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Actis Danna V, Bedwell C, Wakasiaka S, Lavender T. Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis. Glob Health Action 2020; 13:1819052. [PMID: 33040697 PMCID: PMC7580724 DOI: 10.1080/16549716.2020.1819052] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/28/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care. OBJECTIVE To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care. METHODS We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the 'best-fit framework approach'. RESULTS This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model's structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay's definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women's individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach. CONCLUSION This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women's Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women's empowerment during pregnancy and childbirth.
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Affiliation(s)
- Valentina Actis Danna
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carol Bedwell
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sabina Wakasiaka
- College of Health Science, School of Nursing, University of Nairobi, Nairobi, Kenya
| | - Tina Lavender
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Halvorsen CP, Olson L, Araújo AC, Karlsson M, Nguyễn TT, Khu DTK, Le HTT, Nguyễn HTB, Winbladh B, Russom A. A rapid smartphone-based lactate dehydrogenase test for neonatal diagnostics at the point of care. Sci Rep 2019; 9:9301. [PMID: 31243323 PMCID: PMC6595069 DOI: 10.1038/s41598-019-45606-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/07/2019] [Indexed: 11/09/2022] Open
Abstract
There is a growing recognition of the importance of point-of-care tests (POCTs) for detecting critical neonatal illnesses to reduce the mortality rate in newborns, especially in low-income countries, which account for 98 percent of reported neonatal deaths. Lactate dehydrogenase (LDH) is a marker of cellular damage as a result of hypoxia-ischemia in affected organs. Here, we describe and test a POC LDH test direct from whole blood to provide early indication of serious illness in the neonate. The sample-in-result-out POC platform is specifically designed to meet the needs at resource-limited settings. Plasma is separated from whole blood on filter paper with dried-down reagents for colorimetric reaction, combined with software for analysis using a smartphone. The method was clinically tested in newborns in two different settings. In a clinical cohort of newborns of Stockholm (n = 62) and Hanoi (n = 26), the value of R using Pearson's correlation test was 0.91 (p < 0.01) and the R2 = 0.83 between the two methods. The mean LDH (±SD) for the reference method vs. the POC-LDH was 551 (±280) U/L and 552 (±249) U/L respectively, indicating the clinical value of LDH values measured in minutes with the POC was comparable with standardized laboratory analyses.
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Affiliation(s)
- Cecilia Pegelow Halvorsen
- Department of clinical research and education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Neonatal Unit at Sachs' Children and Youth hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam
| | | | - Mathias Karlsson
- Calmark Sweden AB, Stockholm, Sweden.,Department of Medical Sciences, Biomedical Structure and Function, Uppsala University, Uppsala, Sweden
| | - Trang Thị Nguyễn
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Dung T K Khu
- Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam.,Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T T Le
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Hoa T B Nguyễn
- Neonatal Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.,Research Institute for Child Health, Hanoi, Vietnam
| | - Birger Winbladh
- Department of clinical research and education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Aman Russom
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
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Onono MA, Wahome S, Wekesa P, Adhu CK, Waguma LW, Serem T, Owenga MA, Ong'wen P. Effects of an expanded Uber-like transport system on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homa Bay, Kenya. BMJ Glob Health 2019; 4:e001254. [PMID: 31179030 PMCID: PMC6528775 DOI: 10.1136/bmjgh-2018-001254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kenya's progress towards reducing maternal and neonatal deaths is at present 'insufficient'. These deaths could be prevented if the three delays, that is, in deciding to seek healthcare (delay 1), in accessing formal healthcare (delay 2) and in receiving quality healthcare (delay 3), are comprehensively addressed. We designed a mobile phone enhanced 24 hours Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages to address these delays. Our main objective was to evaluate the impact of this intervention on women's adherence to recommended antenatal (ANC) and postnatal care (PNC) regimes and facility birth. METHODS We conducted a prospective cohort study. Women were eligible to participate in the study if they were 15 years or older and less than 28 weeks gestation. We defined cases as those who received the standard of care plus the intervention and the control group as those who received the standard of care only. For analysis, we used logistic regression analysis and report crude and adjusted OR (aOR) and 95 % CI. RESULTS Cases (women who received the intervention) had five times higher odds of having four or more ANC visits (aOR=4.7, 95% CI 3.20 to 7.09), three times higher odds of taking between 30 and 60 min to reach a health facility for delivery (aOR=3.14, 95% CI 2.37 to 4.15) and four times higher odds of undergoing at least four PNC visits (aOR=4.10, 95% CI 3.11 to 5.36). CONCLUSION An enhanced community-based Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages significantly increased the utilisation of ANC and PNC services as well as shortened the time taken to reach an appropriate facility for delivery compared with standard care.
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Affiliation(s)
- Maricianah Atieno Onono
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Samuel Wahome
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline Wekesa
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Catherine Kidiga Adhu
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lawrence Wandei Waguma
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Titus Serem
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mildred Anyango Owenga
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Patricia Ong'wen
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
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Gass JD, Semrau K, Sana F, Mankar A, Singh VP, Fisher-Bowman J, Neal BJ, Tuller DE, Kumar B, Lipsitz S, Sharma N, Kodkany B, Kumar V, Gawande A, Hirschhorn LR. Evaluation of a call center to assess post-discharge maternal and early neonatal outcomes of facility-based childbirth in Uttar Pradesh, India. PLoS One 2018; 13:e0207987. [PMID: 30481209 PMCID: PMC6258538 DOI: 10.1371/journal.pone.0207987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Maternal and neonatal outcomes in the immediate post-delivery period are critical indicators of quality of care. Data on childbirth outcomes in low-income settings usually require home visits, which can be constrained by cost and access. We report on the use of a call center to measure post-discharge outcomes within a multi-site improvement study of facility-based childbirth in Uttar Pradesh, India. Methods Of women delivering at study sites eligible for inclusion, 97.9% (n = 157,689) consented to follow-up. All consenting women delivering at study facilities were eligible to receive a phone call between days eight and 42 post-partum to obtain outcomes for the seven-day period after birth. Women unable to be contacted via phone were visited at home. Outcomes, including maternal and early neonatal mortality and maternal morbidity, were ascertained using a standardized script developed from validated survey questions. Data Quality Assurance (DQA) included accuracy (double coding of calls) and validity (consistency between two calls to the same household). Regression models were used to identify factors associated with inconsistency. Findings Over 23 months, outcomes were obtained by the call center for 98.0% (154,494/157,689) consenting women and their neonates. 87.9% of call center-obtained outcomes were captured by phone call alone and 12.1% required the assistance of a field worker. An additional 1.7% were obtained only by a field worker, 0.3% were lost-to-follow-up, and only 0.1% retracted consent. The call center captured outcomes with a median of 1 call (IQR 1–2). DQA found 98.0% accuracy; data validation demonstrated 93.7% consistency between the first and second call. In a regression model, significant predictors of inconsistency included cases with adverse outcomes (p<0.001), and different respondents on the first and validation call (p<0.001). Conclusions In areas with widespread mobile cell phone access and coverage, a call center is a viable and efficient approach for measurement of post-discharge childbirth outcomes.
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Affiliation(s)
- Jonathon D. Gass
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Katherine Semrau
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fatima Sana
- Population Services International- India, New Delhi, India
| | - Anup Mankar
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Jennifer Fisher-Bowman
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Brandon J. Neal
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle E. Tuller
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Bharath Kumar
- Population Services International- India, New Delhi, India
| | - Stuart Lipsitz
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Bhala Kodkany
- Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Atul Gawande
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Santos DRD, Nogueira LMV, Paiva BL, Rodrigues ILA, Oliveira LFD, Caldas SP. Maternal mortality in the indigenous and non-indigenous population in Pará: contribution to the surveillance of deaths. ESCOLA ANNA NERY 2017. [DOI: 10.1590/2177-9465-ean-2017-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To analyze the occurrence of Maternal Mortality in general and in the indigenous population in the state of Pará. Method: A quantitative, analytical and retrospective study was performed, covering a historical series from 2005 to 2014. For the analysis of the results, non-parametric statistical tests, the Chi-square test and the G test were processed in the BioStat 5.0 software program. Results: A total of 884 maternal deaths were reported in the state of Pará, corresponding to a Mortality Rate of 60.7 per 100,000 live births for non-indigenous women and 135.8 per 100,000 live births for indigenous women. Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and puerperium corresponded to 30.5% (n = 270). Conclusion and Implications for the Practice: Maternal mortality remains a serious public health problem in the state of Pará, clearly demonstrating that indigenous pregnant women require greater care, since they showed higher Maternal Mortality Rates when compared to non-indigenous women.
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Quality in provision of maternity services: the missing link in health-care investments in LMICs? LANCET GLOBAL HEALTH 2016; 4:e769-e770. [DOI: 10.1016/s2214-109x(16)30239-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 11/23/2022]
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Arnold J, Samson M, Schechter J, Goodwin AS, Braganza S, Sesso GC, Lopez A, Fiori K. Getting There: Overcoming Barriers to Reproductive and Maternal Health Services Access in Northern Togo-A Qualitative Study. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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