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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh. PLoS One 2024; 19:e0287622. [PMID: 39037995 PMCID: PMC11262631 DOI: 10.1371/journal.pone.0287622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United Stated of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United Stated of America
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Liu J, Liang Y, Su Y, Lilenga HS, Zhai J. Reasons, experiences and expectations of women with delayed medical care for ectopic pregnancies in Chinese urban edges: a qualitative study. BMJ Open 2024; 14:e076035. [PMID: 38553063 PMCID: PMC10982742 DOI: 10.1136/bmjopen-2023-076035] [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: 05/26/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies. DESIGN A qualitative study. SETTING A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023. PARTICIPANTS 21 patients with delays in seeking medical care for ectopic pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women. RESULTS Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods. CONCLUSIONS A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients' physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.
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Affiliation(s)
- Jing Liu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yulian Liang
- Department of Obstetrics and Gynecology, Guangzhou University of Traditional Chinese Medicine Dongguan Hospital, Dongguan, Guangdong, China
| | - Yinzhi Su
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Jinguo Zhai
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Kalter HD, Setel PW, Deviany PE, Nugraheni SA, Sumarmi S, Weaver EH, Latief K, Rianty T, Nandiaty F, Anggondowati T, Achadi EL. Modified Pathway to Survival highlights importance of rapid access to quality institutional delivery care to decrease neonatal mortality in Serang and Jember districts, Java, Indonesia. J Glob Health 2023; 13:04020. [PMID: 37054399 PMCID: PMC10101726 DOI: 10.7189/jogh.13.04020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background Three-quarters of births in Indonesia occur in a health facility, yet the neonatal mortality rate remains high at 15 per 1000 live births. The Pathway to Survival (P-to-S) framework of steps needed to return sick neonates and young children to health focuses on caregiver recognition of and care-seeking for severe illness. In view of increased institutional delivery in Indonesia and other low- and middle-income countries, a modified P-to-S is needed to assess the role of maternal complications in neonatal survival. Methods We conducted a retrospective cross-sectional verbal and social autopsy study of all neonatal deaths from June through December 2018, identified by a proven listing method in two districts of Java, Indonesia. We examined care-seeking for maternal complications, delivery place, and place and timing of neonatal illness onset and death. Results The fatal illnesses of 189/259 (73%) neonates began in their delivery facility (DF), 114/189 (60%) of whom died before discharge. Mothers whose neonate's illness started at their delivery hospital and lower-level DF were more than six times (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 3.4-12.5) and twice (OR = 2.0; 95% CI = 1.01-4.02) as likely to experience a maternal complication as those whose neonates fell fatally ill in the community, and illness started earlier (mean = 0.3 vs 3.6 days; P < 0.001) and death came sooner (3.5 vs 5.3 days; P = 0.06) to neonates whose illness started at any DF. Despite going to the same number of providers/facilities, women with a labour and delivery (L/D) complication who sought care from at least one other provider or facility on route to their DF took longer than those without a complication to reach their DF (median = 3.3 vs 1.3 hours; P = 0.01). Conclusions Neonates' fatal illness onset in their DF was strongly associated with maternal complications. Mothers with a L/D complication experienced delays in reaching their DF, and nearly half the neonatal deaths occurred in association with a complication, suggesting that mothers with complications first seeking care at a hospital providing emergency maternal and neonatal care might have prevented some deaths. A modified P-to-S highlights the importance of rapid access to quality institutional delivery care in settings where many births occur in facilities and/or there is good care-seeking for L/D complications.
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Affiliation(s)
- Henry D Kalter
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Poppy E Deviany
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Sri A Nugraheni
- Faculty of Public Health, Diponegoro University, Semarang, Indonesia
| | - Sri Sumarmi
- Faculty of Public Health, Airlangga University, Surabaya, Indonesia
| | - Emily H Weaver
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tika Rianty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Fitri Nandiaty
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Trisari Anggondowati
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Endang L Achadi
- Center for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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Mislu E, Seid A, Bililign N, Woyo T, Dulla D. Maternal Third Delay and Associated Factors among Women Admitted for Emergency Obstetric Care in Public Hospitals in Sidama Regional State, Ethiopia. J Pregnancy 2023; 2023:7767208. [PMID: 37091530 PMCID: PMC10118880 DOI: 10.1155/2023/7767208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background Timing to get obstetric care is critical in preventing maternal death and disability. Maternal third delay, the delay in receiving care after reaching health facilities, involves factors related to organization, quality of care, patient referral, and availability of staff and equipment. However, data is limited on maternal third delay and its associated factors at higher health facilities in Ethiopia. Objective This study is aimed at assessing the magnitude of maternal third delay and associated factors among women admitted for emergency obstetric care in public hospitals in Sidama Regional State, Ethiopia, 2021. Methods An institution-based cross-sectional study was conducted from September to November 2021. Face-to-face interview with a structured questionnaire and data extraction from medical charts were carried out in selected 542 women (using systematic sampling method). The collected data were coded and entered using EpiData, and bivariable and multivariable logistic regression analyses were done using SPSS version 25. Statistical significances were declared at p value less than 0.05. Results Maternal third delay was identified among 29.3% (95%CI = 25.2 - 33.5) of the respondents. Additionally, women who arrived with a referral from other health facilities (AOR = 0.311, 95%CI = 0.181 - 0.534), well prepared for birth and its complications (AOR = 2.418, 95%CI = 1.51 - 3.869), self-employed (AOR = 0.223, 95%CI = 0.122 - 0.409), being a government employee (AOR = 0.157, 95%CI = 0.063 - 0.396), having ANC follow-up (AOR = 2.795, 95%CI = 1.318 - 5.928), and absence of health professional (AOR = 4.63, 95%CI = 2.857 - 7.50) were significantly associated with maternal third delay. Conclusion This study identified that maternal third delay was high, which indicates that women have not received emergency obstetric care in the recommended time range after they arrived at the health facilities.
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Affiliation(s)
- Esuyawkal Mislu
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Ali Seid
- Basic Health Science, Dessie Health Science College, Dessie, Ethiopia
| | - Nigus Bililign
- Department of Midwifery, School of Midwifery, College of Health Science, Woldia University, Ethiopia
| | - Terefe Woyo
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
| | - Dubale Dulla
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Ethiopia
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Nimako K, Gage A, Benski C, Roder-DeWan S, Ali K, Kandie C, Mohamed A, Odeny H, Oloo M, Otieno JTB, Wanzala M, Okumu R, Kruk ME. Health System Redesign to Shift to Hospital Delivery for Maternal and Newborn Survival: Feasibility Assessment in Kakamega County, Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:1000-1010. [PMID: 34933993 PMCID: PMC8691889 DOI: 10.9745/ghsp-d-20-00684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Maternal and newborn health (MNH) service delivery redesign aims to improve maternal and newborn survival by shifting deliveries from poorly equipped primary care facilities to adequately prepared designated delivery hospitals. We assess the feasibility of such a model in Kakamega County, Kenya, by determining the capacity of hospitals to provide services under the redesigned model and the acceptability of the concept to providers and users. We find many existing system assets to implement redesign, including political will to improve MNH outcomes, a strong base of support among providers and users, and a good geographic spread of facilities to support implementation. There are nonetheless health workforce gaps, infrastructure deficits, and transportation challenges that would need to be addressed ahead of policy rollout. Implementing MNH redesign would require careful planning to limit unintended consequences and rigorous evaluation to assess impact and inform scale-up.
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Affiliation(s)
- Kojo Nimako
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Caroline Benski
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Khatra Ali
- Kenya Council of Governors, Nairobi, Kenya
| | | | | | - Hellen Odeny
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Micky Oloo
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | | | - Maximilla Wanzala
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | - Rachel Okumu
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Roder-DeWan S, Nimako K, Twum-Danso NAY, Amatya A, Langer A, Kruk M. Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap. BMJ Glob Health 2020; 5:e002539. [PMID: 33055093 PMCID: PMC7559116 DOI: 10.1136/bmjgh-2020-002539] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023] Open
Abstract
Large disparities in maternal and neonatal mortality exist between low- and high-income countries. Mothers and babies continue to die at high rates in many countries despite substantial increases in facility birth. One reason for this may be the current design of health systems in most low-income countries where, unlike in high-income countries, a substantial proportion of births occur in primary care facilities that cannot offer definitive care for complications. We argue that the current inequity in care for childbirth is a global double standard that limits progress on maternal and newborn survival. We propose that health systems need to be redesigned to shift all deliveries to hospitals or other advanced care facilities to bring care in line with global best practice. Health system redesign will require investing in high-quality hospitals with excellent midwifery and obstetric care, boosting quality of primary care clinics for antenatal, postnatal, and newborn care, decreasing access and financial barriers, and mobilizing populations to demand high-quality care. Redesign is a structural reform that is contingent on political leadership that envisions a health system designed to deliver high-quality, respectful care to all women giving birth. Getting redesign right will require focused investments, local design and adaptation, and robust evaluation.
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Affiliation(s)
| | - Kojo Nimako
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Nana A Y Twum-Danso
- Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Archana Amatya
- Health and Nutrition, Save the Children, Kathmandu, Nepal
| | - Ana Langer
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret Kruk
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Alwy Al-Beity F, Pembe AB, Kwezi HA, Massawe SN, Hanson C, Baker U. "We do what we can do to save a woman" health workers' perceptions of health facility readiness for management of postpartum haemorrhage. Glob Health Action 2020; 13:1707403. [PMID: 31928163 PMCID: PMC7006654 DOI: 10.1080/16549716.2019.1707403] [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] [Indexed: 11/22/2022] Open
Abstract
Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (PPH). Aim: In order to better understand these findings, and particularly the contribution of contextual factors on the observed effects, we explored health workers’ perceptions of their health facilities’ readiness to provide PPH care. Methods: We conducted 7 focus group discussions (FGDs) and 12 in-depth interviews (IDIs) in purposively selected intervention districts in the HMS BAB trial. FGDs and IDIs were audio-recorded, transcribed and translated verbatim. Thematic analysis, using both inductive and deductive approaches, was applied with the help of MAXQDA software. Results: Health workers perceive that their facilities have a low readiness to provide PPH care, leading to stressful situations and suboptimal clinical management. They describe inconsistencies in essential supplies, fluctuating availability of blood for transfusion, and ineffective referral system. In addition, there are challenges in collaboration, communication and leadership support, which is perceived to prevent effective management of cases within the facility as well as in referral situations. Health workers strive to provide life-saving care to women with PPH despite the perceived challenges. In some health facilities, health workers perceive supportive clinical leadership as motivating in providing good care. Conclusion: The potential positive effects of single-component interventions such as HMS BAB training on clinical outcome may be constraint by poor health facility readiness, including communication, leadership and referral processes that need to be addressed.
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Affiliation(s)
- Fadhlun Alwy Al-Beity
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hilda A Kwezi
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siriel N Massawe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ulrika Baker
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Tette EMA, Nuertey BD, Azusong EA, Gandau NB. The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E15. [PMID: 32085390 PMCID: PMC7072572 DOI: 10.3390/children7020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/31/2023]
Abstract
Neonatal mortality is the major contributor to under-five mortality rates in many low and middle income countries. We examined the health practices, care-seeking behavior, and referral of sick outborn neonates to a district and regional hospital in the Upper West Region of Ghana. The study was a cross-sectional study conducted over an eight (8) month period in 2018. Data were obtained from caregiver interviews and case notes. Altogether, 153 outborn neonates were examined. Inappropriate practices including the use of enemas, cord care with cow dung, and herbal baths were found. Three babies treated this way died. The majority of caregivers sought care at a health facility. However, 67 (44%) sought care only after their babies were ill for ≥7 days, suggesting the influence of a period of confinement on health seeking. More than half, 94 (61.4%), of the facilities visited referred patients to destination hospitals without giving any treatment. Delayed care-seeking was associated with a low birth weight, using home remedies, and a maternal age of ≥30 years. Altogether, 12 neonates (7.8%) died, consisting of three males and nine females (p = 0.018). Socio-cultural factors strongly influence health seeking behavior and the health outcome of neonates in this setting. There appeared to be a limited repertoire of interventions for treating neonatal disease in primary care.
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Affiliation(s)
- Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana
| | - Benjamin Demah Nuertey
- Department of Community Health, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana
- Public Health Department, Tamale Teaching Hospital, P.O. Box, TL 16, Tamale, Ghana
| | | | - Naa Barnabas Gandau
- Upper West Regional Hospital, P.O. Box 6, Wa, Ghana; (E.A.A.); (N.B.G.)
- School of Medical Science, University for Development Studies, Tamale, Ghana
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