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Soundararajan R, Khan T, Dadelszen PV. Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions. Best Pract Res Clin Obstet Gynaecol 2024:102525. [PMID: 38964990 DOI: 10.1016/j.bpobgyn.2024.102525] [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: 11/21/2023] [Revised: 01/20/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision.
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Affiliation(s)
- Revathi Soundararajan
- Chief Consultant [Maternal Fetal Medicine], Managing Director, Mirror Health, Secretary, SMFM (I), Co-Chair, PEN (I), Bengaluru, India.
| | - Tamkin Khan
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
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Stan D, Dobre CE, Mazilu DC, Brătilă E. Practices, attitudes and knowledge of midwives and nurses regarding gestational diabetes and pregnancy-induced hypertension. J Med Life 2023; 16:227-234. [PMID: 36937469 PMCID: PMC10015574 DOI: 10.25122/jml-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 03/21/2023] Open
Abstract
Midwives (M) and obstetric nurses (ON) play a critical role in providing healthcare for pregnant patients at all stages of pregnancy, and ongoing training and education are essential to ensure the best outcomes. This longitudinal quantitative research study aimed to assess the impact of an educational program on the knowledge, attitudes, and practices of 125 midwives and obstetric nurses regarding care for patients with gestational diabetes and pregnancy-induced hypertension. The original questionnaire consisted of 56 items grouped into 3 subscales assessing knowledge (15 items), attitudes (18 items), and practices (23 items). The questionnaire was administered at three distinct intervals during the educational program: pre-test, post-test, and follow-up at three months. The data were analyzed using ANOVA and Pearson correlation coefficients to determine the significance of the differences between the 3 moments of the administration of the questionnaire. There was a significant increase in the level of knowledge, attitudes, and practices of midwives and obstetric nurses following the training module, which was sustained at 3 months after completion compared to pre-training. The comparative analysis of the total scores for every 3 sets of items revealed the positive impact of the educational program on the level of knowledge, attitudes, and practices of midwives and obstetric nurses.
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Affiliation(s)
- Daniela Stan
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
| | - Claudia Elena Dobre
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
- Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Corresponding Author: Claudia Elena Dobre, Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. E-mail:
| | - Doina Carmen Mazilu
- The Order of Nurses, Midwives and Medical Assistants in Romania, Bucharest, Romania
- Department of General and Specific Nursing, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Scott K, Ummer O, Chamberlain S, Sharma M, Gharai D, Mishra B, Choudhury N, LeFevre AE. '[We] learned how to speak with love': a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India. BMJ Open 2022; 12:e050363. [PMID: 35701061 PMCID: PMC9198783 DOI: 10.1136/bmjopen-2021-050363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mobile Academy is a mobile-based training course for India's accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones, totals 4 hours of audio content. It consists of 11 chapters, each with their own quiz, and provides a cumulative pass or fail score at the end. This qualitative study of Mobile Academy explores how the programme was accessed and experienced by CHWs, and how they perceive it to have influenced their work. METHODS We conducted in-depth interviews (n=25) and focus group discussions (n=5) with ASHAs and other health system actors. Open-ended questions explored ASHA perspectives on Mobile Academy, the course's perceived influence on ASHAs and preferences for future training programmes. After applying a priori codes to the transcripts, we identified emergent themes and grouped them according to our CHW mLearning framework. RESULTS ASHAs reported enjoying Mobile Academy, specifically praising its friendly tone and the ability to repeat content. They, and higher level health systems actors, conceived it to primarily be a test not a training. ASHAs reported that they found the quizzes easy but generally did not consider the course overly simplistic. ASHAs considered Mobile Academy's content to be a useful knowledge refresher but said its primary benefit was in modelling a positive communications approach, which inspired them to adopt a kinder, more 'loving' communication style when speaking to beneficiaries. ASHAs and health system actors wanted follow-on mLearning courses that would continue to compliment but not replace face-to-face training. CONCLUSION This mLearning programme for CHWs in India was well received by ASHAs across a wide range of education levels and experience. Dial-in audio training has the potential to reinforce topical knowledge and showcase positive ways to communicate.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Osama Ummer
- Oxford Policy Management, New Delhi, India
- BBC Media Action, New Delhi, India
| | | | | | | | | | - Namrata Choudhury
- Centre for the Study of Law and Governance, Jawaharlal Nehru University, New Delhi, India
| | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
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Ugwu SN, Adewusi OJ. Pattern of implementation of Emergency Obstetric Life-Saving Skills in public health facilities in Nsukka Local Government Area of Enugu State, Nigeria. J OBSTET GYNAECOL 2021; 42:1065-1071. [PMID: 34951332 DOI: 10.1080/01443615.2021.1999910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maternal mortality and morbidity can be minimised if adequate timely emergency obstetric life-saving care is provided especially at the primary health level. We conducted a descriptive cross-sectional study among 167 community health workers to investigate the pattern of performance of implementation of emergency obstetric life-saving skills (EmOLSS) in health facilities in Nsukka Local Government Area (LGA) of Enugu State. A pre-tested, paper-based questionnaire was utilised and data was analysed using descriptive and Chi-square statistics. Almost all were female (99.4%) and mean age was 39.5 ± 8.17 years. The pattern of core EmOLSS showed that 8.4% always use partograph and 60.8% use oxytocin for active management of third stage of labour. Only 15% had high level of confidence to carry out intrapartum and postpartum EmOLSS activities. Increased workload (66.3%), lack of supportive supervision (91.0%) and lack of infrastructure to work with (81.3%) influenced the pattern of implementation while poor basic knowledge of EmOLSS and lack of time influenced the level of confidence of the health workers. Health workers displayed poor pattern of EmOLSS implementation and low level of confidence. Regular training with supervision and provision of infrastructure will be beneficial to ensure improvement in the quality of care and reduction in maternal mortality.IMPACT STATEMENTWhat is already known on this subject? Emergency obstetric life-saving care is a key interventional strategy in the reduction of maternal mortality and morbidity. Reports showed that effective coordination and implementation of this care especially at the primary care level could reduce birth complications. Yet, there are gaps in the implementation of this essential care in the low and middle income countries.What do the results of this study add? This study revealed poor pattern of implementation of emergency obstetric life-saving care and low level of confidence among frontline health workers in public primary healthcare facilities in Nsukka Local Government Area of Enugu State, Nigeria. While there are efforts geared towards training of these health workers, the pattern of implementation of emergency obstetric life-saving care was affected by other health workers' intrapersonal, client-related and institutional factors.What are the implications of these findings for clinical practice and/or further research? Information from this study is useful to the government and other maternal health stakeholders to formulate policies, and design ecological programs that target the clients, health workers and institutions.
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Affiliation(s)
- Scholastica N Ugwu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwafemi J Adewusi
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Kaur G, Gupta K, Shyam S. Evaluation of antenatal services at Family welfare Centre under RMNCH+A Programme in Delhi. J Family Med Prim Care 2021; 10:3869-3875. [PMID: 34934694 PMCID: PMC8653460 DOI: 10.4103/jfmpc.jfmpc_2341_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/17/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background According to WHO, 536,000 women die every year in the world from causes relating to pregnancy, childbirth, or postpartum. Ninety nine percent of these deaths occur in the developing countries. Primary health centres (in densely populated areas and in urban slums are also referred to as family welfare centres, since they provide the whole continuum of care, from birth through adolescent and delivery and thereafter. Aim To evaluate the antenatal services under Reproductive, Maternal, Newborn, Child plus Adolescent (RMNCHA) programme at a family welfare centre located in Central Delhi, India. We have proposed an action plan that will help in evaluating and improving these services. Methodology The study included health providers of antenatal services and the beneficiaries. With a response rate of 90% from a sample of 218, 203 consenting antenatal women (beneficiaries) visiting the centre for ANC check-up under RMNCH + A programme and PMSMA were included. For quantitative component, a pre-designed, pre-tested semi-structured screening questionnaire were administered to the beneficiaries and healthcare providers to evaluate the antenatal services under RMNCH + A programme at the family welfare centre. Results Qualitative and quantitative analysis was done separately. Only 43% of ANC women said health workers visited them at home during pregnancy and very few could tell about importance of lab investigations. Almost all (97%) knew about key messages given by health workers. Nearly all participants considered that the screening process was smooth. The waiting time and time to undergo varied from 4 to 6 min.
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Affiliation(s)
- Gurmeet Kaur
- Assistant Professor, Department of Community Medicine, Army College of Medical Sciences, Delhi, India
| | - Kalika Gupta
- Assistant Professor, Department of Community Medicine, Ananta Institute of Medical Sciences, Rajsamand, Rajasthan, India
| | - Subhajit Shyam
- Assistant Professor, Department of Community Medicine, ESI-PGIMSR and ESIC Medical College and ESIC Hospital, Joka, West Bengal, India
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Charanthimath U, Katageri G, Kinshella MLW, Mallapur A, Goudar S, Ramadurg U, Vidler M, Sharma S, Derman R, Magee LA, von Dadelszen P, Bellad M, Payne BA. Community Health Worker Evaluation of Implementing an mHealth Application to Support Maternal Health Care in Rural India. Front Glob Womens Health 2021; 2:645690. [PMID: 34816198 PMCID: PMC8593958 DOI: 10.3389/fgwh.2021.645690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: PIERS on the Move (POM) is a mobile health (mHealth) application developed for a smartphone to support community health workers (CHWs) for identification and management of women at risk of adverse outcomes from pre-eclampsia. POM was implemented as an addition to routine antenatal care by accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) during the community level intervention for pre-eclampsia (CLIP) Trial in Karnataka state, India (NCT01911494). The objective of this study was to evaluate the experiences of CHWs of using POM in rural India and their perceptions of acceptability and feasibility of this mHealth intervention. Methods: A posttrial mixed-methods evaluation was designed to measure CHW knowledge and self-efficacy regarding the care of women with pre-eclampsia and perceptions of CHWs on the ease of use and usefulness of POM. A structured survey with open-ended questions was conducted between October and November 2017. The median values on a 5-point Likert scale for knowledge and self-efficacy questions were compared between trial arms by Mann–Whitney U test (p < 0.05 significant). Qualitative analysis was undertaken on NVivo 12 (QSR International, Melbourne, Australia). Results: A total of 48 ASHAs and ANMs were interviewed, including 24 who used POM (intervention arm) and 24 who did not (control arm). Self-reported knowledge and self-efficacy for the care of women with pre-eclampsia did not differ between groups. The qualitative analysis highlighted that health workers who used POM reported improved interactions with women and families in their communities. POM strengthened the role of ASHA as a CHW beyond a “link-worker” accompanying women to health services. With training, the mHealth application was easy to use even for CHWs who did not have much experience with smartphones. Conclusions: Community health workers found the POM app easy to use, useful, and well-received by women and their families. POM did not improve care through increased knowledge but built capacity by increasing the recognition of the ASHA and ANM as critical members of the continuum of antenatal healthcare within their communities. These findings support the important role that mHealth technologies can play in strengthening health systems to reach rural, remote, and marginalized populations to reduce disparities in health.
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Affiliation(s)
- Umesh Charanthimath
- Department of Obstetrics and Gynecology, KLE Academy of Higher Education & Research J.N. Medical College, Belagavi, India
| | - Geetanjali Katageri
- Department of Obstetrics and Gynecology, S Nijalingappa Medical College, Bagalkot, India
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Ashalata Mallapur
- Department of Obstetrics and Gynecology, S Nijalingappa Medical College, Bagalkot, India
| | - Shivaprasad Goudar
- Department of Obstetrics and Gynecology, KLE Academy of Higher Education & Research J.N. Medical College, Belagavi, India
| | - Umesh Ramadurg
- Department of Obstetrics and Gynecology, S Nijalingappa Medical College, Bagalkot, India
| | - Marianne Vidler
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Sumedha Sharma
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Richard Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Laura A Magee
- Department of Obstetrics and Gynecology, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Obstetrics and Gynecology, King's College London, London, United Kingdom
| | - Mrutyunjaya Bellad
- Department of Obstetrics and Gynecology, KLE Academy of Higher Education & Research J.N. Medical College, Belagavi, India
| | - Beth A Payne
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
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Nabulo H, Ruzaaza G, Mugabi F, Bajunirwe F. Perceptions on preeclampsia and eclampsia among senior, older women, in rural Southwestern Uganda. JOURNAL OF GLOBAL HEALTH REPORTS 2021; 5. [PMID: 34541336 PMCID: PMC8445047 DOI: 10.29392/001c.19464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive complication of pregnancy and increases the risk of cardiovascular disease in later life. Pregnancy-related hypertension complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older, senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older and senior women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. Methods We conducted a qualitative study in rural Southwestern Uganda. The key informants were senior, older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants and data were collected till we reached saturation point. We analyzed data using an inductive thematic approach to identify themes. Results We interviewed 20 key informants with four themes identified. The 'causes' theme emerged from the subthemes of confusion with other conditions, spiritual beliefs and high blood pressure. The 'risk factors' theme emerged from the subthemes of oedema-related illnesses, poverty-induced malnutrition, and strained relationships. The 'remedies' theme emerged from the consistent mention of traditional herbal treatment, seek medical help, spiritual healing, emotional healing and corrective nutrition as potential solutions. The theme 'effects of preeclampsia/eclampsia' emerged from the mention of pregnancy complications like premature delivery, child loss, operative delivery like caesarian section delivery as well as death. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, ghost attacks and stress from strained relationships including marital tension. Women were generally aware of the outcomes of eclampsia, mainly that it kills. Conclusions Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel these myths and misconceptions, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.
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Affiliation(s)
- Harriet Nabulo
- Department of Nursing, Mbarara University of Science and Technology, Department of Nursing, Mbarara, Uganda
| | - Gad Ruzaaza
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Mugabi
- Department of Community Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Eddy KE, Vogel JP, Zahroh RI, Bohren MA. Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis. BJOG 2021; 129:379-391. [PMID: 34520111 PMCID: PMC9291451 DOI: 10.1111/1471-0528.16913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO4) is recommended for prevention and treatment of pre‐eclampsia/eclampsia. However, MgSO4 remains underused, particularly in low‐ and middle‐income countries (LMICs). Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO4 to prevent or treat pre‐eclampsia/eclampsia. Search strategy We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021. Selection criteria Primary qualitative and mixed‐methods studies on factors affecting use of MgSO4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion. Data collection and analysis We applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO4. Main results We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation. Conclusions These findings can inform policy and guideline development and improve implementation of MgSO4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used. Tweetable abstract Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. This article includes Author Insights, a video abstract available at https://vimeo.com/manage/videos/623192027 Linked article This article is commented on by LA Magee, p. 392 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16971.
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Affiliation(s)
- K E Eddy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - J P Vogel
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - R I Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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von Dadelszen P, Vidler M, Tsigas E, Magee LA. Management of Preeclampsia in Low- and Middle-Income Countries: Lessons to Date, and Questions Arising, from the PRE-EMPT and Related Initiatives. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Abd El Monem M, Shahin M, Salim H. Safety bundle application on nurses’ knowledge and performance regarding management of hypertension during pregnancy and postpartum period. EGYPTIAN NURSING JOURNAL 2021; 18:98. [DOI: 10.4103/enj.enj_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Sisters in Birth: Improving Birth Outcomes in Mississippi. J Perinat Educ 2020; 29:168-180. [PMID: 33223790 DOI: 10.1891/j-pe-d-20-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mississippi has the poorest birth outcomes in the United States. Sisters in Birth (SIB) is a community-based nonprofit, charitable organization program that links community and clinical health to improve birth outcomes in Mississippi. This article describes the community and clinical health variables that influence birth outcomes and the organization's work or mission. The overwhelmingly positive outcomes of the first 50 women in the program are presented as well as snapshots of individual women's experiences.
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Shah N, Mohan D, Agarwal S, Scott K, Chamberlain S, Bhatnagar A, Labrique A, Indurkar M, Ved R, LeFevre A. Novel approaches to measuring knowledge among frontline health workers in India: Are phone surveys a reliable option? PLoS One 2020; 15:e0234241. [PMID: 32598348 PMCID: PMC7323989 DOI: 10.1371/journal.pone.0234241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs’ knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. Methods We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. Findings The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Conclusions Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
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Affiliation(s)
- Neha Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Smisha Agarwal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meenal Indurkar
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | - Rajani Ved
- National Health Systems Resource Center, National Institute of Health & Family Welfare, New Delhi, Delhi, India
| | | | - on behalf of the Kilkari Impact Evaluation team
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Bellad MB, Goudar SS, Mallapur AA, Sharma S, Bone J, Charantimath US, Katageri GM, Ramadurg UY, Mark Ansermino J, Derman RJ, Dunsmuir DT, Honnungar NV, Karadiguddi C, Kavi AJ, Kodkany BS, Lee T, Li J, Nathan HL, Payne BA, Revankar AP, Shennan AH, Singer J, Tu DK, Vidler M, Wong H, Bhutta ZA, Magee LA, von Dadelszen P. Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:166-175. [PMID: 32554291 PMCID: PMC7471838 DOI: 10.1016/j.preghy.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pregnancy hypertension is associated with 7.1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (<4 h) or non-urgently (<24 h), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of mHealth-guided CHW-provided contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS All 14,783 recruited pregnancies (7839 intervention, 6944 control) were followed-up. The primary outcome did not differ between intervention and control arms (adjusted odds ratio (aOR) 0.92 [95% confidence interval 0.74, 1.15]; p = 0.47; intraclass correlation coefficient 0.013). There were no intervention-related safety concerns following administration of either methyldopa or MgSO4, and 401 facility referrals. Compared with intervention arm women without CLIP contacts, those with ≥8 contacts suffered fewer stillbirths (aOR 0.19 [0.10, 0.35]; p < 0.001), at the probable expense of survivable neonatal morbidity (aOR 1.39 [0.97, 1.99]; p = 0.072). CONCLUSIONS As implemented, solely community-level interventions focussed on pre-eclampsia did not improve outcomes in northwest Karnataka.
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Affiliation(s)
- Mrutunjaya B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India.
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Ashalata A Mallapur
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Umesh S Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Geetanjali M Katageri
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Umesh Y Ramadurg
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - J Mark Ansermino
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Richard J Derman
- Global Affairs, 1020 Walnut Street, Thomas Jefferson University, Philadelphia 19107, USA
| | - Dustin T Dunsmuir
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Narayan V Honnungar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Chandrashekhar Karadiguddi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Avinash J Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Bhalachandra S Kodkany
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Tang Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Amit P Revankar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada; Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Nagraj S, Kennedy SH, Norton R, Jha V, Praveen D, Hinton L, Hirst JE. Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings. Front Cardiovasc Med 2020; 7:40. [PMID: 32266293 PMCID: PMC7099403 DOI: 10.3389/fcvm.2020.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.
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Affiliation(s)
- Shobhana Nagraj
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vivekananda Jha
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India
| | | | - Lisa Hinton
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
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15
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Singh S, Doyle P, Campbell OMR, Murthy GVS. Management and referral for high-risk conditions and complications during the antenatal period: knowledge, practice and attitude survey of providers in rural public healthcare in two states of India. Reprod Health 2019; 16:100. [PMID: 31291968 PMCID: PMC6617826 DOI: 10.1186/s12978-019-0765-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Appropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers' perspectives on management and referrals of antenatal women with high obstetric risk, or with complications. METHODS We surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications. RESULTS Staff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers. CONCLUSION The Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support.
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Affiliation(s)
- Samiksha Singh
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Amar Co-operative society, Plot#1 AVN Arcade, Kavuri Hills, Madhapur, Hyderabad, Telanagana 201010 India
| | - Pat Doyle
- Department of Non-communicable disease epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M. R. Campbell
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - G. V. S. Murthy
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Amar Co-operative society, Plot#1 AVN Arcade, Kavuri Hills, Madhapur, Hyderabad, Telanagana 201010 India
- Department of clinical research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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16
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Scott K, George AS, Ved RR. Taking stock of 10 years of published research on the ASHA programme: examining India's national community health worker programme from a health systems perspective. Health Res Policy Syst 2019; 17:29. [PMID: 30909926 PMCID: PMC6434894 DOI: 10.1186/s12961-019-0427-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As India's accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. METHODS We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW-health systems interface framework. RESULTS A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. CONCLUSION Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight.
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Affiliation(s)
| | - Asha S. George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535 South Africa
| | - Rajani R. Ved
- National Health Systems Resource Centre, New Delhi, India
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17
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Raney JH, Morgan MC, Christmas A, Sterling M, Spindler H, Ghosh R, Gore A, Mahapatra T, Walker DM. Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India. BMC Pregnancy Childbirth 2019; 19:41. [PMID: 30674286 PMCID: PMC6344989 DOI: 10.1186/s12884-019-2186-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inadequately treated, preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates, and are estimated to cause 60,000 global maternal deaths annually. Simulation-based training on obstetric and neonatal emergency management has demonstrated promising results in low- and middle-income countries. However, the impact of simulation training on use of evidence-based practices for PE/E diagnosis and management in low-resource settings remains unknown. METHODS This study was based on a statewide, high fidelity in-situ simulation training program developed by PRONTO International and implemented in collaboration with CARE India on PE/E management in Bihar, India. Using a mixed methods approach, we evaluated changes over time in nurse mentees' use of evidence-based practices during simulated births at primary health clinics. We compared the proportion and efficiency of evidence-based practices completed during nurse mentees' first and last participation in simulated PE/E cases. Twelve semi-structured interviews with nurse mentors explored barriers and enablers to high quality PE/E care in Bihar. RESULTS A total of 39 matched first and last simulation videos, paired by facility, were analyzed. Videos occurred a median of 62 days apart and included 94 nurses from 33 primary health centers. Results showed significant increases in the median number of 'key history questions asked,' (1.0 to 2.0, p = 0.03) and 'key management steps completed,' (2.0 to 3.0, p = 0.03). The time from BP measured to magnesium sulfate given trended downwards by 3.2 min, though not significantly (p = 0.06). Key barriers to high quality PE/E care included knowledge gaps, resource shortages, staff hierarchy between physicians and nurses, and poor relationships with patients. Enablers included case-based and simulation learning, promotion of teamwork and communication, and effective leadership. CONCLUSION Simulation training improved the use of evidence-based practices in PE/E simulated cases and has the potential to increase nurse competency in diagnosing and managing complex maternal complications such as PE/E. However, knowledge gaps, resource limitations, and interpersonal barriers must be addressed in order to improve care. Teamwork, communication, and leadership are key mechanisms to facilitate high quality PE/E care in Bihar.
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Affiliation(s)
- Julia H. Raney
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510 USA
| | - Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Mona Sterling
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Aboli Gore
- CARE India, Bihar technical Support Program, 14, Patliputra Colony, Patna, Bihar 800013 India
| | - Tanmay Mahapatra
- CARE India, Bihar technical Support Program, 14, Patliputra Colony, Patna, Bihar 800013 India
| | - Dilys M. Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
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18
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Olaoye T, Oyerinde OO, Elebuji OJ, Ologun O. Knowledge, Perception and Management of Pre-eclampsia among Health Care Providers in a Maternity Hospital. Int J MCH AIDS 2019; 8:80-88. [PMID: 31723478 PMCID: PMC6804318 DOI: 10.21106/ijma.275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Morbidity and mortality of women and children associated with pre-eclampsia present major global health problems in low and middle income countries. The prevalence of pre-eclampsia in Nigeria ranges from 2% to 16.7%, with approximately 37,000 women dying from preeclampsia annually. This study examines knowledge, perception and management of preeclampsia among healthcare providers in a major maternity hospital in Lagos, southwest Nigeria. METHODS In this descriptive cross-sectional study, 110 health care providers comprising of 75 Nurses, 9 Consultant Physicians, and 26 General Medical Practitioners with varying years of service were selected using purposive sampling technique. Data were collected using a self-administered 36-item semi-structured questionnaire. Data were analysed using the Statistical Package for Social Sciences to generate descriptive and inferential statistics with level of significance set at 0.05. RESULTS Health care providers in the study had an average knowledge of pre-eclampsia with a mean score of 16.69±3.53. There was generally a good perception of pre-eclampsia with a mean sore of 28.31±3.71. The most-prevalent clinical management practices were emergency cesarean section (16%), magnesium sulphate infusion (29%), and fluid/electrolyte management (9%). Knowledge of pre-eclampsia and years of practice were significantly associated (F=3.31; p= 0.023). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Gaps in the knowledge of causes, diagnoses, and treatment of pre-eclampsia may be attributable to lack of refresher trainings and absence of written practice guidelines on pre-eclampsia management. Health care providers at this hospital may benefit from training courses that include current nationally and internationally-approved management of pre-eclampsia.
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Affiliation(s)
- Titilayo Olaoye
- Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria
| | - Oyewole O Oyerinde
- Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria
| | - Oluwatoyin J Elebuji
- Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria
| | - Oluwapelumi Ologun
- Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria
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Malik A, Jee B, Gupta SK. Preeclampsia: Disease biology and burden, its management strategies with reference to India. Pregnancy Hypertens 2018; 15:23-31. [PMID: 30825923 DOI: 10.1016/j.preghy.2018.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
Abstract
Preeclampsia is the cause of significant maternal and fetal mortality and morbidity. It is characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. Preeclamptic women and children born from preeclamptic pregnancies are at greater risk to develop severe cardiovascular complications and metabolic syndromes later in life. The incidence of preeclampsia is estimated to be seven times higher in developing countries as compared to the developed countries. This review summarizes the pathophysiology of preeclampsia, emerging new hypothesis of its origin, risk factors that make women susceptible to developing preeclampsia and the potential of various biomarkers being studied to predict preeclampsia. The health care of developing countries is continuously challenged by substantial burden of maternal and fetal mortality. India despite being a fast developing country, is still far behind in achieving the required maternal mortality rates as per Millennium Development Goals set by the World Health Organization. Further, this review discusses the prevalence of preeclampsia in India, health facilities to manage preeclampsia, current guidelines and protocols followed and government policies to combat this complication in Indian condition.
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Affiliation(s)
- Ankita Malik
- Reproductive Cell Biology Lab, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110 067, India.
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi 110 001, India
| | - Satish Kumar Gupta
- Reproductive Cell Biology Lab, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110 067, India.
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20
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Global Maternal and Child Health:: A Research Partnership's Approach for Addressing Challenges and Reducing Health Disparities in Developing Countries. Dela J Public Health 2018; 4:4-12. [PMID: 34466982 PMCID: PMC8389062 DOI: 10.32481/djph.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Derman RJ, Jaeger FJ. Overcoming challenges to dissemination and implementation of research findings in under-resourced countries. Reprod Health 2018; 15:86. [PMID: 29945654 PMCID: PMC6019998 DOI: 10.1186/s12978-018-0538-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Louis Pasteur once commented on the happiness that a scientist finds when, besides making a discovery, study results find practical application. Where health status is poor and resources are limited, finding such applications is a necessity, not merely a joy. Dissemination, or the distribution of new knowledge gained through research, is essential to the ethical conduct of research. Further, when research is designed to improve health, dissemination is critical to the development of evidence-based medicine and the adoption of evidence-supported interventions and improved practice patterns within specific settings. When dissemination is lacking, research may be considered a waste of resources and a useless pursuit unable to influence positive health outcomes. Effective translation of the findings of health research into policy and the practice of medicine has been slow in many countries considered low or lower middle-income (as defined by the World Bank). This is because such countries often have health care systems that are under-resourced (e.g., lacking personnel or facilities) and thus insufficiently responsive to health needs of their populations. However, implementation research has produced many tools and strategies that can prompt more effective and timelier application of research findings to real world situations. A conscientious researcher can find many suggestions for improving the integration of research evidence into practice. First and foremost, the truthful reporting of results is emphasized as essential because both studies with desirable findings as well those with less than ideal results can provide new and valuable knowledge. Consideration in advance of the audience likely to be interested in study findings can result in suitable packaging and targeted communication of results. Other strategies for avoiding the barriers that can negatively impact implementation of research evidence include the early involvement of stakeholders as research is being designed and discussion before initiation of proposed research with those who will be affected by it. It is also important to recognize the role of education and training for ensuring the skills and knowledge needed for not only the conduct of high quality research but also for the meaningful promotion of results and application of research findings to achieve intended purposes.
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Affiliation(s)
- Richard J Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Frances J Jaeger
- Global Affairs, Thomas Jefferson University, Philadelphia, PA, USA
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22
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Charanthimath U, Vidler M, Katageri G, Ramadurg U, Karadiguddi C, Kavi A, Joshi A, Mungarwadi G, Bannale S, Rakaraddi S, Sawchuck D, Qureshi R, Sharma S, Payne BA, von Dadelszen P, Derman R, Magee LA, Goudar S, Mallapur A, Bellad M, Bhutta Z, Naik S, Mulla A, Kamle N, Dhamanekar V, Drebit SK, Kariya C, Lee T, Li J, Lui M, Khowaja AR, Tu DK, Revankar A. The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India. Reprod Health 2018; 15:101. [PMID: 29945662 PMCID: PMC6019995 DOI: 10.1186/s12978-018-0532-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. METHODS This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. RESULTS There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. CONCLUSION Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
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Affiliation(s)
- Umesh Charanthimath
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | | | - Avinash Kavi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Anjali Joshi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Sheshidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Sangamesh Rakaraddi
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Beth A. Payne
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Richard Derman
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Laura A. Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Mrutyunjaya Bellad
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Zulfiqar Bhutta
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sheela Naik
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Anis Mulla
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Namdev Kamle
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Vaibhav Dhamanekar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sharla K. Drebit
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Chirag Kariya
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Tang Lee
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Jing Li
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Mansun Lui
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Asif R. Khowaja
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Domena K. Tu
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Amit Revankar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
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23
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Munabi‐Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev 2017; 11:CD011558. [PMID: 29148566 PMCID: PMC5721625 DOI: 10.1002/14651858.cd011558.pub2] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care. OBJECTIVES To explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies. SEARCH METHODS Our search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016). SELECTION CRITERIA We included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries. DATA COLLECTION AND ANALYSIS One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. MAIN RESULTS We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs' provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed.Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate health workers, and improve the quality of care; these included good-quality housing, allowances for extra work, paid vacations, continuing education, appropriate assessments of their work, and rewards.Skilled birth attendants' ability to provide quality care was also limited by a lack of equipment, supplies, and drugs; blood and the infrastructure to manage blood transfusions; electricity and water supplies; and adequate space and amenities on maternity wards. These factors were seen to reduce SBAs' morale, increase their workload and infection risk, and make them less efficient in their work. A lack of transport sometimes made it difficult for SBAs to refer women on to higher levels of care. In addition, women's negative perceptions of the health system could make them reluctant to accept referral.We identified some other factors that also may have affected the quality of care, which were based on findings assessed as of low or very low confidence. Poor teamwork and lack of trust and collaboration between health workers appeared to negatively influence care. In contrast, good collaboration and teamwork appeared to increase skilled birth attendants' motivation, their decision-making abilities, and the quality of care. Skilled birth attendants' workloads and staff shortages influenced their interactions with mothers. In addition, poor communication undermined trust between skilled birth attendants and mothers. AUTHORS' CONCLUSIONS Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors.
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Affiliation(s)
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Atle Fretheim
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Harriet Nabudere
- Uganda National Health Research OrganisationPlot 2, Berkeley Lane, EntebbeEntebbeUganda
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24
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Kinney MV, Smith JM, Doherty T, Hermida J, Daniels K, Belizán JM. Feasibility of community level interventions for pre-eclampsia: perspectives, knowledge and task-sharing from Nigeria, Mozambique, Pakistan and India. Reprod Health 2016; 13:125. [PMID: 27716335 PMCID: PMC5045640 DOI: 10.1186/s12978-016-0245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 01/14/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia and eclampsia, remain one of the leading causes of maternal mortality and are contributory in many foetal/newborn deaths. This editorial discusses a supplement of seven papers which provide the results of the first round of the CLIP (Community Level Interventions for Pre-eclampsia) Feasibility Studies. These studies report a number of enablers and barriers in each setting, which have informed the implementation of a cluster-randomized trial (cRCT) aimed at reducing pre-eclampsia-related, and all-cause, maternal and perinatal mortality and major morbidity using community-based identification and treatment of pre-eclampsia in selected geographies of Nigeria, Mozambique, Pakistan and India. This supplement unpacks the diverse community perspectives on determinants of maternal health, variant health worker knowledge and routine management of HDP, and viability of task sharing for preeclampsia identification and management in select settings. These studies demonstrate the need for strategies to improve health worker knowledge and routine management of HDP and consideration of expanding the role of community health workers to reach the most remote women and families with health education and access to health services.
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Affiliation(s)
| | | | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jorge Hermida
- Center for Human Services, University Research Company, Bethesda, USA
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - José M. Belizán
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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