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Hijazi H, Al-Yateem N, Al Abdi R, Baniissa W, Alameddine M, Al-Sharman A, AlMarzooqi A, Subu MA, Ahmed FR, Hossain A, Sindiani A, Hayajneh Y. Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model. Health Expect 2024; 27:e14103. [PMID: 38872450 PMCID: PMC11176592 DOI: 10.1111/hex.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. METHODS Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. RESULTS The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care. CONCLUSION Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. PATIENT OR PUBLIC CONTRIBUTION This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.
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Affiliation(s)
- Heba Hijazi
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nabeel Al-Yateem
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Rabah Al Abdi
- Department of Electrical, Computer, and Biomedical Engineering, College of Engineering, Abu Dhabi University, Abu Dhabi, UAE
- Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Baniissa
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohamad Alameddine
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Alham Al-Sharman
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Rehabilitation Sciences Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alounoud AlMarzooqi
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Muhammad Arsyad Subu
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Fatma Refaat Ahmed
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Ahmed Hossain
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Amer Sindiani
- Department of Obstetrics and Gynsecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaseen Hayajneh
- Ancell School of Business, Western Connecticut State University, Danbury, Connecticut, USA
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Norris G, Hollins Martin CJ, Moylan A, Greig Y. A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care. NURSE EDUCATION TODAY 2024; 136:106144. [PMID: 38471361 DOI: 10.1016/j.nedt.2024.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour. OBJECTIVE In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource. METHOD A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care. PARTICIPANTS A convenience sample of midwives (n = 49) participated in the study. DATA-COLLECTION Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience. DATA-ANALYSIS Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark. FINDINGS Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods. CONCLUSIONS In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience. RECOMMENDATIONS FOR PRACTICE Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.
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Affiliation(s)
- Gail Norris
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Caroline J Hollins Martin
- Maternal Health, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Anne Moylan
- Advanced Neonatal Practitioner, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Weerasingha TK, Ratnayake C, Abeyrathne R, Tennakoon SU. Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka. Heliyon 2024; 10:e28517. [PMID: 38571647 PMCID: PMC10988013 DOI: 10.1016/j.heliyon.2024.e28517] [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: 08/17/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Evidence-based practice (EBP) is an effective approach to improve maternal and newborn outcomes at birth. Objective This study aimed to assess the current intrapartum practices of a tertiary care hospital in Central Province, Sri Lanka, during vaginal births. The benchmark for this assessment was the World Health Organisation's (WHO) recommendations on intrapartum care for a positive childbirth experience. Methods An observational study was conducted at the delivery room of Teaching Hospital, Peradeniya with the participation of 196 labouring women who were selected using systematic random sampling. A non-participant observation checklist covering labour room admission procedures, management of the first, second, and third stages of labour, and immediate care of the newborn and postpartum mother was used for the data collection. The care interventions implemented throughout labour and childbirth were observed and recorded. The data analysis was done using SPSS version 22. Results WHO-recommended practices such as providing privacy (33.2%), offering oral fluids (39.3%), and opioids for pain relief (48.5%) were found to be infrequent. Encouraging correct pushing techniques (77.6%), early breastfeeding (83.2%), regular assessment of vaginal bleeding (91.3%), skin-to-skin contact (93.4%), and using prophylactic uterotonics (100.0%) were found to be frequent. However, labour companionship, use of upright positions during labour, women's choice of birth position, and use of manual or relaxation techniques for pain relief were not observed in hospital intrapartum care. Conclusion The findings of the study indicate that additional attention and monitoring are required to align the current intrapartum care practices with the WHO recommendations. Moreover, the adoption of evidence-based intrapartum care should be encouraged by conveying the standard evidence-based intrapartum care guidelines to the grassroots level healthcare workers to avoid intrapartum interventions.
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Affiliation(s)
| | - Chathura Ratnayake
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - R.M. Abeyrathne
- Department of Sociology, Faculty of Arts, University of Peradeniya, Sri Lanka
| | - Sampath U.B. Tennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Muhammad A, Rizvee MSH, Khan U, Khan H, Bachlany A, Baloch B, Shafiq Y. Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi. PLoS One 2024; 19:e0298120. [PMID: 38578771 PMCID: PMC10997060 DOI: 10.1371/journal.pone.0298120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/16/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. METHODS A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis. RESULTS Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors. CONCLUSION The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.
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Affiliation(s)
| | | | - Uzma Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | - Hina Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | | | - Benazir Baloch
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Yasir Shafiq
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan
- CRIMEDIM–Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Sequeira Dmello B, John TW, Housseine N, Meyrowitsch DW, van Roosmalen J, van den Akker T, Kujabi ML, Festo C, Nkungu D, Muniro Z, Kabanda I, Msumi R, Maembe L, Sangalala M, Hyera E, Lema J, Bayongo S, Mshiu J, Kidanto HL, Maaløe N. Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis. BMC Pregnancy Childbirth 2024; 24:62. [PMID: 38218766 PMCID: PMC10787400 DOI: 10.1186/s12884-023-06096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. METHODS This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. RESULTS A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors. CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.
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Affiliation(s)
- Brenda Sequeira Dmello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), P. O Box 23310, Dar Es Salaam, Tanzania.
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania.
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Wiswa John
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Dan Wolf Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monica Lauridsen Kujabi
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel Nkungu
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Zainab Muniro
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Idrissa Kabanda
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Rukia Msumi
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Luzango Maembe
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Mtingele Sangalala
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Ester Hyera
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Joyce Lema
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Scolastica Bayongo
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Johnson Mshiu
- Muhimbili Medical Research Center, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Nanna Maaløe
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
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Kahraman HG, Gökçe İsbir G. The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial. Women Health 2023; 63:774-786. [PMID: 37807722 DOI: 10.1080/03630242.2023.2266009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.
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Affiliation(s)
| | - Gözde Gökçe İsbir
- School of Health, Midwifery Department, Mersin University, Mersin, Türkiye
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Rattanaprom P, Ratinthorn A, Sindhu S, Viwatwongkasem C. Contributing factors of birth asphyxia in Thailand: a case-control study. BMC Pregnancy Childbirth 2023; 23:584. [PMID: 37582743 PMCID: PMC10426058 DOI: 10.1186/s12884-023-05885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 07/30/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. METHODS A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. RESULTS The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. CONCLUSION Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.
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Affiliation(s)
- Panida Rattanaprom
- Doctoral Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Siriorn Sindhu
- Faculty of Nursing, Mahidol University, Bangkok, 10700 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
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Asim M, Hameed W, Khan B, Saleem S, Avan BI. Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00267. [PMID: 36853644 PMCID: PMC9972373 DOI: 10.9745/ghsp-d-22-00267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. METHODS Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. RESULTS We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. CONCLUSIONS Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Mayimbo S, Chitundu K, Shumba S, Musonda NC, Zulu M, Mushamba DN, Mwape L, Katowa-Mukwato P. Personal protective equipment availability and accessibility among nurses and midwives in selected urban general hospitals in Lusaka, Zambia: a cross-sectional study. Pan Afr Med J 2023; 44:52. [PMID: 37128614 PMCID: PMC10148176 DOI: 10.11604/pamj.2023.44.52.32936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/03/2023] [Indexed: 05/03/2023] Open
Abstract
Introduction the World Health Organization (WHO) declared COVID-19 a pandemic in January 2020, which has spread to many countries, including Zambia. Zambia has had challenges in providing personal protective equipment (PPEs) to nurses and midwives. The study's objective was to assess the availability and accessibility of PPEs among nurses and midwives caring for women in the general hospitals in Lusaka, Zambia. Methods a cross-sectional analytical study design was conducted at five general hospitals in Lusaka on 162 nurses and midwives between February and April 2021, selected by purposive sampling of study sites and simple random sampling to select the participants. Data was collected using a semi-structured self-administered questionnaire and analyzed in STATA version 13. Chi-square and Fisher's exact test were used to test associations between the independent variables and the outcome, and a multivariable logistic regression was used to investigate the predictors of accessing PPEs. Results out of the 162 who participated in the study, 48.8% were nurses, while 51.2% were midwives. Only 10% (16/160) of the participants reported having enough PPEs at work. Age, marital status, PPE use, employment duration, and protection confidence were associated with accessibility (P<0.05). Conclusion overall, there was an inadequate provision of PPEs in the health facilities putting the nurses and midwives at a high risk of acquiring COVID-19. Policymakers need a deliberate move to make the availability and accessibility of PPEs a reality during the pandemic.
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Affiliation(s)
- Sebean Mayimbo
- Department of Midwifery, Women and Child Health, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Kabwe Chitundu
- Department of Mental Health and Psychiatry Nursing, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Samson Shumba
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Corresponding author: Samson Shumba, Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
| | | | - Mutinke Zulu
- Department of Midwifery, Women and Child Health, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | | | - Lonia Mwape
- Mental Health Nursing Department, School of Medicine, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Patricia Katowa-Mukwato
- Department of Basic and Clinical Sciences, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
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12
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Sørensen JB, Housseine N, Maaløe N, Bygbjerg IC, Pinkowski Tersbøl B, Konradsen F, Sequeira Dmello B, van Den Akker T, van Roosmalen J, Mookherji S, Siaity E, Osaki H, Khamis RS, Kujabi ML, John TW, Wolf Meyrowitsch D, Mbekenga C, Skovdal M, L Kidanto H. Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study. Glob Health Action 2022; 15:2034136. [PMID: 35311627 PMCID: PMC8942528 DOI: 10.1080/16549716.2022.2034136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study’s programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants’ motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation.
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Affiliation(s)
- Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira Dmello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania.,Comprehensive Community Based Rehabilitation in Tanzania Tanzania
| | - Thomas van Den Akker
- Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington DC, US
| | - Eunice Siaity
- Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Columba Mbekenga
- Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L Kidanto
- Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
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13
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Maaløe N, Housseine N, Sørensen JB, Obel J, Sequeira DMello B, Kujabi ML, Osaki H, John TW, Khamis RS, Muniro ZSS, Nkungu DJ, Pinkowski Tersbøl B, Konradsen F, Mookherji S, Mbekenga C, Meguid T, van Roosmalen J, Bygbjerg IC, van den Akker T, Jensen AK, Skovdal M, L. Kidanto H, Wolf Meyrowitsch D. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study). Glob Health Action 2022; 15:2034135. [PMID: 35410590 PMCID: PMC9009913 DOI: 10.1080/16549716.2022.2034135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Natasha Housseine
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Obel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira DMello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
- Comprehensive Community Based Rehabilitation in Tanzania, Dar Es Salaam, Tanzania
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Columba Mbekenga
- School of Nursing and Midwifery East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Kryger Jensen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L. Kidanto
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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14
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Brenner S, Madhavan S, Nseya CK, Sese C, Fink G, Shapira G. Competent and deficient provision of childbirth services: a descriptive observational study assessing the quality of intrapartum care in two provinces of the Democratic Republic of the Congo. BMC Health Serv Res 2022; 22:551. [PMID: 35468822 PMCID: PMC9040341 DOI: 10.1186/s12913-022-07737-5] [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: 10/04/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background A majority of women in the Democratic Republic of the Congo (DRC) give birth in a health facility, but maternal and newborn mortality remains high. In rural areas, the quality of facility-based delivery care is often low. This study examines clinical quality of intrapartum care in two provinces of the DRC. Methods We observed process and input elements of delivery care provision at 29 facilities in Kwilu and Kwango provinces. Distinguishing non-performance attributable to provider behavior vs. input constraints, we compared both providers’ adherence to clinical standards (“competent care”) and non-adherence to processes for which required inputs were available (“deficient care”). Results Observing a total of 69 deliveries, care was most competent for partograph use (75% cases) and hemorrhage prevention (73%), but least for postpartum monitoring (4%). Competent care was significantly associated with higher case volumes (p = ·03), skilled birth attendance (p = ·05), and nulliparous women (p = ·02). Care was most deficient for infection prevention (62%) and timely care (49%) and associated with cases observed at hospitals and lower delivery volume. Conclusions Low quality was commonly not a result of missing equipment or supplies but related to providers’ non-adherence to standard protocols. Low case volumes and the absence of skilled attendants seemed to be main factors for sub-standard quality care. Birth assistance during labor stage 2 was the only intrapartum stage heavily affected by the unavailability of essential equipment. Future interventions should strengthen links between birth attendants’ practice to clinical protocols.
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Affiliation(s)
- Stephan Brenner
- Heidelberg Institute of Global Health, University Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Supriya Madhavan
- Global Financing Facility and The World Bank, Washington, DC, USA
| | - Céline Kanionga Nseya
- Institut Supérieur des Techniques Médicales, Kinshasa, Democratic Republic of the Congo.,Bureau Appui Technique, Division Provinciale de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Claude Sese
- Programme de Développement du Système de Santé (PDSS), Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Gil Shapira
- Development Research Group (DECRG), The World Bank, Washington, DC, USA
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15
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Housseine N, Rijken MJ, Weller K, Nassor NH, Gbenga K, Dodd C, Debray T, Meguid T, Franx A, Grobbee DE, Browne JL. Development of a clinical prediction model for perinatal deaths in low resource settings. EClinicalMedicine 2022; 44:101288. [PMID: 35252826 PMCID: PMC8888338 DOI: 10.1016/j.eclinm.2022.101288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most pregnancy-related deaths in low and middle income countries occur around the time of birth and are avoidable with timely care. This study aimed to develop a prognostic model to identify women at risk of intrapartum-related perinatal deaths in low-resourced settings, by (1) external validation of an existing prediction model, and subsequently (2) development of a novel model. METHODS A prospective cohort study was conducted among pregnant women who presented consecutively for delivery at the maternity unit of Zanzibar's tertiary hospital, Mnazi Mmoja Hospital, the Republic of Tanzania between October 2017 and May 2018. Candidate predictors of perinatal deaths included maternal and foetal characteristics obtained from routine history and physical examination at the time of admission to the labour ward. The outcomes were intrapartum stillbirths and neonatal death before hospital discharge. An existing stillbirth prediction model with six predictors from Nigeria was applied to the Zanzibar cohort to assess its discrimination and calibration performance. Subsequently, a new prediction model was developed using multivariable logistic regression. Model performance was evaluated through internal validation and corrected for overfitting using bootstrapping methods. FINDINGS 5747 mother-baby pairs were analysed. The existing model showed poor discrimination performance (c-statistic 0·57). The new model included 15 clinical predictors and showed promising discriminative and calibration performance after internal validation (optimism adjusted c-statistic of 0·78, optimism adjusted calibration slope =0·94). INTERPRETATION The new model consisted of predictors easily obtained through history-taking and physical examination at the time of admission to the labour ward. It had good performance in predicting risk of perinatal death in women admitted in labour wards. Therefore, it has the potential to assist skilled birth attendance to triage women for appropriate management during labour. Before routine implementation, external validation and usefulness should be determined in future studies. FUNDING The study received funding from Laerdal Foundation, Otto Kranendonk Fund and UMC Global Health Fellowship. TD acknowledges financial support from the Netherlands Organisation for Health Research and Development (grant 91617050).
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Affiliation(s)
- Natasha Housseine
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
- Division of Woman and Baby, University Medical Centre Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Corresponding author: Natasha Housseine, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Postal address: Huispost nr 1. STR 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands, Telephone number: +255 745 338950.
| | - Marcus J Rijken
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
- Division of Woman and Baby, University Medical Centre Utrecht, The Netherlands
| | - Katinka Weller
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | | | - Kayode Gbenga
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Caitlin Dodd
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Thomas Debray
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health and Medical Sciences, State University of Zanzibar
- Village Health Works, Kigutu, Burundi
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
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16
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Ekblom A, Målqvist M, Gurung R, Rossley A, Basnet O, Bhattarai P, K C A. Factors associated with poor adherence to intrapartum fetal heart monitoring in relationship to intrapartum related death: A prospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000289. [PMID: 36962317 PMCID: PMC10021382 DOI: 10.1371/journal.pgph.0000289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Poor quality of intrapartum care remains a global health challenge for reducing stillbirth and early neonatal mortality. Despite fetal heart rate monitoring (FHRM) being key to identify fetus at risk during labor, sub-optimal care prevails in low-income settings. The study aims to assess the predictors of suboptimal fetal heart rate monitoring and assess the association of sub-optimal FHRM and intrapartum related deaths. METHOD A prospective cohort study was conducted in 12 hospitals between April 2017 to October 2018. Pregnant women with fetal heart sound present during admission were included. Inferential statistics were used to assess proportion of sub-optimal FHRM. Multi-level logistic regression was used to detect association between sub-optimal FHRM and intrapartum related death. RESULT The study cohort included 83,709 deliveries, in which in more than half of women received suboptimal FHRM (56%). The sub-optimal FHRM was higher among women with obstetric complication than those with no complication (68.8% vs 55.5%, p-value<0.001). The sub-optimal FHRM was higher if partograph was not used than for whom partograph was completely filled (70.8% vs 15.9%, p-value<0.001). The sub-optimal FHRM was higher if the women had no companion during labor than those who had companion during labor (57.5% vs 49.6%, p-value<0.001). After adjusting for background characteristics and intra-partum factors, the odds of intrapartum related death was higher if FHRM was done sub-optimally in reference to women who had FHRM monitored as per protocol (aOR, 1.47; 95% CI; 1.13, 1.92). CONCLUSION Adherence to FHRM as per clinical standards was inadequate in these hospitals of Nepal. Furthermore, there was an increased odds of intra-partum death if FHRM had not been carried out as per clinical standards. FHRM provided as per protocol is key to identify fetuses at risk, and efforts are needed to improve the adherence of quality of care to prevent death.
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Affiliation(s)
- Annette Ekblom
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rejina Gurung
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Angela Rossley
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Ashish K C
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
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17
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Vestering A, de Kok BC, Browne JL, Adu-Bonsaffoh K. Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana. Soc Sci Med 2021; 289:114402. [PMID: 34600357 DOI: 10.1016/j.socscimed.2021.114402] [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: 12/15/2020] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients' and providers' understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers' possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals' and patients' perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients' needs, preferences and experiences.
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Affiliation(s)
| | | | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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18
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Singh S, Goel R, Gogoi A, Caleb-Varkey L, Manoranjini M, Ravi T, Rawat D. Presence of birth companion-a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India. Health Policy Plan 2021; 36:1552-1561. [PMID: 34427637 DOI: 10.1093/heapol/czab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.
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Affiliation(s)
- Shalini Singh
- Indian Council of Medical Research, New Delhi, India
| | - Richa Goel
- Indian Council of Medical Research, New Delhi, India
| | - Aparajita Gogoi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Leila Caleb-Varkey
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Mercy Manoranjini
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Tina Ravi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
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Mugyenyi GR, Ngonzi J, Wylie BJ, Haberer JE, Boatin AA. Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement. Pan Afr Med J 2021; 38:252. [PMID: 34104300 PMCID: PMC8164430 DOI: 10.11604/pamj.2021.38.252.21749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction vital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting. Methods retrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests. Results among 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication. Conclusion very few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.
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Affiliation(s)
- Godfrey Rwambuka Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Blair Johnson Wylie
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, USA
| | - Jessica Elizabeth Haberer
- Harvard Medical School, Boston, USA.,Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Adeline Adwoa Boatin
- Harvard Medical School, Boston, USA.,Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Housseine N, Snieder A, Binsillim M, Meguid T, Browne JL, Rijken MJ. The application of WHO ICD-PM: Feasibility for the classification of timing and causes of perinatal deaths in a busy birth centre in a low-income country. PLoS One 2021; 16:e0245196. [PMID: 33444424 PMCID: PMC7808596 DOI: 10.1371/journal.pone.0245196] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the feasibility of the application of International Classification of Diseases-10-to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions. DESIGN Prospective application of ICD-PM. SETTING Referral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania. POPULATION Stillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018. METHODS Clinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed. MAIN OUTCOME MEASURES Timing and causes of perinatal mortality and their associated maternal conditions. RESULTS There were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events. CONCLUSION Problems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.
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Affiliation(s)
- Natasha Housseine
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Anne Snieder
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mithle Binsillim
- Department of Paediatrics, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Village Health Works, Kigutu, Burundi
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marcus J. Rijken
- Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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21
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Housseine N, Rijken MJ, Punt MC, Meguid T, Franx A, van der Graaf R, Browne JL. Mistreatment during childbirth. Lancet 2020; 396:816-817. [PMID: 32950087 DOI: 10.1016/s0140-6736(20)31556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Natasha Housseine
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Netherlands; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Netherlands; Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania.
| | - Marcus J Rijken
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Netherlands; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Netherlands
| | - Marieke C Punt
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania; Village Health Works, Kigutu, Burundi
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Netherlands
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22
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Palo SK, Kripalini P, Sanghamitra P. Situation of labour room documentation at secondary level public health facilities of Cuttack district, Odisha, India - A SWOT analysis. J Family Med Prim Care 2020; 9:3308-3314. [PMID: 33102288 PMCID: PMC7567242 DOI: 10.4103/jfmpc.jfmpc_376_20] [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: 03/13/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Poor documentation practices in labour rooms have been a challenge especially in resource limited countries. This hinders the efforts towards improving quality of maternal healthcare services. Little effort has been made on this regard in many countries including India. SWOT analysis on labour room documentation would be the first step in understanding the situation, barriers and to formulate strategies for improvement. Materials and Methods: Facility based cross-sectional study was carried out in five secondary health facilities of Cuttack district, Odisha, India. A qualitative method using in-depth interviews among 26 healthcare providers was adopted for data collection and inductive content analysis approach for analysis. Strategies like pioneering, positive, conservative and resistive were formulated under each of the three major components identified. Results: Three major components emerged were i) Adherence and completeness of labour room records and reports, ii) Status of the monitoring and supervision and iii) Utilization of labour room data. Improving knowledge and skill through training and supportive supervision, adopting computer-based application for data management, better coordination among supervisors and labour room staff, infrastructural strengthening for documentation and its security, making documentation a priority, more accountability would improve the documentation. Ensuring data analysis and interpretation, discussion in review meetings and regular monitoring and supervision will improve performance. Conclusion: Ensuring documentation of labour room records, regular quality monitoring and supervision, and analysis and interpretation of data are critical to improve labour room performance. Making it a priority and adopting the strategies will achieve the same, thereby better labour outcome.
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Affiliation(s)
- Subrata Kumar Palo
- Department of Community Medicine, Scientist-D, Regional Medical Research Centre - ICMR, Bhubaneswar, Odisha, India
| | - Patel Kripalini
- Senior Research Fellow, Regional Medical Research Centre - ICMR, Bhubaneswar, Odisha, India
| | - Pati Sanghamitra
- Director, Regional Medical Research Centre - ICMR, Bhubaneswar, Odisha, India
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Kwaleyela CN, Sianchapa BN, Katowa-Mukwato P, Banda Y, Musenge EM, Mwiinga-Kalusopa V, Chapima F, Banda JN, Phiri B, Maimbolwa MC. Quality of Intrapartum Care: Direct Observations in Selected Health Facilities in Zambia. Health (London) 2020. [DOI: 10.4236/health.2020.1211103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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