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Demissie KA, Jejaw M, Wondimu BG, Mersha YT, Demsash ES, Dessie SG, Teshome AG, Geberu DM, Tiruneh MG. Only 9% of mothers have eight and more ANC visit in 14 sub-saharan African countries; evidence from the most recent DHS 2018-2023: a multilevel analysis. BMC Public Health 2024; 24:1631. [PMID: 38898450 DOI: 10.1186/s12889-024-19145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The world health organization's global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes. METHOD The most recent 2018-2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits. RESULT The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76-9.13) ranging from 3.66% (95% CI: 3.54-3.79) in Gabon to 18.92% (95% CI: 18.67-19.17) in Nigeria. The multilevel analysis shows that maternal age (40-44, AOR;2.09, 95%CI: 1.75-2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07-1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16-1.38), wealth status(AOR;1.65, 95%CI; 1.50-1.82), media exposure (AOR;1.20, 95%CI; 1.11-1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05-1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07-1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49-5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30-1.56), urban place of residence (AOR;1.33, 95%CI; 1.22-1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53-0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75-0.86) and survey year (AOR;0.47, 95%CI; 0.34-0.65) were factors negatively associated with having eight and more ANC visits. CONCLUSION In the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.
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Affiliation(s)
- Kaleb Assegid Demissie
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Melak Jejaw
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Befikir Gezahegn Wondimu
- Department of Obstetrics and Gynecology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yekunuamlak Teshome Mersha
- Department of Anatomic Pathology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyuale Sitotaw Demsash
- Department of Surgery, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Samuel Getachew Dessie
- Department of Internal Medicine, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asteway Gashaw Teshome
- Department of Anatomic Pathology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demiss Mulatu Geberu
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Yusrika MU, Al Fattah AN, Kusuma RA, Widjaja FF, Marizni S, Putri VP. Incidence and first trimester risk factors of stillbirth in Indonesia. J Perinat Med 2024; 52:392-398. [PMID: 38407221 DOI: 10.1515/jpm-2023-0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/28/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To determine the incidence and the risk factors of stillbirth from maternal biophysical, ultrasound, and biochemical markers at 11-13 weeks of gestation in the Indonesian population. METHODS This was a retrospective cohort study of pregnant women for first-trimester preeclampsia screening at 11-13 weeks of gestation in some clinics and hospital in Jakarta. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio (Oph-PR) Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified into placental dysfunction-related when it occurred with preeclampsia or birth weight <10th percentile and non-placental dysfunction-related. Bivariate and multivariate logistic regression analyses were employed to determine the risk factors associated with stillbirth. RESULTS Of 1,643 eligible participants, 13 (0.79 %) stillbirth cases were reported. More than half of the stillbirths (7) were placental dysfunction-related. After adjusted with maternal age, body mass index (BMI), and parity status, chronic hypertension (aOR (adjusted odds ratio)) 24.41, 95 % CI {confidence interval} 5.93-100.43), previous pregnancy with preeclampsia (aOR 15.79, 95 % CI 4.42-56.41), MAP >101.85 (aOR 26.67, 95 % CI 8.26-86.06), UtA-PI >1.90 (aOR 10.68, 95 % CI 2.34-48.58, and PlGF <28.77 pg/mL (aOR 18.60, 95 % CI 5.59-61.92) were associated with stillbirth. CONCLUSIONS The incidence of stillbirth in the population is comparable to studies conducted in developed countries. Most routine variables assessed at the 11-13 weeks combined screening for preeclampsia are associated with the risk of stillbirth.
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Affiliation(s)
| | - Adly Nanda Al Fattah
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
| | - Raden Aditya Kusuma
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Harapan Kita National Women and Children Hospital, Jakarta, Indonesia
| | | | - Shinda Marizni
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
| | - Vania Permata Putri
- 633485 Indonesian Prenatal Institute , Jakarta, Indonesia
- Kosambi Maternal and Children Center, Jakarta, Indonesia
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Jejaw M, Teshale G, Yazachew L, Dellie E, Debie A. Adverse birth outcome among women who gave birth at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia. BMC Pregnancy Childbirth 2024; 24:285. [PMID: 38632514 PMCID: PMC11022324 DOI: 10.1186/s12884-024-06478-z] [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: 01/17/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND In Ethiopia, various maternal and child health interventions, including comprehensive and basic obstetric cares were conducted to curb high neonatal and infant morbidity and mortality. As such, adverse birth outcome has been a public health concern in the country. Thus, this study aimed to assess the burden and associated factors with adverse birth outcomes among women who gave birth at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS A health facility-based cross-sectional study was employed from 30 March to 01 May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 455 women were interviewed using a structured questionnaire. A binary logistic regression model was fitted Adjusted Odds Ratio (AOR) with 95%CI and p-value < 0.05 were used to declare factors significantly associated with adverse birth outcomes. RESULTS In this study, 28% of women had adverse birth outcomes (8.4% stillbirths, 22.9% preterm births, and 10.11% low birth weights). Women aged 20-34) (AOR: 0.32, 95%CI: 0.14, 0.76), rural dwellers (AOR: 2.7, 95%CI: 1.06, 6.32), lack of ANC visits (AOR: 4.10, 95%CI: 1.55, 10.85), APH (AOR: 3.0, 95%CI: 1.27, 7.10) and fever (AOR: 7.80, 95%CI: 3.57, 17.02) were associated to stillbirths. Multiple pregnancy (AOR:7.30, 95%CI:1.75, 20.47), rural dwellers (AOR:4.60, 95%CI:1.36, 15.52), preterm births (AOR: 8.60, 95% CI: 3.88, 19.23), previous perinatal death (AOR:2.90, 95%CI:1.35, 6.24), fever (AOR:2.7,95%CI:1.17 ,6.23) and premature rupture of membrane (AOR:2.60, 95% CI:1.02, 6.57) were affecting low birth weights. In addition, previous antepartum hemorrhage (AOR: 2.40, 95%CI: 1.37, 4.10) and fever (AOR: 3.8, 95%CI: 2.13, 6.89) were also factors contributing to preterm births. CONCLUSION Adverse birth outcomes continue to pose a significant public health concern. Such high rates of adverse birth outcomes, such as preterm birth, low birth weight, and birth defects, can have serious and long-lasting effects on the health and well-being of both infants and their families, and the community at large. As such, public health efforts are crucial in addressing and mitigating the risk factors associated with adverse birth outcomes. This may involve implementing interventions and policies to improve maternal health, access to prenatal care and nutritional support, and reducing exposure to environmental risks.
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Affiliation(s)
- Melak Jejaw
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia.
| | - Getachew Teshale
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
| | - Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. BOX: 196, Gondar, Ethiopia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Thabrew KAS, Ranawaka RACS, Ranamukhaarachchi S. Factors associated with terminated pregnancies in Sri Lanka: A case study of the Sri Lankan Demographic and health survey (DHS) 2016. PLoS One 2024; 19:e0298639. [PMID: 38394081 PMCID: PMC10889877 DOI: 10.1371/journal.pone.0298639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Pregnancy termination is considered to have adverse effects on women's health and to have created financial, economic, and social problems in their lives. This study aimed to identify factors associated with pregnancy termination in Sri Lanka. The study used 2016 Sri Lanka Demographic and Health Survey (DHS) data of 16,323 ever-married women aged 15-49, who were clustered in selected enumerated areas. A binary logistic random intercept multilevel model was fitted to find the association between pregnancy termination and the predictor variables in this study. The overall pregnancy termination rate among Sri Lankan women was 16.14%. Increasing age of women was found to be associated with increasing odds of pregnancy termination. Women who were overweight or obese had higher odds of pregnancy termination, with 14% and 36%, respectively, compared to women with a normal weight. With increasing parity, the likelihood of pregnancy termination decreased. Women who used contraceptives had a 24% higher likelihood of pregnancy termination than those who refrained from using them. Cohabiting women had a 57% higher chance of pregnancy termination. Working women had 15% higher odds than unemployed women. Women who experienced domestic violence had a 14% higher odds of pregnancy termination than those who did not. Women from the Northern, Eastern, and North Central provinces had a lower likelihood of pregnancy termination compared to those from the Western province. Women in the urban sector were more likely to terminate their pregnancy than those in the estate sector. Further, women residing in households where indoor smoking was permitted had a 13% greater chance of ending their pregnancy compared to non-smoking households. The study highlights the importance of restructuring education related to health and well-being, family planning, and work-life balancing for both women and their partners, and developing and implementing or strengthening policies and laws related to mitigating pregnancy termination including domestic violence for women.
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Das S, Sagar S, Chowdhury S, Akter K, Haq MZ, Hanifi SMA. The risk of miscarriage is associated with ambient temperature: evidence from coastal Bangladesh. Front Public Health 2023; 11:1238275. [PMID: 38026421 PMCID: PMC10656765 DOI: 10.3389/fpubh.2023.1238275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Exposure to high ambient temperature is reported to cause adverse pregnancy outcomes. However, considering myriad temperature and climatic conditions as well as different contextual factors, the paucity of studies from the developing regions impedes the development of a clear understanding of the heat-pregnancy outcome relationship. Materials and methods This study was conducted in Chakaria, a coastal region of Bangladesh, where International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) administers a health and demographic surveillance system (HDSS). The surveillance workers visit the households every three months as a part of the routine surveillance activity. Between 2012 and 2020, the surveillance workers documented histories of 23,482 pregnancies among 13,376 women and the women were followed up for their pregnancy outcomes. The temperature records were obtained from the Bangladesh Meteorological Department's weather station at Cox's Bazar. The dates of pregnancy outcome were linked with the daily average temperature on the day of pregnancy outcome. A logistic regression model was employed to examine the relationship between temperature and the incidence of miscarriage. Results Out of 23,482 pregnancy outcomes, 3.7% were induced abortions. Among the remaining 22,624 pregnancy outcomes, 86.2% were live births, 10.7% were miscarriages and 3.1% were stillbirths. Miscarriages peaked between 8-14 weeks of gestation and varied according to temperature. For women exposed to temperatures between 28°C and 32°C, the risk of miscarriage was 25% greater (adjusted OR 1.25, 95% CI 1.07-1.47) compared to those exposed to temperatures from 16°C to 21°C. Conclusion The study establishes a connection between miscarriage and high ambient temperatures in a coastal region of Bangladesh. Implementing timely and appropriate adaptation strategies to prevent miscarriages is of paramount importance for a densely populated country like Bangladesh.
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Affiliation(s)
- Susmita Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Mensah Abrampah NA, Okwaraji YB, You D, Hug L, Maswime S, Pule C, Blencowe H, Jackson D. Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda. Int J Health Policy Manag 2023; 12:7391. [PMID: 38618824 PMCID: PMC10590256 DOI: 10.34172/ijhpm.2023.7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. METHODS A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. RESULTS Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. CONCLUSION The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.
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Affiliation(s)
- Nana A. Mensah Abrampah
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yemisrach B. Okwaraji
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Caroline Pule
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Klemann D, Rijkx M, Mertens H, van Merode F, Klein D. Causes for Medical Errors in Obstetrics and Gynaecology. Healthcare (Basel) 2023; 11:healthcare11111636. [PMID: 37297775 DOI: 10.3390/healthcare11111636] [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: 03/26/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in gynaecology and obstetrics and how they could be prevented, we conducted this systematic review. Methods: This systematic review was performed in compliance with the Prisma 2020 guidelines. We searched several databases for relevant studies (Jan 2010-May 2023). Studies were included if they indicated the presence of any potential risk factor at the hospital level for medical errors or adverse events in gynaecology or obstetrics. Results: We included 26 articles in the quantitative analysis of this review. Most of these (n = 12) are cross-sectional studies; eight are case-control studies, and six are cohort studies. One of the most frequently reported contributing factors is delay in healthcare. In addition, the availability of products and trained staff, team training, and communication are often reported to contribute to near-misses/maternal deaths. Conclusions: All risk factors that were found in our review imply several categories of contributing factors regarding: (1) delay of care, (2) coordination and management of care, and (3) scarcity of supply, personnel, and knowledge.
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Affiliation(s)
- Désirée Klemann
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Maud Rijkx
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Helen Mertens
- Executive Board, Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Frits van Merode
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Dorthe Klein
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, 6228 HX Maastricht, The Netherlands
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Tesfay N, Tariku R, Zenebe A, Hailu G, Taddese M, Woldeyohannes F. Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia. PLoS One 2023; 18:e0285465. [PMID: 37159458 PMCID: PMC10168579 DOI: 10.1371/journal.pone.0285465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia. METHODS National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors. RESULT Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death. CONCLUSION Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Rozina Tariku
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Alemu Zenebe
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Muse Taddese
- Centre of Public Health Emergency Management, Ethiopian Public Health Institutes, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Patterson KA, Yang S, Sargeant J, Lwasa S, Berrang-Ford L, Kesande C, Communities B, Twesigomwe S, Anyango Rhoda J, Nkalubo J, Harper SL. Socio-demographic associations with pregnancy loss among Bakiga and Indigenous Batwa women in Southwestern Uganda. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100700. [DOI: 10.1016/j.srhc.2022.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/02/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
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Odhiambo JN, Sartorius B. Joint spatio-temporal modelling of adverse pregnancy outcomes sharing common risk factors at sub-county level in Kenya, 2016-2019. BMC Public Health 2021; 21:2331. [PMID: 34969386 PMCID: PMC8719408 DOI: 10.1186/s12889-021-12210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adverse pregnancy outcomes jointly account for a high proportion of mortality and morbidity among pregnant women and their infants. Furthermore, the burden attributed to adverse pregnancy outcomes remains high and inadequately characterised due to the intricate interplay of its etiology and shared set of important risk factors. This study sought to quantify and map the underlying risk of multiple adverse pregnancy outcomes in Kenya at sub-county level using a shared component space-time modelling framework. Methods Reported sub-county level adverse pregnancy outcomes count from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical spatio-temporal model was used to estimate the joint burden of adverse pregnancy outcomes in space (sub-county) and time (year). To improve the precision of our estimates over time and space, information across the outcomes were combined via the shared and the outcome-specific components using a shared component model with spatio-temporal interactions. Results Overall, the total number of adverse outcomes in pregnancy increased by 14.2% (95% UI: 14.0–14.5) from 88,816 cases in 2016 to 101,455 cases in 2019. Between 2016 and 2019, the estimated low birth weight rate and the pre-term birth rate were 4.5 (95% UI: 4.4–4.7) and 2.3 (95% UI: 2.2–2.5) per 100 live births. The stillbirth and neonatal death rates were estimated to be 18.7 (95% UI: 18.0–19.4) and 6.9 (95% UI: 6.4–7.4) per 1000 live births. The magnitude of the spatio-temporal variation attributed to shared risk was high for pre-term births, low birth weight, neonatal deaths, stillbirths and neonatal deaths, respectively. The shared risk patterns were dominant in sub-counties located along the Indian ocean coastline, central and western Kenya. Conclusions This study demonstrates the usefulness of a Bayesian joint spatio-temporal shared component model in exploiting specific and shared risk of adverse pregnancy outcomes sub-nationally. By identifying sub-counties with elevated risks and data gaps, our estimates not only assert the need for bolstering maternal health programs in the identified high-risk sub-counties but also provides a baseline against which to assess the progress towards the attainment of Sustainable Development Goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12210-9.
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Affiliation(s)
- Julius Nyerere Odhiambo
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Howard College Campus, Durban, 4001, South Africa. .,Department of Management Science and Technology, The Technical University of Kenya, Nairobi, Kenya. .,Ignite Lab, Global Research Institute, William and Mary, Williamsburg, Virginia, USA.
| | - Benn Sartorius
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Howard College Campus, Durban, 4001, South Africa.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Health Metrics Sciences, University of Washington, Seattle, USA
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Sui Y, Ahuru RR, Huang K, Anser MK, Osabohien R. Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age. Front Public Health 2021; 9:724337. [PMID: 34589464 PMCID: PMC8475754 DOI: 10.3389/fpubh.2021.724337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.
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Affiliation(s)
- Yubing Sui
- School of Finance and Economics, Shenzhen Institute of Information Technology, Shenzhen, China
| | - Rolle Remi Ahuru
- Department of Economics, Faculty of Social Sciences, University of Benin, Benin City, Nigeria
| | - Kaishan Huang
- Center for Innovation and Entrepreneurship Education, Shenzhen University, Shenzhen, China
| | - Muhammad Khalid Anser
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Romanus Osabohien
- Department of Economics and Development Studies, Covenant University, Ota, Nigeria
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Association of Stillbirths with Maternal and Fetal Risk Factors in a Tertiary Care Hospital in South India. Obstet Gynecol Int 2021; 2021:8033248. [PMID: 34335785 PMCID: PMC8324385 DOI: 10.1155/2021/8033248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022] Open
Abstract
Background Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India. Methods This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval. Results There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35–32.50), anemia (OR: 21.87, 95% CI: 15.69–30.48), congenital malformation (OR: 11.24, 95% CI: 6.99–18.06), abruption (OR: 10.14, 95% CI: 6.43–15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23–7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03–4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population. Conclusion Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.
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Nkwabong E, Megoze Tanon A, Nguefack Dongmo F. Risk factors for stillbirth after 28 complete weeks of gestation. J Matern Fetal Neonatal Med 2021; 35:6368-6372. [PMID: 34074218 DOI: 10.1080/14767058.2021.1912727] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify the risk factors for stillbirth (SB). MATERIAL AND METHODS This case-control study was carried out between 1 December 2019 and 30 April 2020. Women whose fetuses died after the 28th week of gestation, but before delivery and women whose newborns were alive and healthy after delivery were examined. The main variables recorded included maternal age, educational level, medical and obstetrical past histories, number of antenatal visits, whether the woman was referred or not, body mass index (BMI), and sex of newborn. Fisher exact test, t-test and logistic regression were used for comparison. p < .05 was considered statistically significant. RESULTS Our frequency of SB was 54/1000 births (63 SB out of 1167 deliveries). Significant risk factors for SB were referred parturient (aOR = 7.76, 95%CI = 2.84-21.20), past-history of SB (aOR = 6.54, 95%CI = 1.27-33.63), primary school educational level (aOR = 5.60, 95%CI = 3.63-9.06), pregnancy followed up by a general practitioner (aOR = 5.38, 95%CI = 1.13-25.65 and BMI ≥30kg/m2 (aOR = 3.51, 95%CI = 1.32-9.38). CONCLUSION When the above-identified risk factors are present, pregnancy and delivery should be well followed up, if we want to reduce the frequency of SB.
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Affiliation(s)
- Elie Nkwabong
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Abycail Megoze Tanon
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Felicité Nguefack Dongmo
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Khatibi T, Hanifi E, Sepehri MM, Allahqoli L. Proposing a machine-learning based method to predict stillbirth before and during delivery and ranking the features: nationwide retrospective cross-sectional study. BMC Pregnancy Childbirth 2021; 21:202. [PMID: 33706701 PMCID: PMC7953639 DOI: 10.1186/s12884-021-03658-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Stillbirth is defined as fetal loss in pregnancy beyond 28 weeks by WHO. In this study, a machine-learning based method is proposed to predict stillbirth from livebirth and discriminate stillbirth before and during delivery and rank the features. Method A two-step stack ensemble classifier is proposed for classifying the instances into stillbirth and livebirth at the first step and then, classifying stillbirth before delivery from stillbirth during the labor at the second step. The proposed SE has two consecutive layers including the same classifiers. The base classifiers in each layer are decision tree, Gradient boosting classifier, logistics regression, random forest and support vector machines which are trained independently and aggregated based on Vote boosting method. Moreover, a new feature ranking method is proposed in this study based on mean decrease accuracy, Gini Index and model coefficients to find high-ranked features. Results IMAN registry dataset is used in this study considering all births at or beyond 28th gestational week from 2016/04/01 to 2017/01/01 including 1,415,623 live birth and 5502 stillbirth cases. A combination of maternal demographic features, clinical history, fetal properties, delivery descriptors, environmental features, healthcare service provider descriptors and socio-demographic features are considered. The experimental results show that our proposed SE outperforms the compared classifiers with the average accuracy of 90%, sensitivity of 91%, specificity of 88%. The discrimination of the proposed SE is assessed and the average AUC of ±95%, CI of 90.51% ±1.08 and 90% ±1.12 is obtained on training dataset for model development and test dataset for external validation, respectively. The proposed SE is calibrated using isotopic nonparametric calibration method with the score of 0.07. The process is repeated 10,000 times and AUC of SE classifiers using random different training datasets as null distribution. The obtained p-value to assess the specificity of the proposed SE is 0.0126 which shows the significance of the proposed SE. Conclusions Gestational age and fetal height are two most important features for discriminating livebirth from stillbirth. Moreover, hospital, province, delivery main cause, perinatal abnormality, miscarriage number and maternal age are the most important features for classifying stillbirth before and during delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03658-z.
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Affiliation(s)
- Toktam Khatibi
- School of Industrial and Systems Engineering, Tarbiat Modares University (TMU), Tehran, 14117-13114, Iran.
| | - Elham Hanifi
- School of Industrial and Systems Engineering, Tarbiat Modares University (TMU), Tehran, 14117-13114, Iran
| | - Mohammad Mehdi Sepehri
- School of Industrial and Systems Engineering, Tarbiat Modares University (TMU), Tehran, 14117-13114, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Kurji J, Hackett K, Wild K, Lassi Z. The effect of maternity waiting homes on perinatal mortality is inconclusive: a critical appraisal of existing evidence from Sub-Saharan Africa. BMC Res Notes 2021; 14:86. [PMID: 33750459 PMCID: PMC7942174 DOI: 10.1186/s13104-021-05501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To assess the appropriateness of the statistical methodology used in a recent meta-analysis investigating the effect of maternity waiting homes (MWHs) on perinatal mortality in Sub-Saharan Africa. RESULTS A recent meta-analysis published in BMC Research Notes used a fixed-effect model to generate an unadjusted summary estimate of the effectiveness of MWHs in reducing perinatal mortality in Africa using ten observational studies (pooled odds ratio 0.15, 95% confidence interval 0.14-0.17). The authors concluded that MWHs reduce perinatal mortality by over 80% and should be incorporated into routine maternal health care services. In the present article, we illustrate that due to the contextual and methodological heterogeneity present in existing studies, the authors' conclusions about the effectiveness of MWHs in reducing perinatal mortality were likely overstated. Additionally, we argue that because of the selection bias and confounding inherent in observational studies, unadjusted pooled estimates provide little causal evidence for effectiveness. Additional studies with robust designs are required before an appropriately designed meta-analysis can be conducted; until then, the ability to draw causal inferences regarding the effectiveness of MWHs in reducing perinatal mortality is limited.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kristy Hackett
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Kayli Wild
- Judith Lumley Centre and Institute for Human Security & Social Change, La Trobe University, Plenty Road, Bundoora, Melbourne, 3086, Australia
| | - Zohra Lassi
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Helen Mayo North, 30 Frome Street, Adelaide, Australia.
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Ahinkorah BO, Ameyaw EK, Seidu AA, Odusina EK, Keetile M, Yaya S. Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa. BMC Health Serv Res 2021; 21:125. [PMID: 33549089 PMCID: PMC7866461 DOI: 10.1186/s12913-021-06129-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/28/2021] [Indexed: 01/07/2023] Open
Abstract
Background Antenatal care utilization is one of the means for reducing the high maternal mortality rates in sub-Saharan Africa. This study examined the association between barriers to healthcare access and implementation of the 2016 WHO antenatal care services model among pregnant women seeking antenatal care in selected countries in sub-Saharan Africa. Methods This study considered only Demographic and Health Survey data collected in 2018 in sub-Saharan Africa. Hence, the Demographic and Health Survey data of four countries in sub-Saharan Africa (Nigeria, Mali, Guinea and Zambia) were used. A sample of 6761 from Nigeria, 1973 from Mali, 1690 from Guinea and 1570 from Zambia was considered. Antenatal care visits, categorized as < 8 visits or ≥8 visits, and time of the first antenatal care visit, categorized as ≤3 months or > 3 months (as per the WHO recommendations) were the outcome variables for this study. Both descriptive statistics and ordinal logistic regression were used to analyze the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values < 0.05 were used for the interpretation of results. Results With timing of antenatal care visits, getting money needed for treatment (aOR = 1.38, 95% CI = 1.03–1.92) influenced early timing of antenatal care visits in Mali whereas getting permission to visit the health facility (aOR = 1.62, 95% CI = 1.15–2.33) motivated women to have early timing of antenatal care visits in Guinea. We found that women who considered getting money needed for treatment as not a big problem in Nigeria were more likely to have the recommended number of antenatal care visits (aOR = 1.38, 95% CI= 1.11–1.73). On the contrary, in Guinea, Zambia and Mali, getting permission to visit health facilities, getting money for treatment, distance to the health facility and not wanting to go alone were not barriers to having ≥ 8 antenatal care visits. Conclusion Our study has emphasized the role played by barriers to healthcare access in antenatal care utilization across sub-Saharan African countries. There is the need for governmental and non-governmental organizations to ensure that policies geared towards improving the quality of antenatal care and promoting good interaction between health care seekers and health care providers are integrated within the health system.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | | | - Mpho Keetile
- Population Studies and Demography, University of Botswana, Gaborone, Botswana
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Shattnawi KK, Khader YS, Alyahya MS, Al-Sheyab N, Batieha A. Rate, determinants, and causes of stillbirth in Jordan: Findings from the Jordan Stillbirth and Neonatal Deaths Surveillance (JSANDS) system. BMC Pregnancy Childbirth 2020; 20:571. [PMID: 32993562 PMCID: PMC7526247 DOI: 10.1186/s12884-020-03267-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Annually, 2.6 million stillbirths occur around the world, with approximately 98% occurring in low- and middle-income countries. The stillbirth rates in these countries are 10 times higher than the rates in high-income countries. METHODS An electronic stillbirths and neonatal deaths surveillance system (JSANDS) was established in five large hospitals located in three of the largest cities in Jordan in August 2019. JSANDS was developed as a secure on-line data entry system to collect, organize, analyze, and disseminate data on stillbirths, neonatal deaths, and their contributing conditions. Data on births, stillbirths and their contributing conditions, and other demographic and clinical characteristics in the period between August 2019 - January 2020 were extracted and analyzed. RESULTS A total of 10,328 births were registered during the reporting period. Of the total births, 102 were born dead (88 antepartum stillbirths and 14 intrapartum stillbirths), with a rate of 9.9 per 1000 total births. The main contributing fetal conditions of antepartum stillbirths were antepartum death of unspecified cause (33.7%), acute antepartum event (hypoxia) (33.7%), congenital malformations and chromosomal abnormalities (13.3%), and disorders related to the length of gestation and fetal growth (10.8%). The main contributing maternal conditions of antepartum stillbirths included complications of the placental cord and membranes (48.7%), maternal complications of pregnancy (23.1%), and maternal medical and surgical conditions (23.1%). Contributing fetal conditions of intrapartum stillbirths included congenital malformations, deformations and chromosomal abnormalities, other specified intrapartum disorders, and intrapartum death of unspecified cause (33.3% each). Contributing maternal conditions of intrapartum stillbirths included complications of the placental cord and membranes. In the multivariate analysis, small for gestational age (SGA) pregnancies were associated with a significant 3-fold increased risk of stillbirth compared to appropriate for gestational age (AGA) pregnancies. CONCLUSIONS Although the rate of stillbirth is lower than that in other countries in the region, there is an opportunity to prevent such deaths. While the majority of stillbirths occurred during the antepartum period, care should be taken for the early identification of high-risk pregnancies, including the early detection of SGA pregnancies, and ensuring adequate antenatal obstetric interventions.
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Affiliation(s)
- Khulood K. Shattnawi
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O.Box (3030, 22110 Irbid, Jordan
| | - Yousef S. Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, 22110 Irbid, Jordan
| | - Mohammad S. Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, 22110 Irbid, Jordan
| | - Nihaya Al-Sheyab
- Allied Medical Sciences Department/Faculty of Applied Medical Sciences, the Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, 22110 Irbid, Jordan
| | - Anwar Batieha
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
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Poudel S, Ghimire PR, Upadhaya N, Rawal L. Factors associated with stillbirth in selected countries of South Asia: A systematic review of observational studies. PLoS One 2020; 15:e0238938. [PMID: 32936823 PMCID: PMC7494090 DOI: 10.1371/journal.pone.0238938] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite having the high rate of stillbirth in most of the countries of South Asia, there is a lack of synthesized evidence based on factors associated with stillbirth. This study systematically synthesizes the evidence on factors associated with stillbirth in the four selected countries of South Asia. METHODS This review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies that examined factors associated with stillbirth in South Asia were searched using five major electronic search databases including MEDLINE, CINAHL, Embase, PsycINFO, and Scopus, published between January 2000 and December 2019. In the meta-analysis, significant heterogeneity was detected among studies (I2 >50%), and hence a random effect model was used. RESULTS A total of 20 studies met the inclusion criteria. The pooled rate of stillbirth from the studies in Bangladesh, India, Nepal, and Pakistan was 25.15 per 1000 births. Pregnancy complications, maternal health conditions, fetal complications, lack of antenatal care, and lower Socio Economic Status (SES) were the most common factors associated with stillbirth in countries of South Asia. CONCLUSION This study confirmed that stillbirth in selected countries of South Asia remains high. To reduce stillbirth, a greater focus needs to be on timely management of preterm labor, maternal hypertension, and provision of financial support for quality antenatal and delivery care. The interventions should be targeted for women living in remote areas, who are less educated and those with low SES.
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Affiliation(s)
| | | | - Nawaraj Upadhaya
- Department of Research and Development, HealthWorks, Amsterdam, The Netherlands
| | - Lal Rawal
- School of Health Medical and Applied Sciences, CQUniversity, Sydney, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
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Mozooni M, Pennell CE, Preen DB. Healthcare factors associated with the risk of antepartum and intrapartum stillbirth in migrants in Western Australia (2005-2013): A retrospective cohort study. PLoS Med 2020; 17:e1003061. [PMID: 32182239 PMCID: PMC7077810 DOI: 10.1371/journal.pmed.1003061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Māori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Māori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Māori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.
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Affiliation(s)
- Maryam Mozooni
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Craig E. Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Lang’at E, Mwanri L, Temmerman M. Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis. BMC Health Serv Res 2019; 19:645. [PMID: 31492134 PMCID: PMC6729061 DOI: 10.1186/s12913-019-4462-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 08/26/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.
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Affiliation(s)
- Evaline Lang’at
- Department of Health, County Government of Kilifi, P. O Box 9-80108, Kilifi, Kenya
| | - Lillian Mwanri
- South Australia College of Medicine and Public Health, Flinders University, Flinders University Registry Road, Bedford Park, South Australia 5042 Australia
| | - Marleen Temmerman
- Director at Centre of Excellence in Women and Child Health, Aga Khan University, Aga Khan University Hospital, P.O. Box 30270-00100, Nairobi, Kenya
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Akselsson A, Lindgren H, Georgsson S, Pettersson K, Rådestad I. Increased labor induction and women presenting with decreased or altered fetal movements - a population-based survey. PLoS One 2019; 14:e0216216. [PMID: 31048896 PMCID: PMC6497262 DOI: 10.1371/journal.pone.0216216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Women’s awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction. Material and methods A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week’s gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks’ gestation in 2014 in Stockholm comprises the reference group. Results Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3–1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4–1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more. Conclusions We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.
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Affiliation(s)
- Anna Akselsson
- Sophiahemmet University, Stockholm, Sweden
- Department of Women and Children´s Health, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Helena Lindgren
- Department of Women and Children´s Health, Karolinska Institute, Stockholm, Sweden
| | - Susanne Georgsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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22
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Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, García-Elorrio E, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, Malata A, Marchant T, Matsoso MP, Meara JG, Mohanan M, Ndiaye Y, Norheim OF, Reddy KS, Rowe AK, Salomon JA, Thapa G, Twum-Danso NAY, Pate M. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018; 6:e1196-e1252. [PMID: 30196093 PMCID: PMC7734391 DOI: 10.1016/s2214-109x(18)30386-3] [Citation(s) in RCA: 1469] [Impact Index Per Article: 244.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/16/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Anna D Gage
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Keely Jordan
- New York University College of Global Public Health, New York, NY, USA
| | | | | | | | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | | | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lixin Jiang
- National Centre for Cardiovascular Disease, Beijing, China
| | | | | | | | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - John G Meara
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Manoj Mohanan
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | - Youssoupha Ndiaye
- Ministry of Health and Social Action of the Republic of Senegal, Dakar, Senegal
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gagan Thapa
- Legislature Parliament of Nepal, Kathmandu, Nepal
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23
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Hodgins S. New Evidence on Carbetocin: Another Arrow in Our Quiver. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:405-407. [PMID: 30287526 PMCID: PMC6172116 DOI: 10.9745/ghsp-d-18-00336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Carbetocin is more heat stable than oxytocin with at least equivalent efficacy for preventing postpartum hemorrhage. It will certainly be helpful if the supplier can make it available in low-income country settings at a price comparable to oxytocin. But even so, programs will still need oxytocin and other uterotonic medications.
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Affiliation(s)
- Steve Hodgins
- Editor-in-Chief, Global Health: Science and Practice Journal, and Associate Professor, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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