data model revealed that the utilization rate was associated with MMR deduction continuously. With every 1% increase in utilization rate, the maternal death would decrease by 0.35 per 100,000 livebirths after having the health resources variables adjusted. Conclusions The utilization of maternal health services increased continuously after the introduction of BPHS project in 2009 and MMR went downward from then on. The utilization of maternal health services did have significant association with MMR and could reduce MMR effectively. Such improvement could be attributed to the fact that this program was designed to serve the targeted population throughout the continuum of maternal care and the government’s rigorous efforts in stressing equality and standard care in program implementation.
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Tekela DD, Asmare AG, Gebremariam BM, Assegahegn CA, Wami KD, Nemomssa HD, Simegn GL. Digital postpartum hemorrhage management device (DPHMD). BMC Pregnancy Childbirth 2019; 19:438. [PMID: 31771534 PMCID: PMC6878627 DOI: 10.1186/s12884-019-2601-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Abstract
Background Primary postpartum hemorrhage (PPH) is an obstetric emergency caused by excessive blood loss that occurs most commonly after the placenta is delivered. PPH can lead to volume depletion, hypovolemic shock, anemia, and it is the leading cause of maternal mortality worldwide. With 470 deaths per 100,000 live births, the maternal mortality ratio in Ethiopia is one of the highest in the world. It is estimated that 94% of births occur at home in Ethiopia and that 10% of maternal deaths are attributed to PPH. Currently, physicians use visual estimation to calculate blood loss and provide fluid during delivery. This traditional method is subjective and generally inaccurate. Method In this project, after delivery blood loss measurement system integrated with fluid delivery and vital sign monitoring method is proposed. The collection and measurement system collects blood loss after delivery and measures the amount of blood loss. The management system continuously monitors the mother’s heart rate and blood pressure. These vital sign values are integrated with the measured blood loss to estimate the amount of IV fluid required to be delivered for the mother. The rate of IV fluid delivery is regulated by a flow rate sensor and solenoid valve. Results The prototype was built and undergone through different tests and iterations. The proposed device was tested for accuracy, cost effectiveness and ease to use. 91.28% accuracy has been achieved and the prototype was built with less than 210 USD. Conclusion The proposed design allows physicians, especially those in low resource setting, to estimate blood loss and deliver fluid accurately. This helps to reduce maternal mortality rate that may occur due to postpartum hemorrhage.
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Affiliation(s)
- Derartu D Tekela
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Abeba G Asmare
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Birhan M Gebremariam
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Christian A Assegahegn
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Kidist D Wami
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Hundessa D Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Gizeaddis L Simegn
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia.
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Austad K, Juarez M, Shryer H, Moratoya C, Rohloff P. Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala. BMJ Qual Saf 2019; 29:169-178. [PMID: 31678958 PMCID: PMC7045784 DOI: 10.1136/bmjqs-2019-009524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers-obstetric care navigators (OCN)-trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals. METHODS This project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala's Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods. RESULTS Over the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support. CONCLUSIONS OCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.
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Affiliation(s)
- Kirsten Austad
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala .,Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Division of Women's Health, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Michel Juarez
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala
| | - Hannah Shryer
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala
| | | | - Peter Rohloff
- Wuqu' Kawoq - Maya Health Alliance, Tecpán, Guatemala.,Division of Global Health Equity and Social Change, Brigham & Women's Hospital and Children's Hospital, Boston, Massachusetts, USA
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Azimi MW, Yamamoto E, Saw YM, Kariya T, Arab AS, Sadaat SI, Farzad F, Hamajima N. Factors associated with antenatal care visits in Afghanistan: secondary analysis of Afghanistan Demographic and Health Survey 2015. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:121-131. [PMID: 30962661 PMCID: PMC6433637 DOI: 10.18999/nagjms.81.1.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women were 20-29 years old (53.3%), poor (41.7%), had 2–4 children (43.9%), lived in rural areas (76.1%), and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision about their healthcare and that getting permission from their husbands was a major challenge. Multivariate analysis showed that age, ethnicity, area of residence, parity, women’s education, husband’s education, literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from the husband were significantly correlated with availing of the ANC visits. This study showed that not only the socio-demographic factors but also the cultural factors were associated with ANC visits. The Afghanistan government should improve the education programs at schools and healthcare facilities, for both men and women. To augment women’s propensity to take a decision, the programs for women’s empowerment need to be supported and extended across the country.
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Affiliation(s)
- Mohammad Walid Azimi
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Monitoring Department, Ministry of Public Health, Kabul, Afghanistan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campus Institute, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Nagoya University Asian Satellite Campus Institute, Nagoya, Japan
| | - Ahmad Shekib Arab
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Said Iftekhar Sadaat
- Research and Evaluation Department, Ministry of Public Health, Kabul, Afghanistan
| | - Fraidoon Farzad
- Chief of Staff Office, Ministry of Public Health, Kabul, Afghanistan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Amoo TB, Ajayi OS. Maternal mortality and factors affecting it, among pregnant women in Abeokuta South, Nigeria. ACTA ACUST UNITED AC 2019. [DOI: 10.29328/journal.cjog.1001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mwangi A, Nangami M, Tabu J, Ayuku D, Were E, Fabian E. A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: baseline survey on maternal health. Afr Health Sci 2019; 19:1841-1848. [PMID: 31656466 PMCID: PMC6794517 DOI: 10.4314/ahs.v19i2.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. Objectives The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. Methods This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. Results A total of 6257 women participated in the study, median age 27 years IQR 23–32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Conclusion Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.
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Affiliation(s)
- Ann Mwangi
- Moi University School of Medicine, Behavioural Science
| | | | - John Tabu
- Moi University School of Public Health
| | - David Ayuku
- Moi University School of Medicine, Behavioural Science
| | - Edwin Were
- Moi University, School of Medicine, Reproductive Health
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Justo N, Espinoza MA, Ratto B, Nicholson M, Rosselli D, Ovcinnikova O, García Martí S, Ferraz MB, Langsam M, Drummond MF. Real-World Evidence in Healthcare Decision Making: Global Trends and Case Studies From Latin America. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:739-749. [PMID: 31198192 DOI: 10.1016/j.jval.2019.01.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/19/2018] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Real-world evidence (RWE) is increasingly used to inform health technology assessments for resource allocation, which are valuable tools for emerging economies such as in America. Nevertheless, the characteristics and uses in South America are unknown. OBJECTIVES To identify sources, characteristics, and uses of RWE in Argentina, Brazil, Colombia, and Chile, and evaluate the context-specific challenges. The implications for future regulation and responsible management of RWE in the region are also considered. METHODS A systematic literature review, database mapping, and targeted gray literature search were conducted to identify the sources and characteristics of RWE. Findings were validated by key opinion leaders attending workshops in 4 South American countries. RESULTS A database mapping exercise revealed 407 unique databases. Geographic scope, database type, population, and outcomes captured were reported. Characteristics of national health information systems show efforts to collect interoperable data from service providers, insurers, and government agencies, but that initiatives are hampered by fragmentation, lack of stewardship, and resources. In South America, RWE is mainly used for pharmacovigilance and as pure academic research, but less so for health technology assessment decision making or pricing negotiations and not at all to inform early access schemes. CONCLUSIONS The quality of real-world data in the case study countries vary and RWE is not consistently used in healthcare decision making. Authors recommend that future studies monitor the impact of digitalization and the potential effects of access to RWE on the quality of patient care.
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Affiliation(s)
- Nahila Justo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Real World Evidence, Strategy and Analytics, ICON plc, Stockholm, Sweden.
| | - Manuel A Espinoza
- Department of Public Health, Pontificia Universidad Católica del Chile, Santiago, Chile
| | - Barbara Ratto
- Novartis Pharmaceuticals Corp, East Hanover, NJ, USA
| | - Martha Nicholson
- Real World Evidence, Strategy and Analytics, ICON plc, Stockholm, Sweden
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogatá, Colombia
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Amoakoh HB, Klipstein-Grobusch K, Grobbee DE, Amoakoh-Coleman M, Oduro-Mensah E, Sarpong C, Frimpong E, Kayode GA, Agyepong IA, Ansah EK. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs. JMIR Mhealth Uhealth 2019; 7:e12879. [PMID: 31127719 PMCID: PMC6555115 DOI: 10.2196/12879] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.
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Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Mary Amoakoh-Coleman
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Charity Sarpong
- Regional Health Directorate, Ghana Health Services, Koforidua, Ghana
| | - Edith Frimpong
- Dodowa Research Centre, Ghana Health Service, Accra, Ghana
| | - Gbenga A Kayode
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | | | - Evelyn K Ansah
- Centre for Malaria Research, University of Health and Allied Sciences, Ho, Ghana
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Mobile obstetric and neonatal simulation based skills training in India. Midwifery 2019; 72:14-22. [DOI: 10.1016/j.midw.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/26/2019] [Accepted: 02/06/2019] [Indexed: 11/19/2022]
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Rurangirwa AA, Mogren I, Ntaganira J, Govender K, Krantz G. Quality of antenatal care services in Rwanda: assessing practices of health care providers. BMC Health Serv Res 2018; 18:865. [PMID: 30453996 PMCID: PMC6245627 DOI: 10.1186/s12913-018-3694-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda. METHODS This facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used. RESULTS Nurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively. CONCLUSION The providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.
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Affiliation(s)
- Akashi Andrew Rurangirwa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Box 453, 405 30 Göteborg, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, 4000 South Africa
| | - Gunilla Krantz
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Sole KB, Staff AC, Laine K. The association of maternal country of birth and education with hypertensive disorders of pregnancy: A population-based study of 960 516 deliveries in Norway. Acta Obstet Gynecol Scand 2018; 97:1237-1247. [PMID: 29873810 DOI: 10.1111/aogs.13393] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Previous studies estimating the association of maternal country of birth and education with hypertensive disorders of pregnancy (HDP) have shown conflicting results. The aim of the study was to assess the prevalence of HDP and estimate the association of maternal country of birth and education level with preeclampsia/eclampsia and gestational hypertension in Norway. MATERIAL AND METHODS We performed a population-based observational cohort study linking two population datasets: The Medical Birth Registry of Norway and Statistics Norway (SSB). Singleton deliveries in Norway between 1999 and 2014 (907 048 deliveries) were stratified by parity. Multiple regression analysis was performed. RESULTS In 20% of the deliveries the woman was born outside of Norway. Foreign-born women had lower risk of preeclampsia/eclampsia and gestational hypertension compared with Norwegian-born women. High education reduced the risk for preeclampsia/eclampsia by 34% (adjusted odds ratio 0.66, 95% CI 0.62-0.69), compared with women with secondary education among nulliparous women, and by 39% (adjusted odds ratio 0.61, 95% CI 0.57-0.65) among parous women. Poorly educated women had no increased risk of HDP compared with women with secondary education. Among highly educated nulliparous women the risk of preeclampsia/eclampsia was lower but the risk of gestational hypertension higher compared with women of similar parity with secondary education. Adjustment for confounding variables had minimal effect on these estimates. CONCLUSIONS Maternal country of birth and education were associated with HDP. Women with higher education had the lowest risk of HDP, and Norwegian-born women had the highest risk of HDP, regardless of parity and other confounding factors.
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Affiliation(s)
- Kristina Baker Sole
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,County Governor of Oslo and Akershus, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gynecology, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway.,Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Oslo, Norway
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Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reprod Health 2018; 15:120. [PMID: 29973229 PMCID: PMC6033207 DOI: 10.1186/s12978-018-0554-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
Background/objective Guatemala’s indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates. Methods A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume. Results Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22–58) compared to the later-access arm (median 20 per 100, IQR 0–30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5–50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10–9.86). Conclusions Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts. Trial registration Clinicaltrials.gov NCT02348840.
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Affiliation(s)
- Boris Martinez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Enma Coyote Ixen
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Rachel Hall-Clifford
- Departments of Sociology and Anthropology and Public Health, Agnes Scott College, Decatur, GA, USA
| | - Michel Juarez
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Francis
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | | | - Lisa Stroux
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA.,Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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Yakubu Y, Mohamed Nor N, Abidin EZ. A systematic review of micro correlates of maternal mortality. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:147-161. [PMID: 29729149 DOI: 10.1515/reveh-2017-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
In the year 2000, the World Health Organization launched the Millennium Development Goals (MDGs) which were to be achieved in 2015. Though most of the goals were not achieved, a follow-up post 2015 development agenda, the Sustainable Development Goals (SDGs) was launched in 2015, which are to be achieved by 2030. Maternal mortality reduction is a focal goal in both the MDGs and SDGs. Achieving the maternal mortality target in the SDGs requires multiple approaches, particularly in developing countries with high maternal mortality. Low-income developing countries rely to a great extent on macro determinants such as public health expenditure, which are spent mostly on curative health and health facilities, to improve population health. To complement the macro determinants, this study employs the systematic review technique to reveal significant micro correlates of maternal mortality. The study searched MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and Global Index Medicus of the World Health Organization. Our search was time framed from the 1st January, 2000 to the 30th September, 2016. In the overall search result, 6758 articles were identified, out of which 33 were found to be eligible for the review. The outcome of the systematic search for relevant literature revealed a concentration of literature on the micro factors and maternal mortality in developing countries. This shows that maternal mortality and micro factors are a major issue in developing countries. The studies reviewed support the significant relationship between the micro factors and maternal mortality. This study therefore suggests that more effort should be channelled to improving the micro factors in developing countries to pave the way for the timely achievement of the SDGs' maternal mortality ratio (MMR) target.
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Affiliation(s)
- Yahaya Yakubu
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
- Department of Economics, Faculty of Social and Management Sciences, Bauchi State University Gadau, Bauchi State, Nigeria
| | - Norashidah Mohamed Nor
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
| | - Emilia Zainal Abidin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
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Abstract
This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone.
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Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Togoobaatar G, Thangaratinam S, Khan KS. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. LANCET GLOBAL HEALTH 2018; 6:e548-e554. [PMID: 29571592 DOI: 10.1016/s2214-109x(18)30078-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/09/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. METHODS We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. FINDINGS 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). INTERPRETATION Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. FUNDING Barts and the London Charity.
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Affiliation(s)
- Jahnavi Daru
- Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK.
| | - Javier Zamora
- Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK; CIBER Epidemiology and Public Health, Madrid, Spain
| | - Borja M Fernández-Félix
- CIBER Epidemiology and Public Health, Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - Joshua Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Maria Regina Torloni
- Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil
| | - Suneeta Mittal
- Department of Obstetrics & Gynecology, Fortis Memorial Research Institute, Gurgaon, India
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Shakila Thangaratinam
- Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK
| | - Khalid S Khan
- Barts Research Centre for Women's Health, WHO Collaborating Centre, Queen Mary University of London, London, UK
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49
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Lagrew DC, Kane Low L, Brennan R, Corry MP, Edmonds JK, Gilpin BG, Frost J, Pinger W, Reisner DP, Jaffer S. National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births-Supporting Intended Vaginal Births. J Obstet Gynecol Neonatal Nurs 2018; 47:214-226. [PMID: 29478788 DOI: 10.1016/j.jogn.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit. This National Partnership for Maternity Safety bundle, as with other bundles, is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Bundle components may be adapted to individual facilities, but standardization within an institution is advised. Evidence-based resources and recommendations are provided to assist implementation.
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Lagrew DC, Low LK, Brennan R, Corry MP, Edmonds JK, Gilpin BG, Frost J, Pinger W, Reisner DP, Jaffer S. National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births- Supporting Intended Vaginal Births. J Midwifery Womens Health 2018; 63:235-244. [PMID: 29471583 DOI: 10.1111/jmwh.12738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit. This National Partnership for Maternity Safety bundle, as with other bundles, is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Bundle components may be adapted to individual facilities, but standardization within an institution is advised. Evidence-based resources and recommendations are provided to assist implementation.
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