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Fraiman J, Baver S, Henneberg M. Microevolutionary hypothesis of the obesity epidemic. PLoS One 2024; 19:e0305255. [PMID: 39110707 PMCID: PMC11305523 DOI: 10.1371/journal.pone.0305255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/27/2024] [Indexed: 08/10/2024] Open
Abstract
The obesity epidemic represents potentially the largest phenotypic change in Homo sapiens since the origin of the species. Despite obesity's high heritability, it is generally presumed a change in the gene pool could not have caused the obesity epidemic. Here we advance the hypothesis that a rapid change in the obesogenic gene pool has occurred second to the introduction of modern obstetrics dramatically altering evolutionary pressures on obesity-the microevolutionary hypothesis of the obesity epidemic. Obesity is known to increase childbirth-related mortality several fold. Prior to modern obstetrics, childbirth-related mortality occurred in over 10% of women in their lifetime. After modern obstetrics, this mortality reduced to a fraction of a percent, thereby lifting a strong negative selection pressure. Regression analysis of data for ~ 190 countries was carried out to examine associations between 1990 lifetime maternal death rates (LMDR) and current obesity rates. Multivariate regression showed LMDR correlated more strongly with national obesity rates than GDP, calorie intake and physical inactivity. Analyses controlling for confounders via partial correlation show that LMDR explains approximately 11% of the variability of obesity rate between nations. For nations with LMDR above the median (>0.45%), LMDR explains 33% of obesity variance, while calorie intake, GDP and physical inactivity show no association with obesity in these nations. The microevolutionary hypothesis offers a parsimonious explanation of the global nature of the obesity epidemic.
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Affiliation(s)
- Joseph Fraiman
- Department of Graduate Education, Geisinger Commonwealth School of Medicine, Scranton, PA, United States of America
| | - Scott Baver
- Hanmol LLC, Sudbury, MA, United States of America
| | - Maciej Henneberg
- Biological Anthropology and Comparative Anatomy Unit, The University of Adelaide, Adelaide, Australia
- The Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
- The Unit for Biocultural Variation in Obesity, University of Oxford, Oxford, United Kingdom
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Guérin Benz J, Stancanelli G, Zambruni M, Paulin MR, Hantavololona H, Andrianarisoa VR, Rakotondrazanany H, de Tejada Weber BM, Mangeret FR, Reich MR, Guyer A, Benski C. Simulation training on respectful emergency obstetric and neonatal care in north-western Madagascar: a mixed-methods evaluation of an innovative training program. Adv Simul (Lond) 2024; 9:18. [PMID: 38741188 DOI: 10.1186/s41077-024-00289-0] [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: 09/29/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The rates of maternal and neonatal deaths in Madagascar are among the highest in the world. In response to a request for additional training from obstetrical care providers at the Ambanja district hospital in north-eastern Madagascar, a partnership of institutions in Switzerland and Madagascar conducted innovative training on respectful emergency obstetric and newborn care using e-learning and simulation methodologies. The training focused on six topics: pre-eclampsia, physiological childbirth, obstetric maneuvers, postpartum hemorrhage, maternal sepsis, and newborn resuscitation. Cross-cutting themes were interprofessional communication and respectful patient care. Ten experienced trainers participated in an e-training-of-trainers course conducted by the Swiss partners. The newly-trained trainers and Swiss partners then jointly conducted the hybrid remote/in-person training for 11 obstetrical care providers in Ambanja. METHODS A mixed methods evaluation was conducted of the impact of the training on participants' knowledge and practices. Trainees' knowledge was tested before, immediately after, and 6 months after the training. Focus group discussions were conducted to elicit participants' opinions about the training, including the content and pedagogical methods. RESULTS Trainees' knowledge of the six topics was higher at 6 months (with an average of 71% correct answers) compared to before the training (62%), although it was even higher (83%) immediately after the training. During the focus group discussions, participants highlighted their positive impressions of the training, including its impact on their sense of professional effectiveness. They reported that their interprofessional relationships and focus on respectful care had improved. Simulation, which was a new methodology for the participants native to Madagascar, was appreciated for its engaging and active format, and they enjoyed the hybrid delivery of the training. Participants (including the trainers) expressed a desire for follow-up engagement, including additional training, and improved access to more equipment. CONCLUSION The evaluation showed improvements in trainees' knowledge and capacity to provide respectful emergency care to pregnant women and newborns across all training topics. The hybrid simulation-based training method elicited strong enthusiasm. Significant opportunity exists to expand the use of hybrid onsite/remote simulation-based training to improve obstetrical care and health outcomes for women and newborns in Madagascar and elsewhere.
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Affiliation(s)
| | | | - Monica Zambruni
- Département d'obstétrique, Département de La Femme, de l'enfant et de l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Manjary Ramasy Paulin
- Inspection de La Santé du District, Centre Hospitalier de Référence du District, Ambanja, Madagascar
| | - Habéline Hantavololona
- Safe Motherhood and Family Planning, Département de La Santé Familiale, Ministère de La Santé Publique, Antananarivo, Madagascar
| | | | - Harolalaina Rakotondrazanany
- Safe Motherhood and Family Planning, Département de La Santé Familiale, Ministère de La Santé Publique, Antananarivo, Madagascar
| | - Begoña Martinez de Tejada Weber
- Département d'obstétrique, Département de La Femme, de l'enfant et de l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Flavia Rosa Mangeret
- Neonatology and Paediatric Intensive Care Division, Department of Women, Child and Adolescent, University of Geneva, Geneva, Switzerland
| | - Michael R Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Caroline Benski
- Département d'obstétrique, Département de La Femme, de l'enfant et de l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Jung S, Chi H, Eom YJ, Subramanian S, Kim R. Multilevel analysis of determinants in postnatal care utilisation among mother-newborn pairs in India, 2019-21. J Glob Health 2024; 14:04085. [PMID: 38721673 PMCID: PMC11079700 DOI: 10.7189/jogh.14.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India. Methods Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories. Results Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories. Conclusions Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.
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Affiliation(s)
- Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Callander EJ, Scarf V, Nove A, Homer C, Carrandi A, Abdullah AS, Clow S, Halim A, Mbalinda SN, Nabirye RC, Rahman AF, Rasheed SI, Turk AM, Bazirete O, Turkmani S, Forrester M, Mandke S, Pairman S, Boyce M. Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites. BMJ Glob Health 2024; 9:e013643. [PMID: 38548343 PMCID: PMC10982789 DOI: 10.1136/bmjgh-2023-013643] [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: 08/07/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Achieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes. METHODS The cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars. RESULTS Cost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted. CONCLUSION MLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.
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Affiliation(s)
- Emily J Callander
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Vanessa Scarf
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | - Alayna Carrandi
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | | | - Sheila Clow
- University of Cape Town, Cape Town, South Africa
| | - Abdul Halim
- Centre for Injury Prevention and Research, Dhaka, Bangladesh
| | | | | | | | | | | | - Oliva Bazirete
- Novametrics Ltd, Duffield, UK
- University of Rwanda, Kigali, Rwanda
| | - Sabera Turkmani
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Mandy Forrester
- International Confederation Of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation Of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation Of Midwives, The Hague, The Netherlands
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Sampurna MTA, Pratama DC, Visuddho V, Oktaviana N, Putra AJE, Zakiyah R, Ahmad JM, Etika R, Handayani KD, Utomo MT, Angelica D, Ayuningtyas W, Hendrarto TW, Rohsiswatmo R, Wandita S, Kaban RK, Liem KD. A review of existing neonatal hyperbilirubinemia guidelines in Indonesia. F1000Res 2023; 11:1534. [PMID: 38025296 PMCID: PMC10682606 DOI: 10.12688/f1000research.110550.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. METHODS Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. RESULTS The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. CONCLUSIONS The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Danny Chandra Pratama
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Novita Oktaviana
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Achmad Januar Er Putra
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Rahmi Zakiyah
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Jordy Maulana Ahmad
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Dina Angelica
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Wurry Ayuningtyas
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Toto Wisnu Hendrarto
- Neonatal Intensive Care Unit, Harapan Kita Mother and Child Hospital, Jakarta, 11420, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Risma Karina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kian Djien Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, 6525, Netherlands Antilles
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Sampurna MTA, Pratama DC, Visuddho V, Oktaviana N, Putra AJE, Zakiyah R, Ahmad JM, Etika R, Handayani KD, Utomo MT, Angelica D, Ayuningtyas W, Hendrarto TW, Rohsiswatmo R, Wandita S, Kaban RK, Liem KD. A review of existing neonatal hyperbilirubinemia guidelines in Indonesia. F1000Res 2023; 11:1534. [PMID: 38025296 PMCID: PMC10682606 DOI: 10.12688/f1000research.110550.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neonatal hyperbilirubinemia is one of the most common conditions for neonate inpatients. Indonesia faces a major challenge in which different guidelines regarding the management of this condition were present. This study aimed to compare the existing guidelines regarding prevention, diagnosis, treatment and monitoring in order to create the best recommendation for a new hyperbilirubinemia guideline in Indonesia. Methods Through an earlier survey regarding adherence to the neonatal hyperbilirubinemia guideline, we identified that three main guidelines are being used in Indonesia. These were developed by the Indonesian Pediatric Society (IPS), the Ministry of Health (MoH), and World Health Organization (WHO). In this study, we compared factors such as prevention, monitoring, methods for identifying, risk factors in the development of neonatal jaundice, risk factors that increase brain damage, and intervention treatment threshold in the existing guidelines to determine the best recommendations for a new guideline. Results The MoH and WHO guidelines allow screening and treatment of hyperbilirubinemia based on visual examination (VE) only. Compared with the MoH and WHO guidelines, risk assessment is comprehensively discussed in the IPS guideline. The MoH guideline recommends further examination of an icteric baby to ensure that the mother has enough milk without measuring the bilirubin level. The MoH guideline recommends referring the baby when it looks yellow on the soles and palms. The WHO and IPS guidelines recommend combining VE with an objective measurement of transcutaneous or serum bilirubin. The threshold to begin phototherapy in the WHO guideline is lower than the IPS guideline while the exchange transfusion threshold in both guidelines are comparably equal. Conclusions The MoH guideline is outdated. MoH and IPS guidelines are causing differences in approaches to the management hyperbilirubinemia. A new, uniform guideline is required.
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Affiliation(s)
- Mahendra Tri Arif Sampurna
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Danny Chandra Pratama
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Visuddho Visuddho
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Novita Oktaviana
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Achmad Januar Er Putra
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Rahmi Zakiyah
- Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, Indonesia
| | - Jordy Maulana Ahmad
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Risa Etika
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Kartika Darma Handayani
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Martono Tri Utomo
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Dina Angelica
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Wurry Ayuningtyas
- Neonatology Division, Department of Pediatrics, Dr Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surbaya, 60115, Indonesia
| | - Toto Wisnu Hendrarto
- Neonatal Intensive Care Unit, Harapan Kita Mother and Child Hospital, Jakarta, 11420, Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Risma Karina Kaban
- Neonatology Division, Department of Pediatrics, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kian Djien Liem
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, 6525, Netherlands Antilles
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Small SM, Paratore PD, Peterson SD, Lucia RA, Reiter PD. Obstetric clinical pharmacy: A necessary birth of a new specialty. Am J Health Syst Pharm 2023; 80:1026-1031. [PMID: 37119313 DOI: 10.1093/ajhp/zxad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 05/01/2023] Open
Affiliation(s)
| | | | | | | | - Pamela D Reiter
- Denver Health Medical Center, Children's Hospital Colorado, Denver, CO, USA
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Hussen AM, Ibrahim IM, Tilahun B, Tunçalp Ö, Grobbee DE, Browne JL. Completion of the Continuum of Maternity Care in the Emerging Regions of Ethiopia: Analysis of the 2019 Demographic and Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6320. [PMID: 37444167 PMCID: PMC10342030 DOI: 10.3390/ijerph20136320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Maternal mortality in Ethiopia was estimated to be 267 per 100,000 live births in 2020. A significant number of maternal deaths occur in the emerging regions of the country: Afar, Somali, Gambela, and Benishangul-Gumuz. Achieving the Sustainable Development Goal (SDG) target requires a dramatic increase in maternal healthcare utilisation during pregnancy, childbirth, and the postpartum period. Yet, there is a paucity of evidence on the continuum of maternity care utilisation in Ethiopia, particularly in the emerging regions. Therefore, this study aimed to assess completion and factors associated with the continuum of maternity care in the emerging regions of Ethiopia. This study used the 2019 Ethiopian Demographic and Health Survey data (n = 1431). Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with the completion of the continuum of maternity care. An adjustment was made to the survey design (weight, stratification, and clustering). 9.5% (95% Confidence Interval (CI): 7.0-13.0) of women completed the continuum of maternity care (four or more antenatal care, institutional delivery, and postnatal care within 24 h). Living in Somali (adjusted Odds Ratio (aOR): 0.23, 95%CI: 0.07-0.78) and Benishangul-Gumuz (aOR 3.41, 95%CI: 1.65-7.04) regions, having a secondary and higher educational level (aOR 2.12, 95%CI: 1.13-4.00), and being in the richest wealth quintile (aOR 4.55, 95%CI: 2.04-10.15) were factors associated with completion of the continuum of maternity care. Although nearly half of the women had one antenatal care, fewer than 10% completed the continuum of maternity care. This indicates that women in these regions are not getting the maximum health benefits from maternal healthcare services, and this might contribute to the high maternal death in the regions. Moreover, the completion of the continuum of maternity care was skewed toward women who are more educated (secondary or higher education) and in the richest quintile.
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Affiliation(s)
- Abdulaziz Mohammed Hussen
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
- Department of Midwifery, College of Medicine and Health Science, Samara University, Samara P.O. Box 132, Ethiopia;
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, Samara P.O. Box 132, Ethiopia;
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
- eHealth Lab Ethiopia, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Özge Tunçalp
- UNDP—UNFPA—UNICEF—WHO—World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland;
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands; (D.E.G.); (J.L.B.)
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Boerma T, Campbell OMR, Amouzou A, Blumenberg C, Blencowe H, Moran A, Lawn JE, Ikilezi G. Maternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries. Lancet Glob Health 2023; 11:e1024-e1031. [PMID: 37349032 PMCID: PMC10299966 DOI: 10.1016/s2214-109x(23)00195-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/11/2023] [Accepted: 04/14/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Maternal mortality, stillbirths, and neonatal mortality account for almost 5 million deaths a year and are often analysed separately, despite having overlapping causes and interventions. We propose a comprehensive five-phase mortality transition model to improve analyses of progress and inform strategic planning. METHODS In this empirical data-driven study to develop a model transition, we used UN estimates for 151 countries to assess changes in maternal mortality, stillbirths, and neonatal deaths. On the basis of ratios of maternal to stillbirth and neonatal mortality, we identified five phases of transition, in which phase 1 has the highest mortality and phase 5 has the lowest. We used global databases to examine phase-specific characteristics during 2000-20 for causes of death, fertility rates, abortion policies, health workforce and financing, and socioeconomic indicators. We analysed 326 national surveys to assess service coverage and inequalities by transition phase. FINDINGS Among 116 countries in phases 1 to 4 in 2000, 73 (63%) progressed at least one phase by 2020, six advanced two phases, and three regressed. The ratio of stillbirth and neonatal deaths to maternal deaths increased from less than 10 in phase 1 to well over 50 in phase 4 and phase 5. Progression was associated with a declining proportion of deaths caused by infectious diseases and peripartum complications, declining total and adolescent fertility rates, changes in health-workforce densities and skills mix (ie, ratio of nurses or midwives to physicians) from phase 3 onwards, increasing per-capita health spending, and reducing shares of out-of-pocket health expenditures. From phase 1 to 5, the median coverage of first antenatal care visits increased from 66% to 98%, four or more antenatal care visits from 44% to 94%, institutional births from 36% to 99%, and caesarean section rates from 2% to 25%. The transition out of high-mortality phases involved a major increase in institutional births, primarily in lower-level health facilities, whereas subsequent progress was characterised by rapid increases in hospital births. Wealth-related inequalities reduced strongly for institutional birth coverage from phase 3 onwards. INTERPRETATION The five-phase maternal mortality, stillbirth, and neonatal mortality transition model can be used to benchmark the current indicators in comparison to typical patterns in the transition at national or sub-national level, identify outliers to better assess drivers of progress, and inform strategic planning and investments towards Sustainable Development Goal targets. It can also facilitate programming for integrated strategies to end preventable maternal mortality and neonatal mortality and stillbirths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ties Boerma
- Institute for Global Public Health and Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins University, Baltimore, MA, USA
| | - Cauane Blumenberg
- Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Gloria Ikilezi
- Exemplars in Global Health, Gates Ventures, Seattle, WA, USA
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10
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Duffy K, Connolly S, Nolan A, Maître B. Perinatal mortality in Ireland: inequalities by socio-economic group and country of birth. Eur J Public Health 2023; 33:20-24. [PMID: 36377972 PMCID: PMC9898011 DOI: 10.1093/eurpub/ckac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While perinatal mortality rates have decreased in Ireland in recent years, it is not known if this reduction was shared equally among all groups. The aim of this study is to examine inequalities in perinatal mortality by country of birth and socio-economic group in Ireland between 2004 and 2019. METHODS Data for the analysis was obtained from the National Perinatal Reporting System dataset, which includes all births (including stillbirths) in Ireland. The rate and risk ratios for perinatal death were calculated for mothers' socio-economic group and country of birth for two time periods (2004-11 and 2012-19). Adjustment was made for mothers' age, marital status, parity and country of birth/socio-economic group. A total of 995 154 births and 5710 perinatal deaths were included in the analysis. RESULTS With the exception of African born mothers, the perinatal mortality rate decreased for all groups over time; however, inequalities persisted. Relative to Irish born mothers, the risk for African born mothers increased from 1.63 to 2.00 over time. Adjusting for other variables including socio-economic status reduced but did not eliminate this elevated relative risk. Mothers who were classified as unemployed or engaged in home duties had a higher risk of a perinatal death relative to higher professional mothers, with the relative risk remaining relatively constant over time. CONCLUSIONS Reducing inequalities in health is a key objective of the Irish government. Further research is required to identify why perinatal mortality continues to be higher in some groups so that targeted action can be implemented.
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Affiliation(s)
- Katie Duffy
- Economic and Social Research Institute, Dublin, Ireland
| | - Sheelah Connolly
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Anne Nolan
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Bertrand Maître
- Economic and Social Research Institute, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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11
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Desta M, Ferede AA. Mortality Rate and Predictors Among Women With Obstructed Labor in a Tertiary Academic Medical Center of Ethiopia: A Retrospective Cohort Study. SAGE Open Nurs 2023; 9:23779608231165696. [PMID: 37101828 PMCID: PMC10123876 DOI: 10.1177/23779608231165696] [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: 09/06/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Obstructed labor is one of the most common preventable causes of maternal morbidity and mortality. In Ethiopia, 36% of maternal mortality was due to obstructed labor with uterine rupture. Thus, this study proposed to measure predictors of maternal mortality among women with obstructed labor in a tertiary academic medical center in Southern Ethiopia. Methods An institution-based retrospective cohort study was conducted at Hawassa University Specialized Hospital from July 25 to September 30, 2018. Women who had obstructed labor from 2015 to 2017 were recruited. A pretested checklist was used to retrieve data from the woman's chart. A multivariable logistic regression model was employed to identify variables associated with maternal mortality, and variables with a p-value <.05 were considered significant at 95% CI. Results With a response rate of 96.3%, 156 moms who experienced labor obstruction were included in the study. Obstructed labor caused the deaths of 14 women, resulting in a maternal mortality rate of 8.9% (95% CI: 7.15, 16.4). Maternal mortality from obstructed labor was reduced in women who received antenatal care visits (AOR = 0.25, 95% CI: 0.13, 0.76) and blood transfusions (AOR = 0.49, 95% CI: 0.03, 0.89). Women who experienced uterine rupture (AOR = 6.25, 95% CI: 5.3, 15.6) and antepartum hemorrhage (AOR = 14, 95% CI: 2.45, 70.5) had a greater risk of maternal mortality than women who did not have the corresponding morbidity. Conclusions The center had a higher rate of maternal mortality due to obstructed labor. Early screening and improving the care for women at greatest risk of antenatal and postnatal co-morbidities like uterine rupture and shock were the major priorities and fundamental strategies to decreasing maternal mortality. It also showed that antenatal care visits, early referral, and blood transfusion for women with obstructed labor should be amended in order to lower maternal mortality.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Andualem Ferede
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Addisu Andualem Ferede, Department of Midwifery, College of Health Sciences, Debre Markos University, P.O. Box 226, Debre Markos, Ethiopia.
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12
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De Silva MS, Panisi L, Manubuasa L, Honimae C, Taragwanu S, Burggraaf S, Ogaoga D, Lindquist AC, Walker SP, Tong S, Hastie R. Incidence and causes of stillbirth in the only tertiary referral hospital in the Solomon Islands: a hospital-based retrospective cohort study. BMJ Open 2022; 12:e066237. [PMID: 36585152 PMCID: PMC9809253 DOI: 10.1136/bmjopen-2022-066237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Stillbirth is a major global health issue, which disproportionately affects families living in low-income and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes, however research investigating stillbirth is lacking. Thus, we aimed to investigate the incidence and cause of stillbirth occurring at the National Referral Hospital, Solomon Islands. DESIGN We conducted a retrospective cohort study from January 2017 to December 2018. SETTING At the only tertiary referral hospital in the Solomon Islands, on the main island of Guadalcanal. PARTICIPANTS All births occurring in the hospital during the study period. OUTCOME MEASURES Number of, causes and risk factors for stillbirths (fetal deaths before birth at ≥20 estimated gestational weeks, or ≥500 g in birth weight). RESULTS Over 2 years 341 stillbirths and 11 056 total births were recorded, giving an institutional incidence of 31 stillbirths per 1000 births. Of the cases with a recorded cause of death, 72% were deemed preventable. Most stillbirths occurred antenatally and 62% at preterm gestations (<37 weeks). 59% had a birth weight below 2500 g and preventable maternal conditions were present in 42% of the cases. 46% of the cases were caused by an acute intrapartum event, and among these 92% did not receive intrapartum monitoring. CONCLUSIONS Stillbirth affects 31 in every 1000 births at the National Referral Hospital in the Solomon Islands and many cases are preventable. Our findings highlight the urgent need for increased focus on perinatal deaths in the Solomon Islands with universal classification and targeted training, improved quality of obstetrical care and community awareness.
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Affiliation(s)
- Manarangi Sajini De Silva
- Obstetrics and Gynaecology, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Leeanne Panisi
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Lenin Manubuasa
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Catherine Honimae
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Susan Taragwanu
- Department of Obstetrics and Gynaecology, National Referral Hospital, Honiara, Solomon Islands
| | - Simon Burggraaf
- Department of Maternal and Child Health, Office of the WHO Representative in Solomon Islands, Honiara, Solomon Islands
| | - Divinal Ogaoga
- Ministry of Health of Solomon Islands, Honiara, Solomon Islands
| | - Anthea Clare Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
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13
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McClure EM, Saleem S, Goudar SS, Tikmani SS, Dhaded SM, Hwang K, Guruprasad G, Shobha D, Sarvamangala B, Yogeshkumar S, Somannavar MS, Roujani S, Reza S, Raza J, Yasmin H, Aceituno A, Parlberg L, Kim J, Bann CM, Silver RM, Goldenberg RL. The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe). Lancet Glob Health 2022; 10:e970-e977. [PMID: 35714647 PMCID: PMC9210259 DOI: 10.1016/s2214-109x(22)00180-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Kay Hwang
- Research Triangle Institute International, Durham, NC, USA
| | - Gowdar Guruprasad
- Department of Neonatology, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - Dhananjaya Shobha
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - B Sarvamangala
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Sana Roujani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Anna Aceituno
- Research Triangle Institute International, Durham, NC, USA
| | | | - Jean Kim
- Research Triangle Institute International, Durham, NC, USA
| | - Carla M Bann
- Research Triangle Institute International, Durham, NC, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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14
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Malmir M, Boroojerdi NA, Masoumi SZ, Parsa P. Factors affecting postpartum infection: A systematic review. Infect Disord Drug Targets 2021; 22:e291121198367. [PMID: 34844548 DOI: 10.2174/1871526521666211129100519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Puerperal infection is used to describe any bacterial infection of the reproductive tract after delivery. Identifying the factors affecting postpartum infections can reduce the risk and complications of such factors and postpartum maternal mortality. OBJECTIVE This structured study was designed to evaluate factors affecting postpartum infections. METHODS In this study, after selecting Scopus, PubMed, SID, and Web of Science electronic databases, all observational studies (cohort and case-control) available and published in Farsi and English to investigate factors affecting postpartum infections were searched. The search was performed using the terms postpartum, infection, wound infection, puerperium, reason, risk factor, and their equivalent Persian words from 2010 to November 2019 regardless of publication status. RESULTS Out of the 3227 studies obtained, 19 were reviewed after removing irrelevant articles, duplicates (shared in databases), and animal samples. Age, level of education, delivery method, presence of episiotomy, anemia due to postpartum hemorrhage, interventions and manipulations during childbirth, prenatal hygiene, Povidone Iodine usage before delivery to wash the vagina, antibiotic prevention, increased labor duration, obesity, and the presence of bacteria were common symptoms affecting postpartum infection. CONCLUSION In this study, the factors affecting postpartum infection have been identified, some of which are avoidable. Identifying these factors helps reduce postpartum infections and their complications.
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Affiliation(s)
- Maryam Malmir
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan. Iran
| | | | - Seyedeh Zahra Masoumi
- Mother and Child Care Research Center, Midwifery Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Paarisa Parsa
- , School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
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15
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Chen Y, Wilkins MD, Barahona J, Rosenbaum AJ, Daniele M, Lobaton E. Toward Automated Analysis of Fetal Phonocardiograms: Comparing Heartbeat Detection from Fetal Doppler and Digital Stethoscope Signals. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:975-979. [PMID: 34891451 DOI: 10.1109/embc46164.2021.9629814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Longitudinal fetal health monitoring is essential for high-risk pregnancies. Heart rate and heart rate variability are prime indicators of fetal health. In this work, we implemented two neural network architectures for heartbeat detection on a set of fetal phonocardiogram signals captured using fetal Doppler and a digital stethoscope. We test the efficacy of these networks using the raw signals and the hand-crafted energy from the signal. The results show a Convolutional Neural Network is the most efficient at identifying the S1 waveforms in a heartbeat, and its performance is improved when using the energy of the Doppler signals. We further discuss issues, such as low Signal-to-Noise Ratios (SNR), present in the training of a model based on the stethoscope signals. Finally, we show that we can improve the SNR, and subsequently the performance of the stethoscope, by matching the energy from the stethoscope to that of the Doppler signal.
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16
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Gustiana G, Novemi N, Yusnaini Y, Kartinazahri K, Fitraniar I. The Effectiveness of Placental Drainage in the Active Management of the Third Stage against the Duration of Three Childbirths in the Independent Practice of Midwives in Banda Aceh City. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The third stage of active management has become a standard practice in delivery management. Implementation of childbirth care requires accelerated release of the placenta to avoid bleeding. Placental drainage can shorten the duration of the three stages and reduce blood loss during labor.
AIM: The aim of the study is to analyzing the effectiveness of placental drainage in the third stage active management of the third stage of delivery at the midwife’s independent practice (PMB) in the city of Banda Aceh.
METHODS: This study used a Quasi Experiment design with a post-test control design. This research was carried out for 12 weeks at the PMB in Banda Aceh City, namely mothers who gave birth at the Erni Munir PMB and the Independent Practice Midwife Mutia Yacob. The sampling technique was purposive sampling. The sample in this study amounted to thirty mothers giving birth, divided into two groups, namely, the treatment group with placental drainage as many as 15 mothers and respondents with cord clamping as many as 15 mothers. With the inclusion criteria, the mother is willing to be a respondent, the vital signs of normal mothers, single and live fetuses, term pregnancy, and an interpretation of average fetal weight ≥ 2500 g. Data analysis used the MannWhitney test, with a confidence level of 95%.
RESULTS: The results showed a difference in effectiveness between the placental drainage group and the umbilical cord clamping group, as evidenced by a statistical test with p = 0.001. The length of three stages required by mothers to give birth with placental drainage has a mean value of 4.47 min with a standard deviation of 0.516. The average length of time required by the mother to give birth with umbilical cord clamping is 5.40 min with a standard deviation value of 0.828.
CONCLUSION: Placental drainage was more effective than umbilical cord clamping to shorten the third stage length in the Independent Practice of Midwives in Banda Aceh City.
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17
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He Z, Zhu S, Zhou K, Jin Y, He L, Xu W, Lao C, Liu G, Han S. Sildenafil for pulmonary hypertension in neonates: An updated systematic review and meta-analysis. Pediatr Pulmonol 2021; 56:2399-2412. [PMID: 33983650 DOI: 10.1002/ppul.25444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To provide an updated review and meta-analysis on the efficacy and safety of sildenafil for treating persistent pulmonary hypertension in neonates (PPHN). METHODS PubMed/Medline, SCOPUS, Cochrane Central Register of Controlled Trials, and Web of Science were searched from the inception of publication to January 2021. The principal outcomes include oxygenation parameters, hemodynamic metrics and echocardiographic measurements, as well as adverse outcomes. RESULTS A total of eight studies were included with 216 term and premature neonates with PPHN. Compelling evidence showed the use of sildenafil could improve the prognosis of PPHN neonates, compared with baseline or placebo in neonates with PPHN, and a time-dependent pattern of the improvements can be observed. After 24 h of treatment, the Oxygenation index suggested a steady decrease (SD: -1.80, 95% confidence interval [CI]: -2.92, -0.67) and sildenafil exerted peak effects after 72 h of treatment (SD: -4.02, 95% CI: -5.45, -2.59). No clinically significant side effects were identified. Egger's test and funnel plots of the major outcomes were performed, and the publication bias was not significant. CONCLUSION Improvements were shown in oxygenation index, pulmonary arterial pressure, and adverse outcomes after using sildenafil for PPHN in neonates. However, future research with robust longitudinal or randomized controlled design is still needed.
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Affiliation(s)
- Zonglin He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Kai Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Ya Jin
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Longkai He
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Weipeng Xu
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - CheokUn Lao
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Guosheng Liu
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shasha Han
- Department of Neonatology and Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Izadirad H, Zareban I, Niknami S, Atashpanjeh A. Factors affecting pregnancy care and birth weight among pregnant women in Baluchestan, Iran: an application of the social cognitive theory. Women Health 2021; 61:510-519. [PMID: 34016032 DOI: 10.1080/03630242.2021.1919282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to determine the effects of self-efficacy, social support, and health literacy on prenatal care and birth weight among pregnant women. This descriptive-analytical study was conducted on 860 primiparous pregnant women who referred to health care centers for prenatal care in Iranshahr, Iran. Participants were selected through a two-stage cluster sampling. The data were collected from November 2016 to the end of January 2017 using a valid and reliable questionnaire. Data were analyzed using descriptive tests, chi-square and hierarchical regression analyses in SPSS 20. The findings indicated that health literacy, self-efficacy, income, social support, and education level explained for 7.5%, 4.6%, 2.6%, 1%, and 0.6% of the variances in caring prenatal care, respectively. Moreover, income, prenatal care, insurance, health literacy, and social support were the most effective on birth weight outcome (OR = 2.21, OR = 2.12, OR = 2, OR = 0.66, OR = 0.17). The results of the current study indicated that a combination of health literacy, self-efficacy, and social support are necessary to improve prenatal care and birth weight for Iranian low-income pregnant women.
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Affiliation(s)
- Hossien Izadirad
- Zahedan Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Iraj Zareban
- Zahedan Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shamsoddin Niknami
- Department of Health Education, School of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Alireza Atashpanjeh
- Clinical Immunology Research Center, ELT Department, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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19
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Genowska A, Strukcinskiene B, Villerusa A, Konstantynowicz J. Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union. ACTA ACUST UNITED AC 2021; 79:76. [PMID: 33985577 PMCID: PMC8117592 DOI: 10.1186/s13690-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology, Institute of Public Health, Rīga Stradinš University, Rīga, Latvia
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital, Bialystok, Poland.
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20
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Desta M, Kassa GM, Getaneh T, Sharew Y, Alemu AA, Birhanu MY, Yeneabat T, Alamneh YM, Amha H. Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245977. [PMID: 33886549 PMCID: PMC8062067 DOI: 10.1371/journal.pone.0245977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger’s test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). Results The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). Conclusions The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Getachew Mullu Kassa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yewbmirt Sharew
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Alehegn Alemu
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Tebikew Yeneabat
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Department of Midwifery, University of Technology Sydney, Sydney, Australia
| | - Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Lima SSD, Braga MC, Vanderlei LCDM, Luna CF, Frias PG. [Assessment of the impact of prenatal, childbirth, and neonatal care on avoidable neonatal deaths in Pernambuco State, Brazil: an adequacy study]. CAD SAUDE PUBLICA 2020; 36:e00039719. [PMID: 32130315 DOI: 10.1590/0102-311x00039719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess the impact of programs for prenatal, childbirth, and neonatal care (Mother Owl and Stork Network) on avoidable neonatal mortality in Pernambuco State, Brazil, using the adequacy approach. We analyzed the trend in avoidable neonatal mortality and the impact of these programs on avoidable neonatal mortality in four health regions in the state from 2000 to 2016. The Mortality Information System (SIM) and the Information System on Live Births (SINASC) and official documents were used as the data sources. Deaths were classified according to the Brazilian List of Avoidable Causes of Deaths Via Interventions by the Unified National Health System. Linear regression and joinpoint methods were used to analyze tendencies and identifying turning points in the neonatal mortality curves. There was a sharp drop in avoidable neonatal mortality in the state, especially in early neonatal mortality. Except for the I-Recife region, where there was a downturn in the mortality curves after implementation of the Stork Network, there was no association between the turning points in the curves and the periods with the programs' implementation in the regions. Other factors appear to have led to the improvement of these indicators, such as the expansion of the high-risk network. Strengthening this network can thus help reduce avoidable neonatal deaths, especially early deaths.
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Shirley MK, Cole TJ, Arthurs OJ, Clark CA, Wells JC. Developmental origins of variability in pelvic dimensions: Evidence from nulliparous South Asian women in the United Kingdom. Am J Hum Biol 2020; 32:e23340. [PMID: 31755611 PMCID: PMC7154657 DOI: 10.1002/ajhb.23340] [Citation(s) in RCA: 9] [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: 04/26/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Pelvic growth may be sensitive to early-life nutrition, with implications for maternal risk of obstructed labor. However, the "developmental origins" of adult pelvic variability require further investigation. We tested whether adult pelvic dimensions are associated with two components of height, indexing different periods of linear growth: tibia length, a proxy for early postnatal growth, and height-residual (height regressed on tibia length), a proxy for later growth. We also tested whether adult pelvic dimensions are associated with birth weight, a marker of nutritional investment in utero. METHODS In this cross-sectional study, data were obtained on 68 nulliparous young women of South Asian ancestry. Pelvic dimensions (bi-iliac and bi-acetabular breadth, anteroposterior pelvic inlet and outlet, interspinous and intertuberous diameter) were measured using magnetic resonance imaging. Height and tibia length were measured manually. Birth weight and gestational age were obtained by recall. Multivariable regression models were fitted with a given pelvic dimension regressed on height-residual, tibia, and birth weight, with the latter adjusted for gestational age. RESULTS Controlling for birth weight, height-residual was predictive of bi-acetabular breadth, bi-iliac breadth, and the pelvic inlet, while tibia length significantly predicted all dimensions except interspinous diameter. Controlling for the linear growth variables, birth weight was predictive of bi-iliac breadth only. CONCLUSIONS Markers of linear growth during both early and later development were associated with adult pelvic dimensions, whereas size at birth was poorly predictive. Efforts to reduce stunting in early life may facilitate the attainment of maximum potential growth for both height and the pelvis.
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Affiliation(s)
- Meghan K. Shirley
- UCL Great Ormond Street Institute of Child HealthLondonUK
- School of Public HealthUniversity of São PauloSão PauloBrazil
| | - Tim J. Cole
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - Owen J. Arthurs
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Department of RadiologyGreat Ormond Street HospitalLondonUK
| | - Chris A. Clark
- UCL Great Ormond Street Institute of Child HealthLondonUK
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Enweronu-Laryea CC, Onwona-Agyeman K, Ayibor PK, Annan FB, Gyakari EO, Vanotoo LA. Retrospective review of neonatal morbidity and mortality at public referral hospitals in Greater Accra Region of Ghana:2013-2014. J Neonatal Perinatal Med 2019; 13:105-113. [PMID: 31771076 DOI: 10.3233/npm-180184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reliable local data for evaluating and planning neonatal interventions in low-resource countries are scarce. To provide data for evaluating neonatal interventions in an administrative region of Ghana, the study examined baseline data for inpatient neonatal services prior to the implementation of a 5-years national action plan to reduce newborn deaths. METHODS This is a retrospective review of admissions and deaths registry for the years 2013 and 2014 at 3 referral neonatal units representing district, regional and tertiary referral centres in Greater Accra Region of Ghana. Perinatal, and neonatal hospitalisation data were extracted. Chi-squared test was used to compare outcomes. RESULTS Of the 8228 newborn infants hospitalised for special care, over 99% had antenatal care and were delivered at a health facility, 96.7% and 91.7% had birth weight and outcome data, respectively. Low birth weight infants accounted for 48.5% of total admissions and 67% of deaths. Using birth weight criteria, survival to discharge was 25.6% for infants less than 1000grams, 67.9% for 1000-1499grams, 88% for 1500-2499grams and 88.7% for infants 2500grams and higher. Among infants with birth weight of 1000grams and higher, perinatal asphyxia (70.6%) and respiratory distress (16.4%) accounted for most deaths. CONCLUSION There was significant burden of neonatal morbidity and mortality in hospitalized newborns prior to the implementation of the national action plan. The report provides a yardstick for assessing the impact of the national action plan and comparative analysis of future interventions on neonatal outcome in the region.
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Affiliation(s)
| | - K Onwona-Agyeman
- Tema General Hospital, Ghana Health Service, Greater Accra Region, Ghana
| | | | - F B Annan
- Greater Accra Regional Hospital, Ghana Health Service, Accra, Ghana
| | - E O Gyakari
- Dataway Solutions, Sanshie Avenue, East Legon, Accra, Ghana
| | - L A Vanotoo
- Greater Accra Regional Health Directorate, Ghana Health Service, Promise Initiative Ghana, Accra, Ghana
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Andersson O, Rana N, Ewald U, Målqvist M, Stripple G, Basnet O, Subedi K, Kc A. Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) - a randomized clinical trial. Matern Health Neonatol Perinatol 2019; 5:15. [PMID: 31485335 PMCID: PMC6714434 DOI: 10.1186/s40748-019-0110-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/29/2019] [Indexed: 01/26/2023] Open
Abstract
Background Experiments have shown improved cardiovascular stability in lambs if umbilical cord clamping is postponed until positive pressure ventilation is started. Studies on intact cord resuscitation on human term infants are sparse. The purpose of this study was to evaluate differences in clinical outcomes in non-breathing infants between groups, one where resuscitation is initiated with an intact umbilical cord (intervention group) and one group where cord clamping occurred prior to resuscitation (control group). Methods Randomized controlled trial, inclusion period April to August 2016 performed at a tertiary hospital in Kathmandu, Nepal. Late preterm and term infants born vaginally, non-breathing and in need of resuscitation according to the ‘Helping Babies Breathe’ algorithm were randomized to intact cord resuscitation or early cord clamping before resuscitation. Main outcome measures were saturation by pulse oximetry (SpO2), heart rate and Apgar at 1, 5 and 10 minutes after birth. Results At 10 minutes after birth, SpO2 (SD) was significantly higher in the intact cord group compared to the early cord clamping group, 90.4 (8.1) vs 85.4 (2.7) %, P < .001). In the intact cord group, 57 (44%) had SpO2 < 90% after 10 minutes, compared to 93 (100%) in the early cord clamping group, P < 0.001. SpO2 was also significantly higher in the intervention (intact cord) group at one and five minutes after birth. Heart rate was lower in the intervention (intact cord) group at one and five minutes and slightly higher at ten minutes, all significant findings. Apgar score was significantly higher at one, five and ten minutes. At 5 minutes, 23 (17%) had Apgar score < 7 in the intervention (intact cord) group compared to 26 (27%) in the early cord clamping group, P < .07. Newborn infants in the intervention (intact cord) group started to breathe and establish regular breathing earlier than in the early cord clamping group. Conclusions This study provides new and important information on the effects of resuscitation with an intact umbilical cord. The findings of improved SpO2 and higher Apgar score, and the absence of negative consequences encourages further studies with longer follow-up. Trial registration Clinicaltrials.gov NCT02727517, 2016/4/4 Electronic supplementary material The online version of this article (10.1186/s40748-019-0110-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ola Andersson
- 1Department of Clinical Sciences Lund, Pediatrics/Neonatology, Skane University Hospital, Lund University, SUS, Barn- & Ungdomssjukh. Avd. Ped, 221 85 Lund, Sweden
| | - Nisha Rana
- 2International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Uwe Ewald
- 2International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- 2International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Kalpana Subedi
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Ashish Kc
- 2International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Cameron L, Contreras Suarez D, Cornwell K. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLoS One 2019; 14:e0217386. [PMID: 31158243 PMCID: PMC6546237 DOI: 10.1371/journal.pone.0217386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces. METHODS The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics. FINDINGS Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies. CONCLUSION Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.
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Affiliation(s)
- Lisa Cameron
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Diana Contreras Suarez
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Katy Cornwell
- Centre for Development Economics and Sustainability, Monash University, Clayton, Victoria, Australia
- World Vision Australia, Burwood East, Victoria, Australia
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Canuto IMDB, Alves FAP, Oliveira CMD, Frias PGD, Macêdo VCD, Bonfim CVD. Intraurban differentials of perinatal mortality: modeling for identifying priority areas. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the intraurban spatial distribution of perinatal mortality, its avoidability, and relationship with socioeconomic indicators in Recife, Pernambuco, Brazil, in the period from 2013 to 2015. Method: An ecological study with data from the Information Systems on Mortality and Live Births and the Brazilian Institute of Geography and Statistics, using neighborhoods as the analysis unit. We elaborated an indicator of social deprivation formed by variables from the demographic census. We estimated the Kernel density of the deaths and calculated the Moran index of the perinatal mortality coefficients in the spatial analysis. We elaborated thematic maps of avoidable perinatal mortality and social deprivation. Results: The global statistical analysis of the mortality distribution indicated evidence of spatial aggregation. Moran's index was 0.18. We found clusters of perinatal mortality in neighborhoods of the Central, North, Northwest, and South Regions. In the North, Northwest, Southwest, and South Regions we identified neighborhoods with greater social deprivation and avoidable mortality coefficients. The primary cause of death was of fetuses and newborns affected by hypertensive maternal disorders. Conclusion: We demonstrated intraurban differentials in perinatal mortality among neighborhoods. The stratification of the urban space according to the social deprivation indicator presented a relation with the perinatal mortality and its avoidability.
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Affiliation(s)
| | | | | | - Paulo Germano de Frias
- Secretaria de Saúde do Recife, Brasil; Instituto de Medicina Integral Professor Fernando Figueira, Brasil
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Moreno-Martín G, Martínez-Martínez R, Moreno-Martín M, Fernández-Nieto MI, Sanabria-Negrín JG. Mortalidad materna en Ambato, Ecuador. 2005-2014. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.66622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La mortalidad materna (MM) es uno de los indicadores sanitarios que evidencia con mayor claridad la inequidad de género para la toma de decisiones y la exclusión social, esto toda vez que demanda una intervención médica urgente encaminada a prevenir una muerte.Objetivo. Exponer la magnitud y la tendencia de la MM en el cantón Ambato entre los años 2005 y 2014.Materiales y métodos. Estudio observacional, descriptivo, retrospectivo y transversal de las muertes maternas ocurridas en Ambato entre los años 2005 y 2014. El universo de estudio estuvo conformado por las 46 muertes maternas ocurridas y 51 947 nacidos vivos.Resultados. Se evidenció un ascenso significativo de la natalidad (r=0.652, p=0.041) y en el número de nacidos vivos con asistencia profesional (r=0.894, p=0.000); la razón de MM acumulada en el periodo fue de 88.6, con una tendencia al descenso no significativa (r=0.12 p=0.743). La enfermedad hipertensiva del embarazo fue la primera causa directa de MM (n=17, 41.5%).Conclusiones. La natalidad ha ido en ascenso y la tendencia de la MM a lo largo de 10 años no ha mostrado cambios significativos. La enfermedad hipertensiva del embarazo ha sido la principal causa de MM.
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Nakwan N, Jain S, Kumar K, Hosono S, Hammoud M, Elsayed YY, Ariff S, Hasan B, Khowaja W, Poon WB. An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome. J Matern Fetal Neonatal Med 2018; 33:2032-2037. [PMID: 30318951 DOI: 10.1080/14767058.2018.1536740] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: To explore the incidence, etiologies, diagnostic methods, treatment options and outcomes in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to identify mortality risk factors in a study from six Asian countries.Methods: A retrospective chart review of patients with documented PPHN from seven centers in six Asian countries (Japan, Kuwait, India, Pakistan, Singapore, and Thailand) between 1 January, 2014 and 31 December, 2016, was performed.Results: A total of 369 PPHN infants were identified. The incidence of PPHN ranged from 1.2 to 4.6 per 1000 live births. The all-cause mortality rate was 20.6% (76 of 369). Meconium aspiration syndrome was the primary cause of PPHN (24.1%). In most cases (84.8%) echocardiography was used to establish the diagnosis of PPHN. Sildenafil was the most commonly used pulmonary vasodilator (51.2%). Multivariate multiple regression analysis indicated gestational age <34 weeks (adjusted odds ratio (OR) = 3.27; 95% CI 1.56-6.74), congenital diaphragmatic hernia (CDH)/lung hypoplasia (LH) (adjusted OR = 6.13 (95% CI 2.28-16.42)), treatment with high frequency oscillation ventilation (HFOV) with or without inhaled nitric oxide (iNO) (adjusted OR = 3.11 (95% CI 1.52-6.34)), and inotropic agents (adjusted OR = 9.43 (95% CI 2.71-32.83)) were independently associated with increased risk of death.Conclusions: The incidence of PPHN in the current study was higher than in western settings. Birth weight, gestational age, CDH/LH, HFOV/iNO, and inotropic agents were significant mortality risk factors.
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Affiliation(s)
- Narongsak Nakwan
- Department of Pediatrics, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand
| | - Suksham Jain
- Department of Pediatrics, Govt. Medical College and Hospital, Chandigarh, India
| | - Kishore Kumar
- Department of Pediatrics, Cloudnine Hospital, Bangalore, India
| | - Shigeharu Hosono
- Division of Neonatology, Department of Perinatal and Neonatal Medicine, Jichi Medical University, Saitama, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Majeda Hammoud
- Department of Pediatrics and Neonatology, Faculty of Medicine, Kuwait University and Al-Sabah Maternity Hospital, Kuwait
| | - Yasser Yahia Elsayed
- Department of Pediatrics and Neonatology, Faculty of Medicine, Kuwait University and Al-Sabah Maternity Hospital, Kuwait
| | - Shabina Ariff
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Babar Hasan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Waqar Khowaja
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Fekadu GA, Kassa GM, Berhe AK, Muche AA, Katiso NA. The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:577. [PMID: 30041655 PMCID: PMC6056996 DOI: 10.1186/s12913-018-3370-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. Methods Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger’s test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). Result A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). Conclusion Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | | | | | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of public health, University of Gondar, Gondar, Ethiopia
| | - Nuradin Abusha Katiso
- Department of Nursing, College of Health Sciences and Medicine, Woliata Sodo University, Woliata Sodo, Ethiopia
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Abstract
This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone.
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Moura BLA, Alencar GP, Silva ZPD, Almeida MFD. [Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unified National Health System in São Paulo, Brazil]. CAD SAUDE PUBLICA 2018; 34:e00188016. [PMID: 29412326 DOI: 10.1590/0102-311x00188016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 06/01/2017] [Indexed: 11/21/2022] Open
Abstract
Maternal morbidity, fetal mortality, and neonatal mortality are important indicators of maternal and child health. The study aimed to describe maternal and perinatal outcomes (low birth weight, prematurity, fetal and neonatal deaths, postpartum hospitalizations, and readmission of newborns) in a cohort of pregnant women whose deliveries were covered by the Brazilian Unified National Health System (SUS) in the city of São Paulo, Brazil, in the second semester of 2012. We obtained a retrospective cohort of 55,404 pregnant women with deterministic and probabilistic linkage of data from the Hospital Information System of the SUS (SIH/SUS), Information System on Live Births (SINASC), Mortality Information System (SIM), and National Registry of Health Establishments (CNES) databases. Hospitalizations due to obstetric complications occurred in 4.3% of the women. The most frequent diagnoses were infection, hypertensive disease of pregnancy, and diabetes. Hospitalizations prior to childbirth were more common in pregnant women 35 years or older and those with a history of multiple pregnancies and low schooling. Postpartum hospitalizations were three times greater and maternal mortality was nine times greater in pregnant women with a history of previous hospitalization due to obstetric complications. Adverse perinatal outcomes (fetal and neonatal mortality and low birth weight) were twice as frequent in infants of women with previous hospitalization when compared to those without. A similar pattern was seen in hospitalization of newborns soon after birth and in hospital readmission. Adverse maternal and perinatal outcomes were more frequent in pregnant women with a history of previous hospitalization.
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Andrews K, Bourroul MLM, Fink G, Grisi S, Scoleze Ferrer AP, Diniz EMDA, Brentani A. Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil. PLoS One 2017; 12:e0190060. [PMID: 29272295 PMCID: PMC5741246 DOI: 10.1371/journal.pone.0190060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/07/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Differential trends in mortality suggest that stillbirths may dominate neonatal mortality in the medium to long run. Brazil has made major efforts to improve data collection on health indicators at granular geographic levels, and provides an ideal environment to test this hypothesis. Our goals were to examine levels and trends in stillbirths and neonatal deaths and the extent to which the mortality burden caused by stillbirths dominates neonatal mortality at the municipality- and state-level. METHODS We used data from the Brazilian Ministry of Health's repository on births, fetal, and neonatal deaths (2010-2014) to calculate stillbirth and neonatal mortality rates for São Paulo state's 645 municipalities. RESULTS At the state level, 7.9 per 1000 pregnancies ended in stillbirth (fetal death >22 weeks gestation or fetal weight >500g), but this varied from 0.0 to 28.4 per 1000 across municipalities. 7.9 per 1000 live births also died within the first 28 days. 42% of municipalities had a higher stillbirth rate than neonatal mortality rate, and in 61% of areas with low neonatal mortality (<8.0 per 1000), stillbirth rates exceeded neonatal mortality rates. CONCLUSIONS This analysis suggests large variability and inequality in mortality outcomes at the sub-national level. The results also imply that stillbirth mortality may exceed neonatal mortality in Brazil and similar settings in the next few decades, which suggests a need for a shift in policy. This work further underscores the importance of continued research into causes and prevention of stillbirth.
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Affiliation(s)
- Kathryn Andrews
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maria Lúcia Moraes Bourroul
- Children’s Institute of the Clinics Hospital, School of Medicine at the University of São Paulo, São Paulo, Brazil
| | - Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Sandra Grisi
- Department of Pediatrics, School of Medicine at the University of São Paulo, São Paulo, Brazil
| | - Ana Paula Scoleze Ferrer
- Children’s Institute of the Clinics Hospital, School of Medicine at the University of São Paulo, São Paulo, Brazil
| | | | - Alexandra Brentani
- Department of Pediatrics, School of Medicine at the University of São Paulo, São Paulo, Brazil
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Dossa NI, Philibert A, Dumont A. Using routine health data and intermittent community surveys to assess the impact of maternal and neonatal health interventions in low-income countries: A systematic review. Int J Gynaecol Obstet 2017; 135 Suppl 1:S64-S71. [PMID: 27836087 DOI: 10.1016/j.ijgo.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a need to provide increased evidence on effective interventions to reduce maternal and neonatal mortality in low- and middle-income countries (LMICs). OBJECTIVES To summarize the breadth of knowledge on using routine data (Routine Health Information Systems [RHIS] and Intermittent Community Surveys [ICS]) for well-designed maternal and neonatal health evaluations in LMICs. SEARCH STRATEGY We searched reports and articles published in Embase, Medline, and Google scholar. Selection criteria Studies were considered for inclusion if they were carried out in LMICs, using RHIS or ICS data with experimental or quasi-experimental design. DATA COLLECTION AND ANALYSIS A form was used to collect information on indicators used for interventions' impact assessment. Descriptive statistics and multiple correspondence analyses were then performed. MAIN RESULTS Of the 1201 publications identified, 46 studies met the inclusion criteria. Most of these were using RHIS data (n=40), mainly extracted from health facility registers (n=34), and non-controlled before and after design (n=30). The indicators, which were mostly reported, were related to the use of healthcare services (n=36) and maternal/neonatal health outcomes (n=31). Few studies used ICS data (n=6) or indicators of severity (n=2). CONCLUSION RHIS and ICS data should be increasingly used for impact studies on maternal and neonatal health in LMICs.
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Affiliation(s)
- Nissou I Dossa
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Aline Philibert
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Interdisciplinary Research Centre on Well-being, Health, Society and Environment (CINBIOSE), Université du Québec à Montréal, Canada
| | - Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Martinez B, Hall-Clifford R, Coyote E, Stroux L, Valderrama CE, Aaron C, Francis A, Hendren C, Rohloff P, Clifford GD. Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting. JOURNAL OF HEALTH INFORMATICS IN DEVELOPING COUNTRIES 2017; 11:http://www.jhidc.org/index.php/jhidc/article/view/158/212. [PMID: 28936111 PMCID: PMC5604479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Technology provides the potential to empower frontline healthcare workers with low levels of training and literacy, particularly in low- and middle-income countries. An obvious platform for achieving this aim is the smartphone, a low cost, almost ubiquitous device with good supply chain infrastructure and a general cultural acceptance for its use. In particular, the smartphone offers the opportunity to provide augmented or procedural information through active audiovisual aids to illiterate or untrained users, as described in this article. In this article, the process of refinement and iterative design of a smartphone application prototype to support perinatal surveillance in rural Guatemala for indigenous Maya lay midwives with low levels of literacy and technology exposure is described. Following on from a pilot to investigate the feasibility of this system, a two-year project to develop a robust in-field system was initiated, culminating in a randomized controlled trial of the system, which is ongoing. The development required an agile approach, with the development team working both remotely and in country to identify and solve key technical and cultural issues in close collaboration with the midwife end-users. This article describes this process and intermediate results. The application prototype was refined in two phases, with expanding numbers of end-users. Some of the key weaknesses identified in the system during the development cycles were user error when inserting and assembling cables and interacting with the 1-D ultrasound-recording interface, as well as unexpectedly poor bandwidth for data uploads in the central healthcare facility. Safety nets for these issues were developed and the resultant system was well accepted and highly utilized by the end-users. To evaluate the effectiveness of the system after full field deployment, data quality, and corruption over time, as well as general usage of the system and the volume of application support for end-users required by the in-country team was analyzed. Through iterative review of data quality and consistent use of user feedback, the volume and percentage of high quality recordings was increased monthly. Final analysis of the impact of the system on obstetrical referral volume and maternal and neonatal clinical outcomes is pending conclusion of the ongoing clinical trial.
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Affiliation(s)
- Boris Martinez
- Wuqu’ Kawoq Maya Health Alliance, Santiago Sacatepéquez, Guatemala
| | - Rachel Hall-Clifford
- Departments of Sociology and Anthropology and Public Health, Agnes Scott College, Atlanta, GA
| | - Enma Coyote
- Wuqu’ Kawoq Maya Health Alliance, Santiago Sacatepéquez, Guatemala
| | - Lisa Stroux
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | | | | | - Aaron Francis
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Cate Hendren
- Wuqu’ Kawoq Maya Health Alliance, Santiago Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu’ Kawoq Maya Health Alliance, Santiago Sacatepéquez, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
| | - Gari D. Clifford
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
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Stroux L, Martinez B, Coyote Ixen E, King N, Hall-Clifford R, Rohloff P, Clifford GD. An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala. J Med Eng Technol 2016; 40:356-371. [PMID: 27696915 DOI: 10.1080/03091902.2016.1223196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Limited funding for medical technology, low levels of education and poor infrastructure for delivering and maintaining technology severely limit medical decision support in low- and middle-income countries. Perinatal and maternal mortality is of particular concern with millions dying every year from potentially treatable conditions. Guatemala has one of the worst maternal mortality ratios, the highest incidence of intra-uterine growth restriction (IUGR), and one of the lowest gross national incomes per capita within Latin America. To address the lack of decision support in rural Guatemala, a smartphone-based system is proposed including peripheral sensors, such as a handheld Doppler for the identification of foetal compromise. Designed for use by illiterate birth attendants, the system uses pictograms, audio guidance, local and cloud processing, SMS alerts and voice calling. The initial prototype was evaluated on 22 women in highland Guatemala. Results were fed back into the refinement of the system, currently undergoing RCT evaluation.
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Affiliation(s)
- Lisa Stroux
- a Centre for Doctoral Training in Healthcare Innovation, Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK
| | - Boris Martinez
- b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala
| | - Enma Coyote Ixen
- b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala
| | - Nora King
- b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala
| | - Rachel Hall-Clifford
- c Departments of Anthropology and Public Health , Agnes Scott College , Atlanta , GA , USA
| | - Peter Rohloff
- b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala
| | - Gari D Clifford
- d Departments of Biomedical Informatics and Biomedical Engineering , Emory University and Georgia Institute of Technology , Atlanta , GA , USA
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A Comparative Evaluation of Microbial Pattern and Antibiotic Susceptibility in a Level III NICU Between Two Decades. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.39299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nobre RG, de Azevedo DV, de Almeida PC, de Almeida NMGS, Feitosa FEDL. Weight-Gain Velocity in Newborn Infants Managed with the Kangaroo Method and Associated Variables. Matern Child Health J 2016; 21:128-135. [PMID: 27421733 DOI: 10.1007/s10995-016-2101-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives The Kangaroo method helps promote maternal breastfeeding and adequate growth of low birthweight preterm infants. The objective of this study was to analyze the association between weight-gain velocity during use of the Kangaroo method and maternal and infant variables. Methods A nested cross-sectional study in a cohort of newborn infants managed using the Kangaroo method was carried out at a reference center for the method in Brazil. Data on low birthweight and preterm infants managed using the Kangaroo Method (n = 78) and on their respective mothers (n = 70) was collected between January and July 2014. Maternal and infant variables were associated and correlated with weight-gain velocity (g/kg/day) at each phase of the method (p < 0.05). Results Mean weight-gain velocity increased from 0.12 ± 11.11 g/kg/day in the first phase to 13.47 ± 4.84 g/kg/day in the third phase (p < 0.001), and percentage of adequate weight increased at phase 3 (p < 0.001). Birthweight was inversely correlated with weight-gain velocity at phases 1 and 2 of the Kangaroo method. Birthweight of under 1500 g was associated with a lower likelihood of inadequate weight-gain velocity of the newborn at phase 1 (OR = 0.1; 95 % CI 0.01-0.78; p = 0.012). In phase 3, maternal age was directly correlated with weight-gain velocity. Conclusions Weight-gain velocity was associated with maternal (age) and infant (gestational age at birth, birthweight, weight for gestational age at birth, length of hospital stay and five-minute Apgar score) variables. Knowledge of the factors influencing weight-gain velocity and its behavior at each phase of the method can help guide conduct toward potentializing factors that promote adequate weight-gain.
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Kwiatkowski S, Kwiatkowska E, Rzepka R, Torbe A, Dolegowska B. Ischemic placental syndrome--prediction and new disease monitoring. J Matern Fetal Neonatal Med 2015; 29:2033-9. [PMID: 26444581 DOI: 10.3109/14767058.2015.1072165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The last decade has seen an improved understanding of the cause of the development of pathologies such as gestational hypertension, preeclampsia, intrauterine growth restriction, intrauterine fetal death or placental abruption. Nowadays, we know that most conditions within this group share the same pathogenesis, the cause of which is placental ischemia. The following review is an attempt to propose a new method for prediction, diagnosis and--above all--appropriate monitoring of pregnant women and fetuses developing the ischemic placental syndrome with the use of tests that are new but yet widely available in clinical diagnosis. They are closely related to the condition's pathogenesis, therefore their elevated levels may predate clinical symptoms, and--most importantly--they correlate with syndrome aggravation and the occurrence of complications. Perhaps, the new look will allow us to improve perinatal results by reducing mortality and severe complications in pregnant women and fetal deaths resulting from sudden intrauterine fetal death or placental abruption.
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Affiliation(s)
| | - Ewa Kwiatkowska
- b Department of Nephrology , Transplantology and Internal Medicine , and
| | | | | | - Barbara Dolegowska
- c Department of Laboratory Diagnostics , Pomeranian University of Medicine , Szczecin , Poland
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Garces A, Mcclure EM, Hambidge K, Krebs NF, Figueroa L, Aguilar M, Moore JL, Goldenberg RL. Trends in perinatal deaths from 2010 to 2013 in the Guatemalan Western Highlands. Reprod Health 2015; 12 Suppl 2:S14. [PMID: 26062407 PMCID: PMC4464607 DOI: 10.1186/1742-4755-12-s2-s14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala. Methods We conducted a prospective study in the Western Highlands of Guatemala from 2010 through 2013, enrolling women during pregnancy with follow-up through 42-days postpartum. All pregnant women were identified and enrolled by study staff in the clusters in the Chimaltenango region for which we had 4 years of data. Enrolment usually occurred during the antenatal period; women were also visited following delivery and 42-days postpartum to collect outcomes. Measures of antenatal and delivery care were also obtained. Results Approximately four thousand women were enrolled annually (3,869 in 2010 to 4,570 in 2013). The stillbirth rate decreased significantly, from 22.0 per 1000 births (95% CI 16.6, 29.0) in 2010 to 16.7 (95% CI 13.5, 20.6) in 2013 (p-value 0.0223). The perinatal mortality rate decreased from 43.9 per 1,000 births (95% CI 36.0, 53.6) to 31.6 (95% CI 27.2, 36.7) (p-value 0.0003). The 28-day neonatal mortality rate decreased from 28.9 per 1000 live births (95% CI 25.2, 33.2) to 21.7 (95% CI 17.5, 26.9), p-value 0.0004. The maternal mortality rate was 134 per 100,000 in 2010 vs. 113 per 100,000 in 2013. Over the same period, hospital birth rates increased from 30.0 to 50.3%. Conclusions In a relatively short time period, significant improvements in neonatal, fetal and perinatal mortality were noted in an area of Guatemala with a history of poor pregnancy outcomes. These changes were temporally related to major increases in hospital-based delivery with skilled birth attendants, as well as improvements in the quality of delivery care, neonatal care, and prenatal care.
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