Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Causes of stillbirths at Kgapane hospital, Limpopo province

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.

Neonatal death audits at Kgapane Hospital, Limpopo province

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.

Factors Affecting Breastfeeding in Births Given During the Day and at Night; A Cross-Sectional Comparative Study

Objective: How giving birth at night and during the day affects the breastfeeding process should be evaluated when health services are planned. In this study, we investigated the effect of giving birth at night and during the day on the breastfeeding process. Materials and Methods: In this cross-sectional comparative study, we included 228 women who gave birth at night and 192 women who gave birth during the day. We compared the effect of giving birth at night or during the day on breastfeeding with the univariate analysis in terms of intrapartum and postpartum factors. Results: While the mothers who gave birth during the daytime started the first breastfeeding earlier (p < 0.001), the duration of the first breastfeeding and skin-to-skin contact practice was longer in mothers who gave birth at night (p < 0.05). While the rate of formula supplementing in babies born at night was 44.8%, it was 55.2% in babies born during the day (p < 0.001). The rate of receiving support from health workers (p = 0.040) and intending to breastfeed babies exclusively after discharge (p < 0.05) was higher in mothers who gave birth during the day than it was in mothers who gave birth at night. Conclusion: Day and night labor have different advantages and disadvantages on breastfeeding. It is important to address these differences in terms of intrapartum and postpartum care process to prevent negative breastfeeding experiences in the early period.