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Kavunga-Membo H, Watson-Jones D, Kasonia K, Edwards T, Camacho A, Mambula G, Tetsa-Tata D, Choi EML, Aboubacar S, Brindle H, Roberts C, Manno D, Faguer B, Mossoko Z, Mukadi P, Kakule M, Balingene B, Mapendo EK, Makarimi R, Toure O, Campbell P, Mousset M, Nsaibirni R, Ama IS, Janvier KK, Keshinro B, Cissé B, Sahani MK, Johnson J, Connor N, Lees S, Imbault N, Robinson C, Grais RF, Bausch DG, Muyembe-Tamfum JJ. Delivery and Safety of a Two-Dose Preventive Ebola Virus Disease Vaccine in Pregnant and Non-Pregnant Participants during an Outbreak in the Democratic Republic of the Congo. Vaccines (Basel) 2024; 12:825. [PMID: 39203952 PMCID: PMC11359453 DOI: 10.3390/vaccines12080825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/07/2024] [Accepted: 07/18/2024] [Indexed: 08/08/2024] Open
Abstract
During the 2018-2020 Ebola virus disease (EVD) outbreak, residents in Goma, Democratic Republic of the Congo, were offered a two-dose prophylactic EVD vaccine. This was the first study to evaluate the safety of this vaccine in pregnant women. Adults, including pregnant women, and children aged ≥1 year old were offered the Ad26.ZEBOV (day 0; dose 1), MVA-BN-Filo (day 56; dose 2) EVD vaccine through an open-label clinical trial. In total, 20,408 participants, including 6635 (32.5%) children, received dose 1. Fewer than 1% of non-pregnant participants experienced a serious adverse event (SAE) following dose 1; one SAE was possibly related to the Ad26.ZEBOV vaccine. Of the 1221 pregnant women, 371 (30.4%) experienced an SAE, with caesarean section being the most common event. No SAEs in pregnant women were considered related to vaccination. Of 1169 pregnancies with a known outcome, 55 (4.7%) ended in a miscarriage, and 30 (2.6%) in a stillbirth. Eleven (1.0%) live births ended in early neonatal death, and five (0.4%) had a congenital abnormality. Overall, 188/891 (21.1%) were preterm births and 79/1032 (7.6%) had low birth weight. The uptake of the two-dose regimen was high: 15,328/20,408 (75.1%). The vaccine regimen was well-tolerated among the study participants, including pregnant women, although further data, ideally from controlled trials, are needed in this crucial group.
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Affiliation(s)
- Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Deborah Watson-Jones
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Kambale Kasonia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Tansy Edwards
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8131, Japan;
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Anton Camacho
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Grace Mambula
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Darius Tetsa-Tata
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Edward Man-Lik Choi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Soumah Aboubacar
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Hannah Brindle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Chrissy Roberts
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Daniela Manno
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Benjamin Faguer
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Zephyrin Mossoko
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Pierre Mukadi
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Michel Kakule
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Benith Balingene
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Esther Kaningu Mapendo
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Rockyath Makarimi
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Oumar Toure
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Paul Campbell
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Mathilde Mousset
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Robert Nsaibirni
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Ibrahim Seyni Ama
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Kikongo Kambale Janvier
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Babajide Keshinro
- Janssen Vaccines and Prevention, 2333 CN Leiden, The Netherlands; (B.K.); (C.R.)
| | - Badara Cissé
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Mateus Kambale Sahani
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | | | - Nicholas Connor
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Shelley Lees
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Nathalie Imbault
- Coalition for Epidemic Preparedness Innovations, 0277 Oslo, Norway;
| | - Cynthia Robinson
- Janssen Vaccines and Prevention, 2333 CN Leiden, The Netherlands; (B.K.); (C.R.)
| | - Rebecca F. Grais
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Daniel G. Bausch
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Jean Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
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Kahiririaa MJ, Namyalo J, Mubarak N, Otieno E. Perinatal mortality and its predictors in Beni City, Democratic Republic of Congo: a cross-sectional study. Matern Health Neonatol Perinatol 2024; 10:14. [PMID: 38965609 PMCID: PMC11225334 DOI: 10.1186/s40748-024-00184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/12/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Globally, perinatal mortality rates have decreased considerably in the last 30 years. However, in sub-Saharan African countries perinatal mortality remains a public health burden. Therefore, this study aimed to determine the Perinatal Mortality Rate and the factors associated with perinatal mortality in Beni City, Northeastern Democratic Republic of Congo. METHODS A hospital-based retrospective cross-sectional study was conducted among 1394 deliveries that were documented in Beni General Referral Hospital from 2 January to May 31, 2022. The study was done in the conflict-ridden Beni city of the North Kivu Province. Analysis was done using Open Epi and SPSS version 22. Binary and Multivariate logistic regression analyses were performed. Odds ratio with 95% confidence interval was used to measure strength of association. RESULTS Findings indicate that 60.7% of 1394 participants were below the age of 21 years, and 95.1% (1325) Beni residents. The Perinatal Mortality Rate was 42.3 per 1000 live births. Majority (51) of the postpartum women who experienced perinatal mortality didn`t have a history of perinatal mortality as compared to their counterparts. Multivariable analysis revealed that birth weight (AoR = 0.082, 95% CI 0.014-0.449, p < 0.05) and Apgar score in the 10th minute (AoR = 0.082, 95% CI 0.000- 0.043, p < 0.05) were significantly associated with Perinatal mortality. CONCLUSION The high perinatal mortality rate in Beni General Referral Hospital, approximately four in every 100 births remains a disturbing public health concern of which is attributable to low birth weight and Apgar score. This study may help policy-makers and healthcare providers to design preventive interventions.
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Affiliation(s)
- Mathe Julien Kahiririaa
- Department of Public Health, Uganda Christian University, Mukono, Uganda
- Department of Public Health, Official University of Ruwenzori, Butembo City, Democratic Republic of Congo
| | - Josephine Namyalo
- Department of Public Health, Official University of Ruwenzori, Butembo City, Democratic Republic of Congo
| | - Nasur Mubarak
- Yumbe Regional Referral Hospital, Ministry of Health, Yumbe, Uganda
| | - Emmanuel Otieno
- School of Public Health, Gudie University Project, Kampala, Uganda.
- Uganda Peoples Defense Forces, Kampala, Uganda.
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Service availability and readiness to provide comprehensive emergency obstetric and newborn care services in post-conflict at North Wollo Zone hospitals, Northeast Ethiopia: mixed survey. BMC Health Serv Res 2023; 23:205. [PMID: 36859188 PMCID: PMC9976532 DOI: 10.1186/s12913-023-09165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Countries with humanitarian crises and fragile conditions contribute to 61% of the global burden of maternal mortality. Emergency Obstetric and Newborn Care (EmONC) services reduce direct obstetric complications, which cause approximately 70-80% of maternal deaths and 10% to 15% of neonatal deaths. Therefore, this study was aimed to assess the service availability and readiness to provide comprehensive emergency obstetric and newborn care services in post-conflict at North Wollo Zone hospitals, Northeast Ethiopia. METHODS A facility-based mixed cross-sectional study design was conducted from May 10 to May 25, 2022, among North Wollo zone hospitals. Quantitative data were collected by using structured interviewer-administered questionnaires with observation and record review, entered by using Epi Data Version 4.6, and exported to SPSS 25 for analysis. Qualitative data were collected by key informant interviews and analyzed through thematic analysis. A descriptive data analysis was done to analyze the study variables. RESULTS Only three of the six hospitals (Woldia, Shediho Meket, and Saint Lalibella) performed all signal functions of comprehensive emergency obstetric and newborn care in the preceding three months. Cesarean section was the least performed signal function in post-conflict. The overall readiness to provide comprehensive emergency obstetric and newborn care services was 77.7%. Only one of the six hospitals had sufficient blood without interruption, and three of the six facilities had done screening for hepatitis B, HIV, and syphilis. Lack of supplies, equipment, and drugs were the challenges for the performance of EmONC signal functions. CONCLUSIONS Post-conflict availability and readiness for comprehensive emergency obstetric and newborn care services in the North Wollo Zone was suboptimal. Shortage of medical supplies, equipment and emergency transportation was the challenges to provide these services. Thus, the hospital decision makers should strengthen leadership commitment, which focuses on recovering and rebuilding the destructed hospitals with resource mobilization and support.
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Montoya A, Lozano R, Sanchez-Dominguez M, Fritz J, Lamadrid-Figueroa H. Burden, Incidence, Mortality and Lethality of Maternal Disorders in Mexico 1990-2019: An Analysis for the Global Burden of Disease Study 2019. Arch Med Res 2023; 54:152-159. [PMID: 36697308 DOI: 10.1016/j.arcmed.2022.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Estimates of the sub-national distribution of maternal disorders in Mexico beyond Maternal Mortality Ratios are scarce. Characterizing the sub-national variation of maternal disorders may make it possible to focus more on interventions and thereby reduce their occurrence in a more meaningful and sustained manner. AIM To analyze and describe the sub-national distribution, magnitude, trends and changes in the contribution of maternal causes to women's loss of health in Mexico from 1990-2019. METHODS Using estimates from the Global Burden of Disease (GBD) 2019 study, we describe the distribution and trends of maternal mortality ratio (MMR), mortality rate, case-fatality rate and disability-adjusted life years (DALYs) due to maternal causes, at both national and state levels. RESULTS Between 1990 and 2019, DALYs attributable to maternal causes had decreased 59.5%, mortality 63.8%, and incidence 46.5%. However, Maternal Mortality Ratio only decreased by 33%. The case-fatality rate of maternal disorders decreased by 50% overall; although for obstructed labor and uterine rupture, it remained unchanged. Lethality showed great variation between states, with a 3 fold difference between the maximum and minimum values. CONCLUSIONS Although mortality and incidence of maternal causes in Mexico have greatly decreased in the last 30 years, these changes mostly reflect declines in fertility. The decrease seen in case-fatality rates is driven by decreases in causes such as hypertension and hemorrhage, though for others it remained constant. Efforts should be directed at improving access to, and management of, locally frequent maternal emergencies, formulating tailor-made regional interventions for maternal health.
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Affiliation(s)
- Alejandra Montoya
- Gerencia de Análisis Estadístico y Minería de Datos, Fundación Carlos Slim. Ciudad de México, México
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Jimena Fritz
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Habonimana D, Leckcivilize A, Nicodemo C, English M. Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol. Wellcome Open Res 2022; 7:196. [PMID: 36212218 PMCID: PMC9520631 DOI: 10.12688/wellcomeopenres.17937.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in selected schools and ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what are reasonable staffing norms as well as feasible staffing alternatives within Burundi's budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Affiliation(s)
- Desire Habonimana
- Centre de Recherche Universitaire en Santé (CURSA), Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, 5190, Burundi
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Attakrit Leckcivilize
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catia Nicodemo
- Centre for Health Service Economics and Organisation, Department of Economics, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Habonimana D, Leckcivilize A, Nicodemo C, English M. Addressing the need for an appropriate skilled delivery care workforce in Burundi to support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign): a sequential study protocol. Wellcome Open Res 2022; 7:196. [PMID: 36212218 PMCID: PMC9520631 DOI: 10.12688/wellcomeopenres.17937.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 02/15/2024] Open
Abstract
Background Despite Burundi having formed a network of 112 health facilities that provide emergency obstetric and neonatal care (EmONC), the country continues to struggle with high rates of maternal and newborn deaths. There is a dearth of empirical evidence on the capacity and performance of EmONC health facilities and on the real needs to inform proper planning and policy. Our study aims to generate evidence on the capacity and performance of EmONC health facilities in Burundi and examine how the country might develop an appropriate skilled delivery care workforce to improve maternal and newborn survival. Methods We will use a sequential design where each study phase serially inputs into the subsequent phase. Three main study phases will be carried out: i) an initial policy document review to explore global norms and local policy intentions for EmONC staffing and ii) a cross-sectional survey of all EmONC health facilities to determine what percent of facilities are functional including geographic and population coverage gaps, identify staffing gaps assessed against norms, and identify other needs for health facility strengthening. Finally, we will conduct surveys in schools and different ministries to examine training and staffing costs to inform staffing options that might best promote service delivery with adequate budget impacts to increase efficiency. Throughout the study, we will engage stakeholders to provide input into what is reasonable staffing norms as well as feasible staffing alternatives within Burundi's budget capacity. Analytical models will be used to develop staffing proposals over a realistic policy timeline. Conclusion Evidence-based health planning improves cost-effectiveness and reduces wastage within scarce and resource-constrained contexts. This study will be the first large-scale research in Burundi that builds on stakeholder support to generate evidence on the capacity of designated EmONC health facilities including human resources diagnosis and develop staffing skill-mix tradeoffs for policy discussion.
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Affiliation(s)
- Desire Habonimana
- Centre de Recherche Universitaire en Santé (CURSA), Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, 5190, Burundi
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Attakrit Leckcivilize
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catia Nicodemo
- Centre for Health Service Economics and Organisation, Department of Economics, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Schedwin M, Furaha AB, Kapend R, Akilimali P, Malembaka EB, Hildenwall H, Alfvén T, Tylleskär T, Mapatano MA, King C. Under-five mortality in the Democratic Republic of the Congo: secondary analyses of survey and conflict data by province. Bull World Health Organ 2022; 100:422-435. [PMID: 35813509 PMCID: PMC9243684 DOI: 10.2471/blt.22.287915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To compare coverage of key child health policy indicators across provinces and to explore their association with under-five mortality and level of conflict in the Democratic Republic of the Congo. Methods We made a secondary analysis of nationally representative data from 1380 health facilities and 20 792 households in 2017-2018. We analysed provincial-level data on coverage of 23 different indicators for improving common causes of childhood mortality, combined into mean scores for: newborn health, pneumonia, diarrhoea, malaria and safe environment. Using negative binomial regression we compared the scores with provincial-level under-five mortality. With binary logistic regression at the individual level we compared indicators (outcome) with living in a conflict-affected province (exposure). Findings All grouped coverage scores demonstrated large ranges across the 26 provinces: newborn health: 20% to 61%; pneumonia: 26% to 86%; diarrhoea: 25% to 63%; malaria: 22% to 53%; and safe environment: 4% to 53%. The diarrhoea score demonstrated the strongest association with under-five mortality (adjusted coefficient: -0.026; 95% confidence interval: -0.045 to -0.007). Conflict-affected provinces had both the highest as well as the lowest mortality rates and indicator coverages. The odds of coverage were higher in conflict-affected provinces for 13 out of 23 indicators, whereas in provinces unaffected by conflict only one indicator had higher odds of coverage. Conclusion Conflict alone is a poor predictor for child health. Ensuring that children in unaffected provinces are not neglected while addressing the needs of the most vulnerable in conflict settings is important. Prevent, protect and treat strategies for diarrhoeal disease could help improve equity in child survival.
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Affiliation(s)
- Mattias Schedwin
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | - Aurélie Bisumba Furaha
- Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Richard Kapend
- School of Criminology and Criminal Justice (SCCJ), University of Portsmouth, Portsmouth, England
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
| | | | - Mala Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Tomtebogatan 18a, 17177, Stockholm, Sweden
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