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Tufa FA, Yilma D, Yadesa D, Tura MR. Determinants of stillbirth among deliveries conducted at west Shoa zone public hospitals, central Ethiopia: a case-control study. BMC Pediatr 2024; 24:482. [PMID: 39068401 PMCID: PMC11282670 DOI: 10.1186/s12887-024-04953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Globally, 2.6 million stillbirths are estimated to occur each year. The causes of stillbirth are often unknown but can be attributed to various causes. Therefore, identifying the determinants of stillbirth is quite important for applying further meaningful interventions. The purpose of this study was to identify the determinants of stillbirth among deliveries conducted at selected public hospitals in the West Shoa Zone, Oromia, Ethiopia. METHODS A hospital-based unmatched case‒control study with a 1:4 ratio was conducted. A total of 431 (87 cases and 344 controls) participants were involved. A systematic random sampling method was used for control selection. Data were collected using interview administered questionnaire and analysed using SPSS version 26 software. Binary logistic regression analyses were performed for the independent variables and outcome variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated to assess the strength of the associations, and statistical significance was declared at P value < 0.05. RESULTS In this study, 428 mothers who delivered (85 patients and 343 controls) participated, for a 99.3% response rate. Preeclampsia/eclampsia (AOR = 13.43, 95% CI: 5.67-31.82), other health conditions (AOR = 5.39, 95% CI: 2.34-12.46), mal-presentation (AOR = 3.42, 95% CI: 1.50-7.76), umbilical cord accidents (AOR = 2.57, 95% CI: 1.11-5.93), meconium-stained amniotic fluid problems (AOR = 5.01, 95% CI: 2.15-11.67) and low birth weight (AOR = 2.91, 95% CI: 1.28-6.59) were identified as determinant variables of stillbirth. CONCLUSIONS Low birth weight, referral status, meconium-stained amniotic fluid problems, umbilical cord accidents, mal-presentation and preeclampsia/eclampsia were identified as independent determinants of stillbirth. Therefore, hospitals and health workers are recommended to focus on identifying and preventing these factors.
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Affiliation(s)
- Fayisa Abdisa Tufa
- Department of Public Health, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Delelegn Yilma
- Department of Public Health, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Dereje Yadesa
- Department of Medicine, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Meseret Robi Tura
- Department of Nursing, College of Health Sciences and Referral Hospital, Ambo University, P.O. Box 19, Ambo, Ethiopia.
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Ndjomo G, Blairy S, Durieux N. Prevalence of postnatal anxiety disorders in mothers of preterm infants: a systematic review protocol. JBI Evid Synth 2024; 22:1115-1121. [PMID: 38189434 DOI: 10.11124/jbies-23-00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The objective of this systematic review is to evaluate and synthesize the available evidence on the prevalence of postnatal anxiety disorders in mothers of preterm infants within 12 months of delivery. INTRODUCTION Mothers of preterm infants report more postpartum psychological problems than other mothers. Anxiety disorders are among the most frequently reported manifestations, and affect the quality of maternal care and the baby's development. However, data on the prevalence of postnatal anxiety disorders in mothers of preterm infants are inconsistent and imprecise. It is, therefore, necessary to estimate the prevalence of anxiety disorders among mothers of premature infants in order to develop appropriate interventions for screening, support, and treatment. INCLUSION CRITERIA This review will consider studies conducted in any setting and any geographical location that report on the prevalence of any anxiety disorders in mothers of preterm infants within 12 months of delivery. Any analytical or descriptive observational studies and experimental or quasi-experimental studies will be included. METHODS MEDLINE (Ovid), PsycINFO (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), Google Scholar, MedNar, and the World Health Organization website will be searched for studies written in English or French. Screening, critical appraisal, and data extraction will be performed by 2 independent reviewers using the relevant JBI systematic review tools. The findings will be presented in narrative format, including tables and figures to aid in data presentation. REVIEW REGISTRATION PROSPERO CRD42023428202.
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Affiliation(s)
- Gilles Ndjomo
- Laboratory of Behavioral Sciences and Applied Psychology (LAPSA), Douala University, Douala, Cameroon
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
| | - Sylvie Blairy
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
| | - Nancy Durieux
- Research Unit for a Life-Course Perspective on Health and Education (RUCHE), University of Liège, Liège, Belgium
- JBI Belgium: A JBI Affiliated Group, Leuven, Belgium
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3
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Marincowitz GJO, Marincowitz C. Causes of stillbirths at Kgapane hospital, Limpopo province. S Afr Fam Pract (2004) 2024; 66:e1-e7. [PMID: 38708746 PMCID: PMC11079331 DOI: 10.4102/safp.v66i1.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/22/2023] [Accepted: 02/01/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Stillbirths are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most stillbirths are preventable. OBJECTIVES this study reviewed perinatal clinical audit data from Kgapane Hospital over a 4-year period with a special focus on the factors associated with stillbirths. METHODS File audits were done for all stillbirths occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with stillbirths. RESULTS A total of 392 stillbirths occurred during the study period at Kgapane Hospital and its surrounding clinics, resulting in a stillborn rate of 19.06/1000 births. Of the 392 stillbirths recorded, audits were conducted on 354 of the maternal case records. The five most common causes of stillbirths identified were: hypertensive disorders in pregnancy (HDP) (29.7%), intrauterine growth restriction without HDP (11.6%), birth asphyxia (7.1%), premature labour ( 1000 g) (6.5%) and maternal infections (5.9%) including HIV with unsuppressed VL, intrauterine infection, coronavirus disease (COVID) and syphilis. Modifiable factors that can form the basis of improvement strategies should include training, timeous referral, plus improved resources and staffing. CONCLUSION Understanding the causes of stillbirths can guide improvement strategies to reduce this heart-breaking complication of pregnancy.Contribution: Family physicians working in rural hospitals are also responsible for perinatal care. Understanding the factors associated with stillbirths will guide them to develop improvement strategies to reduce these preventable deaths.
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Affiliation(s)
- Gert J O Marincowitz
- Department of Family Medicine, Faculty of Health Sciences, University of Limpopo, Mankweng.
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Waziri B, Umar IA, Magaji A, Umelo CC, Nalado AM, Wester CW, Aliyu MH. Risk factors and outcomes associated with pregnancy-related acute kidney injury in a high-risk cohort of women in Nigeria. J Nephrol 2024; 37:587-596. [PMID: 38051496 PMCID: PMC11256905 DOI: 10.1007/s40620-023-01822-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Despite a decline in developed countries, pregnancy-related acute kidney injury (PRAKI) remains a significant contributor to maternal mortality and adverse fetal outcomes in resource-constrained settings. Little is known about the impact of pregnancy-related acute kidney injury in Nigeria. Therefore, this study aimed to assess the incidence and maternal-fetal outcomes associated with pregnancy-related acute kidney injury among a cohort of high-risk women in Nigeria. METHODS This prospective multicenter study included women at high risk of acute kidney injury, who were more than 20 weeks pregnant or within 6 weeks postpartum and admitted to the Obstetrics and Gynecology units of two large public hospitals between September 1, 2019, and July 31, 2022. Acute kidney injury was defined and classified using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS A total of 433 women, with mean age (± standard deviation) of 28 ± 6 years, were included in the evaluation. Pregnancy-related acute kidney injury occurred in 113 women (26.1%; 95% confidence interval [CI]: 21.1%-30.2%). The leading cause was preeclampsia (n = 57; 50.1%); 19 women died (4.4%), with 17 deaths (15%) occurring in the PRAKI group. Increasing severity of pregnancy-related acute kidney injury was independently associated with maternal mortality: adjusted odds ratio (aOR) for KDIGO stage 2 = 4.40; 95% CI 0.66-29.34, p = 0.13, and KDIGO stage 3 aOR = 6.12; 95% CI 1.09-34.34, p = 0.04. The overall perinatal mortality was 15% (n = 65), with 28 deaths (24.8%) occurring in the PRAKI group. Pregnancy-related acute kidney injury was also associated with an increased risk of perinatal mortality, aOR = 2.23; 95 CI 1.17-4.23, p = 0.02. CONCLUSIONS The incidence of pregnancy-related acute kidney injury was high, and significantly associated with maternal and perinatal mortality. The leading causes were hypertensive disorders of pregnancy.
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Affiliation(s)
- Bala Waziri
- Renal Unit, Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria.
| | - Isah A Umar
- Renal Unit, Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria
| | - Aminu Magaji
- Jummai Babangida Aliyu Maternal and Neonatal Hospital, Minna, Nigeria
| | - Chijioke C Umelo
- Jummai Babangida Aliyu Maternal and Neonatal Hospital, Minna, Nigeria
| | - Aisha M Nalado
- Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - C William Wester
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
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Koray MH, Curry T. Predictors of perinatal mortality in Liberia's post-civil unrest: A comparative analysis of the 2013 and 2019-2020 Liberia Demographic and Health Surveys. BMJ Open 2024; 14:e080661. [PMID: 38417962 PMCID: PMC10900345 DOI: 10.1136/bmjopen-2023-080661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Perinatal mortality remains a pressing concern, especially in lower and middle-income nations. Globally, 1 in 72 babies are stillborn. Despite advancements, the 2030 targets are challenging, notably in sub-Saharan Africa. Post-war Liberia saw a 14% spike in perinatal mortality between 2013 and 2020, indicating the urgency for in-depth study. OBJECTIVE The study aims to investigate the predictors of perinatal mortality in Liberia using 2013 and 2019-2020 Liberia Demographic and Health Survey datasets. METHODS In a two-stage cluster design from the Liberia Demographic and Health Survey, 6572 and 5285 respondents were analysed for 2013 and 2019-2020, respectively. Data included women aged 15-49 with pregnancy histories. Descriptive statistics was used to analyse the sociodemographic characteristics, the exposure to media and the maternal health services. Bivariate and multivariate logistic regressions were used to examine the predictors of perinatal mortality at a significance level of p value ≤0.05 and 95% CI. The data analysis was conducted in STATA V.14. RESULTS Perinatal mortality rates increased from 30.23 per 1000 births in 2013 to 42.05 in 2019-2020. In 2013, increasing age of respondents showed a reduced risk of perinatal mortality rate. In both years, having one to three children significantly reduced mortality risk (2013: adjusted OR (aOR) 0.30, 95% CI 0.14 to 0.64; 2019: aOR 0.24, 95% CI 0.11 to 0.54), compared with not having a child. Weekly radio listenership increased mortality risk (2013: aOR 1.36, 95% CI 0.99 to 1.89; 2019: aOR 1.86, 95% CI 1.35 to 2.57) compared with not listening at all. Longer pregnancy intervals (p<0.0001) and receiving 2+ tetanus injections (p=0.019) were protective across both periods. However, iron supplementation showed varied effects, reducing risk in 2013 (aOR 0.90, 95% CI 0.48 to 1.68) but increasing it in 2019 (aOR 2.10, 95% CI 0.90 to 4.92). CONCLUSION The study reports an alarming increase in Liberia's perinatal mortality from 2013 to 2019-2020. The findings show dynamic risk factors necessitating adaptable healthcare approaches, particularly during antenatal care. These adaptable approaches are crucial for refining health strategies in line with the Sustainable Development Goals, with emphasis on the integration of health, education, gender equality, sustainable livelihoods and global partnerships for effective health outcomes.
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Affiliation(s)
| | - Tanya Curry
- National Public Health Institute of Liberia, Monrovia, Liberia
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Khan S, Kilpatrick R, Benjamin DK, Kolnik SE, Greenberg RG, Clark R, Zimmerman KO, Puia-Dumitrescu M. Morbidity and mortality of twins and triplets compared to singleton infants delivered between 26-34 weeks gestation in the United States. J Perinatol 2024; 44:231-238. [PMID: 37989884 DOI: 10.1038/s41372-023-01822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To describe in-hospital morbidities and mortality among twins and triplets delivered at ≥26 to ≤34 weeks gestational age (GA) while controlling for prematurity and growth restriction. STUDY DESIGN Retrospective analysis of inborn infants discharged from a neonatal intensive care unit (NICU) managed by the Pediatrix Medical Group between 2010 and 2018. RESULT Among 247 437 infants included, 27.4% were multiples. Adjusted for GA and other factors typically known prior to delivery, in-hospital morbidities varied by plurality and generally were more common in singletons. The odds of death prior to discharge were less for twins at 0.74 (95% CI: 0.67-0.83) and triplets at 0.69 (95% CI: 0.51-0.92) compared to singletons. CONCLUSION Singletons experience greater morbidity and mortality compared to twins and triplets born ≥26 weeks to ≤34 weeks GA, except PDA requiring procedural intervention, ROP requiring treatment, and longer length of stay.
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Affiliation(s)
- Sara Khan
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
| | - Ryan Kilpatrick
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke Clinical Research Institute, Durham, NC, USA
| | | | - Sarah E Kolnik
- Department of Pediatrics, Division of Neonatology, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke Clinical Research Institute, Durham, NC, USA
| | - Reese Clark
- Center for Research, Education, Quality, and Safety, Pediatrix Medical Group, Inc, Sunrise, FL, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Department of Pediatrics, Duke Clinical Research Institute, Durham, NC, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, Division of Neonatology, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
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Marincowitz GJO, Marincowitz C. Neonatal death audits at Kgapane Hospital, Limpopo province. S Afr Fam Pract (2004) 2023; 65:e1-e5. [PMID: 38197690 PMCID: PMC10784183 DOI: 10.4102/safp.v65i1.5815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Neonatal deaths (NNDs) are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most NNDs are preventable. Therefore, this study reviewed perinatal clinical audit data at Kgapane Hospital over a 4-year period with a special focus on the factors associated with NNDs. METHODS File audits were performed for all NNDs occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with NNDs. RESULTS The NND rate for the study period was 12.6/1000 live births. In this study (n = 236), 90% of the deaths could be associated with four factors, namely prematurity (44%); intrapartum complications (19%) including asphyxia, meconium aspiration and breech deliveries; neonatal infections (16%) of which human immunodeficiency virus (HIV) positivity was the most prevalent; and foetal congenital abnormalities (11%). The modifiable factors included inadequate intrapartum foetal monitoring; delays in management interventions; instances where no attempts were made to refer patients for specialised care, or where no beds were available at the next level of care; patient-related factors; and inadequate adherence to management protocols, such as for the management of prematurity and HIV. CONCLUSION Understanding factors associated with NNDs can guide health worker training and improvement strategies to reduce this heart-breaking complication of pregnancy.Contribution: Family physicians working in rural hospitals are also responsible for newborn care. Understanding the factors associated with NNDs will guide them to focus training and develop improvement strategies to reduce these preventable deaths.
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Affiliation(s)
- Gert J O Marincowitz
- Department of Family Medicine, Faculty of Health Sciences, University of Limpopo, Mankweng.
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Izulla P, Muriuki A, Kiragu M, Yahner M, Fonner V, Nitu SNA, Osir B, Bello F, de Graft-Johnson J. Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries. PLoS One 2023; 18:e0293479. [PMID: 37983214 PMCID: PMC10659187 DOI: 10.1371/journal.pone.0293479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023] Open
Abstract
Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.
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Affiliation(s)
| | - Angela Muriuki
- Save the Children, Kenya Regional Office, Nairobi, Kenya
| | | | - Melanie Yahner
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Virginia Fonner
- Adroitz Consultants Limited, Nairobi, Kenya
- Department of Health and Nutrition, Save the Children, Dhaka, Bangladesh
| | - Syeda Nabin Ara Nitu
- Department of Global Health, Save the Children Federation Inc, Washington DC, United States of America
| | | | - Farahat Bello
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Joseph de Graft-Johnson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, South Carolina, United States of America
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Arach AAO, Nakasujja N, Rujumba J, Mukunya D, Odongkara B, Musaba MW, Napyo A, Tumwine JK, Nankabirwa V, Ndeezi G, Kiguli J. Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda. BMC Pregnancy Childbirth 2023; 23:222. [PMID: 37013468 PMCID: PMC10069138 DOI: 10.1186/s12884-023-05550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Perinatal death has profound psychosocial effects on women and their families. Sociocultural contexts influence the burden, rituals and bereaved's support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. METHODS This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes. RESULTS Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. CONCLUSION Stillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, P.O Box 1035, Lira, Uganda.
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Agnes Napyo
- Department of Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child Health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Asefa YA, Persson LÅ, Seale AC, Assefa N. Burden, causes, and risk factors of perinatal mortality in Eastern Africa: a protocol for systematic review and meta-analysis. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13915.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Although global mortality rates in children under 5 years have decreased substantially in the last 30 years, there remain around 2.6 million stillbirths and 2.9 million neonatal deaths each year. The majority of these deaths occur in Africa and South Asia. To reduce perinatal deaths in East Africa, knowledge of the burden, but also the risk factors and causes of perinatal deaths are crucial. To the best of our knowledge, reviews have previously focused on the burden of perinatal deaths; here we aim to synthesize evidence on the burden, causes, and risk factors for perinatal mortality in East Africa. Methods: We will conduct a systematic literature search in Medline, Web of Science, EMBASE, Global Health, SCOPUS, Cochrane Library, CINAHL, HINARI, African Index Medicus, African Journals Online (AJOL), and WHO African Regional Office (AFRO) Library. We will include studies from 2010 to 2022, and to facilitate the inclusion of up-to-date data, we will request recent data from ongoing surveillance in the region, such as the Child Health and Mortality Prevention Surveillance (CHAMPS) network and Health and Demographic Surveillance sites (HDSS sites). To assess the quality of included studies we will use the Joanna Briggs Institute quality assessment tool for observational and trial studies. We will analyze the data using STATA version 17 statistical software and assess heterogeneity and publication bias by Higgins’ I2 and funnel plot, respectively. Conclusions: This systematic review protocol will search for published studies, and seek unpublished data, on the burden, causes, and risk factors of perinatal mortality in East Africa. Findings will be reported and gaps in the evidence base identified, with recommendations, with the ultimate aim of reducing perinatal deaths.
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11
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Bebell LM, Ngonzi J, Meier FA, Carreon CK, Birungi A, Kerry VB, Atwine R, Roberts DJ. Building Perinatal Pathology Research Capacity in Sub-Saharan Africa. Front Med (Lausanne) 2022; 9:958840. [PMID: 35872791 PMCID: PMC9304650 DOI: 10.3389/fmed.2022.958840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Over two million stillbirths and neonatal deaths occur in sub-Saharan Africa (sSA) annually. Despite multilateral efforts, reducing perinatal mortality has been slow. Although targeted pathologic investigation can often determine the cause of perinatal death, in resource-limited settings, stillbirths, early neonatal deaths, and placentas are rarely examined pathologically. However, the placenta is a key source of diagnostic information and is the main determinant of fetal growth and development in utero, influencing child health outcomes. Methods In 2016, our collaborative intercontinental group began investigating infectious perinatal death and adverse child health outcomes in Uganda. We developed and initiated a 4-day combined didactic/practical curriculum to train health workers in placental collection, gross placental examination, and tissue sampling for histology. We also trained a local technician to perform immunohistochemistry staining. Results Overall, we trained 12 health workers who performed gross placental assessment for > 1,000 placentas, obtaining > 5,000 formalin-fixed tissue samples for research diagnostic use. Median placental weights ranged from 425 to 456 g, and 33.3% of placentas were < 10th percentile in weight, corrected for gestational age. Acute chorioamnionitis (32.3%) and maternal vascular malperfusion (25.4%) were common diagnoses. Discussion Through a targeted training program, we built capacity at a university-affiliated hospital in sSA to independently perform placental collection, gross pathologic examination, and placental tissue processing for histology and special stains. Our training model can be applied to other collaborative research endeavors in diverse resource-limited settings to improve research and clinical capacity and competency for diagnostics and management of stillbirth, neonatal death, and child health outcomes.
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Affiliation(s)
- Lisa M. Bebell
- Division of Infectious Diseases, Department of Medicine, Medical Practice Evaluation Center and Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Lisa M. Bebell,
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Frederick A. Meier
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Chrystalle Katte Carreon
- Division of Women’s and Perinatal Pathology, Department of Pathology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Pathology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Abraham Birungi
- Department of Pathology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vanessa B. Kerry
- Division of Pulmonary and Critical Care Medicine and Center for Global Health, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Seed Global Health, Boston, MA, United States
| | - Raymond Atwine
- Department of Pathology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Drucilla J. Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Girma D, Abita Z, Fetene G, Birie B. Individual and community-level factors of perinatal mortality in the high mortality regions of Ethiopia: a multilevel mixed-effect analysis. BMC Public Health 2022; 22:247. [PMID: 35130852 PMCID: PMC8819877 DOI: 10.1186/s12889-022-12695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/31/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Even though perinatal mortality has declined globally; it is still the major public health concern in sub-Saharan Africa countries. Ethiopia is one of the sub-Saharan countries which contribute the highest-burden of perinatal mortality with a devastating rate in some of the regions. Therefore, this study aimed to identify the determinants of perinatal mortality in the high mortality regions of Ethiopia. METHOD A secondary data analysis was done using the 2016 Ethiopian Demographic and Health Survey data. The outcomes of 4120 pregnancies reaching ≥ 7 months of gestational age were considered for the analysis. A multilevel mixed logistic regression model was fitted to identify the predictors of perinatal mortality. Finally, a statistically significant association was declared at a p-value of ≤ 0.05. RESULT The study found that birth interval < 2 years (AOR = 3.71, 95%CI:2.27, 6.07),having no antenatal care (AOR = 2.43,95%CI:1.15,5.38), initiating breastfeeding after 1 h(AOR = 4.01,95%CI:2.49,6.51), being distant from health institutions (AOR = 1.99, 95%CI: 1.24, 3.22), having previous terminated pregnancy (AOR = 4.68, 95%CI:2.76,7.86), being mothers not autonomous(AOR = 1.96, 95%CI:1.19,3.20),being no media exposure (AOR = 2.78, 95%CI:1.48,5.59),being households ≤ 4 family sizes (AOR = 4.12, 95%CI:2.19,7.79), having ≥ 6 parity (AOR = 2.48, 95%CI:1.21, 5.22) were associated with a high odds of perinatal mortality. CONCLUSION The study concludes that birth interval, antenatal care, time for breastfeeding initiation, distance from health institutions, previous history of terminated pregnancy, maternal autonomy, media exposure, family size, and parity were predictors of prenatal mortality. Therefore, programmatic emphases to maternal waiting service utilization for mothers distant from health institutions and media advertising regarding the complications related to pregnancy, childbirth and on its respective direction that the mothers should follow could reduce perinatal mortality in high mortality regions of Ethiopia.
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Affiliation(s)
- Desalegn Girma
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia.
| | - Zinie Abita
- Department of Reproductive Health, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Gossa Fetene
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Bamlaku Birie
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan, Ethiopia
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