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Woodd SL, Kabanywanyi AM, Rehman AM, Campbell OMR, Kagambo A, Martiasi W, TinaDay LM, Aiken AM, Graham WJ. Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study. PLoS One 2021; 16:e0254131. [PMID: 34197559 PMCID: PMC8248639 DOI: 10.1371/journal.pone.0254131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Maternal and newborn infections are important causes of mortality but morbidity data from low- and middle-income countries is limited. We used telephone surveillance to estimate infection incidence and risk factors in women and newborns following hospital childbirth in Dar es Salaam. METHODS We recruited postnatal women from two tertiary hospitals and conducted telephone interviews 7 and 28 days after delivery. Maternal infection (endometritis, caesarean or perineal wound, or urinary tract infection) and newborn infection (umbilical cord or possible severe bacterial infection) were identified using hospital case-notes at the time of birth and self-reported symptoms. Adjusted Cox regression models were used to assess the association between potential risk-factors and infection. RESULTS We recruited 879 women and interviewed 791 (90%). From day 0-7, 6.7% (49/791) women and 6.2% (51/762) newborns developed infection. Using full follow-up data, the infection rate was higher in women with caesarean childbirth versus women with a vaginal delivery (aHR 1.93, 95%CI 1.11-3.36). Only 24% of women received pre-operative antibiotic prophylaxis before caesarean section. Infection was higher in newborns resuscitated at birth versus newborns who were not resuscitated (aHR 4.45, 95%CI 2.10-9.44). At interview, 66% (37/56) of women and 88% (72/82) of newborns with possible infection had sought health-facility care. CONCLUSIONS Telephone surveillance identified a substantial risk of postnatal infection, including cases likely to have been missed by hospital-based data-collection alone. Risk of maternal endometritis and newborn possible severe bacterial infection were consistent with other studies. Caesarean section was the most important risk-factor for maternal infection. Improved implementation of pre-operative antibiotic prophylaxis is urgently required to mitigate this risk.
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Affiliation(s)
- Susannah L. Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abdunoor M. Kabanywanyi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Andrea M. Rehman
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oona M. R. Campbell
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Asila Kagambo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Warda Martiasi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Louise M. TinaDay
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexander M. Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy J. Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Semrau KE, Miller KA, Lipsitz S, Fisher-Bowman J, Karlage A, Neville BA, Krasne M, Gass J, Jurczak A, Pratap Singh V, Singh S, Marx Delaney M, Hirschhorn LR, Kodkany B, Kumar V, Gawande AA. Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India. BMJ Glob Health 2021; 5:bmjgh-2019-002268. [PMID: 32928798 PMCID: PMC7490951 DOI: 10.1136/bmjgh-2019-002268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Evidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality. METHODS Within the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants' practice adherence to perinatal mortality. FINDINGS Across 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality. INTERPRETATION Adherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex. FUNDING Bill & Melinda Gates Foundation. TRIAL REGISTRATION DETAILS ClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.
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Affiliation(s)
- Katherine Ea Semrau
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA .,Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Kate A Miller
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Jennifer Fisher-Bowman
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Optum, Boston, Massachusetts, USA
| | - Ami Karlage
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Bridget A Neville
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret Krasne
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Gass
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Amanda Jurczak
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Megan Marx Delaney
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Ilinois, United States
| | | | | | - Atul A Gawande
- Ariadne Labs at Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States
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