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Hwang WJ, Lee TH. Safe delivery kits and newborn infection in rural Ethiopian communities. Front Public Health 2024; 12:1305255. [PMID: 39185109 PMCID: PMC11341469 DOI: 10.3389/fpubh.2024.1305255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 05/14/2024] [Indexed: 08/27/2024] Open
Abstract
Objectives Our goal in this study to investigate the impacts of using safe delivery kits, along with education on their appropriate use, has on preventing newborn and maternal infection. Design A cross-sectional study. Setting Participants, and Interventions: we conducted the study on 23 sites across a rural district in Oromia Region, Ethiopia. Safe delivery kits were distributed by health extension workers. Participants comprised 534 mothers between the ages of 17 and 45 years, who were given a safe delivery kit at 7 months' pregnancy for use during their subsequent delivery. Data collection was performed by the trained interviewers in rural Ethiopian communities. Results Multiple logistic regression analyses showed an independent association between using the cord tie provided in the kits and decreased newborn infection. Specifically, newborns whose mothers used the cord tie were 30 times less likely to develop cord infection than those not using the cord tie in the kits. Further, mothers who received education regarding safe delivery kit use had lower rates of puerperal infection. Conclusion Single-use delivery kits, when combined with education regarding the appropriate means of using the kit, can decrease the likelihood of maternal infection. Implications for nursing Nurses and health extension workers in low and middle-income countries should educate mothers on safe delivery kits by providing information regarding their usefulness and the importance of correct and consistent use. Implications for Health Policy: our findings emphasize the need for further interventions in vulnerable countries designed to increase the rate of hygienic birthing practices for deliveries outside health-care facilities.
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Affiliation(s)
- Won Ju Hwang
- East-West Nursing Research Institute, College of Nursing Science Kyung Hee University, Seoul, Republic of Korea
| | - Tae Hwa Lee
- School of Nursing, Yonsei University, Seoul, Republic of Korea
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Melkie A, Dagnew E. Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis. Arch Public Health 2021; 79:216. [PMID: 34844656 PMCID: PMC8628469 DOI: 10.1186/s13690-021-00732-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Puerperal sepsis is a genital tract infection that can occur from amniotic fluid rupture to six weeks after birth. Maternal complication associated with puerperal sepsis includes prolonged hospital stay, septicemia, disseminated intravascular coagulation, pelvic inflammatory disease, infertility, and death. Even though, puerperal sepsis is the fourth leading cause of maternal morbidity and mortality in Ethiopia the overall prevalence of puerperal sepsis and its associated factors are not studied at the national stage. As a result, this systematic review and meta-analysis bring out the pooled prevalence of puerperal sepsis and its associated factors in Ethiopia. METHODS A variety of data sources such as Pub Med, Web of Science, Science Direct, Embase, Google Scholar, HINARI, and Ethiopian universities online repositories were searched to identify the primary studies which were used for this systematic review and meta-analysis. The article search was conducted from February10/2021-March 10/2021. The quality of the selected primary studies was assessed using the Newcastle - Ottawa quality assessment Scale (NOS). Data extraction was done with Microsoft Excel and then exported to STATA 11 version statistical software for analysis. The Cochran (Q-test) and I2 test statistics were used to assess the heterogeneity of the studies. Publication bias was evaluated by the eggers regression test. Subgroup analysis was performed with region and sample size category. RESULT In this review, a total of 2222 respondents were involved from seven studies. The pooled prevalence of puerperal sepsis was 14.811% (95%CI; 8.46: 21.16; I2 = 94.2, P ≤ 0.001). Cesarean section delivery (CSD) (OR = 3.26, 95%CI: 1.90, 5.61), membrane rupture≥24 h (OR = 4.04, 95%CI: 2.54, 6.42), being multiparous mother (OR = 3.99, 95%CI: 1.82, 8.78), vaginal examination≥5 times (OR = 3.15, 95%CI: 1.17, 8.52), and anemia (OR = 5.68, 95%CI: 4.38, 7.36) were factors significantly associated with puerperal sepsis. CONCLUSION The prevalence of puerperal sepsis was high in Ethiopia. CSD, membrane rupture≥24 h, being multiparous mother, vaginal examination≥5, and anemia were factors associated with puerperal sepsis. Appropriate standard infection prevention techniques during CSD shall be practiced to reduce the maternal burden of puerperal sepsis. The unnecessary vaginal examination should be discouraged during the intrapartum period. Besides this, routine Iron sulfate supplementation and counsel on iron reach foods during ante partum and postpartum shall be considered for all mothers.
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Affiliation(s)
- Abenezer Melkie
- Department of midwifery, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Enyew Dagnew
- Department of midwifery, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
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Lassi ZS, Fisher Z, Andraweera P, Cummins A, Roberts CT. Effectiveness of birthing kits for clean childbirth: a systematic review. Int Health 2020; 12:3-10. [PMID: 31340003 PMCID: PMC6964231 DOI: 10.1093/inthealth/ihz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 11/12/2022] Open
Abstract
Poor infection control practices during childbirth are recognised as a critical factor leading to life-threatening maternal and newborn sepsis. Therefore, this paper assesses the effectiveness of clean birth kits (CBKs) to ensure a safe birthing environment. We searched PubMed, Cochrane Library and CINAHL, as well as Google Scholar, to identify both qualitative and quantitative studies on CBKs published in English up to November 2018. Studies were included if the pregnant women or women giving birth intended to use or used a CBK. The methodological quality of included papers was assessed. A total of 37 studies, 26 quantitative and 11 qualitative studies, were included. Quantitative studies showed a positive impact of CBKs on reducing the incidence of puerperal sepsis and neonatal tetanus. The review also identified CBK use to be associated with a reduction in perinatal, neonatal and young infant mortality. Qualitative studies suggested that a lack of awareness of the importance of CBKs and clean delivery practices, unavailability of CBKs and financial constraints to purchase CBKs were the potential barriers. CBKs appear to be a promising strategy to reduce maternal and neonatal morbidity and mortality. However, the current evidence is limited and further large-scale trials are required.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Zeshi Fisher
- Birthing Kit Foundation Australia, PO Box 330 Belair South Australia, Australia
| | - Prabha Andraweera
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Alexandra Cummins
- Birthing Kit Foundation Australia, PO Box 330 Belair South Australia, Australia
| | - Claire T Roberts
- Robinson Research Institute, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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Raza SA, Avan BI. Eliminating Maternal and Neonatal Tetanus and Promoting Clean Delivery Practices Through Disposable Clean Birth Kits. Front Public Health 2019; 7:339. [PMID: 31824909 PMCID: PMC6886002 DOI: 10.3389/fpubh.2019.00339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/29/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Syed Ahsan Raza
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Bilal Iqbal Avan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Demisse GA, Sifer SD, Kedir B, Fekene DB, Bulto GA. Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study). BMC Pregnancy Childbirth 2019; 19:95. [PMID: 30885159 PMCID: PMC6423770 DOI: 10.1186/s12884-019-2230-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Puerperal sepsis is an infection of the genital tract, which occurs from rupture of amniotic sacs and within 42ndday after delivery. It happens mainly after discharge in the 1st 24 h of parturition. It is the third leading cause of direct maternal mortality in developing nations. It is also among preventable conditions. Even though multiple interventions were done to overcome these health problems, maternal mortality and morbidities were still significant. Mainly, in Ethiopia lack of clearly identified causes of maternal mortality and morbidity makes the problem unsolved. METHODS Case-control study was conducted at public Hospitals in west shoa zone Oromia regional state, Ethiopia from February 01 to April 30/2018.women with puerperal sepsis (n = 67) were selected by convenience method. Controls (n = 213) were selected by systematic random sampling. Controls to cases ratio was 3:1 and structured questionnaire was used to interviewafter verbal consent was obtained. Data was entered in to epi -info 7.2 then exported to SPSS version 20.0 for analysis. A logistic regression model was used for data analysis. Those variables which have p-value < 0.05 were accepted that they are independent determinants of puerperal sepsis. RESULT Rural residence (AOR [95%CI] = 2.5(1.029-6.054),Mothers with no formal education (AOR [95%CI] = 6.74([1.210-37.541]), up to primary level of education(AOR [95%CI] = 6.72(1.323-34.086), total monthly income of the mother or family<=500 ETB and 501-1500 ETB(AOR [95%CI] = 5.94(1.471-23.93) and (AOR [95%CI] =6.57 (1.338-32.265) respectively, Mothers having 1-2 times antenatal care(ANC)visit (AOR [95%CI] = 6.57([1.338-32.265]), Duration of Labor12-24 h (AOR [95%CI] = 3.12 (1.805-12.115),> = 25 h (AOR [95%CI] = 4.71([1.257-17.687]),vaginal examinations > = 5times (AOR [95%CI] = 4.00([1.330-12.029]), Delivery by C/S (AOR [95%CI] = 3.85 ([1.425-10.413]), Rupture of membrane > 24 h (AOR [95%CI] = 3.73([1.365-10.208]) and those Referred from other health institutions (AOR [95%CI] = 2.53([1.087-5.884],were independent determinants of puerperal sepsis in this study. CONCLUSION Majority of determinants of puerperal sepsis were related with pregnancy and childbirth. Therefore, to tackle a problem of puerperal sepsis all concerning bodies should take measures during prenatal, natal and postnatal period.
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Affiliation(s)
- Getu Alemu Demisse
- Department of Public health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Samuel Dessau Sifer
- Departmentof Nursing, Arbaminch college of health science, Arbainch, Ethiopia
| | | | - Daniel Belema Fekene
- Department of midwifery, Ambo University College of medicine and health science, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of midwifery, Ambo University College of medicine and health science, Ambo, Ethiopia
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Leight J, Sharma V, Brown W, Costica L, Abdulaziz Sule F, Bjorkman Nyqvist M. Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial. PLoS One 2018; 13:e0208885. [PMID: 30586441 PMCID: PMC6306201 DOI: 10.1371/journal.pone.0208885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes. This paper reports a secondary analysis of data from a cluster randomized trial in rural northern Nigeria in which birth kits were distributed by community health workers to pregnant women in their homes, analyzing non-experimental variation in receipt and use of birth kits. More specifically, associations between pregnant women's baseline characteristics and receipt and use of birth kits, and associations between birth kit use, care utilization and maternal and newborn outcomes were assessed. METHODS AND FINDINGS Baseline, post-birth and endline data related to 3,317 births observed over a period of three years in 72 intervention communities in Jigawa state, Nigeria, were analyzed using hierarchical, logistic regression models. In total, 140 women received birth kits, and 72 women used the kits. There were no associations between baseline demographic characteristics, health history, and knowledge and attitudes and receipt of a kit, suggesting that community health workers did not systematically target the distribution of birth kits. However, women who used the kit reported reduced odds of past pregnancy complications (OR = 0.44, 95% CI: 0.19-1.00) as well as significantly higher odds of feeling generally healthy at baseline (OR = 2.00, 95% CI: 1.06-3.76), of exposure to radio media (OR = 1.97, 95% CI: 1.21-3.22), and of perceiving themselves as having a low-risk pregnancy (OR = 3.05, 95% CI:1.39-6.68). While there were no significant associations between birth kit use and facility based delivery, skilled birth attendance or post-natal care, women who used a kit exhibited significantly lower odds of completing four or more ANC visits (adjusted OR = 0.39, 95% CI: 0.18-0.85) and significantly higher odds of reporting prolonged labor (adjusted OR = 4.75, 95% CI: 1.36-16.59), and post-partum bleeding (adjusted OR = 3.25, 95% CI: 1.11-9.52). CONCLUSIONS This evidence suggests that use of birth kits is low in a rural population characterized by minimal baseline utilization of maternal and neonatal health services, and the use of birth kits was not associated with reductions in maternal or neonatal morbidity. While further research is required to understand how the effectiveness of birth kits may be shaped by the mechanism through which women access and utilize the kits, our findings suggest that the provision of kits to women outside of the formal health system may be associated with increased risk of adverse outcomes.
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Affiliation(s)
- Jessica Leight
- Economics Department, American University, Washington, D.C., United States of America
| | - Vandana Sharma
- Harvard T.H. Chan School of Public Health, Cambridge, MA, United States of America
| | - Willa Brown
- Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Laura Costica
- Planned Parenthood Federation of Nigeria, Abuja, Nigeria
| | - Fatima Abdulaziz Sule
- Economics Department, American University, Washington D.C., United States of America
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Hodgins S, Tielsch J, Rankin K, Robinson A, Kearns A, Caglia J. A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations. PLoS One 2016; 11:e0160562. [PMID: 27537281 PMCID: PMC4990268 DOI: 10.1371/journal.pone.0160562] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support. METHODS In this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies. RESULTS In the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25-30%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude. CONCLUSIONS Simple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage.
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Affiliation(s)
- Stephen Hodgins
- Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America
| | - James Tielsch
- Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Kristen Rankin
- Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America
| | - Amber Robinson
- Department of Life Sciences, Brunel University London, London, United Kingdom
| | - Annie Kearns
- Human Care Systems, Boston, Massachusetts, United States of America
| | - Jacquelyn Caglia
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Barker D, McElduff P, D'Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol 2016; 16:69. [PMID: 27267471 PMCID: PMC4895892 DOI: 10.1186/s12874-016-0176-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous reviews have focussed on the rationale for employing the stepped wedge design (SWD), the areas of research to which the design has been applied and the general characteristics of the design. However these did not focus on the statistical methods nor addressed the appropriateness of sample size methods used.This was a review of the literature of the statistical methodology used in stepped wedge cluster randomised trials. METHODS Literature Review. The Medline, Embase, PsycINFO, CINAHL and Cochrane databases were searched for methodological guides and RCTs which employed the stepped wedge design. RESULTS This review identified 102 trials which employed the stepped wedge design compared to 37 from the most recent review by Beard et al. 2015. Forty six trials were cohort designs and 45 % (n = 46) had fewer than 10 clusters. Of the 42 articles discussing the design methodology 10 covered analysis and seven covered sample size. For cohort stepped wedge designs there was only one paper considering analysis and one considering sample size methods. Most trials employed either a GEE or mixed model approach to analysis (n = 77) but only 22 trials (22 %) estimated sample size in a way which accounted for the stepped wedge design that was subsequently used. CONCLUSIONS Many studies which employ the stepped wedge design have few clusters but use methods of analysis which may require more clusters for unbiased and efficient intervention effect estimates. There is the need for research on the minimum number of clusters required for both types of stepped wedge design. Researchers should distinguish in the sample size calculation between cohort and cross sectional stepped wedge designs. Further research is needed on the effect of adjusting for the potential confounding of time on the study power.
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Affiliation(s)
- D Barker
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - P McElduff
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - C D'Este
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 0200, Australia
| | - M J Campbell
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
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Kalter HD, Yaroh AG, Maina A, Koffi AK, Bensaïd K, Amouzou A, Black RE. Verbal/social autopsy study helps explain the lack of decrease in neonatal mortality in Niger, 2007-2010. J Glob Health 2016; 6:010604. [PMID: 26955474 PMCID: PMC4766793 DOI: 10.7189/jogh.06.010604] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study was one of a set of verbal/social autopsy (VASA) investigations undertaken by the WHO/UNICEF-supported Child Health Epidemiology Reference Group to estimate the causes and determinants of neonatal and child deaths in high priority countries. The study objective was to help explain the lack of decrease in neonatal mortality in Niger from 2007 to 2010, a period during which child mortality was decreasing. METHODS VASA interviews were conducted of a random sample of 453 neonatal deaths identified by the 2010 Niger National Mortality Survey (NNMS). Causes of death were determined by expert algorithm analysis, and the prevalence of household, community and health system determinants were examined along the continuum of maternal and newborn care, the Pathway to Survival for newborn illnesses, and an extended pathway for maternal complications. The social autopsy findings were compared to available data for survivors from the same cohort collected by the NNMS and the 2012 Niger Demographic and Health Survey. FINDINGS Severe neonatal infection and birth asphyxia were the leading causes of early neonatal death in the community and facilities. Death in the community after delayed careseeking for severe infection predominated during the late neonatal period. The levels of nearly all demographic, antenatal and delivery care factors were in the direction of risk for the VASA study decedents. They more often resided rurally (P < 0.001) and their mothers were less educated (P = 0.03) and gave birth when younger (P = 0.03) than survivors' mothers. Their mothers also were less likely to receive quality antenatal care (P < 0.001), skilled attendance at birth (P = 0.03) or to deliver in an institution (P < 0.001). Nearly half suffered an obstetric complication, with more maternal infection (17.9% vs 0.2%), antepartum hemorrhage (12.5% vs 0.5%) and eclampsia/preeclampsia (9.5% vs 1.6%) than for all births in Niger. Their mothers also were unlikely to seek health care for their own complications (37% to 42%) as well as for the newborn's illness (30.6%). CONCLUSIONS Niger should scale up its recently implemented package of high-impact interventions to additional integrated health facilities and expand the package to provide antenatal care and management of labor and delivery, with support to reach a higher level facility when required. Community interventions are needed to improve illness recognition and careseeking for severe neonatal infection.
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Affiliation(s)
- Henry D Kalter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Abdou Maina
- Institute National des Statistics, Niamey, Niger
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khaled Bensaïd
- UNICEF, Niger country office, Niamey, Niger (retired staff)
| | | | - Robert E Black
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dhingra U, Gittelsohn J, Suleiman AM, Suleiman SM, Dutta A, Ali SM, Gupta S, Black RE, Sazawal S. Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices. BMC Pregnancy Childbirth 2014; 14:173. [PMID: 24885689 PMCID: PMC4049503 DOI: 10.1186/1471-2393-14-173] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 05/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial. Methods 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2. Results Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby’s first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness. Conclusion The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother. Trial registration ClinicalTrials.gov: NCT01528852
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sunil Sazawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E 5521, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Turab A, Ariff S, Habib MA, Ahmed I, Hussain M, Rashid A, Memon Z, Khan MI, Soofi S, Bhutta ZA. Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project. BMC Pregnancy Childbirth 2013; 13:136. [PMID: 23800194 PMCID: PMC3718721 DOI: 10.1186/1471-2393-13-136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. METHOD/DESIGN This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. DISCUSSION Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.
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Affiliation(s)
- Ali Turab
- Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
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Moyer CA, Aborigo RA, Logonia G, Affah G, Rominski S, Adongo PB, Williams J, Hodgson A, Engmann C. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs. BMC Pregnancy Childbirth 2012; 12:50. [PMID: 22703032 PMCID: PMC3482570 DOI: 10.1186/1471-2393-12-50] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.
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Affiliation(s)
- Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, 48104, USA.
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