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Okonofua F, Ekezue BF, Ntoimo LF, Ohenhen V, Agholor K, Imongan W, Ogu R, Galadanci H. Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities. Int Health 2024; 16:293-301. [PMID: 37386659 PMCID: PMC11062200 DOI: 10.1093/inthealth/ihad044] [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: 03/28/2023] [Revised: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. METHODS The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. RESULTS The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. CONCLUSION We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.
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Affiliation(s)
- Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
- Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Bola F Ekezue
- Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, NC, USA
| | - Lorretta Favour Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Nigeria
| | - Victor Ohenhen
- Department of Obstetrics and Gynaecology, Central Hospital Benin City, Benin City, Nigeria
| | - Kingsley Agholor
- Department of Obstetrics and Gynaecology/Anti-Retroviral Therapy Centre, Central Hospital, Warri, Delta State, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Rivers State, Nigeria
| | - Hadiza Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
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Alipour J, Payandeh A, Karimi A. Prevalence of maternal mortality causes based on ICD-MM: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:821. [PMID: 38017449 PMCID: PMC10683107 DOI: 10.1186/s12884-023-06142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Maternal mortality is a universal public health challenge. ICD-Maternal Mortality (ICD-MM) was introduced in 2012 to facilitate the gathering, analysis, and interpretation of data on maternal deaths worldwide. The present study aimed to estimate the global prevalence of maternal death causes through a systematic review and meta-analysis. METHODS A systematic literature search was conducted using various databases, including Web of Science, PubMed, Scopus, ScienceDirect, Cochrane Library, as well as Persian databases such as MagIran and Scientific Information Database (SID). The search encompassed articles published until August 21, 2022. Thirty-four eligible articles were included in the final analysis. Analysis was performed using a meta-analysis approach. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, and random effects models with Mantel-Haenszel methods were employed using the STATA software version 14.2. RESULTS The most prevalent causes of maternal deaths, listed in descending order from highest to lowest prevalence, were non-obstetric complications (48.32%), obstetric hemorrhage (17.63%), hypertensive disorders of pregnancy, childbirth, and the puerperium (14.01%), other obstetric complications (7.11%), pregnancy with abortive outcome (5.41%), pregnancy-related infection (5.26%), unanticipated complications of management (2.25%), unknown/undetermined causes (2.01%), and coincidental causes (1.59%), respectively. CONCLUSION Non-obstetric complications, obstetric hemorrhage, and hypertensive disorders of pregnancy, childbirth, and puerperium were the most common causes of maternal deaths. To reduce the burden of maternal mortality causes, increasing awareness and promoting self-care management among women of reproductive age, and implementing effective screening mechanisms for high-risk mothers during pregnancy, childbirth, and the puerperium can play a significant role. ICD-MM enables the uniform collection and comparison of maternal death information at different levels (local, national, and international) by facilitating the consistent collection, analysis, and interpretation of data on maternal deaths. Our findings can be utilized by policymakers and managers at various levels to facilitate necessary planning aimed at reducing the burden of maternal mortality causes.
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Affiliation(s)
- Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Payandeh
- Department of Biostatistics and Epidemiology, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Afsaneh Karimi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Ohenhen V, Oshomoh SA, Akpojaro E, Enobakhare E, Ovenseri C, Eboreime E. Birth preparedness and complication readiness: Evaluating the "know-do" gap among women receiving antenatal care in Benin City, Nigeria. J Biosoc Sci 2023; 55:1086-1100. [PMID: 36605008 DOI: 10.1017/s0021932022000475] [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] [Indexed: 01/07/2023]
Abstract
Across several African countries, birth preparedness and complication readiness (BPACR) among pregnant women is poor. The practice of BPACR, though improving in recent years, is not commensurate with the knowledge available to pregnant women. Maternal health indices remain sub-optimal. This study evaluates the determinants of this "know-do' gap among women receiving antenatal care at a secondary health facility in Benin City, Nigeria. A cross-sectional study involving 427 pregnant women was conducted between October and December 2020 using a structured interviewer-administered questionnaire. The prevalence of knowledge and practice were described, and the determinants of BPACR practice evaluated using bivariable (chi-square) analysis and multivariable ordinal logistic regression with post-estimation predictive margins analysis. About 77% of respondents had good birth preparedness practice. Multivariable regression revealed that respondents with poor knowledge and moderate knowledge of components of BPACR had statistically significant lower odds (OR:0.05 (95% CI: 0.02-0.13) and 0.10 (95% CI: 0.03-0.30) times, respectively) for greater practice of BPACR when compared to those with good knowledge. Respondents with poor knowledge of danger signs had statistically significant lower odds (OR: 0.08 (95% CI: 0.03-0.26) for greater practice of BPACR when compared to those with good knowledge. But predictive margins analyses demonstrates that knowledge, though critical to practice, is insufficient to optimize practice. The optimum number of danger signs women need to know to improve practice may be between eight to ten. Beyond this number, practice may not change significantly. Other predictors of BPACR practice include income level, parity, gravidity, and residential settings. The number of antenatal clinic visits had no statistically significant correlation with BPACR practice. Interventions to facilitate practice at the community level may be helpful to improve outcomes and bridge the know-do gap with respect to BPACR within the study context.
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Affiliation(s)
- Victor Ohenhen
- Department of Obstetrics and Gynaecology, Central Hospital, Benin City, Nigeria
| | | | - Ejovi Akpojaro
- Department of General Studies, Edo State College of Nursing Sciences
| | - Egbe Enobakhare
- Department of Family Medicine, Central Hospital, Benin City, Nigeria
| | | | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Okonofua F, Ntoimo LF, Ekezue B, Ohenhen V, Agholor K, Imongan W, Ogu R, Galadanci H. Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design. BMC Pregnancy Childbirth 2023; 23:614. [PMID: 37633892 PMCID: PMC10464082 DOI: 10.1186/s12884-023-05893-y] [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: 12/13/2022] [Accepted: 08/02/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals. METHODS Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals. RESULTS The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals. CONCLUSIONS We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach. TRIAL REGISTRATION The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .
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Affiliation(s)
- Friday Okonofua
- Centre Leader, Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria.
- Department of Obstetrics and Gynaecology, University of Benin, University of Benin Teaching Hospital, Benin City, Nigeria.
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria.
| | - Lorretta Favour Ntoimo
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti, Nigeria
| | - Bola Ekezue
- Fayetteville State University, Fayetteville, USA
| | - Victor Ohenhen
- Department of Obstetrics and Gynaecology, Central Hospital Benin City, Benin City, Nigeria
| | - Kingsley Agholor
- Department of Obstetrics and Gynaecology/Anti-Retroviral Therapy Centre, Central Hospital, Warri, Delta State, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Hadiza Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
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Klemann D, Rijkx M, Mertens H, van Merode F, Klein D. Causes for Medical Errors in Obstetrics and Gynaecology. Healthcare (Basel) 2023; 11:healthcare11111636. [PMID: 37297775 DOI: 10.3390/healthcare11111636] [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: 03/26/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in gynaecology and obstetrics and how they could be prevented, we conducted this systematic review. Methods: This systematic review was performed in compliance with the Prisma 2020 guidelines. We searched several databases for relevant studies (Jan 2010-May 2023). Studies were included if they indicated the presence of any potential risk factor at the hospital level for medical errors or adverse events in gynaecology or obstetrics. Results: We included 26 articles in the quantitative analysis of this review. Most of these (n = 12) are cross-sectional studies; eight are case-control studies, and six are cohort studies. One of the most frequently reported contributing factors is delay in healthcare. In addition, the availability of products and trained staff, team training, and communication are often reported to contribute to near-misses/maternal deaths. Conclusions: All risk factors that were found in our review imply several categories of contributing factors regarding: (1) delay of care, (2) coordination and management of care, and (3) scarcity of supply, personnel, and knowledge.
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Affiliation(s)
- Désirée Klemann
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Maud Rijkx
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Helen Mertens
- Executive Board, Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Frits van Merode
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Dorthe Klein
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, 6228 HX Maastricht, The Netherlands
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Chirwa MD, Nyasulu J, Modiba L, Limando MG. Challenges faced by midwives in the implementation of facility-based maternal death reviews in Malawi. BMC Pregnancy Childbirth 2023; 23:282. [PMID: 37095456 PMCID: PMC10124038 DOI: 10.1186/s12884-023-05536-2] [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: 01/04/2022] [Accepted: 10/14/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Maternal death reviews provide an in-depth understanding of the causes of maternal deaths. Midwives are well positioned to contribute to these reviews. Despite midwives' participation as members of the facility-based maternal death review team, maternal mortality continues to occur, therefore, this study aimed to explore the challenges faced by midwives as they participate in maternal death reviews in the context of the healthcare system in Malawi. METHODS This was a qualitative exploratory study design. Focus group discussions and individual face-to-face interviews were used to collect data in the study. A total of 40 midwives, who met the inclusion criteria, participated in the study. Data was analyzed manually using a thematic content procedure. RESULTS Challenges identified were: knowledge and skill gaps; lack of leadership and accountability; lack of institutional political will and inconsistency in conducting FBMDR, impeding midwives' effective contribution to the implementation of maternal death review. The possible solutions and recommendations that emerged were need-based knowledge and skills updates, supportive leadership, effective and efficient interdisciplinary work ethics, and sustained availability of material and human resources. CONCLUSION Midwives have the highest potential to contribute to the reduction of maternal deaths. Practice development strategies are required to improve their practice in all the areas they are challenged with.
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Affiliation(s)
- Mercy Dokiso Chirwa
- Department of Health Studies, University of South Africa, Preller Street, Po Box 392, Pretoria, 0003, South Africa.
| | - Juliet Nyasulu
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch. University, Cape Town, South Africa
| | - Lebitsi Modiba
- Department of Health Studies, University of South Africa, Preller Street, Po Box 392, Pretoria, 0003, South Africa
| | - Makombo Ganga- Limando
- Department of Health Studies, University of South Africa, Preller Street, Po Box 392, Pretoria, 0003, South Africa
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Okonofua FE, Ekezue B, Ntoimo LFC, Ekwo C, Ohenhen V, Agholor K, Igboin B, Imongan W, Galadanci H, Ogu R. Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2021-007779. [PMID: 35443937 PMCID: PMC9021787 DOI: 10.1136/bmjgh-2021-007779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral health facilities in Nigeria. METHODS This is a quasi-experimental study using an interrupted time-series design to assess a set of multifaceted interventions that address factors identified by stakeholders as associated with PPH. Interventions were implemented at two regional general hospitals, with a general hospital in the same region as the control. Intervention participants were women during antepartum and clinical and administrative staff. Cases of PPH were determined in women at delivery. The outcomes measured were the incidence of primary PPH and related deaths during the study period. Analyses included a comparative description of characteristics of the women, trend of time-series data at intervention and control hospitals, and multivariable analysis of factors associated with PPH occurrence. RESULTS Monthly numbers of primary PPH were collected at participating hospitals over 21 months for 18 181 women. Intervention hospitals represent 54% vs 46% in control hospitals. Time-series analyses show a significant downward trend in intervention hospitals. The overall incidence of primary PPH was lower in the intervention hospitals than in the control hospitals. Multilevel regression adjusted for hospital-level effect showed a 68% reduction in odds of PPH cases at intervention compared with control hospitals. There were 12 PPH-related maternal deaths in one of the control hospitals, with no deaths in the intervention hospitals. CONCLUSION We conclude that multiple interventions that address identified challenges in the prevention of primary PPH can potentially effectively reduce reported primary PPH in Nigerian referral hospitals. This approach is relevant for scaling the development of policies and programmes to prevent primary PPH and maternal mortality in Nigeria.
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Affiliation(s)
- Friday Ebhodaghe Okonofua
- Women's Health and Action Research Centre, Benin City, Nigeria .,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Bola Ekezue
- Fayetteville State University, Fayetteville, North Carolina, USA
| | - Lorretta Favour Chizomam Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria.,Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - C Ekwo
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - V Ohenhen
- Central Hospital, Benin City, Nigeria
| | | | - Brian Igboin
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - H Galadanci
- Faculty of Medicine, Bayero University, Kano, Nigeria
| | - R Ogu
- College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
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Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health 2021; 11:04048. [PMID: 34737857 PMCID: PMC8542378 DOI: 10.7189/jogh.11.04048] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, South Africa.,Department of Obstetrics and Gynaecology, Victoria Falls Hospital, Zimbabwe
| | - Michael Nyakura
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick Machekano
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, South Africa
| | - Robert Pattinson
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Said A, Sirili N, Massawe S, Pembe AB, Hanson C, Malqvist M. Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania. BMJ Glob Health 2021; 6:bmjgh-2021-005040. [PMID: 34020994 PMCID: PMC8144036 DOI: 10.1136/bmjgh-2021-005040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022] Open
Abstract
Background Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system. Methods An exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data. Results Two main themes emerged from this study: ‘Accomplishing by ambitions’ and ‘A flawed system’. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation. Conclusion The implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.
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Affiliation(s)
- Ali Said
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden .,Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Siriel Massawe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Andrea B Pembe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Mats Malqvist
- Department of Women and Children's Health, Uppsala University, Uppsala, Sweden
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10
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Okonofua FE, Ntoimo LFC, Ekezue BF, Ohenhen V, Agholor K, Igboin B, Maduako K, Imongan W, Gidago Y, Galadanci H, Ogu R. Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria. Glob Health Action 2021; 13:1856470. [PMID: 33334274 PMCID: PMC7751393 DOI: 10.1080/16549716.2020.1856470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel. Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria. Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites. Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1). Conclusion: The interventions had positive effects on improving women’s satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women’s concerns relating to the provision of care and consequently improve service utilization.
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Affiliation(s)
- Friday E Okonofua
- Women's Health and Action Research Centre (WHARC) , Benin City, Nigeria.,The Centre of Excellence in Reproductive Health Innovation, University of Benin , Benin City, Nigeria.,The Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital , Nigeria
| | - Lorretta Favour C Ntoimo
- Women's Health and Action Research Centre (WHARC) , Benin City, Nigeria.,Department of Demography and Social Statistics, The Federal University , Oye-Ekiti, Nigeria
| | - Bola F Ekezue
- Department of Accounting, Finance, Healthcare Administration & Information Systems, Fayetteville State University , Fayetteville, USA
| | - Victor Ohenhen
- Department of Obstetrics and Gynaecology, The Central Hospital , Benin City, Nigeria
| | - Kingsley Agholor
- Department of Obstetrics and Gynaecology/Anti-Retroviral Therapy Centre, The Central Hospital , Warri, Delta State, Nigeria
| | - Brian Igboin
- Women's Health and Action Research Centre (WHARC) , Benin City, Nigeria
| | - Kenneth Maduako
- The Centre of Excellence in Reproductive Health Innovation, University of Benin , Benin City, Nigeria.,The Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital , Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre (WHARC) , Benin City, Nigeria
| | - Yagana Gidago
- Department of Obstetrics and Gynaecology, The General Hospital , Minna, Nigeria
| | - Hadiza Galadanci
- Department of Obstetrics and Gynaecology, The Bayero University , Kano, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt , Rivers State, Nigeria
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Okonofua FE, Ntoimo LFC, Ekezue B, Ohenhen V, Agholor K, Gana M, Igboin B, Ekwo C, Imongan W, Galadanci H, Ogu R. Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals. Reprod Health 2020; 17:170. [PMID: 33148284 PMCID: PMC7641810 DOI: 10.1186/s12978-020-00997-6] [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: 04/22/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals. METHODS Intervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool. RESULTS The regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs. CONCLUSION The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources. TRIAL REGISTRATION This study was registered in the ISRCTN on August 14th, 2020. TRIAL REGISTRATION NUMBER SRCTN17985403 . Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209 ).
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Affiliation(s)
- Friday Ebhodaghe Okonofua
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria. .,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria. .,Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria.
| | | | - Bola Ekezue
- Fayetteville State University, Fayetteville, USA
| | | | | | | | - Brian Igboin
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Chioma Ekwo
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre (WHARC), Benin City, Nigeria
| | | | - Rosemary Ogu
- University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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