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Kassie A, Kassie M, Bantie B, Bogale TW, Aynalem ZB. Neonatal Mortality at Felege Hiwot Comprehensive Specialized Hospital in Ethiopia Over 5 years: Trends and Associated Factors. Clin Med Insights Pediatr 2023; 17:11795565231187500. [PMID: 37529621 PMCID: PMC10387765 DOI: 10.1177/11795565231187500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background Globally, neonatal mortality remains a serious catastrophic problem for newborns, particularly in a low-resource setting. There were no neonatal mortality trend studies in the study area. Objective This study aimed to determine the trends and risk factors of neonatal mortality at the neonatal intensive care unit of Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Methods An institution-based retrospective cross-sectional study was conducted among 870 admitted neonates from January 1, 2016 to December 31, 2020 in the neonatal intensive care unit by a stratified simple random sampling technique. Data were entered into EpiData and then exported to STATA 14.0 for analysis. A linear regression statistical model was used for trend analysis and binary logistic regression was carried out to identify explanatory variables of neonatal mortality. Results Overall, neonatal mortality averagely increased by 2.1% per year throughout the 5 consecutive years. In this study, rural residency [adjusted odds ratio (AOR): 1.96, 95% confidence interval (CI): (1.26, 3.06)], birth asphyxia (AOR: 7.73, 95% CI: 4.31, 13.84), congenital deformity (AOR: 3.61, 95% CI: 1.17, 11.18), low birth weight (AOR: 2.13, 95% CI: 1.23, 3.67), respiratory distress syndrome (AOR: 3.32, 95% CI: 1.97, 5.59), Ambu-bag resuscitation (AOR: 0.16, 95% CI: 0.07, 0.38), taking antibiotics (AOR: 0.50, 95% CI: 0.27, 0.90), glucose (AOR: 0.47, 95% CI: 0.30, 0.72), and oxygen (AOR: 0.26, 95% CI: 0.16, 0.41) were associated with neonatal mortality. Conclusions This 5-year trend analysis revealed an increased trend of NMR, indicating more work is still needed to make progress toward meeting the SDG goal by 2030. Rural residency, birth asphyxia, congenital deformity, low birth weight, respiratory distress syndrome, Ambu-bag resuscitation, taking antibiotics, glucose, and oxygen were associated with neonatal mortality. Therefore, all stakeholders shall give due attention to reducing this timely-increasing trend of neonatal mortality.
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Affiliation(s)
- Ayalew Kassie
- Department of Nursing, Bahir Dar Health Science College, Bahir Dar, Ethiopia
| | - Mulugeta Kassie
- Department of Nursing, Wogeda Primary Hospital, Bahir Dar, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Tewodros Worku Bogale
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zewdu Bishaw Aynalem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Galle A, Moran AC, Bonet M, Graham K, Muzigaba M, Portela A, Day LT, Tuabu GK, Silva BDSÉ, Moller AB. Measures to assess quality of postnatal care: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001384. [PMID: 36963034 PMCID: PMC10021656 DOI: 10.1371/journal.pgph.0001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Allisyn C Moran
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
| | - Katriona Graham
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Moise Muzigaba
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Anayda Portela
- World Health Organization Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology, Maternal Newborn Health Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Godwin Kwaku Tuabu
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Bianca De Sá É Silva
- Department of Public Health and Primary Care, WHO Collaborating Centre on Primary Care and Family Medicine, Ghent University, Belgium
| | - Ann-Beth Moller
- World Health Organization Department of Sexual and Reproductive Health and Research, Development and Research Training in Human Reproduction (HRP), UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Geneva, Switzerland
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Rosa-Mangeret F, Benski AC, Golaz A, Zala PZ, Kyokan M, Wagner N, Muhe LM, Pfister RE. 2.5 Million Annual Deaths-Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis 2022; 7:64. [PMID: 35622691 PMCID: PMC9148074 DOI: 10.3390/tropicalmed7050064] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/25/2022] [Accepted: 04/11/2022] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fail to diminish effectively? A bottom-up understanding of neonatal morbi-mortality and neonatal rights is essential to achieve adequate progress, and so is increased visibility. (2) Methods: We performed an overview on the leading causes of neonatal morbi-mortality and analyzed the key interventions to reduce it with a bottom-up approach: from the clinician in the field to the policy maker. (3) Results and Conclusions: Overall, more than half of neonatal deaths in LMIC are avoidable through established and well-known cost-effective interventions, good quality antenatal and intrapartum care, neonatal resuscitation, thermal care, nasal CPAP, infection control and prevention, and antibiotic stewardship. Implementing these requires education and training, particularly at the bottom of the healthcare pyramid, and advocacy at the highest levels of government for health policies supporting better newborn care. Moreover, to plan and follow interventions, better-quality data are paramount. For healthcare developments and improvement, neonates must be acknowledged as humans entitled to rights and freedoms, as stipulated by international law. Most importantly, they deserve more respectful care.
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Affiliation(s)
- Flavia Rosa-Mangeret
- Neonatal Division, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.Z.Z.); (R.E.P.)
- Global Health Institute, University of Geneva, 1205 Geneva, Switzerland;
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Anne-Caroline Benski
- Obstetrics Division, Geneva University Hospitals, 1205 Geneva, Switzerland;
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Anne Golaz
- Center for Education and Research in Humanitarian Action, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
| | - Persis Z. Zala
- Neonatal Division, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.Z.Z.); (R.E.P.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Centre Medico-Chirurgical-Pédiatrique Persis, Ouahigouya BP267, Burkina Faso
| | - Michiko Kyokan
- Global Health Institute, University of Geneva, 1205 Geneva, Switzerland;
| | - Noémie Wagner
- Pediatric Infectious Diseases Division, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Lulu M. Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia;
| | - Riccardo E. Pfister
- Neonatal Division, Geneva University Hospitals, 1205 Geneva, Switzerland; (P.Z.Z.); (R.E.P.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
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Are Primary Health Care Features Associated with Reduced Late Neonatal Mortality in Brazil? An Ecological Study. Matern Child Health J 2021; 26:1790-1799. [PMID: 34731357 DOI: 10.1007/s10995-021-03269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the effect and efficiency of the characteristics of PHC facilities' structures and the work process of PHC teams on late neonatal mortality (LNM). METHODS This ecological time-series study adopted 3.764 Brazilian municipalities as analysis units. The independent variables were sorted into three hierarchical levels and four blocks. The distal level consisted of economic and demographic variables; the intermediate level comprised health coverage and demand for services; and the proximal level included structure and work process. The dependent variable was LNM. A linear mixed-effects regression analysis with a hierarchical approach was performed, estimating the crude (β) and adjusted (alpha = 5%) regression coefficients. Data involution analysis and municipalities were the decision-making unit according to their strata. RESULTS LNM was directly associated with the number of live births and unemployment rate. LNM was inversely associated with the year, per capita income, the community health worker's strategy coverage, vaginal delivery, household visits, and available vaccines. In the 2002-2014 period, the number of municipalities efficient in reducing LNM dropped from 38 to 27. In 2014, a more significant investment occurred in the number of vaginal deliveries in almost all strata to make inefficient municipalities efficient. CONCLUSION FOR PRACTICE The deaths of children aged 7-28 days are affected by the characteristics of the PHC structure and work process.
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands.,Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK.,Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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McGready R, Rijken MJ, Turner C, Than HH, Tun NW, Min AM, Hla S, Wai NS, Proux K, Min TH, Gilder ME, Sneddon A. A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border. Wellcome Open Res 2021; 6:94. [PMID: 34195384 PMCID: PMC8204190 DOI: 10.12688/wellcomeopenres.16599.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 04/30/2024] Open
Abstract
Background: Short emergency obstetric care (EmOC) courses have demonstrated improved provider confidence, knowledge and skills but impact on indicators such as maternal mortality and stillbirth is less substantial. This manuscript evaluates Advanced Life Support in Obstetrics (ALSO) and Basic Life Support (BLSO) as an adult education tool, in a protracted, post-conflict and resource-limited setting. Methods: A mixed methods evaluation was used. Basic characteristics of ALSO and BLSO participants and their course results were summarized. Kirkpatrick's framework for assessment of education effectiveness included: qualitative data on participants' reactions to training (level 1); and quantitative health indicator data on change in the availability and quality of EmOC and in maternal and/or neonatal health outcomes (level 4), by evaluation of the post-partum haemorrhage (PPH) related maternal mortality ratio (MMR) and stillbirth rate in the eight years prior and following implementation of ALSO and BLSO. Results: 561 Thailand-Myanmar border health workers participated in ALSO (n=355) and BLSO (n=206) courses 2008-2020. Pass rates on skills exceeded 90% for both courses while 50% passed the written ALSO test. Perceived confidence significantly improved for all items assessed. In the eight-year block preceding the implementation of ALSO and BLSO (2000-07) the PPH related MMR per 100,000 live births was 57.0 (95%CI 30.06-108.3)(9/15797) compared to 25.4 (95%CI 11.6-55.4)(6/23620) eight years following (2009-16), p=0.109. After adjustment, PPH related maternal mortality was associated with birth before ALSO/BLSO implementation aOR 3.825 (95%CI 1.1233-11.870), migrant (not refugee) status aOR 3.814 (95%CI 1.241-11.718) and attending ≤four antenatal consultations aOR 3.648 (95%CI 1.189-11.191). Stillbirth rate per 1,000 total births was 18.2 (95%CI 16.2-20.4)(291/16016) before the courses, and 11.1 (95%CI 9.8-12.5)(264/23884) after, p=0.038. Birth before ALSO/ BLSO implementation was associated with stillbirth aoR 1.235 (95%CI 1.018-1.500). Conclusions: This evaluation suggests ALSO and BLSO are sustainable, beneficial, EmOC trainings for adult education in protracted, post-conflict, resource-limited settings.
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Affiliation(s)
- Rose McGready
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
| | - Marcus J. Rijken
- Utrecht University Medical Centre, Utrecht University, Utrecht, Utrecht, 3584 CX, The Netherlands
- Julius Centre Global Health, University Medical Center, Utrecht, Utrecht, 3508 GA, The Netherlands
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LG, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Hla Hla Than
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Sophia Hla
- Reproductive Health, Mae Tao Clinic, Mae Sot, 63110, Thailand
| | - Nan San Wai
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Kieran Proux
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Thaw Htway Min
- Shoklo Malaria Research Unit, , Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, 63110, Thailand
| | - Mary Ellen Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University,, Chiang Mai, Chiang Mai, 50200, Thailand
| | - Anne Sneddon
- School of Medicine, Gold Coast campus, Griffith University, Queensland, 4222, Australia
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Bediako VB, Boateng ENK, Owusu BA, Dickson KS. Multilevel geospatial analysis of factors associated with unskilled birth attendance in Ghana. PLoS One 2021; 16:e0253603. [PMID: 34170944 PMCID: PMC8232528 DOI: 10.1371/journal.pone.0253603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Globally, about 810 women die every day due to pregnancy and its related complications. Although the death of women during pregnancy or childbirth has declined from 342 deaths to 211 deaths per 100,000 live births between 2000 and 2017, maternal mortality is still higher, particularly in sub-Saharan Africa and South Asia, where 86% of all deaths occur. Methods A secondary analysis was carried out using the 2014 Ghana Demographic and Health Survey. A sample total of 4,290 women who had a live birth in the 5 years preceding the survey was included in the analysis. GIS software was used to explore the spatial distribution of unskilled birth attendance in Ghana. The Geographic Weighted Regression (GWR) was employed to model the spatial relationship of some predictor of unskilled birth attendance. Moreover, a multilevel binary logistic regression model was fitted to identify factors associated with unskilled birth attendance. Results In this study, unskilled birth attendance had spatial variations across the country. The hotspot, cluster and outlier analysis identified the concerned districts in the north-eastern part of Ghana. The GWR analysis identified different predictors of unskilled birth attendance across districts of Ghana. In the multilevel analysis, mothers with no education, no health insurance coverage, and mothers from households with lower wealth status had higher odds of unskilled birth attendance. Being multi and grand multiparous, perception of distance from the health facility as not a big problem, urban residence, women residing in communities with medium and higher poverty level had lower odds of unskilled birth attendance. Conclusion Unskilled birth attendance had spatial variations across the country. Areas with high levels of unskilled birth attendance had mothers who had no formal education, not health insured, mothers from poor households and communities, primiparous women, mothers from remote and border districts could get special attention in terms of allocation of resources including skilled human power, and improved access to health facilities.
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Affiliation(s)
- Vincent Bio Bediako
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N K Boateng
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
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Goldenberg RL, Goudar SS, Saleem S, Hibberd PL, Tolosa JE, Koso-Thomas M, McClure EM. Reports from the NICHD Global Network's Maternal and Newborn Health Registry: supplement introduction. Reprod Health 2020; 17:177. [PMID: 33256779 PMCID: PMC7703731 DOI: 10.1186/s12978-020-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jorge E Tolosa
- Oregon Health and Science University, Portland, OR, USA
- St. Luke's University Health Network, Bethlehem, PA, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Elizabeth M McClure
- Social Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA.
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